Recovering newborn in OB PACU???

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Specializes in NICU, LDR.

Our nurse manager is planning on changing things around a bit...we are an 11-bed LDR with 8 triage beds, 2 OR rooms, 12-bed Antepartum unit, and 48-bed Postpartum unit. We do ~ 5000 deliveries a year. We are currently all becoming ACLS certified and have moved our C/S recoveries to hospital PACU while ours gets revamped. The plan is for the nurse recovering the mom in our OB PACU to also recover the baby...and we all feel as if this really isn't safe! Does anyone work on a unit that recovers mom & baby s/p Cesearean??? Would love feedback from anyone!!

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Specializes in Obs.

I work in a 13 bed LDR with 4 triage beds (can expand to 6 if necessary), 2 ORs, and a 3 bed PACU. We scrub, circulate, and recover our sections, and unless the babes have to go to NICU, always recover with their moms, whether it be in the PACU or the delivery room. Our antepartum and postpartum units are separate from us and are on two different floors. It has always been this way...I can't imagine it any other way! If you have specific concerns or questions, don't hesitate to ask!

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Specializes in NA, Stepdown, L&D, Trauma ICU, ER.

My unit has a 9 bed triage, 16 LDR rooms, 7 high risk PICU rooms, 3 ORs and 6 PACU beds. We also have a 24 bed ante unit, and 2 PP units with 24 beds each. We deliver ~5k a year also. We have a transitional nursery that comes out to do baby. For vag deliveries, they try to do all the baby care in the room, for sections, the baby goes to nursery for about an hour. I can't imagine trying to do the initial Q5 vitals/assessment while being responsible for the kid too! I'm with you, that just doesn't seem safe. Mom just had major abd surgery, and you're dealing with a brand new baby too? No way! What if mom is bleeding heavily AND baby's grunting????? You're in the middle of 2 bad situations, who do you work on first?

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Specializes in Maternal - Child Health.

I worked in an 18-bed LDRP with a self-contained OR and PACU. Moms and babies were recovered together post C-section, with the circulator caring for mom and the baby nurse caring for baby. Once both mom and baby were stable, the circulator would take over the baby's care and the baby nurse would resume an assignment on the floor. It worked well for us because we always started out with 2 nurses, and the PACU was contained within the LDRP unit, so help was nearby if needed.

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In our unit, NICU staff attends the c section. After they confirm the baby is ok, a "baby Nurse" comes and takes the baby to the nursery to weigh, check temp and give eyes and thighs and the newborn assessment. All this is being done while surgery is being finished up with mom. Once mom is done and comes to PACU, mom and baby are reunited. Usually at our facility ratios in PACU are 2:1 anyway. Obviously if the baby is having issues like grunting, low blood sugar, etc the baby nurse will stay with the baby.

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Specializes in LDRP.

We have 2 obor's and a pacu, too. Baby is evaluated by nicu/nursery staff in OR while section finished, and if stable, comes to pacu with mom. Yes, I recover them both. We do have guidelines, though.

If she had general-baby NOT in pacu. She has to have someone with her to have baby in pacu. baby must be 37 weeks or more. obviously, must be medically stable. twins? if another nurse is around, only.

If i dont think something is right-grunting, fast resps, low temp-or, if mom gets unstable, one call to the nursery and they come get the baby.

I love having the baby there. THey dont get the bonding time in the OR like they do after a lady partsl delivery, so giving them this opportunity to be skin to skin, to breastfeed in teh first hour, etc. is wonderful.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Background:

Small hospital with 10 bed LDRP and 8 general surgical beds. About 70-75 births/month. Have our own OR on unit. Labor nurse circulates; another dedicated to baby in OR. Level 2 nursery that is not always staffed/has a census. Newborns do not go to nursery for recovery unless mom or baby are sick.

Once c/s case is complete, mom is wheeled to her LDRP room, or a PP/surgical room if we are full. She is placed for vitals on a PAR cart for monitoring, Q5min VS until stable, as per AORN standard. The labor/circulating nurse will recover mom and baby together in the PP room and as long as both are stable, it's perfectly safe. Done it this way for years, no problems. Breastfeeding/bonding get established sooner. The nurse does not leave the room for 1 hour, recovering mom PACU-style and watching baby, getting baby to breast, etc. There is plenty of time to watch both closely enough and charting is easy to do when you are in the room for that hour, anyhow.

If there is any problem during recover, another nurse comes in to care for baby or take baby to nursery, if need be. That is rare. Really, if you have one nurse dedicated to the couplet, it is safe and preferable to do it this way. No need to separate them unless one of them is sick!

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We deliver about 10,000/year. We have 22 LDRs, 10 triage rooms, 3 ORs, a 3 bay PACU (only used on weekdays for scheduled c/s), 4 PMU beds, and I couldn't tell you how many AP beds & PP beds.

Unless the baby has issues and needs to go to the NICU, the baby is wheeled out of the OR in mom's arms. The recovering RN stays in the patient's room (if not in the PACU) for the first hour. Baby is there also. We always have a Newborn Assessment Nurse (NAN) on duty from the PP floor. She comes in to do a head-to-toe assessment of baby, give vitamin K, erythromicin ointment, triple-dye the cord, etc... but the recovering RN is otherwise responsible for mom & baby. We don't even have a nursery on our L & D floor. We've never had a problem. I've always got my fellow nurses as backup if I think I have a problem, and I can have NICU staff in the room in less than 1 minute if needed.

If the PACU is in use, the PACU RN (who is a L & D RN) is responsible for 2 moms, 2 babies, and she gets the next c/s ready to go to the OR too. This is a little overwhelming, and we don't typically put newer, inexperienced nurses in this role. I've said for years that I don't think this is safe. I don't think our PACU nurse should be getting the next section ready to go... that should be another nurse. But no one listens to that... someday we'll have a bad outcome and it might change!!

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We have 2 obor's and a pacu, too. Baby is evaluated by nicu/nursery staff in OR while section finished, and if stable, comes to pacu with mom. Yes, I recover them both. We do have guidelines, though.

If she had general-baby NOT in pacu. She has to have someone with her to have baby in pacu. baby must be 37 weeks or more. obviously, must be medically stable. twins? if another nurse is around, only.

If i dont think something is right-grunting, fast resps, low temp-or, if mom gets unstable, one call to the nursery and they come get the baby.

I love having the baby there. THey dont get the bonding time in the OR like they do after a lady partsl delivery, so giving them this opportunity to be skin to skin, to breastfeed in teh first hour, etc. is wonderful.

We even keep baby if

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Background:

Small hospital with 10 bed LDRP and 8 general surgical beds. About 70-75 births/month. Have our own OR on unit. Labor nurse circulates; another dedicated to baby in OR. Level 2 nursery that is not always staffed/has a census. Newborns do not go to nursery for recovery unless mom or baby are sick.

Once c/s case is complete, mom is wheeled to her LDRP room, or a PP/surgical room if we are full. She is placed for vitals on a PAR cart for monitoring, Q5min VS until stable, as per AORN standard. The labor/circulating nurse will recover mom and baby together in the PP room and as long as both are stable, it's perfectly safe. Done it this way for years, no problems. Breastfeeding/bonding get established sooner. The nurse does not leave the room for 1 hour, recovering mom PACU-style and watching baby, getting baby to breast, etc. There is plenty of time to watch both closely enough and charting is easy to do when you are in the room for that hour, anyhow.

If there is any problem during recover, another nurse comes in to care for baby or take baby to nursery, if need be. That is rare. Really, if you have one nurse dedicated to the couplet, it is safe and preferable to do it this way. No need to separate them unless one of them is sick!

This is how we do ours too. Same set-up and about the same # deliveries.

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We do about 12,000 deliveries a year. Both Vag and CS babies stay with the mom the entire time unless they need to go to NICU. There is a nurse in the PACU that is a NICU nurse and is assigned to the role of NRN (neonatal resource nurse) for that particular day. If the PACU nurse thinks something is wrong with the baby then the NRN is right there to look at the baby. They are also there to initiate blood sugars or CBC's on the babies based on risk factors they may have. I also agree though, that if the PACU nurse is 1:1 with the couplet that is adequate observation.

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Our OB PACU nurse recovers mom and baby. However....there are specific guidelines the baby must meet before it can "bond" in the PACU. It must be over 37 weeks, no resp distress whatsoever , temp over 97.6, etc. If at any time the PACU nurse feels the baby isnt stable, she calls the nsy to have the baby taken to the nursery. It works pretty well....the moms love it!!!

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