Recovery for vaginal delivery

Elvish, BSN, DNP, RN, NP · Aug 19, 2009

Generally, recovery starts at my place once placenta is out and lasts an hour before they get turned over to M/B. If there's a lengthy repair or Mom's bleeding is an issue, they'll push turnover back a little and call M/B to let them know.

NurseNora, BSN, RN · Aug 19, 2009

In my place, recovery starts within 15min of placenta delivery. If there's a long repair, we'll keep her a little longer afterwards if necessary, but that's rarely necessary. We usually keep our couplets for 2 hours before sending them to M/B.

bmcm2girls · Aug 19, 2009

Our recovery also starts when the placenta is delivered. Usually it isn't an issue unless a resident is doing a repair that takes forever, lol. Our "goal" is for them to be transfered to MBU within two hours after placenta but that rarely ever happens. We recover mom and baby and the first hour of recovery the focus is on skin to skin care and breastfeeding (saying mom and baby are both doing well). We basically only do VS on mom/baby and fundal checks during that time (along with helping with breastfeeding). Second hour is full assessment, shots, bath, etc for baby. Feeding and showering mom. Our MBU will oftentimes refuse to take a patient that isn't basically able to be walked over and put into bed without needing anything else. Doesn't always happen in that two hours, lol. Actually, unless they are bottle feeding and didn't have an epidural (or not a heavy epidural) so you get baby sooner and mom gets out of bed sooner, two hours almost never happens, lol.

IrishIzCPNP, MSN, RN, APRN, NP · Aug 20, 2009

2 hours?

This hospital that my aunt works at wants the moms off the floor at end of recovery which is 1 hour long and starts at delivery of placenta. Maybe if they kept their moms for 2 hours we would feel different but not 1 hour.

Where I'm at recovery starts when the doctor is finished with the pt...hence recovery because all procedures are complete. The recovery lasts 1 hour and then we work to get them to PP. We never plan to keep a standard lady partsl delivery for 2 hours...we couldn't even consider it because of how busy we are. We have 13 delivery rooms and have been running at capacity just about every night. It's crazy.

I just can't imagine 2 hours...that would seem like forever.

bmcm2girls · Aug 20, 2009

2 hours?
This hospital that my aunt works at wants the moms off the floor at end of recovery which is 1 hour long and starts at delivery of placenta. Maybe if they kept their moms for 2 hours we would feel different but not 1 hour.
Where I'm at recovery starts when the doctor is finished with the pt...hence recovery because all procedures are complete. The recovery lasts 1 hour and then we work to get them to PP. We never plan to keep a standard lady partsl delivery for 2 hours...we couldn't even consider it because of how busy we are. We have 13 delivery rooms and have been running at capacity just about every night. It's crazy.
I just can't imagine 2 hours...that would seem like forever.

I can see how, if you do 1 hr recovery it would be more important to start recovery after repairs are made rather then placenta. I personally can't imagine a 1 hr recovery b/c none of our patients meet our transfer criteria before then, in ANY situation. Our MBU nurses are rather spoiled and so the expectations they have before accepting a pt can't be met in 1 hr. I also work at a decent size hospital (10 LDR's, 2 OR's and 2 RR's, always full, sometimes doing vag deliveries in the RR's b/c we run out of rooms so we are expanding to 14 LDR's, 4 OR's and 4 RR's). We sometimes push our recoveries faster depending on census but generally MB won't budge without a power struggle. The expectation for transfer is that the mom is ambulatory and has pee'd, showered, and had something to eat before transfer. Usually, our epidurals haven't even wore off in 1 hr, lol so there is no way those things could be met. Pee'ing is the big thing for our MB nurses, they refuse to do a cath if necessary, so transfering before pt has legs back or before she has voided would send them on a rampage and they would flat out refuse. (fwiw, our traveler nurses are always floored by our recoveries) We also don't have a nursery nurse to do babies so that is all us as well. This is also another holding block at times. We are a "baby friendly" hospital so we encourage early skin to skin care and breastfeeding from the start. So, like I said before, the first hour is strictly skin to skin and bf'ing. This also allows time for the epi to wear off. 2nd hour is baby assessment, bath, shots, etc and getting mom up to shower/pee/eat. I guess if we had a nursery nurse to do baby (we DO often times have someone in MB that is the "nursery nurse" but depending on who it is, that can sometimes mean someone who does nothing, but without serious begging, 99 percent of the time they refuse to do anything with a vag baby) that would take a chunk of time off. And, if we could transfer before mom is totally ambulatory, etc we could easily do it in an hour. So, I am curious, what all is done in that hour and what are your expectations for transfer?

L&DRNJenn · Aug 21, 2009

Our recovery also starts when the placenta is delivered. Usually it isn't an issue unless a resident is doing a repair that takes forever, lol. Our "goal" is for them to be transfered to MBU within two hours after placenta but that rarely ever happens. We recover mom and baby and the first hour of recovery the focus is on skin to skin care and breastfeeding (saying mom and baby are both doing well). We basically only do VS on mom/baby and fundal checks during that time (along with helping with breastfeeding). Second hour is full assessment, shots, bath, etc for baby. Feeding and showering mom. Our MBU will oftentimes refuse to take a patient that isn't basically able to be walked over and put into bed without needing anything else. Doesn't always happen in that two hours, lol. Actually, unless they are bottle feeding and didn't have an epidural (or not a heavy epidural) so you get baby sooner and mom gets out of bed sooner, two hours almost never happens, lol.

I don't know how you'd ever get all of that done within 2 hours after placenta and you didn't even mention all of the charting and teaching involved!

L&Dnurse13 · Aug 21, 2009

Our recovery starts at delivery of placenta and is 1 hour long in most cases. Baby stays with mom for up to 1 hour then goes to nursery. Our pts usually cannot get up yet due to epidural and are transferred on a stretcher. Most of the time our recovery last a little over an hour. If there is an extensive repair we may keep pt longer. Our Mag pt's stay with us as long as they are on mag. Our c-section recoveries are 1 hour from the time we get to Recovery as long as mom is stable and v/s are within guidelines. Sometimes recovery times can be related to the unit. A smaller unit may be able to do longer recoveries. We are a high risk unit with a level 3 NICU, 15 LDR's and 3 OR's. We do around 500 deliveries a month.

L&Dnurse13 · Aug 21, 2009

I should also add that we have 2 nursery nurses to take baby, we do not do baby baths, meds, and only the initial and 30 minute assessment on baby. If there is a complication with baby they go straight to nursery or we call NICU for assessment. Our pts do not have to be able to walk, shower, or pee. They have to have stable v/s of course, and no post delivery complications. But an hout is possible with teaching included if you do not have to wait for epidural to wear off.

bmcm2girls · Aug 21, 2009

Our recovery starts at delivery of placenta and is 1 hour long in most cases. Baby stays with mom for up to 1 hour then goes to nursery. Our pts usually cannot get up yet due to epidural and are transferred on a stretcher. Most of the time our recovery last a little over an hour. If there is an extensive repair we may keep pt longer. Our Mag pt's stay with us as long as they are on mag. Our c-section recoveries are 1 hour from the time we get to Recovery as long as mom is stable and v/s are within guidelines. Sometimes recovery times can be related to the unit. A smaller unit may be able to do longer recoveries. We are a high risk unit with a level 3 NICU, 15 LDR's and 3 OR's. We do around 500 deliveries a month.

Your unit sounds only slightly larger then mine. We also have the only high risk unit and NICU in the state, and while we have less rooms, our NEED is probably to be the size of yours, lol. We do 400-450 deliveries a month...so not much less. How big is your MB unit? What is the staffing ratio for your MB nurses (and is it couplet care or not)? If we could do those type of recoveries (transfer in stretcher, baby to nursery for bath/shots/etc), I would probably think 2 hrs was long as well, lol. Our CS deliveries are a half hour from the time we enter the RR if mom is stable. Mostly b/c baby goes to nursery rather then being done by us and mom won't be getting out of bed. Basically, it is just to make sure vs are stable and fundus is firm. Our goal is to reunite mom with baby as soon as possible and to have breastfeeding within the first hour so that is why we only do a half hour recovery.

L&Dnurse13 · Aug 22, 2009

I believe our MB unit is 34 rooms. The nurses there do couplet care so 4 moms and 4 babies. L&D RN's and techs float to MB when needed and as staffing allows. MB nurses do not float at this time. We are one of 2 level 3 NICU's in the state, but we do not do neonatal surgeries. All of those OB pts get transferres out or delivered, baby stabilized and flown out. Love working in a high risk unit, but cannot imagine 2 hour recoveries.

bmcm2girls · Aug 24, 2009

Thanks for sharing. We have a 36 bed MB unit and a 12 bed prenatal unit. We don't transport out...we are the ones getting the transports, lol. But it is interesting to me to see that your MB nurses have the same loads as ours (technically, ours can take 5 couplet's but they start asking for an LD float if a few of them start getting 4) but they do much more of the recovery then ours does. In case you can't tell, there is a bit of a disagreement between units at times, lol. For the most part, we do the two hour recoveries b/c several of the MB nurses flat out will refuse to take a patient unless EVERYTHING is done. Basically, when they get a transfer, the pt is expected to be ambulatory, showered, voided, baby TOTALLY done. You basically just tuck them into bed and do a fundal check. Depending on who the charge is that night, there have been times when we have had women laboring in triage (we have a 12 bed triage/testing area) for hours, we are trying to get our delivered pt's to MB to open up rooms. To help with that, we request one hour recoveries...which would mean that the nursery nurse would do baby, and mom's epidural probably hasn't wore off so she would still need some care (not just tucked into bed). Depending on who is there, more often then not, they refuse (unless a manager is there). Our charge nurses have been told to not get into a fight with their charge over taking those patients. Instead, they are supposed to write a unit concern after the fact. Which does nothing really. We end up backlogged and with unhappy patients. The only ones who make out in the deal are the MB nurses, lol. We have brought up the issue of 1 hr recoveries and actually utilizing our nursery nurse for what she is MENT to do (they always insist on having one, but we do rooming in, so more often then not, they do nothing). We are told that it is too difficult for our MB nurses to actually have to recover new vag deliveries with their patient load. We are told it is b/c they do couplet care that it is too much for them. BUT, your unit, with the same staffing ratio and about the same size seems to do well with it. When I float to MB, I really dont' see what the big deal is. You are mostly just orienting to room and going over routine. EVERYTHING else is done. Frustrating when you are in LD and have unsafe staffing and asking for the nursery nurse to do babies to free up LD nurses or asking for a MB nurse to take a one hour post delivery patient with a foley and dead legs and are told no, b/c they are "too busy" and you see four of them sitting at the desk, lol. Ok, that is my vent for the night.