Traditional postpartum care?

Elvish, BSN, DNP, RN, NP · Mar 30, 2009

The hospital where I delivered my son had the traditional pp-nursery-L/D split. But you are right - that seems to be getting more and more rare as time goes by.

mom2michael, MSN, RN, NP · Mar 31, 2009

The facility I worked at before did PP and NBN - so mom hand one nurse and baby had another. I hated it. There was no continuity of care - if mom had questions about baby while you were "her nurse" you had to get the "baby nurse" to answer the questions and vice versa. One nurse had to rely on the other to get d/c stuff done before they could be sent home, if one was busy, the mom (or baby) wasn't going to get discharged. In my opinion it was highly disorganized and lacked a sense of compassion to mom and the baby.

I do couplet care now and it's so much easier and I like taking care of both mom and the baby at the same time. If we have a sick baby (or a sick mom) - then we drop to that couplet only (that mom/that baby) and we do 1:1 care with them.

SmilingBluEyes · Mar 31, 2009

I would much rather do couplet care than m/b nursery care. And I have done it both ways.

RNBelle · Apr 1, 2009

I previously worked in a place that had separate PP and NBN nurses. Where I work now we do couplet care. I do not mind doing either. The only hard time about where I work now we do not staff for a nursery person at nights. So if there is a special care nursery baby, it sucks up a nurse and strains us on the floor and L&D.

OBRN1994 · Apr 3, 2009

I work in a very busy unit that has a small seperate pstpartum unit ( 8 couplets) but with close to 200 deliveries a month & only 14 LDR's, we have to keep some of our PP until discharge. I HATE doing couplets on our floor. Our assignments have to be flexible for antepartum & labor. It's much easier to help with antepartums if you just have moms. It's also a benefit if you have breastfeeding issues etc, then there are 2 nurses available to assist if someone else is having a problem. Just works out so much better on our unit...our moms seem to like having 2 nurses taking care of them. Of course we assist with care of both of the pts & don,t go searching for the other nurse. We also communicate with each other, ie: pedi d/c'ed baby or momwants to go home, plz relay that to the pedi. Etc. WWhae have nursesas

,Etc

FemmeRN · Apr 3, 2009

We do couplet care also, but have an "admission nursery" staffed by one or two RN's, depending on the pt census. The nursery nurses admit and transition the babies for an hour or two. They also take care of babies that are retained if mom has been d/c'd or is on another unit (eg, ICU). We can bring the babies into the nursery if mom is resting, but the floor nurse is still responsible for vital signs, feedings, etc. The nursery RN just "keeps an eye on the baby", as far as making sure it doesn't choke, etc. They will do procedures like IV blood draws, gastric lavage, etc. b/c the floor nurses aren't really trained in this.

I do couplet care now and it's so much easier and I like taking care of both mom and the baby at the same time. If we have a sick baby (or a sick mom) - then we drop to that couplet only (that mom/that baby) and we do 1:1 care with them.

Not to hijack this thread...but when you say we 'drop to that couplet only'...what happens to the rest of your patients? Does the charge nurse take them? Another nurse gets called in? As I've grumbled about before...we don't have any official means for taking acuity into account. If one of the couplets is having problems, it's just like, well our hands our tied, everyone's busy...do the best you can. You can PM me if this is taking things off track.

OBRN1994 · Apr 4, 2009

Sorry for the end of my post last night, I was responding from my blackberry and thought I'd lost the post altogether!

The gest of what I was getting at is that on our floor, it's too difficult to assign couplets and make it work in our situation.

paintedbison · Apr 13, 2009

I moved about a year ago, but before that I was working as a "traditional" postpartum nurse. I liked it for the most part (although I do not think it is an ideal set up). However, it would get annoying because of the overlap of jobs. For instance, the nursery nurses weren't always good about coming out to check on babies. I was on the floor and accessible. So, I was generally the one to help with breastfeeding issues and even standard newborn care questions. I could call nursery to come help, but it was generally easier to just do it myself rather than make the family wait forever. I would have preferred fewer patients and just taking care of the babies too. I do like the mom side of care much better than the baby side, though. So, in that sense, I enjoyed the job.

debswords · Jun 17, 2009

We had abbreviated version of couplet care and decided to trial the separation of care - back to the traditional role of Postpartum nurse and Baby Nurse. Now we are looking at a return to couplet care. Our previous problems were none equal distribution of workload. By that I mean, many of the postpartum nurses did not do their assigned baby assessments but relied on the admission nurse to do this for her while she was out with the mother. The nursery personal were very overwhelmed as you can imagine. So with the thought to return to couplets, do you all expect the nurse assigned to the couplet to complete the assessments on mother and baby? Who follows through with labs/vaccines/circ's for the baby? Do you have one person responsible for calling the various peds for lab reports? Tips welcome!

Elvish, BSN, DNP, RN, NP · Jun 17, 2009

The way it works at my place is that L&D takes the baby to the nursery for his initial bath & assessment. Once all that's complete, baby goes out to mom, and the couplet nurse assumes care.

The couplet nurse is responsible for informing the charge nurse in the nursery of any changes in the baby's status. The charge nurse in the nursery is then responsible for communicating w/ the pediatrician, and back to the couplet nurse. Charge is also responsible for getting circ consents signed and babies put on the circ list - and for communicating w/ the floor nurse to let them know who's getting one.

Couplet nurses are still responsible for the shift assessment on their mothers and babies. Nursery charge is kind of the 'go-to' person - a resource, and the go-between for the pediatricians. If we have to send a baby to NICU, it's the charge nurse that calls report and takes baby over.

debswords · Jun 18, 2009

so you have a charge person and an admission nursery nurse, so you also have a charge postpartum nurse? How many deliveries a yr do you do? Do you wait to give the initial bath greater than 2 hours with a minimal temp of 98.3? Do you practice skin to skin warming and send the babies out to mom without the initial bath? What percentage of your mom's agree to rooming in? Just during the day and evening shift? Any others have input? thanks!