Transitional Care Nursery! Help!

[djohnston28]

A little background first:

I work for a facility that delivers 2000 babies a year. We are one of the only facilities in the area that does couplet care, meaning that each nurse has the mother and newborn as a patient team. Our staff nurses take 3 couplets on average equally 6 patients. As part of insurance requirements for the state of Mississippi all the facilities that deliver newborns are required to earn Baby Friendly Status. We have been working on the guidelines and recently passed our CHAMPS visit with flying colors. However, we are having issues with all of the maternity staff being willing to step up and help with keeping the babies in the room through the transition process (first 4 hours after delivery).

I would like to know how other places perform transitional care. Would anyone be willing to answer the following questions?

1. Who attends the delivery as the babies nurse?

2. Who stays with the baby and mom during the first two hours of life as recommended by the AAP?

3. Do you perform STS in the OR for a c-section? If so, who stays with the baby during that process?

Any advice would be welcome! We are trying to provide the best, safest, care for our patients while not working our staff any harder than they already do!

[vimmie]

I can only speak from the UK but we would never separate mom and baby within the first 4 hours (unless in an emergency and one or both was very sick). The midwife (we don’t have OB nurses) would stay with the woman and baby, making them comfortable, providing refreshments, finishing paperwork while STS is on going. If we were happy with both mum and baby we would leave them with the call bell and then go into the room now and then to check on them and go back if they need anything.

We do skin to skin in the OR after we’ve dried baby and checked they can breathe ok! Then we transfer to recovery remaining skin to skin. Hope that helps.

[AZBlueBell]

On 4/18/2019 at 2:51 PM, djohnston28 said:

A little background first:

I work for a facility that delivers 2000 babies a year. We are one of the only facilities in the area that does couplet care, meaning that each nurse has the mother and newborn as a patient team. Our staff nurses take 3 couplets on average equally 6 patients. As part of insurance requirements for the state of Mississippi all the facilities that deliver newborns are required to earn Baby Friendly Status. We have been working on the guidelines and recently passed our CHAMPS visit with flying colors. However, we are having issues with all of the maternity staff being willing to step up and help with keeping the babies in the room through the transition process (first 4 hours after delivery).

I would like to know how other places perform transitional care. Would anyone be willing to answer the following questions?

1. Who attends the delivery as the babies nurse?

2. Who stays with the baby and mom during the first two hours of life as recommended by the AAP?

3. Do you perform STS in the OR for a c-section? If so, who stays with the baby during that process?

Any advice would be welcome! We are trying to provide the best, safest, care for our patients while not working our staff any harder than they already do!

1. We have a “transition Nurse” role assigned each shift. This is typically a NICU Nurse, but if NICU is full and they can’t spare a Nurse then an L&D Nurse can take this role as well. Typically it is one person assigned as this role each shift.

2. We aren’t required to stay in the room, at all times for those first two hours. We are in and out very frequently so they aren’t alone much but they have their call light when we aren’t in room. Typically our transition nurse cares for baby thefirst two hours and the L&D Nurse cares for Mom. Sometimes, if it’s very busy the transition Nurse will catch and release meaning they come for the delivery/apgars and then the L&D Nurse takes over care for both Mom and baby after that.

3. We sometimes do STS in the OR, depends on the situation. The transition Nurse stays with the baby for this.

When you say you’re having trouble with staff wanting to keep the baby in the room, what does that mean? What do you do with baby at the moment, they are delivered and leave the room?!

[Eyeknit, ADN, BSN]

Not sure if you mean LDRP couplet care or MB couplet care, but at my fac we do STS by default for vag, and we have a nursery nurse assigned only to ‘catch’ babies who does the two hrs after delivery, popping in and out of the room, sometimes juggling 4 or more babies, then upon transfer to MB couplet care two RNs (nsy and l&d) report off to one RN. If it is busy the nsy nurse reports off to l&d nurse as soon as mom and baby are stable. We currently have STS at 100% of the vag deliveries for which it is appropriate. Not so good with the cs. Those we do STS on request, or start in the recovery room. The nsy rn has to be ‘in and out frequently ‘ during skin to skin, we dont do a continual presence.

[Monkey Nurse, ASN, RN]

I'll get back to you as I am about to start a new facility, but I can tell you what it looked like for me in a rural setting as the only OB trained nurse on my shift:

Keep in mind we were a rural hospital so this probably atypical, but we had to be creative with resources:

If no active labor- I did couplet care for up to 8 mom and babies. (I never had more than 3 pairs). If I had an active labor, I would have a CNA round for vitals instead of myself, and I would check in on mom and baby periodically after my initial assessments. (I'd probably have cross coverage from outgoing OB nurse while I did my initial rounds).
For labor and delivery I provided the care from labor to transition to the postpartum wing. At the time of delivery I had to call an M&S nurse who would stay until we were sure the baby was stable. I think less than 30 minutes. All our M&S staff were baby friendly certified, Pals, ACLS, and usually NRP. Once baby was determined to be stable I sent them back to their ward because in most cases I am doing nothing in the first hour except guiding the bonding and occasional VS checks or fundal checks on mom.