unit "culture"

Elvish, BSN, DNP, RN, NP · Dec 10, 2014

What is birth usually like at your facility? How many births do you do and how many providers deliver at your unit? I'm especially interested in second stage management- do all your MDs break the bed? How about delayed cord clamping and skin to skin? Do you have CNMs? Do you do LDRP rooms or LDR and PP, and what do you like/dislike about your set up? Is your facility certified baby friendly, and if so what do you like/dislike about it?

Teaching hospital, avg. 500 deliveries/month. Apart from the residents & attendings, two other practices deliver there too, one of which has CNMs. LDR, then PP. This doesn't help the L&D vs. M/B wars, but too few people are willing to cross-train from either unit for us to do LDRP. That's the biggest downside I can see.

All three groups have individual providers that don't break the bed, but residents are going to be most likely to do it. (Although I will give the OB residents credit - most are willing to learn how to deliver without it.) We will delay cord clamping if parents ask or if gestation

Not certified baby-friendly but working toward certification.

My biggest pet peeves during a delivery: 1) people (docs, nurses, or family, doesn't matter) yelling "Pushpushpushpushpushpushpush!" right in Mom's face; and 2) docs who put their fingers in everyone's lady partss. Um, doc? It's her 4th baby, no epidural. Odds are she'll know what to do...

klone, MSN, RN · Dec 11, 2014

The last place I worked inpatient was a teaching hospital with residents and two different midwifery practices. We did about 400 births/year. The physicians would always break down beds, and the midwives would not. Midwives practiced routine cord clamping, physicians did not unless it was specifically requested. All providers practiced immediate skin to skin unless the baby needed to go to the warmer. They had LDR with separate PP rooms (same unit, though, so everyone did both M/B and L&D (or newborn admit/transition if they weren't trained in L&D). The providers tried to work really hard to be as natural or as medical as the mother prefers. If she was low-risk and requests no IV, we would accommodate that. One of our midwifery practices offers waterbirth in blowup birth tubs, and many of the residents were okay with a woman delivering in the room's bathtub. Intermittent auscultation, wireless tele, and low-dose Pitocin were standard.

Not Baby-Friendly, but still very breastfeeding friendly.

iPink, BSN, RN · Dec 11, 2014

I don't work L&D, but in PP. It's a teaching hospital averaging more than 1,000/month. We have several OB/GYN groups along with CNMs/NPs and care flows from LD, Recovery, then PP (all separate). Not certified baby friendly. Breastfeeding moms get support and we don't condemn moms who chose not to breastfeed. We do have separate "well-baby" nurseries.

Skin to skin is promoted and tub or natural childbirth are options for delivery. No delay for cord clamping either unless otherwise specified.

Sent via iPink's phone using allnurses

BSNbeauty, BSN, RN · Dec 12, 2014

What do you mean by Break down beds klone?

NurseNora, BSN, RN · Dec 12, 2014

Currently I work in a small, 80 deliveries per month, rural hospital. We're not Baby Friendly, but are very supportive of breast feeding. We have 3 OBs, 1 Family Practice, and 1 CNM who deliver here. One of the OBs breaks the bed routinely, the others don't. All place the infant on Mom's abdomen and leave it up to the patient and the nurse to decide on skin to skin. We have LDRs with Couplet Care on another floor. If the census is low we close CC and do LDRP which I prefer. I wish our unit was physically large enough to do LDRP all the time, otherwise, I like our set up.

klone, MSN, RN · Dec 12, 2014

What do you mean by Break down beds klone?

Removing the bottom part of the bed when the woman is about to deliver. I was talking to the midwives about this, and it's an odd thing - OBs tend to remove the bottom of the bed, whereas midwives just lower it. I guess it goes along with the mindset where OBs tend to look at every birth as a potential emergency, and midwives look at it as a natural process.

klone, MSN, RN · Dec 12, 2014

The last place I worked inpatient was a teaching hospital with residents and two different midwifery practices. We did about 400 births/year.

That should have read 4000 births/year, not 400!

cayenne06, MSN, CNM · Dec 13, 2014

One of the best things about the hospital I am doing my student rotations at (student CNM) is that the CNMs train and supervise the 1st years, so they learn the midwifery way before they move onto the higher risk patients. We are a tertiary center and do maybe 400 births a month.

Our unit also has a policy that ALL newborns get delayed cord clamping and a minimum of an hour of uninterrupted S2S- no weights, no measurements, nothing. Of course, this is assuming everyone is healthy and mom actually wants S2S. I've had a few who were like, "uh, no. I just carried the kid for 9 months, go put him in the warmer so I can eat my damn sandwich!" I can sympathize with that lol!

I work as an RN in a small community hospital (300 births a year, low risk only)- we hand out formula like candy and uninterrupted S2S is actively frowned upon by the nursing staff (we need to get our weights and measures so we can call admitting!). We have one OB and two CNMs. The OB absolutely will not deliver someone who isn't in stirrups unless the baby's whole head is out before he can wrangle them into the footrests. Cord is clamped and baby gets held up for the ever-important OB-holding-screaming-wet-baby-pics before he will pass them to mom for a quick look-see, and then we whisk the baby to the warmer for all the routine newborn stuff. We love our bulb suction and our 39 week social inductions too.

cayenne06, MSN, CNM · Dec 13, 2014

oh my goodness, this reminded me- when the new group of interns started this fall, we had one shadowing us to observe a birth. She was like 5-6cm IIRC. Asked to go to the bathroom, and of course she preciped. The baby plopped right into the toilet and the cord evulsed!

OMG, cute little new doctor! I swear, midwives don't like to delivery babies into toilet water. I promise.

klone, MSN, RN · Dec 13, 2014

One of the best things about the hospital I am doing my student rotations at (student CNM) is that the CNMs train and supervise the 1st years, so they learn the midwifery way before they move onto the higher risk patients. We are a tertiary center and do maybe 400 births a month.
Our unit also has a policy that ALL newborns get delayed cord clamping and a minimum of an hour of uninterrupted S2S- no weights, no measurements, nothing. Of course, this is assuming everyone is healthy and mom actually wants S2S. I've had a few who were like, "uh, no. I just carried the kid for 9 months, go put him in the warmer so I can eat my damn sandwich!" I can sympathize with that lol!
I work as an RN in a small community hospital (300 births a year, low risk only)- we hand out formula like candy and uninterrupted S2S is actively frowned upon by the nursing staff (we need to get our weights and measures so we can call admitting!). We have one OB and two CNMs. The OB absolutely will not deliver someone who isn't in stirrups unless the baby's whole head is out before he can wrangle them into the footrests. Cord is clamped and baby gets held up for the ever-important OB-holding-screaming-wet-baby-pics before he will pass them to mom for a quick look-see, and then we whisk the baby to the warmer for all the routine newborn stuff. We love our bulb suction and our 39 week social inductions too.

Your experiences sound SOOO similar to mine. From the small community hospital (and yes, I would hear that EXACT thing about needing to weigh baby so they can call admitting) to working in a teaching hospital where the interns work with the midwives.

Your last paragraph really resonated with me. Sounds SO familiar! THat environment is where I started as a new grad and worked for the first 4 years of my career, and I didn't know any different. I learned SO much there (because I worked nights and the OBs did not want to come in until the head is on the perineum, so I've delivered lots of babies myself), but I don't know if I could ever work in that type of environment again, for lack of EBP and patient autonomy.

cayenne06, MSN, CNM · Dec 13, 2014

Your experiences sound SOOO similar to mine. From the small community hospital (and yes, I would hear that EXACT thing about needing to weigh baby so they can call admitting) to working in a teaching hospital where the interns work with the midwives.

Argh it drives me up the wall!