What's all available in L&D?

LightningRN · Jul 31, 2007

At my hospital L&D nurses may work in L&D triage, L&D, L&D OR, PACU or Antepartum. We have seperate nursery and PP units and we do not staff those with L&D nurses.

tntrn, ASN, RN · Jul 31, 2007

At my hospital L&D nurses may work in L&D triage, L&D, L&D OR, PACU or Antepartum. We have seperate nursery and PP units and we do not staff those with L&D nurses.

Add Post post partum to that for our unit (although we do have some PP nurses who do not do Labor) and some of our NICU nurses also do all the rest.

rn/writer, RN · Jul 31, 2007

I think what you are asking is, "How many areas are there in OB/Gyn?"

L&D is a part of OB/Gyn. Other components are Antepartum, Postpartum, Well-Baby Nursery, and Gynecology.

What you are going to find out in the working world depends on the size and setting of the hospital in question. The two main configurations you will run into are LDRP and L&D/postpartum and other units.

Many, if not most, hospitals offer LDRP--Labor, Delivery, Recovery and Postpartum. From the time she is admitted until she is discharged, the woman stays in the same room. The exception would be when a c-section is needed. Then the patient will go to either a dedicated c-section OR or, in smaller hospitals, a regular OR. After the surgery, she will recover in a special area as well. After recovery, she will go back to the LDRP unit or to postpartum.

LDRP rooms look like regular patient rooms. But within pieces of furntiture or hidden behind pictures on the walls are the medical components needed for the delivery. A delivery cart, a baby warmer, and a crib are added at the appropriate times. The lower portion of the mom's bed "breaks away" just prior to the delivery.

The advantage of this kind of room is that a woman and her entourage can stay put from beginning to end. No awkward and painful transition from a bed to a gurney and onto a delivery table as happened years ago. Also, the patient will see the same set of nurses throughout her stay.

Another kind of configuration is LDR, with a separate postpartum area. The woman will labor, deliver and recover in one room, and then when she and her baby are stable, they will be taken to another unit for the postpartum portion of their stay.

It's unusual to see LDR with a separate postpartum outside of a large hospital because of the extra staffing needed to maintin this set-up. In some hospitals, staff is cross-trained and can work on either unit. In others, nurses stay on one unit or the other.

Antepartum is for moms who need care and/or monitoring during the pregnancy for conditions which pose a threat to the health and life of the mother or baby. An LDRP unit might have several rooms set aside for this purpose, there might be an individual unit for antepartum, or in small hospitals, antepartum patients could be placed on a medical floor.

Well-baby nurseries do not exist in some hospitals, as the feeling is that all stable newborns will be rooming in with mom. Other places make provision for the fact that moms may need a break, especially after a section, and have a nursery where babies can be taken between feedings (or even fed by staff if mom is unable to do so). Such a nursery can be a part of the unit moms are on or a separate area with staff that works only in the nursery.

Another OB/Gyn necessity is triage. Part of L&D, triage is the area where women come in to see if they are, indeed, in labor or if there are problems which need to be assessed and managed. Many women are sent home when it is determined that all is well and they are experiencing Braxton-Hicks contractions (which can be painful but do not advance labor).

There are also women who come for various surgical procedures--hysterectomies and such--that may be placed on an OB/Gyn unit.

And there are women whose babies will not be going home with them. Sometimes the baby needs to be observed in the NICU (neonatal intensive care unit) for respiratory or other difficulties. The child will be transferred back to mom when it is stable. Or it may stay longer in cases of prematurity or other conditions requiring more serious treatment. Occasionally, the pregnancy fails or the baby is stillborn or it dies shortly after birth. These patients are sometimes placed on an antepartum unit or a medical unit where they will not have to hear babies crying.

The size of the hospital often determines the arrangement. Smaller rural facilities might have everything in a 4-10 room suite. A larger urban hospital might have separate units for each component with many rooms in each one.

Delivery rates per facility can range from under 100 per year to 15,000. Treatment levels also vary, from low-risk to high. The smaller hospitals usually make arrangements to transfer moms who themselves are high risk or whose babies are likely to need serious intervention before or after birth.

I would encourage you to inquire at the hospitals in your area about what kind of units and staffing they have. They might let you tour or even job shadow.

Hope this helps. I wish you the best.