Who is in the OR during a c-section?

[kirchnerfamily]

Hi! I'm trying to put together a little handout on c-sec's and I wanted to have a figure to represent mom and baby with stick people representing the folks in the OR. Going off of what I have personally seen having had 3 c-sections, I know that in a normal term delivery there is the anesthesiologist, the L&D nurse and the OB...but who are all the other people? It seems there is maybe a NICU nurse and a few surgical techs and one or two more doctors assisting the OB. It would be helpful to know exact titles and any extras one might find in a premature or twin delivery. Thanks!

[mentalhealthRN]

It may depend on the hospital. Some teaching hospitals you may find any variety of people. The Attending OB, residents, fellows, interns. Some assisting, some just observing. Generally I found at least for the short time I worked in L&D there are not staff from the NICU/Special care nursery there unless there are mulitples or the OB has requested in advance due to any concerns of potential issues, really pre-term, etc. Or at times they are called in last minute when needed after the delivery if something unexpected happens with the baby. There is a Surgical tech in there always. The anesthesiologist or CRNA. And of course the mom, baby and significant other--keep in mind to be PC as this is not always the "dad" but may be the moms (female) significant other.

So yeah there are standard people you will always find in there but it varies depending on the hospital and the situation really.

[VICEDRN, BSN, RN]

1. the doc

2. the anesthesia doc and/or CRNA (they might both be present for a breath while at the beginning)

3. pt's ob nurse

4. the "baby nurse" : responsible for primarily caring for baby while ob nurse cares for mother

5. surgical tech

6. NICU nurse and doc if so indicated (and it may be indicated by precipitating events but not used upon baby's arrival). these folks will be low key but present without announcing all of that

7. respiratory therapist to assess baby upon arrival

8. a patient care tech (nurse's aide) to help clean up baby

various and sundries:

students

resident

patient's midwife or laboring ob (just to help and because they are invested in pt)

[SummitRN, BSN, RN]

don't forget the circulator

[klone, MSN, RN]

At my facility (teaching hospital):

OB attending

Resident

Intern

CRNA/Anesthesiologist

Scrub tech

Circulating nurse

Usually the charge nurse or another L&D nurse to assist the circulator

Peds team (pediatric attending, resident, maybe an intern)

Where I used to work (non-teaching hospital):

OB

First Assist

Scrub tech

Circulating nurse

Anesthesiologist

Pediatrician

RN (OB nurse who then becomes the pediatrician's assistant)

[LDRNMOMMY, BSN, RN]

Hospital #1:

OB

First assist - this is sometimes a resident or sometimes it was a surgical tech

Surgical tech

CRNA

OB circulator

NICU team - NNP, RT, and NICU RN

NICU team was there for every c/s.

Hospital #2::

OB

First Assist - Usually the backup call OB doc or CNM. If it was a true emergency and after hrs it would be a surgical tech

Surgical tech

CRNA

Circulator

L&D RN for baby

Med tech to assist L&D RN for baby

NICU would only come for emergencies, bad strip, provider request etc. They were not there for every C/S. This was a much smaller hospital.

[kirchnerfamily]

Thanks everyone! So, the person that is helping the main OB...is a resident? Or intern? Or another OB? Or an MD? Or could be any??? And what is the role of the OB nurse during a c-sec? It seems to me they just hang out by my side and explain what is going on...I assume they have more to do than that such as charting?

[klone, MSN, RN]

Thanks everyone! So, the person that is helping the main OB...is a resident? Or intern? Or another OB? Or an MD? Or could be any??? And what is the role of the OB nurse during a c-sec? It seems to me they just hang out by my side and explain what is going on...I assume they have more to do than that such as charting?

It depends on the facility. In one hospital (non-teaching hospital, no residents), it was usually another OB in the practice, or one practice had a CNM who was first assist. Our facility also had designated "First Assists" - not physicians, not nurses, but specially trained techs. At the teaching hospital I work at, one of the senior residents usually performed the surgery with the attending OB looking over her shoulder, and there was usually the intern present helping out as well.

As far as the OB nurse, where I work now, the L&D nurse who was with the patient during labor (or prepped her for the C/S if it's scheduled) acts as circulator. That means she coordinates all the roles, inserts the foley, does the sterile prep, does the time out, does the instrument count with the scrub tech, notes times, acts as a gofer for any supplies, and basically makes sure everything runs smoothly. As circulator, I spend very little time at the patient's side.

Where I used to work, that nurse would take over as the pediatrician's assistant - helper for the baby, performs NRP if necessary, etc . That facility had a designated OR team - when the patient went into the OR, the OR had their own circulator they used.

[klone, MSN, RN]

For a twin delivery, you will have twice as many people there from the peds/NICU team. For a premature delivery, you'll have extra peds/NICU people there, as well as someone from respiratory for airway.

[Rathyen]

One more example for good measure, at my facility, single birth, no risk factors:

One OB doc

One CNM or second OB doc

L&D nurse

Surgical tech

anesthesia

Postpartum nurse

Pretty much the same thing everyone else has said. Twins, double it. High risk, add NICU and ped doc, maybe respiratory.

[Irishobrn]

Where I work:

Patient

Patient's support person

OB

House Officer (hospitalist ob to assist with the surgery)

Scrub Tech

Circulating Nurse (L&D nurse who is primary care nurse for patient)

Neonatologist (MD or NP)

NICU nurse

Anesthesiologist

If we are lucky there is a second L&D nurse to assist with the baby once the NICU is done assessing the baby...but most of the time the circulating nurse does that too.

For Twins we have two NICU nurses and one other L&D nurse to help with the extra baby.

[mitchsmom]

This has been mostly answered, but every place is a little different. At my work:

Patient

Patient's support person

OB

First assist (RNFA or tech; we VERY rarely have a 2nd MD present)

Scrub Tech

Circulating Nurse (L&D nurse who is primary care nurse for patient)

Baby Nurse (another L&D nurse who is available to "catch")

Anesthesia (MD or CRNA)

RT to assist Baby Nurse if needed

(we only call Pediatrician to be present if unplanned/ anticipate complications/ certain risk factors)

We are a community hospital and don't have a NICU, so we L&D nurses (& pedi/RT) would serve as "NICU" nurses to stabilize a sick baby for transport if needed (for instance if it's a preemie coming before mom could be transferred, or some other kind of sick baby (beyond TTN, abx for sepsis prophylaxis without symptoms, other mild issues).

Like others said, we occasionally have students, etc.