OB/Newborn: Detailed Information
The on call pediatrician is responsible for all newborn consultations. We also attend all C-Sections and any deliveries of infants who are less than 36 weeks gestation. We are called for meconium deliveries and any other deliveries where there is evidence of significant fetal distress. Pediatricians are available to come to any delivery if the FM physician has concerns about the fetal/ newborn status. All sick newborns should be seen by the pediatrician to arrange or assist in arranging a transport via Lifemed with or without a NICU NP. Usually the FM physician’s admit and follow newborns, but a pediatrician may elect to admit and follow an infant that is less than 36wks or that they have some concerns about.
At YKHC we do not have a nursery. All babies room-in with their moms until discharge. There is a procedure room for nursing care plus resuscitation and stabilization if needed. We are not able to keep babies that will need more than mother’s care. Each delivery room is set up for meconium deliveries and any initial resuscitation. If a baby requires ongoing resuscitation or intubation, they need to be moved into the procedure room. There are two neonatal crash carts, one in the procedure one and one on the unit, across from the nurse’s station. The carts have all the needed resuscitation supplies and meds. On top of each cart are neonatal resuscitation worksheets with equipment sizes, medication doses, and fluids based on weight or estimated gestation age. Use these for all sick newborns. Make sure the pharmacist and nurses are aware of the gestational age and weight you are choosing for medications, equipment and fluids etc.
The goal of OB nursing and provider staff at YKHC is to ensure the safest delivery and the best care possible for our newborns as well as promoting good maternal-newborn bonding and avoiding separating moms and babies whenever possible, but occasionally infants will be delivered that will need further evaluation, observation, interventions and/or transport to a higher level of care. Because we do not have a nursery or the staffing level to care for sick infants, we need to decide which babies will need to be transported out. We can do some limited observation and supportive care, but for all sick infants that require a higher level of care, providers will stabilize and transport the patient as quickly as possible.
If a newborn has a possibly transient condition (examples: TTN, low glucose, minor depression from precipitous delivery etc) a baby may be evaluated and watched in the nursery for a limited length of time. If the newborn is not showing signs of improvement and it does not appear that they can be cared for as a rooming in patient with mom by 4-8 hours of life (depending on staffing and nursing comfort level), arrangements need to be made to medevac the infant.
If a newborn is stable and shows no signs of illness or instability (ie can room in with mom), but needs labs and observation for 48 hours (ex: GBS exposure without appropriate maternal prophylaxis or jaundice and phototherapy) the baby may stay with mom in OB with or without a heplock in place. Heplocks will be monitored per hospital policy.
At this time, if a newborn is well, but has borderline or questionable screening labs that require 48 hours of antibiotics and observation, the infant will need to be transferred to NW or to ANMC.
Things to Remember
- Many of our OB patients are multiparous, and deliveries here often go quickly. You probably have less time to get in than you think. We have a 20 minute allowance to get into the hospital when activated; this is often not enough time! If it seems a meconium or other delivery is imminent and you’re coming in from home, consider asking the OB clerk to call the ER provider or get an NRP trained nurse to stand in for you at the delivery until you can get there.
- When given a “heads up” on a pending delivery it is a good idea to go directly to the delivery room and assure the bed has been set up and any equipment that you might need is readily available i.e. meconium aspirator etc. The OB nurses are usually NRP trained and are usually very good at setting up the equipment, but they may be occupied with other patients. If there is time before the delivery and the mother is emotionally available, introduce yourself and explain your role in the delivery.
- For meconium deliveries that you attend, complete an H&P and do all of the admission paperwork. If the baby is stable you can get the FM doc to accept the baby back to their service and write transfer care back to FM on the admission order.
- If you come in in the middle of the night for a meconium delivery and the baby has already delivered, you do not need to stay and complete the admission. If, however, the FM provider is very busy please consider offering to help them out with the baby admission. It will come back to you!
- If you are awaiting a preterm or other likely unstable infant’s delivery, activate the medevac prior to delivery whenever possible. For all native infants, you need to activate via ANMC, even if the infant will end up going to Providence NICU (only Level III NICU in the state, all intubated/critical babies and micro preemies go there). You can also call to consult the on-call neonatologist for any infant – they are very helpful. Activating early can mean a difference of hours in the arrival of the neonatal nurse practitioner/transport team, which can be a critical factor in the outcome for a very ill newborn.
- If you are not certain that an infant will need transfer, wait until delivery to activate. After the infant is born, initial stabilization is done, and the decision to transfer is made call 907-563-2662—ANMC peds on call. Then activate the transport team.