Re: Third stage, how long?
From: Gail Graham (GA12L@aol.com)
Sun Jun 25 03:23:04 2006
It must be very frustrating to not be able to do all that. It's easy for
us as midwives do their own notes and we don't have to dictate letters
to anyone it all gets put on the discharge summary when the woman goes
home which gives us at least 6 hours to weigh etc. if the woman is
having a 6-hour discharge. She is given a summary to give to her
community midwife along with the postnatal notes when she visits her at
home the next day and one for her GP for information only although some
GP's will make one home visit in the first couple of days. The
community midwife will go out to her home for a minimum of 10 days but
can be up to 28. This is in the process of changing though to make it
12 weeks. Our postnatal care is called the Cinderella of the maternity
services!
Gail
ainsron@sbcglobal.net wrote:
> One of the reasons the nurses try to get the weight taken as soon as
> possible is because I (and by assumption other physicians, CNMs) need the
> data to complete our work. For example, I dictate my delivery notes. For
> them to be complete, I need the birth weight, Apgar score, delivery time.
> When I leave the delivery room or shortly afterwards, I want that
> information in my hand so that I'm not sitting around waiting or dictating
> multiple blanks in the note to be filled in later. On the other hand, I
> think it is important to place the baby on Mom's tummy after the baby is
> born, I always offer it, unless there are concerns about the baby such as
> meconium and the pediatrician is present to evaluate the baby. I always
> offer the DAD a chance to cut the cord after I clamp it, but I don't think
> there is credible evidence that the timing of cord clamping and cutting
> matters. Breast feeding immediately is always an option we support, but
> most babies aren't in a great hurry to latch on. Delaying the Emycin, bath,
> etc. is something the nursing staff is always willing to work with patient
> on and individualize. I guess I am still somewhat of a dinosaur on nasal
> suctioning and try to suction on the perineum, unless the baby comes out
> screaming before his chest delivers.
>
> Ronald E. Ainsworth, MD, FACOG
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Jamie
> Sent: Thursday, June 22, 2006 3:54 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Third stage, how long?
>
> Good point. And re your previous post-healthcare is just as stuck on
> "that's what we've always done" as any other business. Nurses are more
> likely to be open to "allowing" mom to hold her baby if the routine
> makes that less possible. The things that absolutely have to be done in
> the delivery room are stabilization and identification. Both of those
> can be done in the mother's arms (as long as baby is healthy), but if
> the nurses are also used to getting footprints, weighing, giving Vit K
> and eye ointment, etc. immediately (and expected to do so), they may
> feel that their work is being held up. If those things can be done a
> little later on, it frees the nurse to complete paperwork and monitor
> other laboring patients while the mother and baby spend some time
> together. It is very anxiety producing to think about all the work
> you've got to get done, while you sit and wait for someone to decide you
> can begin doing it.
>
> At Thu, 22 Jun 2006, D. Ashley Hill wrote:
>> Gail- I think it's important to remember that even though we might offer
>> immediate skin-to-skin contact and breastfeeding, many of our moms don't
>> want this, and prefer that the baby get "cleaned up" before returning
>> all bundled. Also, some moms want to be with the baby 24/7 after
>> delivery, but others want a break from their new responsibilities and
>> are happy to send the baby to the nursery so they can sleep or whatever.
>> Therefore, like a lot of "informed consent" issues, I always ask.
>>
>> Ashley
>>
>> At Thu, 22 Jun 2006, Gail Graham wrote:
>>> ajfields@pine-net.com wrote:
>>>> Although it is changing in some areas, here is it most common that the
>>>> baby is born and handed to a nurse, who places the baby under a radiant
>>>> warmer (you can see similar over the french fries at McDonald's ;-)).
>>>> Baby is dried, suctioned-routine delee suctioning isn't common anymore,
>>>> APGARs are done. If the baby seems to be transitioning slowly or
>>>> poorly, that is addressed. In some hospitals, the Vit K and
>>>> erythromycin are given at this point-in others those things are done in
>>>> the nursery.
>>> Erythromycin? What, on all babies? Why?
>>>
>>> It is often assumed that the mother doesn't want to hold
>>>> the baby until she is cleaned up and tucked in, at which time she'll be
>>>> handed her baby burrito. If the mother asks for the baby to be handed
>>>> directly to her, many docs will do so, but unless she asks, it's
>>>> uncommon to offer.
>>> Speechless!
>>>
>>> Nurses sometimes complain about the difficulty of
>>>> accessing the baby on mom's abdomen.
>>> Blimey, a healthy term baby needs to be with it's mother not assessed by
>>> some complaining nurse.
>>>
>>>> Rooming in varies a lot, as well. In some hospitals it is standard
>>>> procedure that the baby go to the nursery for a number of hours for
>>>> recovery.
>>> Not familiar with Nils Bergman's research then? Or the baby friendly
>>> initiative?
>>>
>>> In that case, the baby usually goes no later than an hour
>>>> after birth. When mom sees the baby again, it has usually been bathed
>>>> and dressed. If she's planning to bf and is really lucky, no one will
>>>> have given it a bottle of water or formula. Again, compliance with
>>>> mother's wishes IRT bfing varies a lot from one location to another.
>>> And everyone is happy with this?
>>>
>>> Gail
>> --
>> D. Ashley Hill, MD
>> Associate Director
>> Department of Obstetrics and Gynecology
>> Florida Hospital Family Practice Residency
>> Medical Directo, Loch Haven Ob/Gyn Group
>> Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
>> Orlando, Florida
>>
>
> --
> JFields, RN, BSN
>
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