Impending Delivery Skin-to-Skin in the Labor Room The Mizzou Standard of Care Call 4th Floor and transition nurse (TN) to alert them of impending delivery Impending Delivery May Breastfeed Nurse remain with infant Observe until stable Respiration 60-70 O2 Sat > 85 Infant actively rooting No grunting, flaring, retracting YES Baby is born & immediately goes to chest Mother/Baby candidate for immediate S2S? NO Newborn is quickly dried and placed bare inside gown against mom’s bare chest (no bra) Observe infant Baby can remain skin-to-skin No feeding Baby to Resuscitation Room Respirations >60 O2 Sat > 85 Mild grunting, flaring, retractions Respiratory Instability? Baby Stable? NO Inform mother of baby’s status and where the baby is going YES Baby remains S2S whileTN/Baby Nurse continually assesses: Breathing Color Tone Cry Stability of infant on chest Baby Nurse bulb suctions and stimulates as needed Respirations >70 O2 Sat below target range Significant grunting, flaring, retractions Resuscitation Team works with infant Temperature Instability in 1st 30 minutes of life? Infant Stabilized? YES Notify Physician, Infant to NOU/NICU Keep mother up to date on baby’s progress – begin pumping and hand expressing in recovery room (within 3 hours) NO What is the issue? Prior to 1 hour of life: 1 - Administer Erythromycin eye ointment and Vitamin K injection 2 – Perform second set of vitals Temp ≤ 36.3 Temp > 38? Send colostrum to NICU/NOU for oral care or feeds Ensure baby prone on mothers chest between breasts Replace dry warm blankets on baby and replace hat Increase room temperature Recheck temp in 30 minutes Are any of the following Present? Maternal temp > 38.0 GBS pos and no ABX Risks for Chorio ABX received in labor <36 weeks gestation Prolonged ROM (>18 hrs) Newborn remains skin to skin at least one hour (if baby has not latched at one hour, baby remains S2S until 1st feed complete) Record in chart: Hand expression taught Time that pumping/hand expression performed Temp > 36.3? NO YES YES Teach mother: Feeding cues Importance of S2S Biologic Hold Hand expression Assist baby in latch NO Encourage mother to do S2S immediately upon being reunited with her infant Resume normal care Check bedside glucose Infant to warmer Call infant healthcare provider Monitor Recheck temp for one hour Call Provider Concerning Vitals Vital signs outside the parameters below warrant an assessment, intervention, and reevaluation. Interventions must be documented in the chart. Temp < 36.3 Temp > 37.5 HR < 100 HR > 170 Resp < 35 Resp > 65 Blood glucose <40 Infant is weighed Temp < 38 w/i one hour Temp remains > 38 for one hour Once mother/infant stable and PACU nurse comfortable, call up report to NOU and record information: Record that infant went S2S within 5 minutes Record infant vitals (30 and 60 minutes) Record newborn weight Call Provider Resume Normal Care Infant transferred to 4th floor in mother’s arms Immediate S2S Candidates Gestational Age >34 6/7 weeks gestation No chest compressions Cord gas pH >7.0 No chorioamnionitis Absence of meconium Absence of operative delivery Newborn bath and assessment occur in mother’s room (delay until there is time and the mother can participate) 11-18-13 cs