Labor and Delivery
Labor and Delivery consists of a 20 beds operating on a 24-hour-a-day, 7-day-a-week basis on the third floor of the Shands UF. The unit is geographically referred to as the 3400 area and is adjacent to the Mother-Baby Unit, Neonatal Intensive Care Unit II and Neonatal Intensive Care Unit III.
The beds are allocated in the following manner:
- Four outpatient triage beds
- Three operating rooms
- Twelve labor, delivery and recovery beds*
- Four recovery room (PACU) beds
*One of these labor, delivery and recovery beds is set up to convert to negative pressure for isolation of patient with a contagious process (i.e., TB, chickenpox, etc.]
The average number of L&D inpatient visits per month is 410. The average number of deliveries per month is 210. In addition to the deliveries performed in L&D, an average of 140 inpatient and outpatient antenatal test and procedures (biophysical profile, PUBS and amniocentesis) are performed each month. There are approximately 10,000 outpatient triage visits to L&D annually. The average triage length of stay varies widely, ranging from two to 18 hours, depending on the needs of the patient.
Equipment on this unit is provided for the purpose of maintaining mother and baby in a safe environment with consideration for pain management, performing diagnostic and therapeutic procedures and facilitating the birth process.
Each bedside has capability for electronic fetal monitoring. In each labor, delivery and recovery bed, cabled fetal monitors allow tracings to appear on a centralized screen in both the nurses station and the staff lounge.
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Patient Population
Women of childbearing age who are 20 weeks or more in gestation with actual or potential pregnancy-related problems are evaluated and/or treated on this unit. Vital signs and /or EKG monitors are present at each bedside for adult patients. There are portable equipment for continuous invasive and noninvasive monitoring of high risk mothers. These are not attached to a central monitoring station. Anesthesiologists are available 24 hours a days, seven days a week. Electronic pumps are provided for controlled administration of epidural medications. The anesthesia department maintains all standard equipment required in the three operating rooms. Neonates are encouraged to stay with their mothers from birth to 2 hours of age; or until transfer to the Mother-Baby Unit or NICU nursery based on the medical needs of the baby. Efforts to provide a family-centered birth experience in a safe environment are promoted. Because Shands is a tertiary care center, staff is focused on prevention of primary and secondary complications through the prompt detection of emergency conditions. When perinatal death is inevitable, every effort is made to provide family support. In the event of perinatal loss or adoption, patients will be given the option to be transferred to an off-service unit unless medically contraindicated.
Patients are admitted and seen in Labor and Delivery on a 24-hour-a-day, 7-day-a-week basis. There is a chief resident as well as an attending obstetrician available in-house to supervise and assist with the care provided by the OB resident staff. Patient care assignments are made in L&D as described in the hospital plan for nursing care. The assignments are based on the census, acuity, anticipated workload and experience level of those on duty. Due to the unpredictable and rapid changes in census and workload in Labor and Delivery, staffing needs are assessed throughout the shift.
Nursing Care
Registered nurses in the Labor and Delivery unit meet the basic requirements for registered nurse staff in accordance with the unit-based job descriptions, as described in the hospital plan for nursing care. Additional requirements for the registered nurse include completing a neonatal resuscitation course and adult CPR. Ongoing competency requirements for the Labor and Delivery staff include circulating for OR cases, triage, scrub nurse skills, AP test and fetal monitoring. Responsibilities of the Labor and Delivery nurse include the initial evaluation and admission of patients in labor; continuing assessment and evaluation of patients in labor, including checking the status of the fetus, recording vital signs, observing the fetal heart rate, observing uterine contractions and supporting the patient; and supervising the performance of nurses with less training and expertise. The nurses are skilled in the recognition and nursing management of complications of labor and delivery. L&D nurses are expected to provide support, guidance, direction and education related to childbirth to laboring moms and their coaches throughout the labor process. The orientation of the L&D staff is coordinated by the unit practice coordinator. This program is accomplished with the assistance of the nurse manager, the advanced nurse practitioner and staff nurses who serve as preceptors. The nursing assistants, OB tech and unit clerks meet the basic requirements of their positions and function in accordance with their unit-based job description as described in the hospital plan for nursing care.
A positive attitude toward family centered care and patient satisfaction is a focus of the perinatal care team. The ability, willingness and interest in working with the age-appropriate needs of all patients is an additional requirement for all who work on the Labor and Delivery Unit.