Labor and Delivery
Description of Unit
Labor and Delivery consists of a 24 beds operating on a 24 hour basis, 7 days a week, on the third floor of the Patient Services Building. The unit is geographically referred to as the 3400 area and is adjacent to the Mother-Baby Unit, Neonatal Intensive Care Unit II (NICU II) and Neonatal Intensive Care Unit III (NICU III).
The beds are allocated in the following manner:
- 5 Outpatient Triage Beds
- 3 Operating Rooms (OR)
- 12 Labor, Delivery, and Recovery (LDR) Beds
- 4 Recovery Room (PACU) Beds
*One of the LDR’s can be converted to a negative pressure isolation room for patients needing respiratory precautions.
The average number of L&D inpatient visits per month is 600. The average number of deliveries per month is 250. In addition to the deliveries performed in L&D, an average of 180 Inpatient and Outpatient antenatal test and procedures (Biophysical Profile, PUBS, Amniocentesis) are performed per month. There are approximately 11,000 Triage visits to L&D annually. The average triage length of stay varies widely, ranging from 2 hours to 18 hours, depending on the needs of the patient and/or admission.
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 the capability for Electronic Fetal Monitoring. In each LDR, cabled fetal monitors allow tracings to appear on a centralized screen in both the Nurses Station, Nursing Lounge, & Resident Staff Lounges. Fetal monitoring is also available on a secured web-based program.
Description of Patient Population
Women of childbearing age who are 16 weeks or greater 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 gravid patients. There is portable equipment for continuous invasive and non-invasive monitoring of High Risk mothers. These are not attached to a central monitoring station. Anesthesiologists are available 24 hours a days, 7 days a week. Electronic pumps are provided for controlled administration of epidural medications. The Anesthesia Department maintains all standard equipment required in the 3 Operating Rooms. Neonates are encouraged to stay skin to skin with their mothers from birth to two 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. As Shands is a tertiary care center, staff is focused on prevention of primary and secondary complications through the prompt detection of emergent 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 24/7 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 principle-based and designed to accommodate the dynamic nature of caring for women during labor and birth. The assignments are based on AWHONN Staffing Guidelines and include evaluation of 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.
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 RN includes, completing a neonatal resuscitation course, adult CPR or check off in the Nursing Education Department, Fetal Monitoring, and Breast Feeding Education Modules. Ongoing competency requirements for the Labor and Delivery staff include: circulating for OR cases, PACU skills, triage, scrub nurse skills, 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 childbirth to laboring moms and their coaches throughout the labor process. The orientation of the L&D staff is coordinated by the Clinical Leader. This program is accomplished with the assistance of the Nurse Manager, and staff nurses who serve as Preceptors. The Nursing Assistants, OB Surgical 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 are an additional requirement for all who work on the Labor and Delivery Unit.
Health Care Team
The medical director of the Labor and Delivery Unit is an Obstetrician who is also board certified in maternal-fetal medicine. The faculty and residents provide 24 hour medical care to the obstetric patient 7 days a week. The newborn patient is managed collaboratively with the Pediatrician and Neonatologist responsible for the Newborn Nursery and Neonatal Intensive Care Unit respectively. Multidisciplinary, comprehensive care is provided to the mothers and babies in Labor and Delivery by medicine, nursing, social work, and other services as indicated by the patients’ health status and identified needs. Unit clerks, nursing assistants, and Obstetric Surgical Techs provide support for the direct patient care givers. Nursing students and EMS Students, who are assigned to the unit, are under the direct supervision of their College Instructor.
Nursing management for the unit is comprised of a Nurse Manager and one Clinical Leader who have 24 hour accountability for unit operations and outcomes focused patient care; The Clinical Leader (CL) also provides clinical expertise and support to the staff; and a shared Unit Administrator (with the NICU) provides administrative assistance. Nursing Coordinators provide additional administrative support on the evening and night shifts.
The Nursing leaders on the unit promote and foster autonomous, accountable nursing practice. Registered Nurses are encouraged to solve problems independently and exercise critical thinking while carrying out individual patient care assignments. The Nursing Staff in Labor and Delivery provide care using a Total Patient Care model; direct care providers in L&D are all RNs.