Larissa314

We have 2 operating rooms dedicated for our OB department specifically for c-sections and any other surgeries the mothers would need (dilation & curretage, tubal ligation, hysterectomy, etc.). In all but the most rare (thankfully) super-emergency cases, we allow one support person to be at the side of the mother. I is usually the father. Whoever it is sits beside the mother's head out of the sterile field after putting on a gown, shoe covers, face mask and head cover. After the baby is born and initially stabilized we invite the support person to the radiant heat warmer we keep in the operating room for them to come see and welcome the baby, take photos or video of the baby, etc. The support person can then decide whether to stay with the mother or follow us taking the baby to the well-baby nursery or the NICU to see where the baby is going. The support person is taught that if they leave the operating room they will not be allowed to return but can return to the mother's room to wait for her there. The OB nurses take care of the post-operative needs of the mother in her room. We do not require any special testing of the support person, like TB testing, etc.

Policy Statement from the American Academy of Pediatrics reprinted in "Advances in Neonatal Care", Volume 6, Number 4 (August), 2006: pp220-223: "Abstract: The Apgar score provedes a convenient shorthand for reporting the status of the newborn infant and the response to resuscitation. The Apgar score has been used inappropriately to predict specific neurologic outcome of the term infant. There are no consistent date on the significance of the Apgar score in preterm infants. The Apgar score has limitations, and it is inappropriate to use it alone to establish the diagnosis of asphyxia. An Apgar score assigned during resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. An expanded Apgar score reporting form will account for concurrent resuscitative interventions and provide information to improve systems of perinatal and neonatal care." Both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists propose use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions. The article in "Advances in Neonatal Care" has a diagram of what the proposed Expanded Apgar score form looks like. I attempted to demonstrate it in this forum but because of the size of the forum pages it did not come out correctly. I very highly recommend you look for the form as seen in either the "Pediatrics" or "Advances in Neonatal Care" journals. I think it is a wonderful idea to help demonstrate what was happening during the delivery of premature babies and babies who require resuscitation at delivery. "Figure 1. Expanded Apgar score form. Record the score in the appropriate place at specific time intervals. The additional resuscitative measures (if appropriate) are recorded at the same time that the score is reported using a check mark inthe appropriate box. Use the comment box to list other factors including maternal medications and/or the response to resuscitation between the recorded times of scoring. PPV/NCPAP indicates positive-pressure ventilation/nasal continuous positive airway pressure; ETT, endotracheal tube." In general the Apgar score form looks like it always did and is printed on the left side of the page. At the top right is "Gestational Age_______ weeks". To the right of the form there are 5 boxes under the headings of 1, 5, 10, 15, and 20 minute intervals for recoreding of more apgar scores as a resuscitation progresses. Beneath this is a second area of which the left side is an empty box with the word "Comments" in it. To the right of the box is the title "Resuscitation" and under it is a table with the times of 1,5,10,15 and 20 minute intervals which a placed immediately under the Apgar table above it. To the left of the table each line has a specific word: oxygen, PPV/NCPAP, ETT, Chest compressions, Epinephrine. I will try to demonstrate that below. .......................................Resuscitation _____________________________________________ Minutes.......................1.....5......10......15......20 _____________________________________________ Oxygen _____________________________________________ PPV/NCPAP _____________________________________________ ETT _____________________________________________ Chest Compressions _____________________________________________ Epinephrine _____________________________________________ I hope this is helpful. A.M.,RNC Level III NICU Staff Nurse Southeastern USA