Guidelines for Paediatric Presence at Delivery

 

Reviewed by Clinical Practice Committee
May 2016
Clinical Guidelines Back Newborn Services Home Page

See also:

Attendance at High Risk Deliveries

Attendance at Low Risk, Elective Caesarean Deliveries

Paediatric resident medical staff and NS-ANP’s are available to attend at risk deliveries and compromised fetuses. Referrals should be made by the LMC attending the mother. In emergencies or situations of urgency, messages can be relayed through clerical staff.  Paediatric staff often have to prioritise calls, so accurate information is needed.

In most situations the 1st call locator (usually a paediatric SHO, registrar, or NS-ANP) should be called. Except in the situations set out below when 2nd call registrar or NS-ANP should attend, the 1st call person is responsible for informing other paediatric staff if he/she wants them to attend as well. The registrar/NS-ANP will attend deliveries with a house surgeon at the beginning of a run, until the house surgeon is competent at resuscitation.

The paediatric registrar/NS-ANP will contact the specialist if his/her presence is indicated, unless there is a prior arrangement.

The paediatric service should be informed of women in labour if the baby is likely to require care from the Newborn Service. Communication would normally be to the Neonatal Paediatric Medical team regarding clinical information. Bed status should be checked with the Clinical Charge Nurse. Referrals requesting neonatal paediatric input to the management of pregnancy/labour should be to specialists.

  1st Call Registrar-NS-ANP-SHO Locator
93 5537
or
021 852 598
or 29598
Level 2 Registrar-NS-ANP Locator
93 5536
or
021 891 404
or 29283
Level 3 Registrar-NS-ANP Locator
93 5535 or
021 891 409
or 29361
Specialist
Meconium staining
light, no fetal distress
No      
light + fetal distress Yes      
Thick Yes      
Fetal distress Yes if severe    
Preterm 35-36 weeks Yes      
Preterm 32-34+6 weeks   Yes    
Preterm < 32 weeks  

  Yes Discuss prior to labour/delivery
Term IUGR Post delivery      
Term Severe IUGR (<2.2kg)   Yes    
Suspected fetal infection Yes      
         
Term Multiple pregnancy   Yes    
LSCS (Elective low risk with regional anaesthetic) No      
Urgent or Category 1 LSCS   Yes    
Low forceps No      
High forceps Yes      
Low ventouse delivery, no fetal concerns No      
Ventouse delivery with fetal distress, meconium, or obstetric concerns Yes      
Vaginal Breech delivery Yes      
Maternal Substance Use Post delivery      
Fetal abnormality likely to affect condition at delivery       Discuss prior to labour/delivery
Fetal abnormality other than above       Discuss prior to labour/delivery
Haemolytic disease       Discuss prior to labour/delivery

All three resident paediatric staff answer 777 emergency calls. The 777 call does not go to the specialist on call - a request for specialist attendance will need to be directed through the operator. If a specialist is required urgently, then contact them via their mobile phone.