I remember back during my OR rotation in nursing school,( yes I  
graduated in 1989) that the general OR's were kept quite cool to help  
reduce blood loss. Never was there a mention of infection control  
being the reason for the cool temp.  At least that is what I remember  
about it.  Staff who were not routinely gowned often wore a tshirt  
under their scrubs especially if they were in the open heart OR.  In  
contrast, the OR's where I work are comfortably warm.  I work in a  
maternity only hospital, though we do do some day of surgery gyne  
ops.  I've never seen a hypothermic mother who was not critically  
ill.  When a woman is unstable and receiving multiple transfusions,  
she is put under a warming blanket to prevent hypothermia, in this  
case, her baby would not be kept with her because if her condition.

It is possible that if cesareans are performed in OR's where all the  
other surgeries take place, that they are a little chilly, but they  
shouldn't be so cold as to render the mothers hypothermic.  I expect  
that if the babies were skin to skin, they would be warmer than if  
they were bundled in blankets and held by the mother's partner,  
especially if the OR is so cold.

I too wonder if the patient's temperatures are being taken by tympanic  
thermometers.  We had so many false low readings with these that we  
eventually abandoned them for oral/axillary thermometers.  Also,  
epidural/spinal anesthesia does not cause low temperatures, rather  
they are more likely to cause fever.  Regional anaesthesia should be  
the pretty much the norm for most cesareans as it is safer than  
general anaesthesia in pregnant women.

My experience in the delivery room is that babies who are not held and  
are not skin to skin get cold whereas, the babies who are bundled in  
warm blankets and passed around get cold.  It saves time (for many  
reasons) to keep mom and baby skin to skin.  Email me if you want to  
hear more on this.

If you can, speak with people a little higher up than the staff  
nurses, a nurse manager, an educator, an anaesthetist, a  
pediatrician.  You may hear a different story and you need others on  
your side if you want to make change.

Cordelia Merritt  RN BSN IBCLC


On Jan 29, 2009, at 7:10 PM, LACTNET automatic digest system wrote:

> Date:    Thu, 29 Jan 2009 17:49:06 -0500
> From:    Sam <[log in to unmask]>
> Subject: Re: s2s after c/s
>
> Surgical patients should never be below 36C/96.8F due to increased  
> risk of
> infection (infection rate doubles), increased pain, increased risk of
> cardiac events, increased risk of surgical bleeding and impaired wound
> healing. (Rothrock, J., Alexander's Care of the Patient in Surgery,  
> Mosby,
> 2007)
>
> Someone needs to address the concerns (and increased mortality rate)  
> of the
> *mothers* hypothermic state before addressing the lack of s2s. If  
> the mother
> is sick or dead, the baby is the lesser concern.
>
> Best wishes,
> Sam Doak (with a pile of initials, but currently a student Peri- 
> operative
> Nurse)
>
> We're going to Candy Mountain, Charlie!
>
> <<
> Forgive me if this was discussed in the recent thread concerning  
> reasons
> not to put c/s babies skin to skin after delivery.  My L&D staff  
> told me
> today that they do not put infants skin to skin after delivery when
> mothers are hypothermic.  Mothers in the PACU (recovery room) are
> frequently 36C or less post delivery at our hospital.  I am told that
> this is due to low OR temperatures (which is per infection control
> standards) and the anesthetic. So I don't know where to take it from
> there. Maybe the baby won't get cold if the couplet is covered with
> heated blankets. Has anyone done a study on this? Or does anyone know
> Nils Bergman's email? Obviously, hypothermic infants then have to go  
> on
> glucose protocol, get a septic work up and here we go again.
>
> Kind of crazy because I live in South Florida where babies would  
> hardly
> ever get cold if it weren't for air conditioning.
>
>
>
> Polly Westra


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