The focus of care is quite different where birth is normal.  We don't do
vitals except on admission to labor ward (if we have time!) and then check
blood pressure two hours post partum, if everything has been normal so far.
Mothers who have had C-sections, about one in six or seven in my hospital,
get temps checked twice daily.  Actually, they do it themselves and report
to us when we come in to look at their incision.  These mothers are normally
eating and drinking ad lib by the next morning, and can have a snack on
coming to the ward from post-op about 6 hours after surgery.  We check
fundal heights and stitches on everyone at least once before discharge,
oftener if mother feels she is bleeding more than expected or is having
excessive pain.  Babies are simply observed, for example while helping
mother breastfeed, and as long as they aren't blatantly ill, we don't
measure any of their vital signs either, except if there has been prolonged
ruptured membranes, defined as over 24 hours before birth.  Those babies
have temp, pulse and resp.rate measured twice per shift for two days after
which it is discontinued if all has been normal.  They stay with mother on
the ward unless she begs us to mind the baby for a couple of hours so she
can nap.  As mothers only stay a few days in the hospital and arrive in
absolutely clean beds, we only change linens if they are soiled.  The
hospital's nutritious and appetizing meals are served in a dining room on
the ward, only mothers unable to get up are served food in bed.  Staff
levels make for busy days anyway, we have about 5 mother-baby pairs to
concentrate on per person on day shift, about 7-8 on evenings, and twice
that on nights.  But the activity level on the ward is correspondingly lower
on nights and evenings-- no doctor's rounds, visitors, babies being sent for
EKGs or hip work-ups, etc.
I suspect we are lucky in our staff/mother ratio, but I think it helps that
we don't do a lot of worthless 'nursing' care on healthy people who've just
given birth.  We use our professional skills to determine who needs
'nursing' and they do get it.
Our system is not without flaws either.  However, the main priority during
hospital stay is to get breastfeeding off to a good start.  If you neglect
that, nothing else matters.  If you manage that, most of the rest of it
sorts itself out.
Rachel Myr
militant in Norway

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