Sample Student Midwife
Phase One Check List
Equipment obtained in birth bag:
Doppler and gel,
Blood pressure cuff
Black ink pen,
Watch with second hand,
Hand bag to keep tools in. Student should practice on clients using her own equipment.
____ Verbalize different kinds and brands of each item, and the advantages of each.
____ Each item has identifying name or marker for each student.
____ Demonstrate how to use each item.
____ Demonstrate how to clean each item.
____ Demonstrate organization of bag,
____ Bringing them to clinic day, using them.
The Midwife Student is able to:
____Give instructions to birth mom for a clean catch of urine.
____ Read urine test strips accurately. Know what each color represents, the ranges, percentages and warning signs stand for on the strip.
____ Assess birth mom’s hydration level, when to advise to drink more and what to drink. Asses for severe dehydration associated with morning sickness. Verbalize what to do and when to do it.
____ Obtain maternal temp., pulse and respirations on mom. Verbalize healthy ranges. Verbalize possible problems associated with vitals not within normal range for mom. Verbalize what to do and when.
____ Take blood pressure. Correct position (sitting up), know healthy ranges and warning signs. Verbalize possible causes of elevated pressure, or additional symptoms to look for with elevated pressure and what might mean. Verbalize possible problems associated with severe low blood pressure, how to advise mom, when is it too low and what to do.
____ Perform Leopold’s maneuvers. Verbalize what you are looking for with each step.
____ Identify baby presentation. (presenting part, Vertex, breech, shoulder ) Describe how you know.
____ Identify baby lie. ( Anterior, Posterior, Cephalic, Oblique, ) Describe how you know.
____ Identify baby attitude. (flexed, brow, military, asynclitic etc…). Describe how you know.
____ Measure fundal height (with tape turned upside down, turn right side up to read).
Demonstrate how to find fundus with hands, and where to start measure on pelvis.
____ Obtain fetal heart tones with stethoscope (after 30 weeks).
____ Obtain fetal heart tones with fetoscope (after 28 weeks). Verbalize advantages.
____ Obtain fetal heart tones with Doppler. Verbalize cautions when using a Doppler.
____ Check for low iron: Obtain blood sample with hemoglobinmeter. Know ranges and cautions in using the machine. Demonstrate correct way to use machine, handwashing, drying alcohol, needle placement in poker, and how to dispose of needle. Know when to take ferriten level to check for storage iron level. Know what to advise when ranges are lower than desired.
____ Obtain blood sample for glucose meter. Demonstrate hand cleaning, why and how. Know how to administer a 28 week, 1 hour glucose test with 50 gram glucose load. Know ranges. Know what to do when ranges are higher than normal.
____ Check for edema. Know pitting edema and different ranges. When and where edema is O.K. When it is not. What to advise, when to refer to doctor.
____ Check for diastasis recti. Share with mom correct exercise method to help heal.
____ Fill out prenatal forms according to Preceptor’s specifications.
____ Set up all equipment for prenatal and birth.
____ Demonstrate disposable supply stock. Restocking: where to get supplies and when. Where they logically go in closet or birth room. What each item is and why it is used. Any substitutes that can be used for it in an emergency. Proper disposal.
____ How to dispose of placentas, blood clots, bloody chux pads.
____ How to clean up feces, urine and vomit: on mom, on floor, on bed, in tub, on laundry, on equipment, on self.
____ Proper cleaning and care of instruments after use. What to do and not to do. How to preserve instruments for longevity of use.
____ Needle/sharps disposal and handling of scissors and sharps. What to do if you get a needle puncture or cut.
____ Sterilize equipment with at least 3 different methods. Know how to prepare instruments for cleaning, to store them, to handle them when in use, and how to hand to someone else when using them.
____ Demonstrate aseptic technique for hand washing: how often when working with clients, how to dry, solving possible challenges (cleaning finger nails, stained hands, managing cuts or burns)
____ Demonstrate sterile technique for hand-washing.
____ Correctly time contractions and assess their strength. Both externally and internally with vaginal exam.
____ Assess approximate dilation of cervix at different stages of labor.
____ Demonstrate technique for immediate relief of leg cramps. Verbalize what not to do. (No heavy massaging legs, to avoid blood clot dispersal).
____ Administer enema and verbalize reasons you would do this for a mom and when not to.
____ Give IM injections and knowledgeably use Pitocin, methergine and reasons for using cytotec.
____ Clamp and cut cord. Verbalize when to cut cord (Not before it stops pulsing and how to know when it has stopped pulsing). Demonstrate different cord cutting methods and cord clamps, how much cord to leave on baby and why, asceptic technique.
____ Examine placenta, membranes, and cord. Verbalize possible anomalies and how to tell if something is missing.
____ Obtain cord blood. Why we obtain it and what to do with it. Label, store, fill out lab slip, get to lab.
____ Administer oxygen to mom. Use of tank, how much oxygen when, and why to use it. Correct mask placement. Turn tank on and off. How to get tank filled. Verbalize potential dangers of tank.
____ Do clean up after birth. Use proper Universal Precautions when handling bloody pads, vomit etc… Verbalize how to remove blood from blankets, and correct washing technique. Know what to throw away and what to reuse.
____ Perform fundal massage. Know where fundus is. What different levels are correct for which time after birth. Verbalize warning signs. Keep uterus firm after birth gently, and not harshly causing extreme pain for mom. Know when uterus is not firm and what to do. Know when to massage lower uterine segment and why.
____ Make perineal ice pack. When to use it. When not to use it.
____ Clean women’s perineum using correct technique. After birth, before birth (remove fetal matter discreetly), wash gently and not harshly. Dispose of bloody rags or 4 by 4’s correctly.
____ Suggest 9 techniques to encourage mom to urinate after a birth.
____ Obtain newborn axillary temp, define normal ranges. Verbalize what to do if elevated, not accompanied with other warning signs. Verbalize baby warning signs. What to do about it.
____ Assess APGAR score. Verbalize what each letter means and description of different numbers.
____ Give baby blow-by oxygen. Demonstrate correct use of tank, mask and level.
____ Use bulb syringe correctly. Know when, and when not to use bulb syringe.
____ Provide immediate non-emergency care of newborn just as they are born. Know how to assess for time of birth, breathing, baby heart beat, keeping covered, proper stimulation of newborn, and general things to look for when baby has just been born. (color, breathing, cord care, etc..)
____ Weigh, measure length, head and chest circumference of baby.
____ Learn different reflexes, what they mean and how to elicit them.
____ Listen to baby heart beat and lungs. Verbalize warning signs.
____ Check for and describe oral thrush and dangers to mom and baby.
____ Check for signs and description of cord and skin infection on baby.
____ Assess baby lethargy, dehydration, verbalize possible causes. Verbalize steps to take to help.
____ Assess jaundice level. Describe what to look for, warning signs (immediate newborn jaundice, yellowing to nipple line, lethargy, not nursing, etc..) Verbalize what to do about it.
____ Demonstrate use of Ictometer
____ Obtain baby foot print.
____ Perform postpartum abdominal exam, assess for signs of uterine infection. Verbalize what to do when signs are present.
____ Evaluate lochia: amount, color, consistency, normal time frame. Verbalize what is abnormal bleeding, what to recommend, when to refer to physician.
____ Assess for mastitis. Verbalize causes and when to refer to physician.
____ Check nipples for breastfeeding ease. Verbalize different nipple types and how to help mothers nurse with inverted or flat nipples.
____ Prepare a sitz bath. Verbalize reasons to give mom one and reasons not to.
____ Demonstrate use of breast pump. Verbalize when pump is used and why.
____ Demonstrate care of baby that is not feeing well. How to take vitals on newborn. When to help mom rehydrate baby with bottle fluids and what to use. When to refer baby to physician.
This skills example was taken in part from Carolyn Steiger’s classic book, Becoming a Midwife, Edition 1987. Hoogan House Publishing Portland, Oregon.
ISBN – 0-9619239-0-3 She states in the inside cover: The information in this book is intended to encourage students to make their own choices and decisions. The author and publisher do not advocate the use of any particular skill or birthing method. Each teacher and student should fully explore the advisability of everything described I this book, and consult with midwifery organizations, textbooks, and qualified health care providers. The author and publisher are not responsible for any negative effects resulting from the use of nay of the information, techniques, or procedures in this book, or in the recommended books on the reading lists. Please use this book only if you are willing to assume responsibility for the risks you may choose to take.