Phase 2 Student Learning

 Phase Two Check List

Equipment obtained in birth bag:

Sterile gloves

Sterile lubricant

2 hemostats

Cord clamps

Cleaning solutions or things to sterilize your equipment

De Lee suction catheter or some way to suction baby

Alcohol pads

Syringe and needles and pitocin

Tubes for collecting cord blood

Measuring tape

Herbal kit and information

Oxygen tank and Neonatal resuscitation equipment, face mask for baby and mother, nasal canulas

 

 

Skills Prenatal

    ____  Drawing blood, vein puncture or finger poke for lab tests or in-house glucose.

    ____  Pelvic assessment, shape and size

    ____  Urine test strip interpretation

    ____   Non stress test and FHR patterns.  Does baby seem responsive to your touch?

    ____   Determine estimated due date.  LMP, ultrasound, measurement,

    ____   CVA tenderness for kidney /bladder infections

    ____   Assess DTR and clonus in knee, elbow

    ____    Check blood glucose and know safe perimeters

    ____   Check hemoglobin and know safe perimeters

    ____   Use oximeter to determine oxygen level in blood on mom

   

                          

Skills for Labor

    ____   Determine dilation, effacement and position of cervix, and station of presenting part.

    ____  Describe how to perform emergency episiotomy

    ____  Demonstrate immediate response to fetal distress during labor

    ____  Check for nuchal cord and different responses

    ____   Demonstrate response to prolapsed cord

    ____   Assessing safety in blood loss.  When is it a hemorrhage?

    ____   How to avoid exhaustion in labor

    ____   Ways to get labor going

    ____   When to rest and when to promote stronger labor

    ____  Set up birth tray and oxygen  

     

Birth and Placenta

   ____    Adult CPR

   ____     Perform Brandt – Andrews maneuver to assess placenta detachment

   ____     Assess hemorrhage risk

   ____   Perform abdominal massage immediately after birth and support

   ____     Length of labor

    ____   Estimated blood loss immediately after birth of baby

    ____   Previous history

    ____  Size and strength of woman

    ____   Facilitate delivery of placenta and properly manage third stage

                 ____ When to use active management of placenta

                 ____ When waiting is OK

                 ____  How long is OK to wait?

                 ____  Properly manage reluctant membranes

                 ____  How to assess if placenta is complete

                 ____ Recognize and list signs of maternal shock

                

   ____ Assess degree of laceration and assist in laceration repair

   ____ What size of suture and needle goes where and when?

   ____ How to find landmarks in tissues

   ____ What kind of laceration can be safely left alone to heal?

   ____  Determine if bladder is distended

               ____ Point out urethra and demonstrate how to catherize the bladder

               ____ When to use a catheter

               ____What kinds are available and which to use?

  ____ Estimation of blood loss after 300 ccs.

 

 Baby

____Administer eye ointment

____Perform heel stick on baby for glucose or newborn screen

____Administer vitamin K oral and injectible

____Perform adequate general newborn exam:

                 ____Color

                 ____Body proportions and symmetry

                 ____Nutritional status (IUGR?  Or over weight? )

                 ____ Posture  (using Dubowitz maturity scale, determine gestational age of baby)

                 ____ Respirations / lung sounds / mucus

                 ____ Movements of head and equal for extremities

                 ____ Weight and measurements

                 ____ Skin / birth marks / rashes / hydration

                 ____ Sutures,  Fontanel’s

                 ____ Skull / swelling  / caput  /

                 ____ Neck, collar bones,

                 ____ Eyes / eye lids / pupils

                 ____ Ears  / shape / placement

                 ____ Nose / patent (open)

                 ____ Mouth / palate / tooth “pearls” / tongue / attachment

                 ____ Cry

                 ____ Thorax

                 ____ Breasts / swelling / discharge

               ____ Lungs / equal sounds both sides /

               ____ Femoral pulse

               ____ Use oximeter on baby to determine possible heart defects

                                   ____  Ranges of normal for how many minutes old

                                   ____  Checking both left and right side.

                                   ____ Heart   / rhythm and rate / murmurs or cardiac sounds like swoosh or clicks

              ____ Cord / adequate clamp / bleeding / soreness / infection

              ____ Hernia  normal versus need for referral

              ____ Abdomen

              ____  Liver  / Kidneys / size / rib cage structure and lung placement

              ____Anus / open / meconium

              ____ Genitals

                               ____ Penis / placement of urethra / size /  testes descended?

                               ____ Female  labia normal, urethra normal placement

              ____ Feet / Normal size and shape /rocker bottoms or club feet

              ____ Legs  same size, same length

              ____ Hips  no click in sockets

              ____ Hands / creases normal

              ____ Spine and back / no dimples or swelling / spine straight

             

____ Band cord with different styles of closures

____ Suction baby using

                 ____ Rescue vac

                 ____ Bulb syringe

                 ____ Dee Lee

____ Resuscitate baby with bag / mask  or mouth to mouth

____ Perform cardiac massage on baby

                      ____When to do that?

____Assist mom with establishing breastfeeding

                  ____ When baby will not suck

                  ____  When baby has low tone, as in hypotonia

                  ____   With cleft palate

                  ____ After c-section

 

Mother

____ Assess involution of uterus at different stages of postpartum

____  Elicit Holman’s sign

____ Assess lacerations of perineum or vulva for infection and healing

____ Prepare herbal tea, salves, infusions, and tinctures / recipe book

____ Know which herbs to use for which problems or conditions:

                  ____ Relaxation and sleep

                  ____ Uterine toner

                  ____ Low iron

                  ____ Miscarriage (possible)

                  ____ High blood pressure  / pre-eclampsia / swelling

                  ____ Nausea  / Hyperemisis gravidarum

                  ____ Drying up milk if breastfeeding is not to be established

                  ____ Getting labor started

                   ____ Varicose Veins and painful hemorrhoids

                   ____ Heart burn

                   ____ Headaches not due to pre-eclampsia

                   ____ Itchy skin

                   ____ Urinary tract infections

                   ____  Retained placenta

                   ____ Postpartum pain for vulva

                   ____ Postpartum cramping

 

Using Herbs              

____ Herbs to avoid in pregnancy

____ Herbs to use during breastfeeding

                   ____Engorgement

                   ____ More milk

                   ____ Sore breasts

                   ____ Clogged duct

                   ____ Mastitis

                 

 

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.