Phase 3 Student Learning

Midwife Student

Phase Three Check List

 

Prenatal Care

____ Obtain a complete history, to assess risk management: safety in birth for baby and mom, safety for midwife practice.

____ Which paperwork is most important, which can wait and answering questions regarding the different forms

____ Explain birth philosophy and assess if patient is good risk for natural birth

____ Knows when to refer woman for physician care

____ Perform external version after 36 weeks

____ Date pregnancy by bimanual exam of uterus, assess problems for too small, too large

____ Elicit Hegar’s sign, Chadwick’s sign for early pregnancy

____ Perform complete gynecological exam for well woman in pregnancy and postpartum

____ Use speculum, obtain PAP smear on slide, Surepath, fill out lab paperwork, prices

____ Obtain a Gonorrhea / Chlamydia culture

____ Estimate fetal weight

____ Perform rectal, vaginal exam

____ Perform breast exam

____ Prepare a wet-mount slide to identify yeast, trichomonasis, etc…

____ Check for amniotic fluid with positive fern test

____ Perform gram staining

____ Elicit fluid thrill to check for polyhydraminos

____ Ultrasound basics and when one is warranted

____ Do an adult general physical exam, understand what is normal

____ Explain various body systems, cardiovascular, urinary/elimination, skin/integumentary, digestion,

               hormonal system, bones and ligaments and answer questions about potential problems.

____ Address “pain” in the abdomen.  Give signs and symptoms for potential problems with gall bladder, appendicitis, bladder infection, kidney infection, stomach/digestion/elimination, pubic bone separation, diastalsis recti, liver pain with pre-eclampsia, tubal pregnancy,

 

 

Labor and Birth

____ Determine position and attitude of the baby by palpation of sutures and fontanelles

____ Assess dilation of cervix with improving accuracy

____ When to push, specific to each delivery individually

____ Demonstrate how to deliver a baby in the vertex position (Hand maneuvers, cord around neck)

____ Demonstrate emergency breech delivery

____ Demonstrate delivery of baby in face presentation, in brow.

____ Demonstrate all techniques to use when a baby has shoulder dystocia. ( Gaskin, suprapubic pressure, gentle downward traction, rotation to oblique, Woods Cork Screw maneuver, extracting arm.

____ Emergency birth of twins, what to do, what to look for

____ Perform amniotomy with anmihook and amnicot

____ Perform urinary catherization during labor, why, risks

____ Manage an anterior, cervical, swollen lip

____ Risk assessment for failure to progress

____ Talk about different kinds of progress in labor

____ Manage nuchal hand, arm

 

Third and Fourth Stage

____ Perform bimanual compression for hemorrhage

____ Perform manual removal of placenta or membranes or clots

____ Manage 3 or 4th stage hemorrhage

____ Repair 1st degree tear

____ Repair 2nd degree laceration, identify tissue parts and anatomy

____ Inspect upper vagina and cervix for laceration using retractors

____  Manage maternal shock, symptoms, care, vitals to look for, plan of action

____ Estimate blood loss

____ Use local anesthetic for laceration repair or emergency episiotomy

____ Manage vaginal bleeder (torn blood vessel)

____ Perform exploration of uterus. When to, why, problems, iatrogenic complications

____ Demonstrate response of uterine inversion

____ Demonstrate urinary catherization postpartum, why and what to look for

 

Baby

____ Use LMA mask to facilitate airway for NNR

____ Use Rescue Vac to get out a mucus plug

____ Score gestational age of baby with Dubowitz chart

____ Do Braelton’s Neonatal Behavior Assessment

____ Do neurological exam of baby

____ Do physical exam of baby

____ Demonstrate how to prepare baby for transport with spina bifida, omphalocele, other major anomolies.

____ Obtain cultures or blood work from baby.  Cord blood (which tube, which lab), blood type without cord blood, hematocrit, glucose level for low blood sugar, billirubin level in jandice.

____ Use opthamascope and otoscope

 

Mother

____ Check for cystocele

____ Rectocele

____ Uterine inversion versus postpartum week

____ Risk management for postpartum pain, what is normal, what is not

____ Managing hemorrhoids

____ Bladder infections

____ Check perineum for proper closure of any tears, health of stitches, if any, etc…

 

 

Paperwork

____  Fill out birth certificate and let parents know how to obtain a copy of their own

____  Fill out paperwork for state, including reports,

____  Hearing evaluation paperwork

____  Fill out MANA Stats