Skills Level 2

Skills Checklist Apprenticeship Level II

 

Prenatal Care:

            Obtain a complete history including family, general medical, gynecological, obstetric and current pregnancy.

            Identify clients with special needs which require further follow up, e.g. risk of genetic disorder, environmental hazards, FAS, parenting disorders

            Demonstrate use of hemoglobinometer (see instructions with meter)

            Perform pelvic measurements and assess pelvic shape and size and cervical ripeness

            Take an adequate diet history, demonstrate good grasp of general nutritional needs and of individual factors influencing such needs during pregnancy.

            Interpret urine test stick results

            Obtain and interpret appropriate/adequate laboratory data for initial assessment

            Perform home non-stress test and assess FHR patterns

            Perform finger puncture

            Check for CVA tenderness

            Elicit and assess DTR’s and Clonus (+1 – +4)

            Check blood glucose

            Is familiar with community resources and utilize networking skills in meeting needs of client and family beyond the scope of midwifery practice.

            Identify signs and symptoms of possible emergent complications.  Follow up on needs assessment and abnormal findings with appropriate further investigation, treatment, counseling, consultations, or referral.

            Understand the principles of informed consent

            Chart all information neatly and thoroughly

 

Labor:

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

            Locate, count, and interpret FHT’s during and in between contractions and respond appropriately.

            Demonstrate immediate response to fetal distress

            Demonstrate management of prolapsed cord

            Perform controlled delivery of head and shoulders with minimal trauma or lacerations of maternal tissues (i.e. offers perineal support, maintains flexion of head, anticipates position of head.)     Check for nuchal cord and demonstrate several different responses

            Understand the concept of ongoing risk assessment

            Observe and maintain sterile technique appropriately

            Recognize abnormal second stage labor patterns and respond appropriately

            Recognize dehydration or full bladder, understand significance of these in progress of labor

            Identify when hospital transport is necessary; communicate rationale to client and support persons; organize transport effectively including making necessary phone calls and gathering necessary equipment

            Communicate with hospital staff clearly and accurately regarding client’s history, labor progress and significant findings.

 

Birth, Third and Fourth Stage:

            Perform adult CPR

            Observe expectant management of third stage, recognizing signs of placental separation, with readiness to handle third or fourth stage emergencies

            Massage uterus properly if necessary

            Assist with birth of placenta by gentle cord tractions and guarding of uterus, and immediate attention to fundus after expulsion.  Performing Brandt- Andrews maneuver

            Recognize signs of retained or partially retained placenta and/or membranes, summoning medical aide when indicated.

            Perform thorough inspection of placenta, membranes and cord, recognizing abnormalities

            Assess degree of laceration and assists repair

            Monitor maternal vital signs and respond appropriately.  Recognize and list signs of maternal shock.

            Estimate blood loss accurately and respond appropriately

            Determine knowledge of management of postpartum hemorrhage, including appropriate use of pitocin, in an emergent situation.

            Perform intramuscular injection

            Determine need for and perform bimanual compression

Respond to nutritional and hydration needs.

            Induce urination within appropriate time period

            Encourage immediate postpartum breastfeeding and bonding.  Facilitate bonding between parents, baby and other family members.

            Complete birth registration records appropriately and on time. (Including records of birth, postpartum, birth certificate, and any other records State demands).

 

Newborn Care:

            Use a De Lee trap

            Resuscitate baby with bag and mask

            Resuscitate baby with mouth-to-mouth method

            Perform cardiac massage on baby

            Perform general newborn exam and follow-up

            Assess gestational age accurately

            Advise parents on normality and danger signs of the newborn

            Recognize respiratory distress

            Recognize signs of cardiac disorder/distress

            Promote temperature regulation

            Assist mother in establishment of breastfeeding when mother or baby has special needs: cleft lip and palate, premature baby, twins,Downssyndrome, after a cesarean

            Consult /refer appropriately when deviations from normal are identified

            Collect specimens appropriately: (HCt, PKU, cord blood, ect.)

            Do appropriate lab work for Rh – mothers

            Administer eye prophylaxis or informed consent signed

            Administer Vitamin K or informed consent signed

 

 

Postpartum:

            Instruct clients in self-care such as monitoring vaginal bleeding, signs of postpartal infections, perineal hygiene, breast care / immediate changes, degree of activity, baby care; cord stump, temperature, jaundice, bowel movements, nursing patterns, and sexuality

            Recognize the need for medications when appropriate

            Recognize problems in postpartal psychological adjustments and offer appropriate support and/or referrals.

            Recommend administration of RhoGam when appropriate

            Assess involution

            Assess site of lacerations for infection

            Offer counsel about family spacing methods