Admission
● Greet, establish rapport (have a friendly face)
● Orientation to room, facilities, equipment that you are using
● Informed consent (if laboring or suspect delivery) IMPORTANT
● Notify physician/CNM that they have arrived
Admission Assessments
● the woman in labor? - Term or Preterm
● Are there factors that put the laboring woman or the fetus at risk (high risk)? -
Hypertensive disorders?, Bleeding?, your patient… Diabetic, Obese, Previous large
infant, Excessive weight gain?
● Should ambulation or bed rest be encouraged?
● Frequency of monitoring needed? - Continuous, Intermittent
Admission Assessments (cont.)
● What does the woman and/or couple want during labor and birth? - Birth plan
● Who will be with the laboring woman for social support?
● Birth plan:
○ Environment - write the options you have chosen for the environment for your
labor
○ Pain Management - write the options you have chosen for pain management. Do
they want an epidural, IV pain Medication, or completely natural
○ case of emergency - write the options you have chosen if cesarean or other
medical intervention becomes necessary
○ Newborn Care -write the options you have chosen for how your baby should be
cared for
Physical Assessment
● Vital signs and weight
● Allergies (especially drug allergies)
● Medical/Surgical/Psychiatric History
● Social/Cultural History
● Obstetrical History
○ GTPAL, any problematic pregnancies (including this preg.) or deliveries?
○ Fetal activity?
● Medications
● Hydration/nutrition
● Labs:
○ Blood type/Rh factor
○ CBC
○ Type and screen
○ Group B Strep (GBS)-negative or positive
, ■ Positive- start antibiotics
■ PCN 5 mill units IV then 2.5 mill units q 4 hrs. until delivery
■ allergic: - then Clindamycin 900 mg IV q 4 hours until delivery
○ Rubella status-immune, non-immune, equivocal
○ Urine- protein
○ Urine Drug Screen
Group B Strep
● Can be apart of the natural flora but it can make the baby sick
External Fetal Monitor
● Make sure that the TOCO which is the contraction monitor is on the fundus of the uterus
● Ultrasound should be put on the area where the fetal shoulders are because that is the
loudest spot that you can hear the baby’s heartbeat
External Electronic Fetal Heart Monitoring- Ultrasound (US)
Advantages:
● Produces a continuous graphic recording, shows the pattern
● Can show the baseline, baseline variability, and changes in the FHR
● Noninvasive
● Does not require rupture of membranes
● Nurse can place
External Electronic Fetal Heart Monitoring- Ultrasound (US)
Disadvantages:
● susceptible to interference from maternal and fetal movement
● May produce a weak signal
● Maternal size may make it difficult to hear through a lot of adipose tissue
● Tracing may become sketchy and difficult to interpret
External Electronic Uterine Monitoring- Tocodynamometer (Toco)
Advantages:
● Noninvasive
● Easy to place
● May be used before and following rupture of membranes (do not need the water to be
broken)
● Can be used intermittently
● Provides a permanent, continuous recording
● Nurse can place & palpate contractions for intensity
External Electronic Uterine Monitoring- Tocodynamometer (Toco)
Disadvantages:
● Greet, establish rapport (have a friendly face)
● Orientation to room, facilities, equipment that you are using
● Informed consent (if laboring or suspect delivery) IMPORTANT
● Notify physician/CNM that they have arrived
Admission Assessments
● the woman in labor? - Term or Preterm
● Are there factors that put the laboring woman or the fetus at risk (high risk)? -
Hypertensive disorders?, Bleeding?, your patient… Diabetic, Obese, Previous large
infant, Excessive weight gain?
● Should ambulation or bed rest be encouraged?
● Frequency of monitoring needed? - Continuous, Intermittent
Admission Assessments (cont.)
● What does the woman and/or couple want during labor and birth? - Birth plan
● Who will be with the laboring woman for social support?
● Birth plan:
○ Environment - write the options you have chosen for the environment for your
labor
○ Pain Management - write the options you have chosen for pain management. Do
they want an epidural, IV pain Medication, or completely natural
○ case of emergency - write the options you have chosen if cesarean or other
medical intervention becomes necessary
○ Newborn Care -write the options you have chosen for how your baby should be
cared for
Physical Assessment
● Vital signs and weight
● Allergies (especially drug allergies)
● Medical/Surgical/Psychiatric History
● Social/Cultural History
● Obstetrical History
○ GTPAL, any problematic pregnancies (including this preg.) or deliveries?
○ Fetal activity?
● Medications
● Hydration/nutrition
● Labs:
○ Blood type/Rh factor
○ CBC
○ Type and screen
○ Group B Strep (GBS)-negative or positive
, ■ Positive- start antibiotics
■ PCN 5 mill units IV then 2.5 mill units q 4 hrs. until delivery
■ allergic: - then Clindamycin 900 mg IV q 4 hours until delivery
○ Rubella status-immune, non-immune, equivocal
○ Urine- protein
○ Urine Drug Screen
Group B Strep
● Can be apart of the natural flora but it can make the baby sick
External Fetal Monitor
● Make sure that the TOCO which is the contraction monitor is on the fundus of the uterus
● Ultrasound should be put on the area where the fetal shoulders are because that is the
loudest spot that you can hear the baby’s heartbeat
External Electronic Fetal Heart Monitoring- Ultrasound (US)
Advantages:
● Produces a continuous graphic recording, shows the pattern
● Can show the baseline, baseline variability, and changes in the FHR
● Noninvasive
● Does not require rupture of membranes
● Nurse can place
External Electronic Fetal Heart Monitoring- Ultrasound (US)
Disadvantages:
● susceptible to interference from maternal and fetal movement
● May produce a weak signal
● Maternal size may make it difficult to hear through a lot of adipose tissue
● Tracing may become sketchy and difficult to interpret
External Electronic Uterine Monitoring- Tocodynamometer (Toco)
Advantages:
● Noninvasive
● Easy to place
● May be used before and following rupture of membranes (do not need the water to be
broken)
● Can be used intermittently
● Provides a permanent, continuous recording
● Nurse can place & palpate contractions for intensity
External Electronic Uterine Monitoring- Tocodynamometer (Toco)
Disadvantages:
