1. UNIT 8: Confidentiality & HIM
1.1. Blood work
1.1.1. This could be ordered by a Family Dr. or OB/GYN to determine if there are any complications with the pregnancy or risks during labour and delivery. The hospital would acquire this through fax from the OB/GYN.
1.1.1.1. Conditions that can be tested through bloodwork include hormone levels including progesterone and estrogen. Other conditions like cholestasis can be determined by testing bile acids in the blood.
1.2. Fetal Ultrasound
1.2.1. This would be ordered by an OB/GYN to determine if there are any complications with the development of the baby, position of the placenta and baby, issues with pelvic organs and amniotic fluid levels to determine risks to the baby and mother. The hospital would obtain this through fax from the OB/GYN.
1.2.1.1. Ultrasounds are important for labour and delivery to determine if there are any risks that would require a C-section if a vaginal birth is too risky to the mother or baby.
2. UNIT 7: Admission, Transfer & Discharge
2.1. The Maternity Unit usually have obstetrical admissions where patients would sign a form in advance to register. This would be for mothers experiencing labour and delivery or if they have complications late in their pregnancy. The typical length of stay is 6 hours to 36 hours depending on type of birth and complications. Newborn admissions would also be connected to the mother’s chart.
2.1.1. Support 1 - Referral to Newborn Clinic: Patients are referred to this outpatient clinic for newborn assessment, monitoring, and help with breastfeeding in the days after delivery.
2.1.1.1. This support is necessary to ensure the newborn is healthy with no complications in the days after their birth.
2.1.2. Support 2 - Medications: Mothers may be prescribed pain medication . The potency would be dependent on their pain tolerance and whether it was a vaginal birth or C-section.
2.1.2.1. This support is important to provide pain management to new mothers after the trauma their body has endured.
2.1.3. Support 3 - Communication Tools: New parents receive informational forms on what to expect when caring for a newborn, warning signs to look out for, and what mothers can expect as their body recovers.
2.1.3.1. This support is important to provide education to new parents for how to care for their newborn and to provide support for mothers as they recover and/or experiencing post-partum depression.
3. UNIT 6: Patient Records
3.1. Transcription Records
3.1.1. Operative Report
3.1.1.1. If a patient underwent a C-section their surgeon would dictate the surgery including anesthesia used, length of surgery, blood loss and any complications.
3.1.2. Graphic Records: Pain Score
3.1.2.1. Pain Scores are used to determine how the patient feels as their labour progresses and contractions become more intense. This would help determine if they need more help with pain management.
3.1.3. Medication Administration Records
3.1.3.1. Various medications can be administered to patients including anti-biotics and epidurals. As epidurals are a narcotic it is important that amount administered is recorded and if the amount changes.
4. UNIT 5: Communication
4.1. Communication Challenges
4.1.1. Patient Access Codes
4.1.1.1. The HOA may have challenges if a family member wants to visit or ask about the status of the baby or mother, but they don't have a patient access code.
4.1.1.1.1. This is a challenge for the HOA as they would have to deal with frustrated individuals over the phone.
4.1.2. Misinformation
4.1.2.1. Misinformation about unmedicated births vs. epidurals can prevent patients from having better pain management.
4.1.2.1.1. This is a challenge if the patient is stubborn but experiencing extreme pain and may become more irritable with the staff leading to a break down in trust.
4.1.2.2. Misinformed patients with high-risk pregnancies may be resistant to necessary medical intervention because of outside opinion and desire to adhere to their "birth plan."
4.1.2.2.1. This is a challenge as it creates a medical dilemma with what the patient wants based off of preconceived knowledge instead of what it necessary for their health and their baby's health.
4.2. Communication Devices
4.2.1. Communication Board
4.2.1.1. Unit is constantly changing so it's important to know who MRP is, who each patient's nurse is, what the patient has rated their pain, and if they are expecting any visitors post-partum.
4.2.2. Pagers
4.2.2.1. Patients can go into active labour at any time meaning their MRP and nurses must be contacted promptly if they are in another area.
5. UNIT 4: Risk Management
5.1. Specific Risks
5.1.1. Child Abduction
5.1.1.1. Patients can come from complicated backgrounds and someone they know may try to abduct their baby
5.1.1.2. Mentally ill individuals may also try to sneak into the ward and abduct a child which is why maternity wards are secure units.
5.1.2. Violent Patient/ Family
5.1.2.1. Childbirth is a high pressure situation where a patient's partner may become violent to staff if they disagree with treatment or if Family Services is involved.
5.1.2.2. The patient may have a complicated relationship with their partner who could become violent if they are escorted out of the room or refused to see the patient
5.2. Hospital Codes
5.2.1. Code Pink Cardiac Arrest/ Medical Emergency for an Infant/ Child
5.2.1.1. Childbirth is stressful for newborns and can lead to cardiac arrest or they may not be breathing if the cord is wrapped around their neck
5.2.2. Code Blue
5.2.2.1. Childbirth can have complications for the mother if they hemorrhage or have respiratory distress. Its specific name is an Obstetric Code Blue
5.2.3. Code White
5.2.3.1. A family member/ partner could become violent if their birth plan must change for a medical reason
6. UNIT 1: Health Care Professionals
6.1. Physicians
6.1.1. MRP: Obstetrician/ Gynecologist (OB-GYN)
6.1.1.1. OB-GYNs are the primary care physician in the Maternity Ward. They specialize in treating issues concerning the women's reproductive system and caring for women and their infant during pregnancy and childbirth.
6.1.2. Consultant: Obstetric Anesthesiologist
6.1.2.1. Obstetric Anesthesiologists are consulting physicians who provide medical and non medical pain management treatments during childbirth including epidurals, spinal blocks, and breathing techniques.
6.1.3. MRP: Perinatologist
6.1.3.1. Perinatologists are specialized OB-GYNs who provide treatment for complicated pregnancies. Examples include multiple babies, preeclampsia, and abnormalities with the fetus.
6.2. Nurses
6.2.1. Labour & Delivery Nurse
6.2.1.1. Provides emotional care for mother during labour and delivery and communicate physical condition to MRP
6.2.2. Post-partum Nurse
6.2.2.1. Cares for the mother and newborn after the delivery and for the rest of the mother's stay in the ward.
6.2.3. Charge Nurse
6.2.3.1. Supervising nurse who ensures quality care and safety standards are being met for all patients.
6.3. Allied Health Care Professionals
6.3.1. Certified Midwife (CM)
6.3.1.1. A Certified Midwife provides a holistic and more natural approach to childbearing and newborn care.
6.3.2. Lactation Consultant
6.3.2.1. A Lactation Consultant provides support and advice for mothers who are breastfeeding.
6.3.3. Social Worker
6.3.3.1. Social workers provide mental health support to new mothers including anxiety and post-partum depression.
7. UNIT 2: Organization of Health Care Unit
7.1. Unit Information
7.1.1. Maternity Wards are an inpatient unit which provides care for women in active labour, vaginal delivery, Caesarean section, post-partum care, and assess the health of the newborn.
7.1.2. Maternity Wards are also outpatient units as new mothers can leave six hours after their delivery if they have a midwife to look after them at home.
7.1.3. Patients who have a vaginal delivery are expected to stay in hospital for at 6-24 hours. Patients who have a Caesarean section stay in hospital for at least 36 hours as long as there are no complications.
7.2. Purpose of Unit
7.2.1. Maternity wards are designed to provide women in labour with a safe and comfortable environment for them to deliver their baby.
7.2.2. Maternity wards monitor the mother and fetus during labour and provide immediate medical attention to both should any complications arise.
7.3. Diagnoses/ Procedures
7.3.1. Procedure: Fetal Monitoring
7.3.1.1. A fetal monitor is a machine designed to record contractions and the fetus' heartbeat to determine how the baby is doing during the labour process
7.3.1.1.1. Internal Monitoring
7.3.1.1.2. External Monitoring
7.3.2. Procedure: Inducing Labour
7.3.2.1. If the patient is still pregnant past 39 weeks or there are complications the doctor may perform a procedure to induce labour.
7.3.2.1.1. Procedure 1: Breaking the amniotic sac to release some amniotic fluid, release prostaglandin, and allow the baby's head to press on the cervix to start contractions
7.3.2.1.2. Procedure 2: Insert prostaglandin with a gel or tampon-like instrument to begin contractions
7.3.2.1.3. Procedure 3: Use synthetic oxytocin through an I.V. and gradually increase amount until contractions begin.
7.3.3. Caesarean Birth
7.3.3.1. A surgical procedure where an incision is made in the mother's abdomen and uterus then the baby is pulled out. They can be planned or performed in an emergency.
7.3.3.1.1. C-sections are only performed if there is a risk to the mother or baby. Examples include: baby is in breeched position, mother's pelvis is too small for a vaginal birth, placental abruption, or cord prolapse.
8. UNIT 3: Staffing & Scheduling
8.1. Standard Staffing Pattern
8.1.1. Maternity wards use a primary care model where one nurse is responsible for the patient. This allows the nurse to become an expert in their patient’s birth plan, condition, and avoid confusion over procedures.
8.2. Possible Staffing Ratio
8.2.1. The staffing ratio for the active labour process is 1:1 as the patient’s condition can change quickly. The staffing ratio during delivery is 2:1 so there is one nurse for the mother and one for the baby. The staffing ratio for post-partum patients is 1:4 or 1:5 depending on the hospital.
8.3. Coverage
8.3.1. Maternity wards are open 24/7 on weekends and statutory holidays as pregnant individuals can have complicated labours and can deliver at any time. This requires coverage for days, evenings, and nights. Staff typically work in 12 hour shifts.
8.4. Shift Premiums
8.4.1. Evening Premiums from 1500-2300 and Night premiums from 2300-0700 are given as Mat Wards are open 24/7.
8.4.2. Statutory Premiums are given as Maternity Units are open on all statutory holidays.
8.4.3. Charge Premium: A charge nurse is vital as patients are constantly rotating in and out of the ward. Charge nurse would monitor the flow and resources to determine what is needed to manage standard labour & delivery, patients coming in to be induced, and C-sections.