Birthing Suite flow chart

Birthing Suite

Orient pt to room

get pt to change into gown

ask pt about their birth plan

ask pt to fill out questionnaire

ask pt if they are interested in healthy baby, healthy children program

confirm emergency contact information and ask if there are persons the pt would not like to be present (safety reasons and personal preference)

fill out admission tab and information we have in delivery page 1 and page 2 (confirm number of instruments and gauze/towels/sponges) on ISP

print out medication record form

Pitocin

Yes

No

perform IA every 30 minutes

take blood samples if pt has not come from triage at the same time as initiating an IV

start with 2 units

once pitocin is started, monitor and document FHR and contractions every 15 minutes

increase Pitocin depending on pt’s contractions and only if fetus meets all requirements (depends on FHR strip/monitor)

pt requests epidural

Yes

No

Monitor pt's vital signs and FHR strip every 30 minutes until delivery

give pt bolus of NaCl of 500ml/hr

prep the pt (remove any monitors, remove blood pressure cuff if still attached to pt, position pt in sitting position, raise the bed, put pt’s hair into a disposable surgical cap, give everyone else in the room a disposable surgical cap and face mask, nurses included)

bring epidural cart into pt’s room and take out an epidural kit, tegaderm, prepare 4 strips of paper tape to secure tegaderm to catheter site

document in ISP epidural requirements and procedures

take pt’s BP every 5 minutes for the next 30 minutes to ensure BP does not drop

input doctor’s (anesthesiologist) orders (continuous rate, bolus amount, bolus lockout time, how many times a pt can receive a bolus per hour) into epidural pump, get a second check from another nurse), prime the line using the epidural pump (not manually like an IV line)

connect to pt’s epidural catheter

insert urinary catheter once pt is comfortable

once epidural is completed, dermatome checks must be done every hour with documentation on movement

When mom is in second stage of labour, set up vaginal delivery tray (sterile technique)

coach and encourage pt through pushing

have another nurse assist in documentation

baby is delivered

doctor will take blood sample from cord vein and artery, take the samples and label and send to lab for analysis

place baby directly on mom’s chest, skin to skin

listen to baby’s heartbeat and lungs to ensure they are working properly and lungs are clear

assign APGAR score after 1 minute, then 5 minutes, and then 10 minutes

apply bracelets to mom’s wrist, supporting person’s wrist (if applicable), and both of baby’s ankles

30 minutes after baby is born take full set of vital signs

Fundus assessment and vital signs every 15 minutes for 1 hour after delivery then every 30 mins

Transfer pt to mat/child unit after 1 hour