CBL 6_Meconium, Home Birth Transfer, Newborn Hips

Question 1

What are current SOGC IAP reccomendations for GBS +?

Answer 1

SOGC: Start IAP with active labour or PROM/ROM every 4 hours till bb born

• AOM notes that for midwifery clients ICD should include SOGC recs AND PROM<18hrs is an alternative
• Outlining the current lack of evidence on how best to prevent EOGBSD with term PROM.

Question 2

What is the first line Tx for GBS prophylaxis?

Answer 2

Penicillin G

Question 3

What is a consideration when someone decides to not have IOL for PROM but does chose IAP?

Answer 3

If client chooses abx w PROM, but not IOL, this will mean frequent (q4) delivery of abx until the birth.

(This is why AOM refers to this with ‘taking into account local resource constraints’, i.e. may not be possible for all midwives to offer this.)

Question 4

What should be used for IAP if client allergic to penicillin but has low risk of anaphylaxis

Answer 4

Cefazolin 2g IV then 1 g every 8 hours

Question 5

What should be used for IAP if client allergic to pen with risk of anaphylaxis?

Answer 5

Clindamycin 900 mg IV every 8 hours or
Vancomycin 1 g IV every 12 hours

Question 6

What is the best practice for clients who have an unconfirmed pen allergy?

Answer 6

Pen allergy testing as soon as possible in pregnancy

Question 7

How many people report having pen allergy?

Answer 7

10 %

Question 8

How many people report severe pen allergy?

Answer 8

1 %

Question 9

How many people lose their pen allergy status after being tested for an unconfirmed pen allergy?

Answer 9

95 %

Question 10

Priorities for birth assessment?

Answer 10

1 - FHR/fetal wellness
2 - client condition
3 - Labor assessment..and NOT a VE unless you need this information immediately

Question 11

Recommendations for MSAF?

Answer 11

• CEFM
• ped at birth

therefore transfer to hospital if time allows (and client agrees)

Question 12

BCCNM rec for MSAF?

Answer 12

MSAFis an indication for consultation during labour and delivery: “(a)t minimum, at time of birth, due to the increased risk of neonatal resuscitation.”

Question 13

What are options for cx lip? (8)

Answer 13

• Position changes (hands and knees, side lying, forward leaning, open knees to chest - child’s pose with bum up)
• Patience and more time
• Acupressure
• Digital Cx reduction by VE
• Water immersion
• Ice to cervix in glove
• IV benadryl
• epidural

Question 14

Stats/Risk of MSAF?
(4)

Answer 14

• 1 in 4 bbs MASF
• 1 in 10 of those babies deveolop MAS (mild, mod, severe)
• Of those Bbs with MAS - 3%–5% of baby’s die.
• If you have MASF **0.06% ** chance you’re bb will die

SMALL NUMBER

Question 15

What makes a fetus poop lol or why MSAF? (3)

Answer 15

• HIgh CO2 activates parasympathetic nervous system - relaxes anal sphincter
• Acute/chronic hypoxia - process it gets into the fluid
• Mature fetus - normal physiological thing to do .

Question 16

When would you be most concerned about MSAF? (3)

Answer 16

• Clear fluid - then became mec stained in labour - if thick it just happened in labour/recently
• How dark it is (older meconium is thinner)
• FHR anomalies

Question 17

When does mec become a problem for newborns?

Answer 17

Gasping motion and with hypoxia – gets deeper in lungs

Question 18

What is BCCNM’s focus prolonged 2nd stage?

Answer 18

Lack of descent rather than certain number of hours

Question 19

How long is 2nd stage for non-epidural birth to be considered dystocia?

Answer 19

Second-stage dystocia:

greater than one hour of active pushing with no descent of the presenting part

Question 20

How long is 2nd stage for epidural birth to be considered prolonged for nulip?

Answer 20

lack of progress for three hours with regional anesthesia

Question 21

**How long is 2nd stage for non-epidural birth to be considered prolonged for nulip?

Answer 21

lack of progress for two hours without regional anesthesia

Question 22

BCCNM recommendation for birth debrief?

Answer 22

Frank and honest discussion with the client can go a long way to preserving the relationship and building trust with the clients.

Good communication can greatly reduce the chance that the client will file a complaint with the BC College of Nurses and Midwives (BCCNM) or start legal action.

Question 23

GBS positive algorithm?

Answer 23

GBS positive birthing parent, adequate IAP, no risk factors OR GBS-negative or GBS-unknown status, with one other risk factor and** adequate IAP: **

Infants do not require investigation or treatment for sepsis. They may be discharged home after 24 hours if they remain well, meet other discharge criteria and if parents understand signs of sepsis and when to seek medical care.

Question 24

Inadequate IAP pp protocol for HB clients ?

Answer 24

“CPS guidance differs from midwifery approaches, as it focuses on in-hospital birth, birth, and recommendations regarding postpartum management are structured around standard discharge times….

For those who have received adequate or inadequate IAP, the CPS is consistent with midwifery approachessuggesting that routine investigation or treatment is not required in these populations…

*Note this depends on RM being able to do early (<24hr) home visit- this may not be the practice for your clinic, in which case clients should not be offered at home follow up and should have clear recommendation to stay in hospital. But if midwives offer close home follow up, then home observation is appropriate, and parents should be instructed on

observing temperature and breathing q3-4 hours.

Document clearly your ICDs including all information provided (recommendations/ community standards/ decision made by client/ instructions to client & f/u plan)

Question 25

What should parents monitor with inadequate IAP pp from HB?

Answer 25

parents should be instructed on observing temperature and breathing q3-4 hours.

Question 26

How many HB clients transfer to hospital?

Answer 26

23% clients require transfer to hospital: 45% nullip; 14% multip