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Vaginal Birth
Education Workshop (click to go to the desired section)
Introduction
This interactive workshop is designed to go along with a workbook. Keep the workbook handy as you go through the workshop to engage in the required activities. This is a web-based workshop, and thus has links throughout each page to enable you to move throughout the workshop. Whenever you see words underlined like this, you can click on that area to go to another section or to find more information on a topic. At the bottom of each page are navigational buttons to help you move through the workshop. You can go through as much or as little of the workshop as you like at a time. If you have any questions about how to use this workshop or the individual pathways, feel free to ask your Site Champion.
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This pathway is for patients who come to our hospital for a vaginal birth. The pathway consists of 7 parts:
Clinical Practice Guideline Pre-Printed Orders Patient Pathway Patient Education Booklet Breast Latch Assessment Tool Vaginal Birth Clinical Pathway Newborn Clinical Pathway
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2004-2007 Grey Bruce Health Network Vaginal Birth Clinical Practice Guideline
Two guidelines were used in the development of this pathway - Family Centered Maternity and Newborn Care: National Guidelines, Health Canada, and Healthy Beginnings: Guidelines for Care During Pregnancy and Childbirth, Society of Obstetricians and Gynecologists of Canada (SOGC). These guidelines summarize the evidence used in the development of this pathway. They can be found electronically on the GBHN website www.gbhn.ca .
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There are four sets of pre-printed orders for this pathway package:
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Patient Materials
This package has a patient pathway, which explains to the patient what is happening to them while in hospital. It should be given to the patient in the pre-admission clinic. In addition, there is a patient education booklet called Having your baby in a Grey Bruce Health Network hospital, which should also be handed out in the pre-admission clinic. (When printing booklet from GBHN website include the Pacifiers and Respiratory Syncytial Virus(RSV) handouts ) This booklet should be discussed at the pre-admission clinic to go over any questions before the patient arrives, and discussed again in the postpartum period before the patient is discharged. There are also several accompanying education materials that should also be used for education of the caregivers.
There are 4 pieces Lets Grow a Healthy Baby, Community Resources for Parents order from Public Health Unit at (519) 376-9420 x 433, and Hearing Screening for your New Baby Hearing Foundation at 866-HEAR-YOU) Back To Sleep (613) 954-5995 or visit the website at: www.hc-sc.gb.ca/hppb/childhood-youth
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This pathway is intended for patients who have come in for a Vaginal Birth. The first page of the pathway is the Labour Triage with Admission. It is to be used when the patient presents to hospital. At the right hand side of the sheet is a place to enter the date. The patient outcome and performance indicators we are looking to achieve need to be dated and inputted as met or not met. There is space on this page for your progress notes (use regular progress note sheets if more space is needed)
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The next two pages of the pathway cover Postpartum (324hrs) and Postpartum 24-48hrs. Date and time the column for your shift, tasks are initialed as they are completed, or enter N/A and initial if they are not applicable to the patient. The patient outcome we are looking to achieve is to be initialed and inputted as met or not met. There is space available for progress notes on the bottom at the back of the page (add regular progress notes page if you require more space)
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You will notice a new task beginning Postpartum 324 hours that refers to a Latch Score. This refers to a Breast/Latch Assessment tool that is to be used. The Discharge Criteria, the last page of the pathway, should also be checked daily. If any of the criteria have been met, these should be initialed and dated.
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Once the baby is born, the doctor can use the Postpartum and Newborn order sets. The Newborn Pathway should be started on the babys chart. This pathway is a day-style pathway, and follows the babys stay for the 48 hours in hospital. Like the mothers pathway, tasks should be initialed as they are completed, or indicate N/A and initial if the task does not apply for the patient. For example, if the baby is female, circumcision will not be discussed under Psychosocial Support/Education, so this can be entered as N/A, and initialed.
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Indicators need to be entered as met or not met. The discharge criteria (last page) should be checked daily and initialed if any of the criteria are met. Space is available for progress notes on the bottom at the back of the page (add regular progress notes page if you require more space). When all discharge criteria have been met for both baby and mother, they can be discharged home
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This is the end of the general information for the Vaginal Birth pathway. To get further information by trying the pathway on a sample patient, move to the Simulation portion of the Vaginal Birth workshop. Test your knowledge of Vaginal Birth by doing the Vaginal Birth quiz.
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Simulation
Try it! Click here to see the clinical pathway. Take a look at the clinical pathway. On the first page is a master signature sheet. Sign it, and then for the remainder of the pathway you can just initial as tasks are complete (if you have a Master Signature Sheet for your facility, this will not be on your pathway page). There are also some basic instructions on the first page on how to use the pathway. Each page will need a patient ID sticker. Flip to the first page of the pathway, Labour Triage with Admission:
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Simulation Contd
Our sample patient Nancy is pregnant and has arranged for a hospital visit and pre-admission appointment. During her visit, Nancy should receive her patient education materials and be instructed to bring these with her when she comes back in to have the baby. When Nancy arrives in hospital in labour, the Labour Triage With Admission page should be started. It also includes the Performance and Patient Outcome Indicators for Active Labour and the 1st 2hrs Postpartum.
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Assess the Patient Outcome and Performance Indicators Labour Triage with Admission Patient received appropriate prenatal care Met Not Met N/A 2. Patient meets criteria for admission Met Not Met N/A 3. Fetal Heart rate measured by intermittent auscultation Met Not Met N/A
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Do any documentation on the progress notes at the bottom of this sheet instead of your regular progress notes. Complete other documentation as per your corporation.
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Active Labour
4. Fetal Heart rate measured by intermittent auscultation Met Not Met N/A 5. IV or Saline Lock started for medication administration only Met Not Met N/A
Do any documentation on the progress notes at the bottom of this sheet instead of your regular progress notes. Complete other documentation as per your corporation.
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Simulation Contd
Once labour is complete, the pathway moves into the postpartum phase first 2 hours. Assess the Patient Outcome and Performance Indicators 6. Immediate skin-to-skin Mother-Newborn contact 7. Breastfeeding initiated within 1st hour postpartum
Do any documentation on the progress notes at the bottom of this sheet add your regular progress notes sheet if you need more space. Complete other documentation as per your corporation.
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Simulation Contd
Once the baby is born, there is another pathway to be used for his/her chart, called the Newborn pathway. It works much the same as the Vaginal Birth pathway. The Newborn pathway follows the same format with postpartum first 24 hours and 24-48 hours. There are tasks to be initialed for each day, and indicators that should be met as well. 1. Prophylactic medications given after 1 hr post-birth 2. Breastfeeding assessed using latch assessment tool
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Simulation Contd
The next page of the Vaginal Birth pathway is the rest of the first postpartum day(3-24 hrs). You will see columns on the right hand side (one for each shift ) write in todays date at the top. Below the date, write in the hours you will be caring for Nancy. You will then use this column to initial as each task on that page is completed. The rest of the sections are tasks that are to be completed for that day. Again, some tasks are not applicable to each patient, or to each shift. For example, if it is night shift, you may not be teaching Nancy, so under Psychosocial Support/Education, you can indicate N/A and initial Review Patient Pathway. You will notice on the postpartum pages that there is a reference to a Latch Score assessment. This refers to the Breast/Latch Assessment tool, which helps document feeding and latching of the baby.
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Simulation Contd
At the end of each day, in the Discharge Planning section (last section of each page), you will notice it says Assess Discharge Criteria Daily. This means you will need to flip to the last page, the Discharge Criteria once a shift, and check if any of these goals have been met. If they have, initial and date them.
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Simulation Contd
Lets assume it is the second postpartum day, and Nancy and her baby have now achieved all the Discharge Criteria. They are now ready to be discharged. If Nancy is transferred to another hospital, there are instructions on what documents to send the receiving hospital, so they can continue using the pathway on the first page of the pathway under the heading HOW TO USE THE CLINICAL PATHWAY
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What are the inclusion/exclusion criteria for this pathway? What patient education materials are used for this pathway? When are they handed out? When is this pathway started? Where is the documentation done during the phases of labour? What is the Breast/Latch Assessment tool and how is it used?
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Answers
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What are the inclusion/exclusion criteria for this pathway? This pathway is used for all women admitted for vaginal birth with no identified risk factors. What patient education materials are used for this pathway? When are they handed out? There is the booklet Having your baby in a Grey Bruce Health Network Hospital, as well as accompanying materials Lets Grow a Healthy Baby, Community Resources for Parents, and Hearing Screening for your Baby. These are all handed out in the pre-admission clinic. When is this pathway started? This pathway is started in the preadmission clinic. Where is the documentation done during the phases of labour? There is standard corporate documentation already in existence for the phases of labour, so documentation is done on these sheets rather than on the pathway to avoid duplication. What is the Breast/Latch Assessment tool and how is it used? This tool is used to help us assess the mothers breast, as well as how the baby is feeding and latching .
If you have had difficulty with any of these questions, go back through the material on this pathway and/or the general pathway information in this workshop, or ask your Site Champion any other questions you have or contact EBC program
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