Home birth intrapartum care

Kaiser Permanente expects the following labor, delivery, and immediate post-partum care.

Labor

Care during labor

During labor you will provide the following care:

  • Assess the status of labor in the client's/patient's home and arrange for admission to the hospital if the patient is no longer an appropriate candidate for home birth.
  • Review the patient's antenatal records.
  • Provide support and comfort measures throughout labor.
  • Maintain adequate hydration by encouraging clear liquids by mouth.
  • Assess need for intravenous fluids throughout the process of labor and delivery.
  • Administer fluids as indicated.
  • Prevent bladder distention by encouraging mother to void at least every two hours.
  • Administer intrapartum antibiotic prophylaxis as appropriate for the prevention of early onset Group B strep infection.

Observation during labor

During labor, also obtain, evaluate, and record the following information:

  • Onset of labor
  • Status of membranes
  • Quality, duration, and interval of contractions
  • Vital signs of mother
  • Heart rate of fetus
  • Dilation and effacement of cervix
  • Station of presenting part
  • Confirmation of cephalic presentation
  • Presence or absence of any signs or symptoms of complications
  • Fetal heart rate every 15 to 30 minutes in active first stage labor
  • Maternal pulse and blood pressure every two hours
  • Maternal temperature every four hours if membranes intact; every two hours if membranes ruptured
  • Station and dilation as needed

Delivery and immediate post-partum care

Pre-delivery

To prepare for delivery, ensure that:

  • The room is adequately warmed to 75 degrees or more
  • Your delivery pack and emergency equipment are at hand
  • Receiving blankets or towels are ready to dry infant

During delivery

During delivery you will provide the following care:

  • Monitor fetal heart rate every five to 10 minutes.
  • Assist mother to push and deliver infant in manner and position that she finds most comfortable and effective.
  • Perform episiotomy when indicated.

Immediate post-partum care

Immediately upon delivery, you will offer the following postpartum care. See also Home Birth Newborn Care.

  • Clear infant's airway with bulb, DeLee, or other suction if needed.
  • Dry infant well with receiving blanket or towel and place infant on mother's abdomen, preferably making skin-to-skin contact.
  • Clamp and cut cord, collecting cord blood sample when patient is Rh negative or there is a history of neonatal hyperbilirubinemia with a previous infant.
  • Administer Rhogam to Rh-negative mother within 72 hours of delivering an Rh-positive infant.
  • Assist in spontaneous delivery or simple expression of placenta and membrane.
  • Inspect placenta, membranes, and cord.
  • Inspect vagina and perineum for lacerations and repair, if necessary, after local infiltration with anesthetic.
  • Estimate total blood loss.
  • Administer oxytocic agent when bleeding is excessive and fundus is atonic.
  • Encourage family bonding and establish suckling.
  • Monitor maternal vital signs, fundus, lochia, and bladder for a minimum of two hours following delivery.
  • Be prepared to manage emergent conditions, such as postpartum hemorrhage and neonatal respiratory depression. Summon emergency aid when necessary.
  • Review postpartum instructions with mother before you leave the home.

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