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.
• Blood loss should be quantitated (pads and sponges are weighed).
• 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.