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