Alternate OB & Newborn

INTRODUCTION: Unit Description (Facility) The OB Unit consists of 8 LDRP (Labor-Delivery-Recovery-Postpartum) rooms with a total of 16 available beds (8 mother and 8 newborn), one C-Section Delivery room, two OB Triage rooms, an infant treatment area, and a potential infant isolation area. Additionally, Room #1 can function as a negative air flow isolation room.

An average of 400 deliveries occur annually with the number increasing each year. The unit provides care to outpatient and inpatient obstetrical patients with a gestation of > 20 weeks gestation as well as newborns born in the unit. There is no nursery and babies room-in with the mothers unless they are being observed for a short while or are being stabilized for medevac.

OB Medevacs

In consultation with HROB and the ANMC OB on-call physician, OB patients with a serious but stable medical condition may need transport to a higher level of care (ANMC or other). Once an accepting physician is identified, LifeMED should be activated and the patient should discharged pending medevac team arrival. Essential documentation should include a transfer summary and three papers from the “Transport Pack” completed by hand:

• PTO
• Signed consent form
• Diagnostic imaging request form for studies to be loaded on a CD
• Discharge summary, which you should do before LifeMed team arrives.

see Labor in the Village for a detailed discussion about a reason to medevac from a village to Bethel

OB Procedures

Nexplanon:

This is one of the most popular birth control methods postpartum on the OB Unit. It is an insertable 3-year capsule and can only be inserted by a specially trained (and certified) provider. This can usually be arranged for the patient within a 24 hour (or sooner) period.

Induction:

See the new Induction Policy in the NWing Doc’s Office in the “Induction Book.” The YKHC Clinical Guidelines (2011) concerning this are not current.

Episiotomy:

See the same topic above under “Deliveries”

Vacuum assist/extraction:

See the same topic above under “Deliveries”

Repair of Vaginal Delivery Lacerations:

1st and some 2nd degree lacerations may not need repair if hemostasis evident and anatomy is intact (e.g. peri-urethral, vaginal wall).

3rd and 4th degree lacerations repairs usually require HROB presence.

Newborns

Links to page with the following contents:
Newborn Admissions
Scenarios/Special Situations
Newborn Rounding
Newborn Discharge Process

Transfers/Medevacs (Transfer/medevac section LINK)

As soon as it is obvious that a mom or baby needs to be transferred (in some cases this is before the baby delivers i.e. when there is a known maternal or infant problem that necessitates a NICU or higher level of care for mother and/or infant during labor and/or delivery).

• Call ANMC and get an accepting physician for mom, if she has not delivered, or for baby if baby has delivered…if a patient is non-native the accepting physician should be from Providence NICU.
• Complete the Patient Transport Order (PTO) and other paper work in the transport packet
• Complete the Admit Orders and Medication Reconciliation
• Continue to monitor and stabilize the infant
• Complete the Newborn Discharge/Transfer Summary and add updates as needed. You can create your own transfer template or you can use McClure’s shared template and modify and save it for your own use.
• Update Diagnoses and Problem List
• Complete and E&M charge
• Complete the Medication Reconciliation