Home Birth Intrapartum Care
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Kaiser Permanente expects or recommends 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.
- 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.
The Provider Manual is not intended for any use by any party other than as a resource for Kaiser Foundation Health Plan of Washington's contracted providers in fulfilling their obligations under provider contracts. Kaiser Permanente intends for the manual to be accurate for its intended purpose but doesnt guarantee accuracy. Providers should comply with the terms of their provider contracts and any legal requirements in the event of an inconsistency between the manual and a requirement in their provider contracts or the law.