Subject: Utilization of Oxygen in Intrapartum Period

POLICY: Oxygen will be utilized intrapartum when maternal or fetal wellbeing is assisted by its use and will be used post birth for infant stabilization as outlined in this and infant resuscitation protocol. The safe use of oxygen is critical in The Birth Center.

GUIDELINES:

1.   In the birth room there will be an oxygen tank with a full delivery system ready for maternal use with an attached regulator and an adult face mask (one time use).

2.   In the birth room there will be an oxygen tank with a full delivery system ready for infant use with an attached regulator and a neonatal resuscitation bag and mask (one time use).

3.   In the birth room there will be an extra full tank of oxygen ready for use with an attached regulator.

4.   Oxygen tanks will be secured on an oxygen cart or on the infant warmer oxygen station to avoid danger of falling and damage occurring to the tank which endangers those in the presence of the tank.

5.   Extra oxygen tanks are found under the sink in the sterilization area.

6.   Oxygen may be utilized in the event of:

a.   Fetal bradycardia or tachycardia

b.   Signs and symptoms of maternal shock

c.   Maternal comfort

d.   Infant Resuscitation

e.   Cord Prolapse

f.    And as the midwife deems necessary

7.   The regulator is utilized for safe use of the oxygen. For adult use the usual setting on the regulator is 8 liters per minute and for neonatal use the usual setting is 4 liters per minute.

8.   Oxygen will not be utilized in the presence of smoking, flame, sparks or excessive heat.

 

PROCEDURE:

1.   Oxygen set up will be checked at each birth by the midwife and the birth assistant. The following items will be checked:

a.   There will be one tank at least ¼ full with wrench, regulator and maternal set up in the birth room.

b.   There will be one tank at least ¼ full with wrench, regulator and infant set up in the birth room.

c.   There will be one extra full tank in the birth room with a wrench and regulator attached.

d.   Extra full tanks will be stored; under the sink in the sterilization area for The Birth Center 1 and in the supply closet in The Birth Center 2.

e.   Empty (less than ¼ full) tanks will be placed in the storage room for refilling.

f.    Full oxygen set up must be completed before the birth if the setup is not complete.  Extra masks and resuscitation masks are to found in the storage room. 

g.   The regulator will be attached and oxygen turned on to test operation of the equipment. 

2.   If the midwife determines that oxygen will be utilized the client will be informed of the need for oxygen and alternatives will be given.

3.   Open the main valve with the wrench when the flow meter is set to “0”.

4.   Open the flow meter to desired setting.

a.   Maternal use of oxygen can be set from 6-12 liters per minute. Usual setting is 8 liters per minute.

b.   Infant use of oxygen can be set from 2-6 liters per minute. Usual setting is 6 liters per minute.

5.   Adjust maternal mask on the mother so that it is comfortable for her resting on the bridge of her nose.

6.   Infant oxygen will be utilized according to AAP neonatal resuscitation recommendations and the Respiratory Distress at Delivery Protocol.

7.   Document use of oxygen, start time, flow rate and how given (ie: face mask or nasal canula).

8.   Continue regular documentation of status of reason for oxygen (ie: FHT’s or mother’s condition) and when oxygen discontinued and status of client after discontinuation.

9.   When oxygen use is discontinued:

a.   Check oxygen tank reserve; if less than ¼ tank, remove to be refilled. If still over ¼ tank then:

                                         i.    Close main valve with the wrench.

                                        ii.    Drain or “bleed” the regulator of extra oxygen by keeping flow open until oxygen flow reads “0” then turn flow off.

10.               If oxygen is considered necessary for greater than one hour intrapartum or postpartum, the midwife needs to consider transfer to hospital for higher level of care.