Subject:         Labor Monitoring for Inpatient Care

POLICY:         Careful monitoring of the obstetrical client and fetus during the laboring period will assist the midwife to determine variations from normal that will require more aggressive management in order to assure the health of mother and fetus in the intrapartum period.  Monitoring will include vital signs of mother, fetal heart tones of fetus, and contractions for frequency, duration and intensity.  It is understood that monitoring must be done in the most unobtrusive manner possible in order to preserve the psychological process of labor.

GUIDELINES: 1. Maternal vital signs (VS) are taken to ascertain the health of the mother and the affect of her health on her fetus.  Although there are policies regarding the timing of monitoring:

·         The midwife will be responsible to determine if more frequent monitoring is needed or if the situation warrants transfer to physician care. 

·         Complete vital signs include temperature, blood pressure, and heart rate (respiratory rate is added at admission assessment)

2. Fetal Heart Tones (FHT’s) determine the fetal response to the stress of labor and is therefore critical to ascertain the health of the fetus. 

·         They are to be monitored as per protocol. 

·         Monitoring is to be more frequent when deemed necessary or ordered by the midwife. 

·         The fetal monitoring machine found in the triage room is to be used only for a short period during labor when fetal health cannot be adequately assessed with the Doppler.  

·         When continuous monitoring is necessary the client is to be transferred to the hospital for care since they are no longer low risk and appropriate for our center.

3. Contractions are to be assessed continuously when the client is in the center. 

·         Providers will be in the room assessing FHR patterns at least every 30 minutes, therefore the contraction pattern must be assessed at that time as well. 

·         Notations are to be placed on the chart as per protocol and when there is a change in the contraction pattern. 

·         Because all the signs that are monitored (VS and FHR) will change with the contraction pattern, it is critical to keep good notations about the contraction pattern.

 

PROCEDURE: 1. Vital signs (VS) will be monitored as follows:

·         Complete set of VS at admission

·         Repeat complete set of VS Q 4 hours in labor

·         VS are to be taken at more frequent intervals if warranted and can be ordered by the midwife

2. Fetal Heart Tones (FHT’s) are to be monitored as follows:

·         at admission and is to include:

o   monitoring during a contraction

o   through the peak of the contraction

o   continuing until at least 15 seconds past the contraction in order to ascertain fetal tolerance of labor.

·         FHT’s are to be monitored every 30 minutes in active labor:

o   At least every hour the monitoring is to include:

§  monitoring during a contraction

§  through the peak of the contraction

§  continuing until at least 15 seconds past the contraction in order to ascertain fetal tolerance of labor.

·         FHT’s are to be monitored, at a minimum, every 15 minutes during second stage pushing

o   at least every 30 minutes monitoring will include:

§  monitoring during a contraction

§  through the peak of the contraction

§  continuing until at least 15 seconds past the contraction in order to ascertain fetal tolerance of second stage labor.

·         FHT’s are to be monitored immediately following rupture of membranes (ROM) to include:

o   a contraction

o   continuing until at least 15 seconds past the contraction.

3. Contractions are to monitored as follows:

·         Notations are to be made on the chart at least every hour during the active phase of labor and at least every 30 minutes during the second stage of labor, noting:

o   Frequency

o   Duration

o   And strength of contractions

Normal Vital Signs

Vital signs include your heart beat, breathing rate, temperature, and blood pressure. Normal vital signs change with age, sex, weight, exercise tolerance, and overall health.

Normal vital sign ranges for the average healthy adult while resting are:

  • Blood pressure: 90/60 mm/Hg to 120/80 mm/Hg
  • Breathing: 12 - 18 breaths per minute
  • Pulse: 60 - 100 beats per minute
  • Temperature: 97.8 - 99.1 degrees Fahrenheit / average 98.6 degrees Fahrenheit

Normal vital sign ranges for the average healthy neonate while resting are:

  • Breathing: 30 - 60 breaths per minute
  • Pulse: 100 – 180 beats per minute while awake
  • Pulse:  80 - 160 beats per minute while asleep
  • Temperature: 97.8 - 99.1 degrees Fahrenheit / average 98.6 degrees Fahrenheit

All vital signs that are outside the range of normal must be reported to the provider immediately.