Takes complete responsibility for patients during labor and delivery as long as their progress remains within the bounds of the midwifery collaborative agreement. Manages emergency situations such as postpartum hemorrhage, shoulder dystocia, or infant resuscitation in a conventionally approved manner until physician assistance arrives. Obtains physician consultation for plan of management for any medical or obstetrical complications.
* Evaluates the status of labor and makes decisions on admitting patients to the labor area.
* Performs admission physical examinations within 24 hours.
*Orders laboratory and diagnostic tests and evaluates results.
* Evaluates progress of labor by vaginal exam.
* Makes decision regarding ambulation of patient during labor.
* Inserts and manages cervical ripening according to departmental protocols.
* Provides analgesia.
* Requests conduction anesthesia.
* Performs amniotomy.
* Applies the external fetal monitor and tocodynamometer.
* Applies internal fetal scalp electrode and intrauterine pressure catheter.
* Evaluates fetal monitor tracings and consults with physician if abnormalities are present.
*Monitors patients on I.V. oxytocin and regulates oxytocin infusion for induction or stimulation of labor.
*Makes decision regarding the position(s) of the patients during second stage labor.
*Makes decisions regarding performance of delivery in the labor room or transfer to the delivery room.
*Utilizes local infiltration or pudendal block.
* Performs and repairs episiotomies.
* Conducts spontaneous deliveries of vertex presentation.
*Conducts spontaneous deliveries of cephalic presentations in multiples pregnancies with physician in attendance.
*Manages the labors and conducts the deliveries of vaginal birth after cesarean section (VBAC).
*Obtains a section of cord for cord gases.
* Manages the third stage of labor.
* Performs cervical and vaginal inspection.
* Repairs minor vaginal and perineal lacerations. Seeks physician consultation for repair of cervical or extended vaginal lacerations.
*Takes responsibility for management of uncomplicated patients in the recovery room.
*Decides when the normal infant should be transferred to the nursery.
*Requests attendance of pediatrician at delivery when neonatal problems are anticipated.