Course Syllabus ©National College of Midwifery 2017 11/2017
Course Title: Antepartum Basic Skills
Credits: 1
Course Description:
This course provides a basic academic foundation from which students will build a comprehensive understanding of the basic skills used by a midwife caring for a healthy mother and fetus during the antepartum period. This course covers the use of techniques, instruments and equipment that monitor the growth and development of the fetus and the well-being of the pregnant mother. Information in this course is framed in the context of OSHA regulations as they relate to the midwifery workplace, and clinical skills most commonly practiced by Certified Professional Midwives. This course uses current research in midwifery and obstetrics to broaden the student’s understanding of the following NARM skills and MANA core competencies learned under clinical supervision:
NARM Skills
II. General Healthcare Skills
(21)-II A. Demonstrates Universal Precautions
(22)-II B. Demonstrates the application of OSHA regulations as they relate to the midwifery workplace
(23)-II C. Demonstrates the application of aseptic technique
II D. Demonstrates the use of instruments and equipment including:
(26)-II D 3. Blood pressure cuff
(30)-II D 7. Doppler and/or Fetoscope
(31)-II D 8. Gestation calculation wheel/calendar
(34)-II D 11. Lancets
(35)-II D 12. Newborn and adult scale
(40)-II D 17. Speculum
(41)-II D 18. Stethoscope
(43)-II D 20. Tape measure
(44)-II D 21. Thermometer
(45)-II D 22. Urinalysis strips
(47)-II D 24. Vacutainer/blood collection tube
(48)-II D 25. Vaginal culture equipment
(73)-III F. Assesses correlation of weeks gestation to fundal height
Learning Activities:
- Student reads appropriate sections from the Learning Materials/Resources.
- Student answers the questions listed in the Learning Objectives by researching the Learning Materials/Resources for the course and correctly cites the sources and page numbers for each of their answers.
- Student presents answers the questions listed in the Learning Objectives for review by preceptor.
- Student participates in preceptor elaboration/discussion of Learning Objectives.
- The student must research, prepare & present a summary of current best midwifery care/practices appropriate to the topic of the course from a current journal article/study, less than 5 years old.
- Recommended Role-playing and/or Clinical Interactions
Note: The clinical requirement of NARM /Clinical Skills is completed at any time throughout the ASM apprenticeship during actual clinical practice and is NOT a requirement to complete this academic course.
Activities specific to NARM skills learned in this section:
- Practice appropriate gloving and un-gloving techniques.
- Identify the implementation of OSHA regulations in your clinical setting.
- Practice creating a sterile field and “no-touch” technique.
- Practice taking blood pressure on another student or on preceptor
- Practice gestational age calculation with imaginary LPMs using Naegele’s rule, Nichol’s rule and a gestational calculating wheel
- Practice FHT counts by using flash cards to memorize 5-second counts.
- Practice weighing yourself and others on a scale used in a clinical setting.
- Observe a speculum examine.
- Assist with a speculum exam.
- Practice lancet use by using several different kinds of lancets including spring loaded and manual.
- Practice re-loading spring-loaded lancets.
- Practice listening to heart rate with a stethoscope and taking a radial pulse. Evaluate your accuracy by comparing these values.
- Practice listening to respirations with a stethoscope and by observing respiratory effort. Evaluate accuracy by comparing these values.
- Practice palpation through a folded blanket with a doll.
- Practice taking an axial and oral temperature with the same thermometer. Compare these values.
- Take your temperature half an hour before and half an hour after you eat lunch. Compare these values.
- Practice drawing blood on a willing friend or preceptor. Make sure to practice changing tubes during blood draw.
- Review the current laboratory guidelines regarding which collection tubes are appropriate for routine prenatal blood tests.
- Role-play a routine prenatal visit with another student or preceptor. Create a checklist of skills to practice and repeat this exercise until you feel confident and comfortable with all aspects of a routine visit.
Learning Materials / Resources:
Please use textbooks less than 5 years old or most recent edition.
1. Johnson, Ruth and Taylor, Wendy. Skills for Midwifery Practice. 4th edition. Elsevier Churchill Livingston. 2016.
2. Weaver, Pam and Evans, Sharon K. Practical Skills Guide for Midwifery, 4th Edition. Morningstar Publishing Co. Wasilla. 2007
3. Davis, Elizabeth. Heart and Hands: A midwife’s guide to pregnancy and birth. 5th Edition. Celestial Arts Press. 2012
4. Frye, Anne. Holistic Midwifery: A comprehensive Textbook for Midwives and Home Birth Practice, Vol I, Care During Pregnancy. Revised Edition. Labrys Press. 2010
5. United States department of Labor, Occupational Health and Safety Administration (OSHA). http://www.osha.gov/index.html. 2017
6. MEAC Abbreviated NARM Skills Form: http://www.midwiferycollege.org/AcademicProgram/Downloads/ASM/Clinical/Form-NARMSkills.pdf
7. MEAC Essential Competencies: http://www.midwiferycollege.org/downloads/worddocs/Curriculum-Checklist-of-Essential-Competencies-rev-2014.pdf
8. Midwives Model of Care®: http://cfmidwifery.org/mmoc/brochures.aspx
9. Students must find 1 article/study less than 5 years old. Recommended internet links as needed for latest developments in midwifery care: https://www.midwiferycollege.edu/resources-national-college-of-midwi
Evaluation Tools / Methods:
Minimum passing grade for each course is a cumulative 80% / B-. Students and preceptors are encouraged to work together until the student masters the information.
Final grade for the course is based on preceptor evaluation of the following:
A. Learning Objectives count for 50% of the final grade.
The preceptor evaluates each answer based on three elements:
1. Answers should reflect a thorough review of current literature regarding best current practices in midwifery care.
2. Each answer should be formed in the student’s own words or paraphrased from the text. The answer should be minimal, not a re-write of the entire text, but enough to show appropriate comprehension of the learning objective.
3. Student identification of sources and page numbers for each of the Learning Objectives. (Preceptor should do a random check to determine that sources cited are correctly identified.)
B. Enrichment Activities, including research essays and summaries of articles: 20%
C. Discussions: 15%
D. Tests and Exams: 15%
Course credit:
One Academic credit equals approximately 15 hours of formal time plus 30 hours of additional study or homework. Formal time is defined as the amount of time taken to answer the Learning Objectives to the level of 80% and to complete any learning activities to the preceptor's satisfaction, including any time spent face to face with the preceptor. Informal time includes any time spent actively reading relevant sources and textbook/s, researching Learning Objectives, and studying for examinations.
Learning Objectives:
A. The student must research, prepare & present a summary of an aspect of current best midwifery care/practices appropriate to the topic of the course from a current journal article/study.
B. Student answers the questions below and cites the sources and page numbers.
1. Name the most important skill a midwife can have to prevent the spread of disease and germs and give your rationale.
2. Discuss indications for hand washing in a clinical setting.
3. Discuss the principles of universal (standard) precautions.
4. Name at least four bodily fluids around which midwives must use universal precautions.
5. Describe the OSHA regulation regarding containment of contaminated sharps.
6. Describe the OSHA regulation regarding contaminated laundry and discuss how midwives should follow this regulation in a home-birth setting.
7. Describe how OSHA regulations are followed in your preceptor’s clinical setting regarding contaminated sharps, blood borne pathogens, hazardous waste and hazardous materials.
8. Describe the concept of a sterile field and how it is maintained.
9. Give 3 examples of when aseptic technique is indicated.
10. Discuss the risk of environmental contamination to a sterile field and how it can be minimized.
11. Describe the method of instrument sterilization used in your preceptor’s clinical setting. Outline the steps of this method.
12. Describe the instruments that are common in midwifery practice and identify which ones should be sterilized before use with a client and give your rationale.
13. Define blood pressure, include the difference between systolic and diastolic pressure.
14. Discuss the normal range of blood pressure in childbearing women and factors that influence this during pregnancy.
15. Discuss the placement of a sphygmomanometer cuff and stethoscope when taking blood pressure on a pregnant woman. Where are these instruments placed and why?
16. Discuss what factors can effect accuracy when taking blood pressure and how to minimize errors.
17. Define the normal heart rate range for a healthy woman and what factors may influence heart rate.
18. Discuss what changes in heart rate are normal during pregnancy and why.
19. List at least five sites on the body where pulse can be taken
20. Discuss the steps of taking a pulse during a routine prenatal visit, including the appropriate method of counting.
21. Discuss the normal temperature range for adults and the effects of temperature extremes on the body.
22. Discuss 7 factors that influence body temperature.
23. Discuss normal changes in temperature related to childbirth.
24. Name the three most common sites where temperature is recorded and the advantages and disadvantages for each.
25. Name two types of thermometer and how each is used most effectively.
26. What are two ways to assess adult respirations and when is it important to do so?
27. Discuss 5 factors that can influence normal respiration in an adult.
28. Describe how to obtain a capillary blood sample for a glucose analysis with glucometer.
29. Discuss three tests that require a venous blood sample.
30. Describe how to locate a suitable vein for venepuncture.
31. What anatomical structures should be avoided in locating a vein suitable for venepuncture?
32. Name three suitable veins in the arm for venepuncture.
33. List equipment needed for venepuncture of an adult.
34. Discuss how a Vacutainer/needle system functions in venepuncture.
35. Describe how to obtain a person's weight at a routine prenatal visit.
36. Define urinalysis and why this is used as a screening tool in pregnancy.
37. What are the three physical characteristics of a urine sample that should be assessed?
38. List 6 substances that may be found by urinalysis and the significance of each during pregnancy.
39. Discuss the steps of urinalysis and the equipment needed to perform it.
40. Describe in minute detail how to obtain a clean catch urine specimen as if you were giving instructions to the mother.
41. Describe the importance of midstream urine specimens when screening for infection.
42. Describe the difference between a Graves and Pederson speculum, and circumstances when each should be used.
43. Describe the method for visualizing the cervix with a speculum. Include proper technique for insertion, positioning and withdrawal of the speculum.
44. Discuss ways to reduce discomfort during a speculum exam.
45. Describe the steps for doing a sterile speculum exam and when this is indicated.
46. Describe three tests for which a speculum exam is needed to collect a specimen.
47. Explain the difference between obtaining a “high” and “low” vaginal culture. Give examples of lab tests that require each.
48. Discuss two methods of estimating delivery date by a client’s last menstrual period.
49. Discuss how the length of an individual’s menstrual cycle can effect due date estimation.
50. Describe how you might explain the use of a gestation calculation wheel to a client.
51. Describe the importance of obtaining a detailed client history including details about menstrual history, birth history, and sexual activity around the estimated time of conception in order to calculate an accurate estimated due date.
52. Describe the steps of Leopold's Maneuvers and what you expect to determine with each step.
53. Describe two methods for determining fundal height; describe the anatomical landmarks and equipment used for each.
54. Describe the importance of using both palpation and fetal heart tone auscilation to determine fetal positioning.
55. List three instruments used to hear fetal heart tones. Describe the advantages and disadvantages of each.
56. Describe how you determine where the fetal heart tones will be most easily heard.
57. Explain how to count fetal heart tones most accurately.
58. Describe the steps for determining the location and quantity of edema.
59. Describe the use of the reflex hammer.
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