Course Syllabus ©National College of Midwifery 2017 11/2017

Course Title: Intrapartum Diagnostic Lab Tests Procedures

Credits: 0.5

Course Description: This course reviews diagnostic tools that are used during intrapartum care. Students learn tools to confirm rupture of membranes, evaluate urine for health indicators and other common tests. This course reviews the indications and efficacy of electronic fetal monitoring, ultrasound, and uses of x-ray in labor. 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

I. Midwifery Counseling, Education and Communication

(1)-I A. Provides interactive support and counseling and/or referral services to the mother regarding her relationships with her significant others and other healthcare providers

(2)-I B. Provides education, support, counseling and/or referral for the possibility of less-than-optimal pregnancy outcomes

(3)I C. Provides education and counseling based on maternal health/reproductive/family history and on-going risk assessment

(4)-I D. Facilitates the mother’s decision of where to give birth

(5)-I E. Educates the mother and her family/support unit to share responsibility for optimal pregnancy outcome

(7)-I G. Applies the principles of informed consent

(8)-I H. Provides individualized care

II. General Healthcare Skills:

II D. Demonstrates the use of instruments and equipment including:

(36)-II D 13. Nitrazine paper

(37)-II D 14. Needle and syringe

(40)-II D 17. Speculum

(45)-II D 22. Urinalysis strips

(47)-II D 24. Vacutainer/blood collection tube

Learning Activities:

  1. Student reads appropriate sections from the Learning Materials/Resources.
  1. 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.
  1. Student presents answers the questions listed in the Learning Objectives for review by preceptor.
  1. Student participates in preceptor elaboration/discussion of Learning Objectives.
  1. The student must research, prepare & present a summary of current best midwifery care/practices appropriate to a topic covered in this course from a current journal article/study, less than 5 years old.
  1. 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:

  1. Role play with your instructor or another student how you would do a speculum exam for premature rupture of membranes.
  1. Practice using nitrazine paper on different fluids to determine pH level.
  1. Role play with your instructor or another student what you would say to a client regarding how testing for fetal fibronectin levels is done and what the results mean.
  1. Practice looking for ferning patterns with a microscope, using pictures from a textbook for comparison.
  1. Practice discretely evaluating uterine contraction strength while observing a woman in labor.
  1. Attend a workshop on continuous fetal heart rate monitoring at your local hospital.
  1. Practice evaluating urine strips for protein, ketones, glucose, and blood.

Learning Materials / Resources:

Please use textbooks less than 5 years old or most recent edition.

1.Frye, Anne. Understanding diagnostic tests in the childbearing year: A wholistic approach. Seventh edition. Labrys Press. 2007

2.Marshall, Jayne E, Raynor, Maureen D(editor). Myles Textbook for Midwives. Churchill Livingstone; 16 edition. 2014.

3.Chapman, Vicky and Charles, Cathy. The midwife’s labour and birth handbook.3rdedition. Blackwell Publishing. 2013

4.Johnson, Ruth and Taylor, Wendy. Skills for Midwifery Practice. 4th edition. Elsevier Churchill Livingston. 2016

5.Weaver, Pam and Evans, Sharon K. Practical Skills Guide for Midwifery, 5th Edition. Morningstar Publishing Co. Wasilla. 2012.

6.Varney, Helen. Varney's Midwifery, 5th Edition. Jones and Bartlett Publishers. 2014.

Resources for all Courses:

MEAC Abbreviated NARM Skills Form:

MEAC Essential Competencies:

Midwives Model of Care®:

Students must find 1 article/study less than 5 years old. Recommended internet links as needed for latest developments in midwifery care:

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 a topic from this course from a current journal article/study.

B. Student answers the questions below and cites the sources and page numbers.

  1. Describe the method for observing pooling amniotic fluid in the posterior vaginal fornix.
  1. Describe the use of nitrazine paper when placed in alkaline amniotic fluid.
  1. Describe the significance of a ferning pattern when observed in amniotic fluid placed on a glass slide.
  1. Describe the other fluid that can cause false-positive results when trying to prove ROM.
  1. Discuss the difference between continuous and intermittent fetal heart rate monitoring techniques during labor.
  1. Cite evidence of the ability of continuous and intermittent monitoring to identify fetal distress.
  1. Describe the evidence for the effectiveness of the two methods of evaluating fetal heart rate in reducing fetal mortality and morbidity.
  1. Describe 2 ways in which ultrasound can be used during labor.
  1. Describe how urine analysis can be used to differentiate between a UTI and early labor.
  1. Describe the how maternal hydration can be assessed and its significance during labor.
  1. Describe how testing for ketones is carried out and its significance in labor.
  1. Discuss how testing for glucose is performed and its significance during labor.
  1. Discuss how testing for protein is performed during labor and why these results are often inaccurate as labor advances and after membranes have ruptured.
  1. Discuss what diagnostic tests are routine before the administration of epidural analgesia.
  1. Describe the use of X-ray in labor.
  1. Discuss the use of a contraction monitor during labor. What information can be gathered by monitoring the strength of contractions?
  1. Discuss a low-intervention method of assessing contraction strength often used by midwives at home?
  1. List 2 biochemical markers that may indicate an increased risk for preterm labor.
  1. Discuss the diagnostic tests that can be used to test for the above mentioned biochemical markers and how they are performed.
  1. Discuss when it is appropriate to measure cervical length by ultrasound and how this procedure is performed.
  1. Discuss the diagnostic tests that are available for assessing fetal lung maturity and how they are performed.
  1. When is it appropriate to consider fetal lung maturity as a factor in decision making during labor?
  1. Name the lab tests that should be obtained for women about to be placed on tocolysis.
  1. Discuss the practice of fetal scalp blood sampling. What is the rationale behind this type of testing and why has it decreased in popularity?
  1. Explain the visual diagnostic that can be performed by examining the amniotic fluid released after the rupture of membranes during labor.
  1. How can the information gathered with the above visual diagnostic tool inform the midwife about fetal well-being?
  2. Discuss the way in which pulse oximetry can be used during labor.
  1. Why is assessing blood oxygen saturation levels useful in labor?
  1. Discuss the diagnostic tests that can be used to identify maternal infection during labor.
  1. What test can be done to assess electrolyte balance in labor and when would it be appropriate to perform this test?

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