fetal surveillance for out of hospital midwives
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What is the importance of fetal surveillance in midwifery care?
This 10-week course is designed to equip midwives working in out-of-hospital settings with the knowledge and skills necessary for effective fetal surveillance. The course will cover essential topics ranging from understanding fetal development to utilizing various surveillance methods and interpreting findings. Emphasis will be placed on critical thinking, decision-making, and communication skills essential for providing safe and competent care to pregnant individuals and their babies. This course provides midwives with the knowledge and skills to assess fetal well-being throughout pregnancy and labor in an out-of-hospital setting. By translating ACOG guidelines, NICHD consensus, and the Biodynamic model of midwifery, this course ensures that midwives can make informed, evidence-based decisions to optimize maternal and neonatal outcomes. This course is part of our Maternal Health Specialist Program. |
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What Does This Course Teach?
This 10-week class will cover the basics of fetal surveillance.
Course Title: Fetal Surveillance in Out-of-Hospital Midwifery Practice
Week 1: Foundations of Fetal Surveillance
Week 2: Fetal Oxygenation and Circulatory Adaptations
Week 3: Prenatal Fetal Assessment Methods
Week 4: Intrapartum Fetal Assessment – Tools & Techniques
Week 5: Fetal Heart Rate Patterns & Variability
Week 6: Decelerations and Their Implications
Week 7: Addressing Fetal Distress & Intrauterine Resuscitation
Week 8: Evaluating FHTs in Community Birth
Week 9: Charting & Documentation for Fetal Surveillance
Week 10: Special Considerations & Case Reviews
Week 1: Foundations of Fetal Surveillance
- Introduction to Fetal Surveillance in the Out-of-Hospital Setting
- Importance of fetal assessment in midwifery
- Overview of physiological vs. pathological surveillance
- Review of Relevant Physiology
- The role of the placenta in fetal oxygenation
- Factors affecting placental function
- Prenatal Preparations for Intrapartum Monitoring
- Identifying pre-existing risk factors
- Evaluating fetal well-being before labor
Week 2: Fetal Oxygenation and Circulatory Adaptations
- Fetal Oxygenation
- Six factors necessary for maternal-fetal oxygen transfer
- Role of the placenta, maternal hemoglobin, and umbilical circulation
- Fetal Circulatory Adaptations
- Two key features that reduce fetal hypoxia risk
- Role of the ductus venosus and foramen ovale
Week 3: Prenatal Fetal Assessment Methods
- Assessing Prelabor Damage and Risk Factors
- Early identification of hypoxia risk
- Implications for out-of-hospital birth
- Auscultated Acceleration Test (AAT)
- Purpose and application in midwifery care
- AAT Studies and Evidence-Based Use
Week 4: Intrapartum Fetal Assessment – Tools & Techniques
- Introduction to Intrapartum Monitoring Methods
- Standards and guidelines for intermittent auscultation
- Comparing Doppler vs. fetoscope monitoring
- Recognizing Fetal Heart Rate (FHR) Abnormalities
- How to calculate a baseline FHR
- Defining tachycardia and bradycardia
Week 5: Fetal Heart Rate Patterns & Variability
- Understanding FHR Variability
- Normal vs. concerning variation
- Interpreting amplitude and frequency changes
- Quick Guide: Amplitude Chart & Reactivity Grid
- Identifying reassuring vs. non-reassuring patterns
- Accelerations and non-reactive tracings
Week 6: Decelerations and Their Implications
- Decelerations in FHR Monitoring
- Early, variable, and late decelerations
- The 5-60-60-60 Rule for Variable Decels
- Can Hypertension Cause Prolonged Decels?
- Shifting research on variable decelerations
- When to escalate care in an out-of-hospital setting
Week 7: Addressing Fetal Distress & Intrauterine Resuscitation
- How to Respond to Decelerations
- Step-by-step interventions
- The sound of silence: Identifying fetal compromise
- Intrauterine Resuscitation Techniques
- Current methods and supportive evidence
- PDF Resource: "Things to Try in an Out-of-Hospital Setting"
Week 8: Evaluating FHTs in Community Birth
- NICHD FHR Categories
- Category I, II, and III tracings
- When to transfer for continuous monitoring
- Reassuring vs. Non-Reassuring FHTs in a Community Setting
- Guidelines for out-of-hospital care
Week 9: Charting & Documentation for Fetal Surveillance
- Strategies for Monitoring & Charting While Protecting Physiologic Birth
- How to document findings effectively
- Risk management in midwifery care
- PDF: How to Chart FHTs Correctly
Week 10: Special Considerations & Case Reviews
- Special Considerations for Waterbirth & FHR Monitoring
- Best practices for waterbirth auscultation
- When to intervene or modify care
- Complex Situations & Case Study Analysis
- Applying the knowledge from previous weeks
- Real-life scenarios and decision-making practice
- Final Review & Course Quiz
- Weekly multiple-choice quizzes
- Short answer discussions
- Final case study assessment
- Varney’s Midwifery – Textbook covering fetal assessment in midwifery practice.
- Fetal Heart Monitoring Principles & Practices (AWHONN) – Comprehensive guide on FHR monitoring.
- Biodynamic Midwifery & Fetal Assessment – Integrating physiologic birth with modern fetal surveillance.
- Midwifery & Childbirth in the Home – Focus on community-based birth practices.
- Neonatal Resuscitation Textbook (AAP & AHA) – Essential for understanding primary and secondary apnea.
- Demonstrate comprehensive knowledge of fetal development and assessment techniques.
- Apply critical thinking skills to interpret fetal surveillance data and make informed clinical decisions.
- Effectively communicate findings with clients, families, and other healthcare providers.
- Navigate ethical and cultural considerations in providing fetal surveillance in diverse settings.
- Collaborate effectively in interprofessional teams to optimize maternal and fetal outcomes.
- List six factors needed for maternal-fetal transfer of oxygen, carbon dioxide, and nutrients.
- Discuss two features of fetal circulation that reduce the risk of fetal hypoxia.
- List four factors used in assessing fetal well-being in labor.
- Describe how the fetus responds to catecholamines (stress hormones).
- List potential fetal stressors.
- Describe the conditions leading to primary apnea and secondary apnea.