Fetal Surveillance for Out of Hospital midwives
Description
Course Title: Fetal Surveillance in Out-of-Hospital Midwifery Practice
Course Overview: 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.
Course Outline (10 Weeks)
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 PhysiologyThe role of the placenta in fetal oxygenation
- Factors affecting placental function
- Prenatal Preparations for Intrapartum MonitoringIdentifying pre-existing risk factors
- Evaluating fetal well-being before labor
Week 2: Fetal Oxygenation and Circulatory Adaptations
- Fetal OxygenationSix factors necessary for maternal-fetal oxygen transfer
- Role of the placenta, maternal hemoglobin, and umbilical circulation
- Fetal Circulatory AdaptationsTwo 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 FactorsEarly 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 MethodsStandards and guidelines for intermittent auscultation
- Comparing Doppler vs. fetoscope monitoring
- Recognizing Fetal Heart Rate (FHR) AbnormalitiesHow to calculate a baseline FHR
- Defining tachycardia and bradycardia
Week 5: Fetal Heart Rate Patterns & Variability
- Understanding FHR VariabilityNormal vs. concerning variation
- Interpreting amplitude and frequency changes
- Quick Guide: Amplitude Chart & Reactivity GridIdentifying reassuring vs. non-reassuring patterns
- Accelerations and non-reactive tracings
Week 6: Decelerations and Their Implications
- Decelerations in FHR MonitoringEarly, 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 DecelerationsStep-by-step interventions
- The sound of silence: Identifying fetal compromise
- Intrauterine Resuscitation TechniquesCurrent methods and supportive evidence
- PDF Resource: "Things to Try in an Out-of-Hospital Setting"
Week 8: Evaluating FHTs in Community Birth
- NICHD FHR CategoriesCategory I, II, and III tracings
- When to transfer for continuous monitoring
- Reassuring vs. Non-Reassuring FHTs in a Community SettingGuidelines for out-of-hospital care
Week 9: Charting & Documentation for Fetal Surveillance
- Strategies for Monitoring & Charting While Protecting Physiologic BirthHow 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 MonitoringBest practices for waterbirth auscultation
- When to intervene or modify care
- Complex Situations & Case Study AnalysisApplying the knowledge from previous weeks
- Real-life scenarios and decision-making practice
- Final Review & Course Quiz
Assessment & Course Materials
Assessments:
- Weekly multiple-choice quizzes
- Short answer discussions
- Final case study assessment
Recommended Readings:
- 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.
Learning Outcomes: By the end of this course, participants will be able to:
- 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.
This course aims to empower midwives practicing in out-of-hospital settings with the necessary skills and confidence to provide safe and evidence-based care throughout the antepartum and intrapartum periods.