Charlotte is a certified nurse-midwife who is opening a freestanding birth center within 5 miles of a major community ho

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Charlotte is a certified nurse-midwife who is opening a
freestanding birth center within 5 miles of a major community
hospital. The birth center is accredited by the local association
for birth centers and has a collaborative agreement, including a
transfer agreement with the community hospital and an obstetric
practice consisting of three physicians and a women’s health nurse
practitioner.
In order to promote patient engagement and to provide a personal
health record (PHR), Charlotte installs iPad stations in her
waiting rooms and antepartum assessment rooms. Using these
electronic stations, pregnant women provide their health history
and update their health status throughout their pregnancy. The PHR
is also accessible online and can be viewed by patients and HCPs at
the birth center, obstetrician’s office, and the hospital. This
allows for a seamless, continuity of care should risks develop and
the patient needs to trans to an obstetrician’s care.
Although intrapartum transfers from birth center to hospital
comprised less than 12% of the population of women using a birth
center, it is important for Charlotte to develop policies in
conjunction with the obstetric practice and hospital to promote
maternal and newborn safety. One reason for emergent transfer in
the immediate postpartum period is postpartum hemorrhage. By using
the protocols outline in the Obstetric Hemorrhage Toolkit,
Charlotte is able to provide the women and families the best care.
This clinical information document provides antepartum, admission,
and ongoing risk assessment procedures to identify patients at
highest risk for PPH, parameters to diagnose PPH, and a protocol
for management. For example, patients are screened for antepartum
risks including severe anemia, history of labor uterine fibroids,
body mass index greater than 35, estimated fetal weight greater
than 4kg, more than four previous vaginal births, history of
bleeding disorders, and a lack of consent to receive blood products
in an emergency. The protocols for management of PPH include active
management of the third stage of labor by the CNM. Active
management procedures are administration of 10 units Pitocin
(oxytocin) intramuscularly and vigorous fundal massage following
delivery of the placenta. Also, all birth center staff are educated
in accurately estimating blood loss and implementing appropriate
transfer protocols. Not only does this toolkit promote
standardized, quality care between the healthcare professionals,
but, when shared with the birth center patients, it promotes shared
decision making and patient empowerment.
2. Discuss the role of the digital healthcare tools and the
internet?