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Suggested plan for client care should any risk factor occur:
With a risk factor of 1 or 2, the midwife needs to observe further and then evaluate for increased risk; or immediately evaluate for risk depending on the severity of the individual case. Parents are informed of any increased risk.
With a risk factor of 3, the midwife may decide to go to a peer to determine if physician consultation is necessary or referral to another health care practitioner. Parents are informed of the increased risk.
With a risk factor of 4, referral should be made to a medical health care provider. Parents and peers are made aware of the increased risk through discussion. The midwife ensures continuity of care.
With a risk factor of 5, MoonDragon Birthing Services does not support home birth. The following steps are to be taken:
1. Discuss the problem with the parents, specifically that the situation is high risk and advise against home birth.2. For a risk factor of 5 developing prenatally, if the parents still choose to remain home, and the midwife agrees to attend; the midwife should discuss the birth with her peers, educate herself further on the subject, and determine what extra care must be taken during the birth. She should explain why she is taking the birth, as well as what she has considered in making the decision. She must have the client arrange for a medical referral, including phone # to a physician and have an ambulance on call during labor.
3. For a risk factor of 5 developing during labor, the increased risk factor must be discussed fully with the parents, the ambulance should be notified. The midwife must offer to transport if the ambulance is not used. If they choose to go, the midwife will accompany the family to the hospital and give a copy of the records to the hospital personnel if the family wishes or desires. Peer discussion is recommended after the birth.
4. For a risk factor of 5 developing when the birth is imminent, the ambulance is called immediately while the midwife assesses the degree of danger to the mother and child; relative risks of staying home or transporting; her skills; equipment. Discussion of the risks with parents may be limited to emergency instructions, but it should be discussed in full later, with peer discussion after the birth.
5. For a risk factor of 5 developing after the birth, parents must be made aware of the high risk situation, and the midwife recommends immediate transport. Ambulance is called or midwife transports - if the situation is no longer a 5 when the ambulance arrives and it is rated a 4 then the case may be referred for medical opinion later. Midwife will bring records to hospital or physician if family agrees or desires. Peer discussion should occur sometime after delivery.
RISK FACTORS ARE NOT ADDITIVE, ALTHOUGH AN ADDITIVE METHOD COULD GIVE A GOOD OVERVIEW OF THE MOTHER OR BABY'S CONDITION.
NOTE: If multiple risk factors exist in catagories 1 or 2, consultation with peers becomes necessary.
Risk Factors: Initial History and Physical
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