Raven EMS Education Program ManualMedical Childbirth Evaluation Form
Date:
Student name:
Evaluator name:
Steps:
Take BSI precautions.
Explain the procedure to the patient or family.
Provide for modesty and protection from onlookers.
Open the OB kit, drape the patient, and cleanse the perineum using sterile technique.
Place one hand gently on the baby’s head and the other hand on the perineum to prevent explosive delivery of the head.
After the head delivers, check for the cord around the baby’s neck.
If present, attempt to slip the cord over the baby’s head.
If unable to slip the cord over the head, place the provided umbilical clamps on the cord in two places and cut between the clamps.
Wipe the baby’s mouth and nose to clear them of fluids (use a bulb syringe only as needed).
As the baby begins to be pushed out, guide the head downward to release the upper shoulder, then guide the head upward to release the lower shoulder.
Hold the baby in the Trendelenburg position at the level of the mother’s perineum.
Note the time of birth.
Clamp the cord in two places and cut between the clamps.
Assess the baby’s ABCs.
Stimulate the baby to produce a cry (dry the child off, briskly rub the back).
Wrap the baby in dry towels/blanket to keep warm.
Place baby on mother’s chest skin-to-skin, if able.
Assess the Apgar score at 1 and 5 minutes after birth.
Assess the mother’s vital signs.
Deliver the placenta when visible.
Assess the fundus every 5 minutes and massage until firm.
Place the placenta in a plastic bag or bucket for transport.
Dispose of the equipment/linen using an approved technique.
Accepts evaluation and criticism professionally.
Shows willingness to learn/asks appropriate questions.
Interacts with simulated patient and other personnel in a professional manner (ie, uses appropriate name, explains procedures, maintains modesty, is courteous to crew, etc).
Passing criteria:
Pass: At least 70% (? of ?) successfully completed above. Currently at 0% completed.
Fail.
Fails to take BSI precautions prior to performing procedure.
Did not explain and reassure the patient to allow informed consent.
Fails to clear infant’s airway in order (mouth, then nose).
Fails to keep infant warm.
Fails to assess mother for blood loss.
Fails to clamp and cut cord appropriately.
Fails to dispose/verbalize disposal of equipment properly.
