Labor & Postpartum Simulation
Objectives:
Select appropriate nursing interventions based on fetal heart rate monitoring strips.
Choose appropriate pushing techniques and positions based on maternal and fetal assessments.
Distinguish normal from abnormal assessments in the postpartum patient.
Evaluate maternal status for the postpartum hemorrhage (PPH) patient.
Distinguish between normal and abnormal findings that may indicate high risk conditions for the
PPH patient.
Student Learning Outcomes:
Recognize normal and abnormal fetal heart rate patterns.
Explain the role of the OB nurse at delivery.
Report the normal and abnormal assessment findings for the postpartum patient.
Demonstrate maternal assessments and tests.
Report normal and abnormal assessment findings for the PPH patient.
Explain the importance of maternal assessments in the PPH period
Labor and Postpartum Simulation Prep work
Required ATI Real Life RN Maternal Newborn 3.0 scenario prep work is to be completed the
night before your scheduled simulation experience, due by 2359.
“Postpartum Hemorrhage” ATI Real Life RN Maternal Newborn 3.0 scenario. To access
>My ATI > Apply tab > Real Life RN Maternal Newborn 3.0 card > Postpartum
Hemorrhage. Student must earn a ‘Strong’ or ‘Satisfactory’ score. Download your report
and upload the document into Canvas the day before your scheduled simulation by 2359.
Answer the following questions and submit into Canvas the day before your scheduled
simulation by 2359. This is your “ticket” into the nursing simulation lab.
1. What is the Bishop Score? How do you determine the score and what does the score
mean?
2. What medications can be used for the induction of labor?
3. Identify potential causes of fetal heart rate decelerations?
a. Late decelerations:
b. Early decelerations:
c. Variable decelerations:
4. What interventions should the nurse perform when fetal heart rate decelerations occur?
a. Late decelerations:
b. Early decelerations:
c. Variable decelerations:
5. What is normal blood loss for a vaginal delivery? For a cesarean delivery?
6. Identify risk factors for postpartum hemorrhage.
7. What medications are used for the management of postpartum hemorrhage? What
mechanical methods can be used?
Labor & PP Simulation Pre-conference
PowerPoint
A PowerPoint presentation reviewing labor and postpartum nursing care will be used. This
information will have previously been discussed in the didactic portion of the course. This
PowerPoint presentation should be a review for the student.
Clear and Muddy Points Activity
This will occur after the review of labor and postpartum nursing care PowerPoint presentation
and before the simulation scenario occurs. This activity will ask the students to write their
clearest point on labor and postpartum nursing care, and their muddiest, or most confusing point
on labor and postpartum nursing care. The clear and muddy points will be handed to the nursing
faculty members and reviewed before the simulation begins. The nursing faculty members can
use this time to clarify areas of confusion for students.
Pre-simulation quiz
A quiz will also quickly assess if the student is well-prepared for the labor and postpartum
simulation. This five question quiz will be given after the review PowerPoint presentation and
before the simulation scenario occurs. The student will not be able to reference their notes for
this quiz, however, it will not be graded. The student should use this short quiz to gauge their
level of preparedness for the simulation, and then review any areas of concern.
L&D and PPH Simulation
For the labor and delivery and postpartum simulation scenario you will take care of a laboring
patient through all stages of labor, delivery, and postpartum recovery. You will have to read the
electronic fetal heart rate monitor and perform appropriate interventions to ensure adequate
oxygenation and perfusion to the fetus. You will also assess the mothers’ response to labor and
pushing efforts. In the postpartum period you will make the appropriate assessments to rule out
or identify high risk situations. You will provide care during a postpartum hemorrhage; including
implementing treatments, administering medications, and notifying the provider.
Required Simulation Tasks
Monitor EFM and make appropriate changes in maternal positions, IV rate, Pitocin infusion, and
oxygen administration.
Provide support and guidance during pushing efforts.
Perform fundal checks and fundal massage (if necessary).
Perform postpartum assessments.
Identify postpartum hemorrhage.
Continue to massage the fundus.
Take vitals.
Perform an assessment.
Identify risk PPH factors for Rochelle.
Weigh the chux pads for quantitative blood loss (QBL).
Call the provider for orders.
Explain what is occurring and what treatments and medications will be administered.
Administer Oxytocin (Pitocin) 30 units in 500 mL NaCl 0.9% at 500 mL/hr.
Administer methylergonovine (Methergine) 0.2 mg IM, if blood pressure is not elevated.
Administer carboprost (Hemabate) 250 mcg IM and/or misoprostol (Cytotec) 1000 mcg PR
and/or tranexamic acid 1000 mg in 100 mL NS IV over 10 minutes; if needed and not
contraindicated.
Continue vigorous fundal massage.
Insert Foley catheter.
Administer O2 via nasal cannula.
Start 2nd IV site if estimated blood loss is over 1000 mL.
Take vital signs, including O2 saturation and LOC, every 5 minutes until stable, then every 15
minutes for 1 hour.
Explain what occurred, the potential cause, and what to expect.
Keep patient warm.
Order a type and screen, if not previously ordered, and repeat CBC.
Obtain blood transfusion consent if ordered.
Monitor vital signs and I&O hourly.
Prepare a handoff report for your patient using the SBAR tool.
Perform these actions while providing patient centered care and allowing bonding and respecting
the wishes of the mother and father.