Course Syllabus ©National College of Midwifery 2012
01/2012
Course Title: Newborn Diagnostic Lab Tests & Procedures
Credits: 0.5
Course Description: This course examines diagnostic tests commonly used during the
neonatal period. Student will learn what the community standards regarding the indications for,
administration of and the risks/benefits of bio-technical screening techniques. Emphasis is
placed on understanding normal lab values in the healthy newborn and the significance of
abnormal test results. This course uses current research in midwifery and obstetrics to
broaden the student’s understanding of the following NARM skills and MANA core
competencies learned under clinical supervision:
NARM Skills
I. Midwifery Counseling, Education and Communication
(7)-I G. Applies the principles of informed consent
(8)-I H. Provides individualized care
(9)-I I. Advocates for the mother during pregnancy, birth and postpartum
(19)-I J 10. Newborn care including normal/abnormal newborn activity, responses, vital signs,
appearance, behavior, etc
II. General Healthcare Skills
(21)-II A. Demonstrates Universal Precautions
(22)-II B. Demonstrates the application of OSHA regulations as they relate to midwifery
workplace
(23)-II C. Demonstrates the application of aseptic technique
II D. Demonstrates the use of instruments and equipment including:
(28)-II D 5. Cord clamp and/or cord tape
(34)-II D 11. Lancets
(37)-II D 14. Needle and syringe
(47)-II D 24. Vacutainer/blood collection tube
VII. Well-Baby Care
(149)-VII A. Provides well-baby care 2-6 weeks
MANA Core Competencies:
I. Guiding Principles of Practice.
The midwife provides care according to the following principles:
1 H. Midwives recognize the empowerment inherent in the childbearing experience and strive
to support women to make informed decisions and take responsibility for their own well-being.
1 J. Midwives synthesize clinical observations, theoretical knowledge, intuitive assessment and
spiritual awareness as components of a competent decision making process.
1 K. Midwives value continuity of care throughout the childbearing cycle and strive to maintain
continuous care within realistic limits.
II. General Knowledge and Skills
The midwife provides care incorporating certain concepts, skills and knowledge from a
variety of health and social sciences including, but not limited to:
2 C. Community standards of care for women and their developing infants during the
childbearing cycle, including midwifery and bio-technical medical standards and the rationale
for and limitations of such standards
2 M. The ability to develop, implement and evaluate an individualized plan for midwifery care.
1
Course Syllabus ©National College of Midwifery 2012
01/2012
2 N. Woman-centered care, including the relationship between the mother, infant and their
larger support community.
2 O. Knowledge and application of various health care modalities as they apply to the
childbearing cycle
IV. Care During Labor, Birth and Immediately Thereafter
The midwife provides health care, support, and information to women throughout labor,
birth and the hours immediately thereafter. She determines the need for consultation or
referral as appropriate. The midwife uses a foundation of knowledge and/or skill which
includes the following:
4 B. Parameters and methods for evaluating maternal and fetal well-being during labor, birth
and immediately thereafter, including relevant historical data.
4 L. Understanding of and appropriate support for the newborn's transition during the first
minutes and hours following birth.
VI. Newborn Care
The entry-level midwife provides health care to the newborn during the postpartum
period and support and information to parents regarding newborn care. She determines
the need for consultation or referral as appropriate. The midwife uses a foundation of
knowledge and/or skill which includes the following:
6 A. Anatomy, physiology and support of the newborn’s adjustment during the first days and
weeks of life
6 B. Parameters and methods for evaluating newborn wellness including relevant historical
data and gestational age.
6 D. Community standards and state laws regarding indications for, administration of, and the
risks and benefits of prophylactic bio-technical treatments and screening tests commonly used
during the neonatal period.
6 E. Causes of, assessment of, appropriate treatment and emergency measures for neonatal
problems and abnormalities.
Learning Activities:
A. Student reads appropriate sections from the Learning Materials/Resources.
B. Student answers the questions listed in the Learning Objectives by researching the
Learning Materials/Resources for the course and correctly cites the sources and page
numbers for each of their answers.
C. Student presents answers the questions listed in the Learning Objectives for review by
preceptor.
D. Student participates in preceptor elaboration/discussion of Learning Objectives.
E. In the case that the required texts are more than 5 years old, the student must research,
prepare & present a summary of current best midwifery care/practices appropriate to a
topic covered in this course from a current journal article/study, less than 5 years old.
2
Course Syllabus ©National College of Midwifery 2012
01/2012
F. Recommended Role-playing and/or Clinical Interactions
Note: The clinical requirement of NARM /Clinical Skills is completed at any time
throughout the ASM apprenticeship during actual clinical practice and is NOT a
requirement to complete this academic course.
Activities specific to NARM skills learned in this section:
1. Talk through or role play collecting cord blood at birth and ordering the
direct coombs, type and Rh. Practice filling out a lab requisition form for
these tests.
2. Talk through or role play collecting a newborn specimen for the newborn
metabolic screen. Role play educating the parents about newborn
metabolic screens.
3. Talk through or role play collecting a glucose screen on a newborn.
Practice collecting and analyzing the glucose of another student or your
instructor if you have a glucometer available.
4. On all of the above practice sessions, be sure to include how you would
demonstrate universal precautions while drawing blood samples.
5. Observe blood culture testing of a newborn in a hospital newborn
intensive care nursery.
Learning Materials / Resources:
Please use textbooks less than 5 years old or most recent edition.
1. Frye, Anne. Understanding Diagnostic Tests in the Childbearing Year: A Wholistic
Approach. 7th edition. Labrys Press. 2007
2. Johnson, Ruth and Taylor, Wendy. Skills for Midwifery Practice. Second edition.
Elsevier Churchill Livingston. 2006.
3. Weaver, Pam and Evans, Sharon K. Practical Skills Guide for Midwifery, 4th Edition.
Morningstar Publishing Co. Wasilla. 2007
4. Thureen, et al. Assessment and Care of the Well Newborn. 2nd ed. Elsevier Saunders.
2005.
5. Fraser, DM, et al. Myles Textbook for Midwives. 15th ed. Churchill Livingstone Press.
2009.
6. Davis, Elizabeth. Heart and Hands: A midwife’s guide to pregnancy and birth. 4th
Edition. Celestial Arts Press. 2004
3
Course Syllabus ©National College of Midwifery 2012
01/2012
7. Varney, Helen. Varney’s Midwifery. Fourth edition. Jones and Bartlett Publishers. 2004
8. MEAC Abbreviated NARM Skills Form.
9. MANA Core Competencies for Midwives
10. Midwives Model of Care®.
11. Students must find 1 article/study less than 5 years old. Recommended internet links
as needed for latest developments in midwifery care:
The Cochrane Collaboration
EBSCO
National Library of Medicine
PubMed
Medline
SCIRUS
Medscape
World Health Organization
Evaluation Tools / Methods:
Minimum passing grade for each course is a cumulative 80% / B-. Students and preceptors
are encouraged to work together until the student masters the information.
Final grade for the course is based on preceptor evaluation of the following:
A. Learning Objectives count for 80-90% of the final grade.
The preceptor evaluates each answer based on three elements:
1. Answers should reflect a thorough review of current literature regarding best
current practices in midwifery care.
2. Each answer should be formed in the student’s own words or paraphrased
from the text. The answer should be minimal, not a re-write of the entire text,
but enough to show appropriate comprehension of the learning objective.
3. Student identification of sources and page numbers for each of the Learning
Objectives. (Preceptor should do a random check to determine that sources
cited are correctly identified.)
B. Summary of current journal article / study counts for 10% of the final grade in the case that
other scholarly resources used are more than five years old.
C. Exam counts for 10% of the final grade.
Course credit:
One Academic credit equals approximately 15 hours of formal time plus 30 hours of additional
study or homework. Formal time is defined as the amount of time taken to answer the Learning
Objectives to the level of 80% and to complete any learning activities to the preceptor's
4
Course Syllabus ©National College of Midwifery 2012
01/2012
satisfaction, including any time spent face to face with the preceptor. Informal time includes
any time spent actively reading relevant sources and textbook/s, researching Learning
Objectives, and studying for examinations.
Learning Objectives:
A. The student must research, prepare & present a summary of an aspect of current best
midwifery care/practices appropriate a topic from this course from a current journal
article/study.
B. Student answers the questions below and cites the sources and page numbers.
1. Define PO2, PCO2, pH, and base excess.
2. Describe what the expected acid/base balance should be in the normal newborn and
why.
3. Describe the occasions when acid/base balance in the newborn should be checked and
why.
4. Discuss the actions that can be taken to correct metabolic and respiratory acidosis.
5. Describe the occasions when newborn hemoglobin/hematocrit should be checked and
why. How is the test performed?
6. Discuss the expected fluctuations in the neonate's hematocrit from the 10-minute-old
term newborn, to the 1 hour old, to the 1 week old.
7. How does hematocrit in the term newborn differ from that in the premature newborn and
why?
8. Discuss when it is important to perform a white blood cell count on a newborn.
9. What is the expected normal range of white bloods cells in the newborn?
10. What values would be considered abnormal in the newborn and what is the significance
of this test outcome?
11. Discuss what actions can be taken to correct high hematocrit and low hematocrit.
12. Discuss the expected range of normal glucose levels at birth and how they fluctuate in
the first few hours of extrauterine life.
13. Describe the occasions when glucose levels in the newborn should be tested and why.
14. How is the glucose test performed on the newborn?
15. Discuss the actions that can be taken to correct low glucose levels.
5
Course Syllabus ©National College of Midwifery 2012
01/2012
16. Discuss the purpose of knowing the baby's blood type and Rh. How is this test
performed?
17. Discuss the direct coombs test.
18. What are the expected results of the direct coombs test in a healthy newborn?
19. What is the significance of abnormal results of the direct coombs test?
20. What are the expected bilirubin levels in the first 3-4 days of life?
21. Describe the occasions when bilirubin levels should be checked and why.
22. How are bilirubin levels checked?
23. Describe the actions that can be taken to correct high bilirubin levels.
24. Cite the expected calcium levels in the newborn and when it might be necessary to
determine calcium levels.
25. How is the test performed to check for calcium levels in the neonate?
26. Discuss the purpose of the metabolic screen.
27. Discuss how metabolic screening is performed.
28. Discuss the timing of the metabolic screen and why it is performed twice.
29. Describe in detail the most prevalent neonatal disorder that is screened for with the
metabolic screen.
30. Describe what tests constitute a septic work-up on the newborn.
31. When would septic work-up be indicated?
6