Guidelines for Family Practice Resident and Attending Staffing for Labor and Delivery at HUP

(reviewed Feb 2005 PFC OB Group)

Mission: To provide high quality family centered maternity care to the patients of Penn Family Care, Health Annex and Covenant House and to provide a high quality educational experience in Family-Centered Maternity Care for the University of Pennsylvania Family Practice Residents.

Obstetrical Situations

1. Active 1st Stage of Labor (Regular Contractions and cervix more that 5 cm dilated)
1. Resident must be on the labor and delivery floor to monitor patient
2. Attending must be at HUP and immediately available
2. 2nd and 3rd Stage of Labor (pushing and delivering)
1. Resident and attending must be on the labor and delivery floor (preferably in the room with the patient)
3. Early 1st Stage of Labor (Regular contractions but less than 5cm)
1. Resident must be at HUP and immediately available (should be on labor floor unless patient duties dictate limited time in other parts of HUP, examples would be rounding on postpartum or medicine floors)
2. Attending must be easily available by phone and able to immediately come to HUP if necessary
4. R/o labor evaluation
1. Resident see call guidelines for when to come in.
2. Attending needs to be available by phone.
5. Preterm labor
1. Resident must be on labor floor if patient is contracting and not stabilized (shown to be progressing and/or tocolytics are being started)
2. Resident may leave labor floor (but must stay in HUP) if patient is contracting and stable or is on tocolytics and on labor and delivery
3. Attending must be in HUP and immediately available if patient is unstable (contracting and progressing)
6. Induction with Cervidil
1. Resident must be on labor and delivery for initial evaluation and placement of Cervidil and for 2 hours after placement.
2. Resident may be in HUP or nearby (such as Presby) but must be immediately available after the initial 2 hours and must have regular contact and communication with the patient’s nurse.
3. Attending must be available by phone and able to immediately come to HUP.
4. If patient develops complications (non-reassuring tracing, hyperstimulation, etc.) the resident must be on labor and delivery and notify attending
7. Induction with Pitocin
1. Resident must be in HUP once pitocin started and follow the guidelines for 1st stage of labor as above.
2. Attending must be in HUP once Pitocin is started
8. Preeclampsia Postpartum (on MgSO4)
1. Patient must be evaluated no less frequently than every 4-6 hours. Resident should remain in house as for eary 1st stage patients above.
2. If patient is stable, attending may be out of hospital (in call range).
9. Infection Postpartum (On antibiotics)
1. If patient is stable and on S8 or R9, resident may be within call range (see resident call guideline) but must be able to return immediately to HUP if necessary.
2. Attending must be in call range (or sign out to person on call).
10. Preterm Pyelonephritis (admitted to HUP)
1. If stable, resident may be in call range.
2. Attending may be in call range.