Midwife Nurse Midwifery Mount Sinai Hospital Per Diem Days

The per diem Midwife is responsible for the primary care and management of patients health including obstetric and gynecological care. Both low risk and high-risk pregnancies are managed as outlined within practice guidelines. Develops and supports excellence in the clinical practice and patient care. Maintains the Maternal Child Health Services mission philosophy and policies as well as the standards and practices of the Medical Center.

1. The midwife performs functions as an integrated member of the Department of OB/GYN and Nursing. The midwife will: Coordinate prenatal care to the caseload of patients in the ambulatory care setting.

2. Take pertinent history. Perform physical & pelvic examination. Obtain laboratory and diagnostic tests. Provide counseling & teaching as needed.

3. Identify risk factors and develop appropriate plan of management. Manage the care of selected patients admitted to the inpatient unit-based on unit protocols and with the collaboration of the attending physician.

4. Obtain physician consultation for plan of management for any medical or obstetrical complications not addressed in departmental protocols. Performs functions as identified in the Midwife Scope of Practice.

5. Provide Intra-partum Care as follows: Evaluate the status of labor and admits patient to the labor floor. Perform admission physical examination.

6. Perform venipuncture and starts intravenous infusions if nursing staff is unavailable. Obtain laboratory and diagnostic tests & evaluates results. Evaluate the progress of labor by vaginal examination. Make decisions regarding ambulation of the patient during labor. Request conduction anesthesia.

7. Perform amniotomy as indicated. Apply external fetal monitor & tocodynamometer. Apply internal fetal scalp electrode & pressure catheter. Evaluate fetal monitor tracing & consults with physician if abnormalities are present. Make decisions regarding the position(s) of the patient during second stage of labor. Make decisions regarding performance of delivery in the birthing room or transfer to the delivery room.

8. Utilize local infiltration or pudendal block. Perform & repairs episiotomies. Conduct spontaneous deliveries of cephalic presentations. Obtain specimen of cord blood for cord gases when appropriate. Manage the third stage of labor. Perform cervical & vaginal inspection. Repair minor vaginal & perineal lacerations. Take responsibility for the management of the uncomplicated patient in recovery room.

9. Decide when the normal infant should be transferred to the nursery. Request attendance of pediatrician at delivery when neonatal problems are anticipated. Order intermittent fetal monitoring based on patients risk status. Perform immediate appraisal of the newborn. Perform newborn physical examination. Sign birth certificate of delivery (operative delivery requires physician signature). Coordinate patient care in triage room on L&D. Attend and participate in L&D board rounds.

10. Participate in the care of patients during labor & delivery in consultation with attending physician: Perform prostaglandin insertions for cervical ripening. Manage Oct(s) after evaluation of the patient by the physician. Insert intrauterine pressure catheters. Perform & monitor amnio infusion. Monitor patient on IV oxytocin & regulates oxytocin infusion for induction or stimulation of labor following the initial stabilization & monitoring of the patient by the physician. Conduct spontaneous deliveries of these patients under supervision of the attending.

11. Manage the labor & conduct the deliveries of patients who have been approved by the physician for vaginal birth after cesarean section (VBAC). Repair cervical or extended vaginal lacerations under the supervision of the attending. Repair third & fourth degree extensions under the direct supervision of the attending. Participate as first assist on C-sections and/or BTL. Insert Foley catheter bulb for induction of labor. Perform misoprostol (Cytotec) insertions for labor induction. Order appropriate drugs to treat hemorrhage during third stage of labor per department policy for Post-Partum Hemorrhage. Manually remove placenta. Perform exploration of uterus. Perform selected patient high risk delivery at discretion and under the supervision of the physician.

12. Provide postpartum care as follows: Make daily rounds examine patients orders & interpret laboratory results diagnostic tests & monitor the postpartum course. Provide postpartum teaching & counseling. Prepare patients for postpartum bilateral tubal ligations. Manage patients who have had cesarean sections or postpartum bilateral tubal ligations based on unit protocols & under the supervision of the attending physician. 1) Write medication & non-medication orders 2) Remove surgical sutures & staples Perform fever work-ups for patients with postpartum febrile morbidity as per unit protocols & consults the physician for management assistance. Make appropriate discharge plans. Obtain physician consultation for plan of management for any medical or obstetrical complication. Obtain informed consent for circumcision of male infant.

Education Requirements See Attached for Additional Detail

Masters degree in nursing preferred.

Education Requirements See Attached for Additional Detail

Masters degree in nursing preferred.

Experience Requirements

Evidence of completion of a Pharmacology course passing the examination & receiving authorization to issue prescriptions pursuant to Section 6951 (2) of the NYS Education Law.

Demonstrate clinical experience related to obstetrics and the care of women & children.

Licensing and Certification Requirements (if applicable)

License: CNM Issuing Agency: DOH/Office of Professions

Name: Basic Life Saver (BCLS) Issuing Agency: AHA

Certification: NRP (Labor and Delivery NICU dept)

Certification: ACLS (in ED; PACU/ASU; ICUs; Telemetry Units; SDU; IR Interventional Cardiology (CCL/EP/Echo); L&D; Endoscopy and APN Adult Oncology

Collective bargaining unit: NYSNA-MSH