I am an RN working L&D in Ontario. Had a mom that was postpartum day 3, had been induced for post dates, pit drip, epidural and vac delivery, hgb 71, slightly hypotensive, breastfeeding ok, baby had apgars 9&9, voiding and stooling ok; however last one was dark, jaundiced, otherwise asymptomatic. One day bili 170, next day bili 284 which indicated phototherapy. We r a level 1 so no pediatrician. Pt was originally looked after by midwife until transfer of care for induction, augmentation, vac delivery, etc. but still responsible for baby. Upon hearing bili is high she says sge will call level 2 for consult. When I ask her if she is going to consult pt's family doc who has priveleges at our facility, she says, why would I and was super mad. I am having trouble finding info via Ontario college of midwives and/or our hospital protocol on this. Anyone have any thoughts? I thought midwives only cared for well and/or normal moms and babes?!?
Jun 8, '12
Midwives in Ontario only consult for jaundice within first 24 hours or pathological jaundice. She wouldn't need to consult in the case you've mentioned.
There's a full list of consult guidelines on the CMO's website. Generally midwives are very conscientious about consulting when required.