OB Rules of the Game

Obstetrics: Appendix A

Each resident is supplied with an OB manual (white 3 ring binder). This manual is updated annually by the maternal child coordinator. The manual contains policies and procedures for the care of Obstetrical patients both in the FMC and the hospital as well as reading assignments regarding obstetrical care. It is the residents' responsibility to be familiar with the information in the OB manual. The highlights of the policies and procedures are below:

  1. When an obstetrical patient is admitted, a resident needs to do a history and physical at the time of admission. This should not be different from any other type of admission.
  2. Although FMC patients are assigned to various faculty and residents, they are all patients of the UNR Family Medicine Clinic. The physician caring for an obstetrical patient needs to be notified of their patient's admission and at that time can communicate to the on-call person or family practice inpatient resident if they will be able to participate in the patient's care and delivery. If the patient's family physician is unable to attend the delivery, it is the responsibility of the on-call team or inpatient team to care for the patient.
  3. When patients are in labor, the resident is expected to actively manage the care of the patient. A progress note should be documented in the patients chart at least every two hours and after any procedures, significant events or change in management plan.
  4. When patients are in active labor (4 to 5 cm or rapidly changing cervix), a resident and/or faculty member should be at the hospital from that time until the patient's care is completed. If a resident is in house with a patient, the faculty should again be notified when the patient's cervix is dilated to 8 cm for nulliparous or 6 cm for parous patients.
  5. Scheduled inductions should be done when adequate staffing is available, and the hospital attending has been consulted. If a physician needs to schedule a patient for induction and they cannot personally care for the patient during this procedure, they must notify either the on-call or inpatient team to make arrangements with them.
  6. When a patient is undergoing induction or augmentation, a resident or faculty member must be present. Ideally, the patient's family physician should monitor them during an induction/augmentation but if this is not possible, then weekends and nights would be covered by the on-call resident, weekday mornings by the inpatient family practice team and weekday afternoons by the inpatient attending unless that attending makes other arrangements for the inpatient resident to see their clinic while the inpatient resident stays in the hospital.
  7. Prostin gel inductions will be done in house on patients except in unusual circumstances. When these patients develop an active labor pattern, the same rules for resident or faculty in house supervision will apply as for other OB patients.
  8. If you need a formal OB consult on a patient, it should be made clear that you want a formal consult and it should be done only after the case is discussed with the family medicine attending.
  9. For any non-stress tests, biophysical profiles or scheduled inductions, you need to let the on-call resident or inpatient resident and labor and delivery know prior to the patient arriving.
  10. If an FMC patient requires a C-section, the attending and resident should serve as first assistant with the attending in the operating room. This way, we will be able to participate in our patient's care, gain increased C-section experience for our residents and be able to bill for our first assistant fees.
  11. All walk-in patients (those who have either no prenatal care or have had prenatal care elsewhere and their doctor is not on staff) are to be evaluated by residents. Many need to be evaluated, treated and sent home with prenatal labs done and an appointment with The Pregnancy Center.

Rev: 6/4/13