CRITICAL PATHWAY for Intrapartal Stages - cont'd
Category	First Stage	Second and Third Stage	Fourth Stage Birth to 1 Hour Past Birth
Nutrition	Ice chips and clear fluids Evaluate for signs of dehydration	Ice chips and clear fluids	Regular diet if assessments are WNL Encourage fluids Expected Outcomes: Nutritional needs met
Elimination	Voids at least q2h; urine clear, strawcolored, negative for protein Bladder nondistended May have bowel movement Monitor I & 0 with IVs	May void spontaneously with pushing May pass stool with pushing	Voids spontaneously Expected Outcomes: Urinary bladder and bowel function unimpaired
Medications	Administer pain medication per woman’s request	Local infiltration of anesthetic agent for birth by CNM/physician Pitocin 10 units IM, IVP per IV tubing, or added to IV fluids	Continue Pitocin infusion Administer pain medication Expected Outcomes: Comfort enhanced by pain relieving techniques, administration of analgesia agent or an analgesic or anesthetic block
Discharge planning	Evaluate knowledge of labor and birth Evaluate support system and need for referral after birth		Provide information if mother to be moved from LDR room Provide opportunity for parents to ask questions regarding newborn Evaluate knowledge of normal postpartum, newborn care Expected Outcomes: Mother and newborn transferred to low-risk postpartal and newborn care
Family involvement	Identify available support person(s) Recognize possible impact of culture on responses Observe interaction between woman and partner Create moment alone with woman to identify possible abuse Assess current parenting skills	Provide opportunities for woman and support person(s) to watch newborn assessments Perform newborn assessment on mother’s abdomen/ chest if possible	Provide opportunity for parents to be with baby Encourage skin-to-skin contact Darken room to encourage eye-to-eye contact Provide quiet time for new family Parenting: demonstrates early culturally expected parenting behaviors Expected Outcomes: Incorporation of newborn into family Family verbalizes comfort with newborn care