Check BP, pulse (may be WNL)
Palpate fundus (boggy)
Massage uterus (was a pain 3/10 but goes up to 7/10 when they massage)
 

II. Peri-Pad and blue pads are saturated

   Patient: “_Estoy mojada, muy mojada. ?Qué pasa?   ”

 

   Critical Interventions:

Call for help (and interpreter if not done before, - on the way…)
Notify docs/midwife
Massage uterus   “ !Ay ay ay! !No! !Me duele, me duele! Quiero ver a mi familia. ”
Start large bore IV with Lactated Ringers (2nd IV may be necessary)
Preload with 1000ml
Clearly explain the situation to the patient/significant others at the appropriate level “ ?Es necesario? ”
Request that infant be sent back to the nursery
Anticipate medications/check standing orders:
oxytocin (Pitocin) (dosage, route, precautions)
cytotec  (dosage, route, precautions)
methylergonovine maleate (Methergine) if not hypertensive (dosage, route, precautions)
or Hemabate if she does not have a history of asthma (dosage, route, precautions)
Set up BP cuff & pulse oximeter
Continue to assess bleeding
Labs:  Hgb, type & screen (hold for cross-match) (are patients are typed before admission?)
 

III. While the staff is occupied with the mother, an unidentified person in a lab coat/scrubs enters the room and wheels the baby out in the basinet.

 

   Critical Interventions:

Prevents removal of infant unless person in lab coat/scrubs is appropriately identified
 

If they allow the infant to be removed, a few minutes later, a nursery staff member comes to the room to offer help: “I heard you are really busy in here, I can take the baby back to the nursery”.

   Critical Interventions:

Recognize that there has been a potential infant abduction
Call an infant abduction code
Staff move to appropriate doorways/lock down.