Notes for Applied Health Sciences in Maternity Care (AHS)

Overview

  • Course title: Applied Health Sciences for Maternity Care Providers (MIDW 103, 2025)
  • Scope: Provides an overview of fundamental concepts in biochemistry, physiology, immunology, and microbiology within health and pregnancy contexts.
  • Application: Highlights how these concepts apply to clinical care across pregnancy, birth, postpartum, and the newborn stage.
  • Supplemental context: Includes perinatal testing guidelines, records, and laboratory standards relevant to midwifery practice.

Course Structure

  • Readings on topic outline
  • Weekly tutorials: recordings and PowerPoint slides within Canvas modules
  • Assessments: assignments, midterm exam
  • Practical components: Newborn lab test assignment and presentation
  • Participation expected

Foundational Topics in Course Structure

  • Perinatal Services BC Testing Guidelines
  • The Antenatal Record
  • BC College of Registered Nurses and Midwives (BCCNM) standards
  • Foundational lectures:
    • Immunity in pregnancy
    • The amazing placenta
    • Genetics
  • Tests: behind the requisition (conceptual): understanding what tests mean beyond the paperwork

British Columbia Antenatal Record Part 1

The Part 1 section collects comprehensive baseline information and health history. The fields are organized as numbered items with details as shown below.

  • 1. Primary maternity care provider name
    • Fields to capture: Surname, Given name, Patient surname, Patient given name(s), Date of birth (dd/mm/yyyy), Age at EDD, Address, Surname at birth, Preferred name/pronoun, Language preferred, Relationship status, Highest level of education completed, Occupation, Phone number, Indigenous identity (First Nations, Métis, Inuk), Status (Non-status, Live on reserve, etc.), Ethnicity*, Personal Health Number, Partner information (Surname, given name(s), Occupation, Ethnicity), Biological father/donor details (Surname, given name(s) or Same as partner), Age, Relationship to the baby, Live on/off reserve.
  • 2. Allergies incl. reaction
  • 3. Contraceptives: Type; Last used (dd/mm/yyyy); None; Medications/OTC drugs/herbals/vitamins (examples include Preconception folic acid, T1 folic acid); Pregnancy planned; LMP (dd/mm/yyyy); EDD by LMP (dd/mm/yyyy); Dating US (dd/mm/yyyy); GA by US (wks/days); EDD by US (dd/mm/yyyy); Options for pregnancy planning: No/Yes.
  • 4. Obstetrical History
    • Details collected: Gravida, Date, Place of birth (mm/yyyy), GA (wks/days), Term status, Duration of labour (hrs), Preterm, Abortus (Induced/Spontaneous), Living, Mode of birth, Perinatal complications/comments, Sex of birth, Birth Breastfed, Weight (kg or g, age in months for breastfeeding status), Child's present health
  • 5. Present Pregnancy
    • Variables: No/Yes (specify), ART: (select one only) Ovarian stimulation only; IUI only; Ovarian stimulation + IUI; IVF (of embryos transferred)
  • 7. Medical History
    • No/Yes (specify) for categories like Surgery, Anesthetic complications, Neuro, Resp, CV (hypertension, prev. hypertension in pregnancy), ICSI (of embryos transferred), Abdo./GI, Gyne./GU, Bleeding, Nausea, Travel, Infection/rash/fever, Other, Hematology (transfusion, thromboembolism/coagulation), etc.
  • 8. Lifestyle/Social Concerns
    • No/Yes (specify) for Diet/nutrition, Exercise, Financial, Housing/food security, Transportation, Safety, Gender-based violence (Partner/Non-partner), Relationships/support, Other
  • 9. Substance Use
    • Alcohol: 3 Months Before Pregnancy; During Pregnancy; No/Yes
    • Cannabis: routes (Primary route options: Smoke, Vaporize, Edible/oral, Other); Quit cannabis: No/Yes, date
    • Other substances: Cocaine, Opioids, Methamphetamines, Other; # Times used per day/week/month
    • Tobacco: No/Yes; # cigarettes per day; Exposed to second-hand smoke: No/Yes; Quit tobacco: No/Yes, date
    • Methadone, Suboxone treatment, CBD products only; 2nd substance use details
    1. Family History
    • No/Yes (specify) for Anesthetic complications, Hypertension, Thromboembolic disease, Diabetes, Mental health issues, Substance use disorder, Inherited conditions/defects (examples: Tay-Sachs, Sickle Cell, Congenital Heart Defect, Cystic Fibrosis) for Mother and Biological father/donor, Other
    1. Initial Physical Examination
    • Date (dd/mm/yyyy)
    • Blood Pressure (BP), Heart Rate (HR per min), Norm/Abnorm findings; Lymph/head & neck, Breasts & nipples, Heart & lungs, Abdomen, Musculoskeletal; Height (Ht in cm)
    • # Drinks per week; Endocrine: T1DM, T2DM, Prev. GDM, Thyroid, Other
    • 4 or more drinks at one time (risk factor)
    • Tobacco/Alcohol cessation history; Mental health: Anxiety, Depression, Prev. PPD, Bipolar; #Cigarettes per day; Eating disorder; Substance use disorder; Exposure to second-hand smoke; Quit tobacco: date
    • Immunizations: Flu (date), Tdap (date), Other
    • Primary route of substance use: Smoke, Vaporize, Edible/oral, Other
    • Others: STI test (dd/mm/yyyy), Pap test (dd/mm/yyyy), Other
    • *Note: A reference page provides guidance and discussion topics.
    1. Comments/Follow-up (incl. details from sections 5-10)
    • Care provider (signature): MD/RM/NP

British Columbia Antenatal Record Part 2

    1. Planned place of birth @ 20 wks and @ 36 wks
    • Referral hospital; Surname, Given name, Address; Confirmed EDD (dd/mm/yyyy); US IVF details; Copy to hospital
    1. Investigations
    • Date (dd/mm/yyyy); Antibody Titre; Date RhIg given (dd/mm/yyyy); Hemoglobin (g/L); ABO; Rh factor; T1, T3; Results; Follow-up/Comments; Phone number; Postpartum vaccine required; Personal Health Number; Syphilis; HBV DNA; HBsAg; Anti-viral therapy required; Newborn vaccine required; Newborn HBIg required; 15. Ultrasounds & Other Imaging Investigations (Date, GA, Comments)
    • Gonorrhea/Chlamydia (Neg/Pos; T3 repeat if Pos); Urine C&S (Neg/Pos); Culture; GDM screening at 24-28 wks; GCT (50g) and 1 hr post-load; GTT (75g) with 0 hr, 1 hr, 2 hr values; Value (mmol/L) at 1 hr
    1. Edinburgh Perinatal/Postnatal Depression Scale*
    • Date; GA (wks/days); Total score; Anxiety subscore (questions 3-5); Follow-up
    1. Perinatal Considerations & Referrals
    • Pregnancy type: Singleton, Twin, Multiple
    • GBS (35-37 wks): Neg/Pos; Other labs (Ferritin, TSH, HepC) with Value and Date
    • Copy to hospital
    • VBAC eligibility @ 36 wks; VBAC planned @ 36 wks; Plan to breastfeed: No/Yes/N/A
    • Prenatal Genetic Investigations: SIPS, IPS, Quad; Results; CVS/Amnio; Declined; Self-harm subscore (Q10); NIPT MSP or self-pay; Other
    1. Date (dd/mm/yyyy); GA (wks/days); Urine BP (if indicated); Weight (kg); Fundus (cm); FHR (per min); FM; Presentation & position; Lifestyle/substance use; Pregnancy, Labour & birth, Breastfeeding, Postpartum, Contraception plan, Newborn
    1. Sign-Offs
    • 1. Name; 2. Name; 3. Name; Comments*; Next visit; Initials; Signature lines for multiple providers (MD/RM/NP)
  • PSBC reference: PSBC 1905 January 2020; Perinatal Services BC contact details

Screening and Diagnostic Tests: Standards, Limits, and Conditions for Registered Midwives

  • Scope: Standards, limits, and conditions apply to screening and diagnostic tests ordered, collected, and interpreted by midwives within their scope
  • Nature of standard: Inclusive list of general standards plus test-specific limits/conditions; adherence mandatory
  • Lab testing access:
    • Midwives may order labs for clients admitted to hospital
    • Midwives may refer clients to fee-for-service outpatient labs
    • MSP guidelines referenced for current lab reference schedule and fee codes
  • References and ranges:
    • Both standardized and typical reference ranges may be included; typical reference range is a guideline; laboratories may have different reference norms
    • If reference range is not on the report, consult local lab pathologist
  • Decision-making: Clinical decisions should be based on local reference ranges when they differ from the guideline ranges
  • For more information: Link to MSP midwives lab resources provided in the document

Laboratory Requisition (Lab Requisition) Overview

  • Document format: MSP billing at top; patient label; patient DOB; PHN; Sex; Current medications; Ordering midwife; MSP number; Signature/date
  • Patient status: Pregnant (Yes/No); RM/NP/MSP number; Date/time of diagnosis and indications for guideline protocol
  • Time-sensitive orders: Indicate times and pre-test requirements (e.g., fasting collection)
  • Test categories (with examples):
    • HEMATOLOGY: Hematology Profile (Hgb, Hct, RBC indices, WBC, platelets, differential when indicated); Ferritin; Hemoglobin only
    • CHEMISTRY: Serum beta-hCG (pregnancy test); TSH, free T4 if abnormal; Glucose (Random); Hemoglobin A1C; GDM screen (50g, 1 hr post-load); OGTT (75g with 0/1/2 hr); Serum B12
    • MICROBIOLOGY: Proper labeling of specimens with patient name, DOB, PHN; Urine testing; Chlamydia & Gonorrhea urine; Amies swab; Group B Streptococcus; Yeast/BV/Trich culture; CT & GC swabs; Herpes culture if applicable
    • SEROLOGY: Syphilis screen; HIV serology (nominal); Anti-HCV; Rubella IgG; HBsAg; HIV serology with nominal vs non-nominal reporting; VZV IgG; Parvo B19 IgG/IgM; Toxo IgG/IgM; CMV IgG/IgM; Herpes IgG/IgM; Rubella IgM; VZV IgM; Parvo B19 IgM; Toxo IgM; CMV IgM; Herpes IgM
    • NEWBORN: Newborn screen; Serum bilirubin (with frequency for repeats)
    • ADDITIONAL TESTS & INSTRUCTIONS: Standing orders with expiry and frequency; Date & signature
  • Instructions for the lab:
    • This requisition can be taken to any lab in British Columbia (hospital outpatient labs, Lifelabs, BC Bio)
    • Reference resources: MSP lab resources listing labs and locations
  • Electronic/Signature: Requisition is electronically signed; date recorded

Practical Notes on Data Entry and Test Management

  • Labeling: All specimens must be labeled with patient’s first & last name, DOB and/or PHN, and site
  • Documentation flow: Fill out sections consistently; ensure required sections (date, physician, patient identifiers) are completed
  • Follow-up: Document results, interpretation, and any follow-up or referrals in the appropriate sections (e.g., Investigations, Sign-Offs, Follow-up plans)

Quick Reference: Additional Activity

  • Page 10 activity: Introductions exercise
    • Task: Introduce yourself in four words: first and last name, current location, and favorite plant