Labour and Delivery Visit Workflow

Purpose

The Labour & Delivery (L&D) visit records the complete birth event in the Immunization Information System (IIS) — from maternal assessment to newborn registration — ensuring the mother–baby linkage and immediate documentation of birth-dose vaccines and Vitamin K.

This page explains how to:

• Start the L&D visit for the mother

• Record maternal vital signs

• Complete the Birth Registration

• Save to generate the newborn barcode and record

• Use the Start Neonatal Visit button to open the baby’s visit

• Verify the mother–child link

• Review the newborn Vaccination Card and Healthy Baby / Child Carepath

• Complete Pregnancy (mandatory for all pregnancies, including live births)

• End the visit and discharge appropriately

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Navigation

From the sidebar, expand Patients → Search.

• Find and open the mother’s View Patient page.

• Click Start Visit.

In Create New Visit, choose Labour & Delivery Visit and click Start Visit.

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Workflow

1

Open the L&D Visit

Confirm the correct facility and session at the top banner.

Panel Overview

• Visit Actions lists all required actions (e.g., Vital Signs, Birth Registration).

• Each line includes Complete / Back-Enter / Remove options.

2

Maternal Vital Signs

Vital signs are automatically part of a Labour & Delivery visit.

Enter:

• Heart Rate, Blood Pressure, Temperature, Respirations

• Review validation indicators (Normal / High / Low) before saving.

Click Complete to save.

If vitals were not obtained (e.g., emergency delivery / equipment unavailable):

• Click Remove beside Vital Signs.

• The system removes the task without asking for a reason, allowing a clean visit close.

Tip – Safe Recording Press Save anytime to preserve data if you step away or the patient is transferred.

3

Birth Registration Event

Choose Add → Birth Registration (or click the Birth Registration line).

Field	Description / Examples
Date & Time of Birth	Exact timestamp of delivery
Delivery Method	Vaginal / Caesarean
Delivery Outcome	Live Birth / Stillbirth
Sex (At Birth)	Female / Male
Multiple Birth	Twin / Triplet
Apgar Scores	1-, 5-, 10-minute
Birth Weight / Length / Head Circumference (HC)	Newborn measurements
Gestational Age (weeks)	Auto-calculated from LMP/EDD if available, else enter manually
BCG 0 & HepB 0	Enter lot numbers + confirm administration
Vitamin K	Tick Given (record batch # if configured)

4

Vaccines and Supplements Given at Birth

Immediately after delivery, the newborn should receive two vaccines and one supplement (recorded in the Birth Registration form).

Name	Timing	Purpose	IIS Field
BCG 0	≤ 24 h	Prevents severe TB forms; ID, left arm	Enter Lot # + Diluent Lot # (if applicable) + mark given
HepB 0	≤ 24 h (≤ 7 d)	Prevents perinatal Hep B transmission; IM, right thigh	Enter Lot # + mark given
Vitamin K	≤ 6 h	Prevents VKDB; 1 mg IM, left thigh	Tick Vitamin K given (record batch # if configured)

If any birth-dose can’t be given (e.g., unstable infant / stock-out), leave unchecked and document reason for follow-up at the newborn visit.

5

Save → Generate Barcode & Newborn Record

Click Save / Complete on the Birth Registration.

• The system creates the newborn record and displays a Barcode (IIS Unique ID).

6

Neonatal Visit (Button)

After saving, a Start Neonatal Visit button appears on the Birth Registration panel.

• Click Start Neonatal Visit to open the Day-0 encounter on the baby’s record.

• Click View to open the linked newborn record without starting a visit.

• The button remains available if you defer starting the visit.

Button State Appears only after the Birth Registration is saved and all required fields are complete. If disabled, complete missing fields and save again.

7

Verify Newborn Record & Mother–Child Link

Use Quick Search → Patients to find the infant by barcode or name.

Confirm:

• Name / Sex / DOB correct

• Mother–child relationship visible under Relatives / Family Members

8

Newborn Vaccination Card & Carepath

From the infant Dashboard, you can verify BCG 0 and HepB 0 are Done and future doses scheduled.

Scroll to Care Pathways / Plans to see automatic enrollment in Healthy Baby / Child Carepath.

9

Pregnancy Completion (Mandatory)

Add this within the same L&D visit to formally close the pregnancy — required for every pregnancy, including live births.

1. From Visit Actions → Add → Pregnancy Completion / Termination.

2. Complete the form fields:

• Outcome of Pregnancy: Live Birth / Stillbirth / Miscarriage / Induced Abortion / Unknown

• # of Pregnancies (Gravida)

• # of Births (Term ≥ 37 wks)

• # of Preterm Births (< 37 wks)

• # of Abortions (Induced & Spontaneous)

• Births – Living

1. Click Complete to save.

Required to Proceed If Pregnancy Completion is not completed, the mother remains flagged as Pregnant and cannot be enrolled into a new ANC Carepath.

After saving, the Active Conditions panel shows Pregnancy Status = Complete, confirming the pregnancy is closed and the patient is marked Not Pregnant.

Dashboard – Before vs After Pregnancy Completion

Before Completion: Active pregnancy visible on dashboard.

After Completion: Pregnancy History updated; status shows Not Pregnant (GTPAL manually updated).

10

End Visit & Discharge (Mother)

Return to the mother’s record and click End Visit.

• Actions Performed: Verify Vitals, Birth Registration, and Pregnancy Completion are done.

• Detected Problems: Review alerts before discharge.

• Discharge Reason: Discharged Home, Admitted Postpartum, Transferred to NICU, Left AMA.

Finalize:

• Cancel → Return without ending

• End Visit → Close and remove from queue

Post-Discharge Carepath Check

After ending the visit, the system checks ANC eligibility. If the mother no longer meets criteria, a confirmation appears to remove her from the ANC Routine Immunization Carepath.

End-Visit & History Examples

End Visit / Discharge modal – shows Birth Registration details + Outcome of Pregnancy.

Visit History entry – records the completed Birth Registration event.

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Clinical Reference – Maternal & Newborn Vital Ranges

Maternal Vital Signs

Measure	Normal Range	Notes
Heart Rate (bpm)	60 – 100	May rise with contractions or pain
Respiratory Rate (breaths/min)	12 – 20	Tachypnea > 24 → review
Blood Pressure (mm Hg)	90/60 – 140/90	≥ 140/90 → rule out pre-eclampsia
Temperature (°C)	36.5 – 37.5	Fever > 38 → investigate infection
SpO₂ (%)	95 – 100	< 94 → oxygen assessment

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Newborn Vital Signs (0 – 28 days)

Measure	Normal Range	Notes
Heart Rate (bpm)	120 – 160	Higher when crying
Respiratory Rate (breaths/min)	30 – 60	Periodic breathing common
Blood Pressure (mm Hg)	60/30 – 80/45	Neonatal cuff required
Temperature (°C)	36.5 – 37.5	Maintain warmth / skin-to-skin
SpO₂ (%)	95 – 100	Check probe placement

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Newborn Anthropometrics (35 – 42 weeks GA)

GA (weeks)	Male Weight (g)	Female Weight (g)
35	2300 – 3350	2200 – 3200
36	2450 – 3500	2350 – 3350
37	2552 – 3665	2452 – 3543
38	2766 – 3877	2658 – 3738
39	2942 – 4049	2825 – 3895
40	3079 – 4200	2955 – 4034
41	3179 – 4328	3051 – 4154
42	3233 – 4433	3114 – 4251

GA (weeks)	Male Length (cm)	Female Length (cm)
35	45.0 – 47.5	44.0 – 46.5
36	46.0 – 48.5	45.0 – 47.5
37	47.0 – 49.5	46.0 – 48.5
38	48.0 – 50.5	47.0 – 49.5
39	49.0 – 51.5	48.0 – 50.5
40	50.0 – 52.5	49.0 – 51.5
41	50.5 – 53.0	49.5 – 52.0
42	51.0 – 53.5	50.0 – 52.5

GA (weeks)	Male HC (cm)	Female HC (cm)
35	31.0 – 32.5	30.5 – 32.0
36	32.0 – 33.5	31.5 – 33.0
37	33.0 – 34.5	32.5 – 34.0
38	34.0 – 35.5	33.5 – 34.5
39	34.5 – 36.0	34.0 – 35.5
40	35.0 – 36.5	34.5 – 36.0
41	35.5 – 37.0	35.0 – 36.5
42	36.0 – 37.5	35.5 – 37.0

System Behaviour Ranges apply automatically once Gestational Age + Sex (At Birth) are entered. Out-of-range values show High (red) or Low (red) flags. Alerts don’t block saving but prompt clinical review.

Head Circumference After Vacuum or Forceps Delivery

Do not finalize the first HC measurement if molding / caput is present. Re-measure after 24 – 72 hours once swelling subsides. Record both: Initial HC and Re-measured HC. If swelling persists or crosses suture lines, assess for subgaleal hemorrhage.

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Stillbirths

When Delivery Outcome = Stillbirth, the Birth Registration form displays a minimal newborn panel for MoH reporting.

Field	Purpose
Sex (At Birth)	Required for sex-disaggregated reporting
Gestational Age (weeks)	Distinguishes preterm (< 37 wks) vs term stillbirths
Birth Weight (grams)	Used for low-birth-weight and perinatal indicators
Apgar Score (optional)	Differentiates fresh vs macerated stillbirths
Delivery Method & Location	For obstetric and facility statistics
Delivery Outcome	Automatically recorded as Stillbirth

System Behaviour

• ❌ No barcode or newborn record is created.

• ✅ Data saved on the mother’s L&D visit → Birth Registration event.

• ✅ Information flows into facility totals and national perinatal statistics.

Clinical & Reporting Guidance Stillbirths (≥ 28 weeks or ≥ 1000 g) count in total births, stillbirth rate, and perinatal mortality rate. These fields must be recorded even though no infant record is created.

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False Labour / No Delivery

If admitted for suspected labour but no delivery occurred, end the visit as No Delivery or Not in True Labour.

Workflow

1. Record observations (e.g., Vital Signs, Assessment, Notes).

2. Set Delivery Outcome = No Delivery / Not in True Labour.

3. Click End Visit.

The system does not create a child record unless a Birth Registration is later added.

If the patient returns and delivers:

• Open the same record → Add → Birth Registration.

• Saving creates the newborn record and barcode as usual.

Tip — Ending an L&D visit for false labour does not lock the record; Birth Registration can be added later if delivery occurs.

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Multiple Births

• Create one Birth Registration per infant.

• Each save generates a unique barcode.

• Confirm all infants link to the same mother.

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Born Before Arrival (BBA)

• Adjust Date/Time to actual birth.

• Record birth-doses if given elsewhere.

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Clinical Guidelines – Apgar Scoring

Component	0 Points	1 Point	2 Points
Appearance	Blue/pale	Body pink, extremities blue	Completely pink
Pulse	Absent	< 100 bpm	≥ 100 bpm
Grimace	No response	Grimace / weak cry	Active cry, cough, sneeze
Activity	Limp	Some flexion	Active motion
Respiration	Absent	Slow / irregular	Good cry, regular breathing

Interpretation	Score	Action
Severe distress	0 – 3	Immediate resuscitation
Moderate distress	4 – 6	Continue resuscitation, monitor
Good condition	7 – 10	Routine care

How to Perform

1. Assess at 1 min, 5 min, and 10 min (if < 7 at 5 min).

2. Document scores in the Birth Registration Event.

3. Record any resuscitation provided.

Clinical Notes

• Low 1-min scores often improve by 5 min.

• Persistent < 7 at 5 min → monitor for hypoxia.

• For stillbirths, Apgar may be recorded as 0 to indicate no signs of life (but no live record created).

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Troubleshooting

Issue	Resolution
Start Neonatal Visit button missing or disabled	Ensure Birth Registration is saved and all mandatory fields are complete; refresh panel.
No barcode after Save	Confirm Outcome = Live Birth → Save again → Sync if offline
Newborn not linked	Check Birth Registration was saved on mother’s visit; Sync and refresh
Birth-doses missing	Ensure BCG 0 / HepB 0 recorded with Lot #s
Stillbirth record appeared	Edit Outcome = Stillbirth → remove infant record per protocol
Cannot enroll mother into new ANC / still “pregnant”	Add Pregnancy Completion / Termination within a visit → Complete → manually update GTPAL

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Summary

During a Labour & Delivery visit, the nurse starts the encounter under the mother, records maternal vitals (or removes if not done), and completes the Birth Registration with delivery details, Apgar scores, and birth-dose vaccines (BCG 0, HepB 0, Vitamin K). Saving the Birth Registration creates the newborn record and barcode and displays the Start Neonatal Visit button. After verifying the mother–child link and newborn Carepath, the nurse adds the Pregnancy Completion form within the same visit to close the pregnancy. Once saved, the ANC Carepath ends and the nurse manually updates GTPAL in Current Status → Observations. Finally, the visit is ended with an appropriate discharge reason, and the system prompts to remove the mother from ANC Carepath if no longer eligible.