WEBVTT

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[music]

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After watching this video

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the clinician will be able to perform Leopold's Maneuvers,

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assess the fetal status through use of Doppler or fetoscope,

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perform an accurate measurement of the uterine fundus,

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and make a general assessment of maternal

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and fetal well-being within the accepted length of parameters.

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Hi Becky, how are you feeling?

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Fine.

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Baby moving good?

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Mhm.

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Moving at least 10 times a day? Being active?

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Mhm.

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You having any problems with swelling?

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Just hot.

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Just hot, yeah.

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What about any bad headaches, blurry vision,

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spots before your eyes, anything unusual going on?

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No.

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Position the woman comfortably with a pillow

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under her head and shoulders.

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Her knees should be bent slightly

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and her arms should be at her sides.

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With clean, warm hands prepare the woman

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draping her lower body, and exposing her abdomen

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for examination.

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Be sure the woman has emptied her bladder

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prior to the examination.

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A full bladder can make the fundal height

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seem higher than it actually is.

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Facing the woman, locate the symphysis pubis

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and the top of the fundus.

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Remember, the symphysis pubis has nothing to do

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with the pubic hairline.

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Place your hands along each side of her abdomen

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and palpate to the top of the fundus

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noting the size, shape, consistency, and mobility.

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The part of the fetus that is smooth, firm, and curved

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is the fetal back.

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And the small, knobby, irregular bumps are fetal knees,

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feet, elbows, and hands.

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This determines the lie of the fetus.

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You may feel movement or kicking on the side.

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Grasping the area above the symphysis pubis

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between your thumb and middle finger,

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press gently but firmly into the abdomen.

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This maneuver allows you to ascertain the presenting part.

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If the presenting part is the fetal head

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the mass will be moveable and ballotable,

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able to move fully between fingers

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unless it is engaged in the pelvis.

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Using the combined Pawlick grip

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you will be able to convey the presenting part

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with the top of the fundus.

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If the presenting part is ballotable,

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and if the top of the fundus moves the whole span of the fetus,

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the fetal lie is in the vertex position.

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Next, facing the woman's feet,

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place your hands on the lower sides of the uterus

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with your fingers toward the symphysis pubis.

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Press deeply with your fingertips into the abdomen

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in the direction of the pelvic inlet.

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You will feel a hard, round protrusion:

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the cephalic prominence.

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If the head is in the vertex position,

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it will be well-flexed

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and you will feel the prominence on the same side

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as the small fetal parts.

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If the presenting part is engaged within the pelvic inlet,

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you will not be able to feel it.

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A tape measure is commonly used to measure the fundal height.

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First, locate the woman's superior border

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of the symphysis pubis at the midline.

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Hold the "zero" end of the tape measure here

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and pull the tape over the abdomen to the top of the fundus.

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The measurement in centimeters

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should correspond to the weeks of gestation.

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For example, 35 weeks equals 35 centimeters.

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Variables to this measurement include positions of the fetus

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such as breech, transverse lies,

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and lightening, and engagement.

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Note that too much elevation of the women's torso

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can affect the accuracy of the measurement.

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[Doppler sounds, heart beat]

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Having previously located the back of the fetus

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during the Leopold's meneuvers,

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you will be able to judge with some accuracy

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where to listen for the fetal heart tones, or FHT.

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[heart tones]

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For a term fetus in the vertex position,

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you can locate the fetal heart tones below the umbilicus

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on either side of the midline, the left or lower right quadrant

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(LLQ, or RLQ) depending on the lie.

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For a fetus in the posterior position,

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fetal heart tones are close to the midline

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or in the flank area,

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in which case you would be listening to the fetal chest.

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Let's be sure and get the gel off.

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And I always like to assess the weight of the baby

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toward the end of the pregnancy.

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I bet this baby is about six and a half pounds right now.

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And we're about three weeks away from her due date

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so, about another eight pound baby.

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if it comes on time.

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Alright, do you have any questions Becky?

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Do you really think it's going to be an eight pound baby?

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Well if you're right on time I think it will.

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Hi Jennifer.

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Hi.

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How are you doing today?

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Very good.

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Heavy moving day? [???]

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Mhm, more active.

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More active, that's what I like to hear.

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Are you having any problems?

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No.

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Swelling any?

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Just a little.

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Just a little. Any severe headaches? Blurred vision?

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Spots before your eyes?

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No.

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Okay, well let's check you

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and see what this baby's doing today.

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Starting at the bottom of the fundus.

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Assess the fundus, until you...the uterus until you

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find the fundus.

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Top of the uterus, right here.

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Here is your baby's back

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mostly on top.

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This feels like a fetal head right there.

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I think this baby's in the breech position.

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This is the baby's bottom right down here.

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So the baby's curled up this way.

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And we should hear fetal tones

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right about here.

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[beep]

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[Doppler sounds, fetal heart tones]

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The fetal heart tones of a breech presention

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will be level with or above the umbilicus.

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Okay.

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Starting

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from the top of the pubic bone.

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The really superior portion of the pubic bone

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to the top of the fundus.

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The baby's position can really [???] on the fundal height measurement.

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Breech.

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Transverse lie.

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When the baby's head is on one side

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and then his bottom is on the other then you get

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a smaller fundal height measurement.

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So whatever position the baby is in

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can make a big difference in the measurement

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that we get each time.

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It's better if the measurement's taken by the same person

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every time.

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Feel a lot of kicking and moving over on this side?

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Mhm.

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Probably a lot right down in here.

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Mhm.

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Has anything changed?

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I think I dropped down more.

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Okay. That's always a good sign.

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Let's see how this baby's laying.

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The sides, and I can feel a little fin [?] or something over here.

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[???] if he never moves.

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Baby's bottom is right up here.

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Feels like we got back pretty much coming across the top.

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Press deeply with your fingertips into the abdomen

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in the direction of the pelvic inlet.

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You will feel a hard, round protrusion,

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the cephalic prominence.

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If the head is in the vertex position

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it would be well-flexed and you would

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feel the prominence on the same side as the small fetal parts.

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If there is a base presentation

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you should feel the prominence of the occiput

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on the same side as the fetal back.

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If the presenting part

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is engaged within the pelvic inlet

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you will not be able to feel it.

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This position is referred to as dipping.

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Let's see where our measurement is this week.

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Sometimes as a baby's head gets lower

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the measurement goes down a little bit

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instead of up.

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You're right around there.

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Be sure to record all the findings on position,

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measurement, and fetal heart tones rate,

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and location for future reference and comparison.

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His head is really low.

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It's under the symphysis pubis,

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what we call dipping down.

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From your assessment of fetal status

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you may also be able to estimate fetal weight.

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I think you've got about an eight pound baby right now.

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The mother's heart rate by Doppler or fetoscope

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will be much slower and make a swishing sound.

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If you are unsure whether you are hearing the fetus or the mother

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check the mother's radial pulse as you listen to the heart rate.

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Once you identify the fetal heart tones,

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take a moment to assess the rate and strength of them.

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Fetal heart tones are rapid and deep,

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usually around 130-160 beats per minute.

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Everything looks really good.

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Okay, do you have any questions?

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These visits also provide an opportunity

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to discuss the overall health of the mother.

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General physical feeling,

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genitourinary status,

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edema, nausea, energy and fatigue level,

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nutritional intake,

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account of fetal movement,

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and any concerns of either of you.

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Vital signs and urine tests are necessary each visit.

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Share your findings with the woman

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and be open for her questions.

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Communication is key in establishing confidence

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between you and your client.

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[cheesy music]