Second Attendant Position

PREAMBLE

The role of the Saskatchewan College of Midwives (SCM) is to protect the public by regulating midwives in the province of Saskatchewan. As such, the SCM has developed this document to guide midwives in the role and appropriate utilization of second attendants.

DEFINITIONS

• A second attendant is a person whose salaried role is to provide assistance to the midwife during labour, birth and immediately thereafter, in an out-of-hospital/home birth situation.
• The second attendant possesses the competencies and practical experience to properly assist the midwife in the delivery of safe and competent midwifery care.
• The second attendant always works under the direction and immediate, in person, supervision of the primary midwife. The second attendant shall be another regulated and licensed health professional. The second attendant must possess the advanced competencies and experience necessary to assist the midwife during the labour, birth and immediate postpartum period.
• As a member of another regulated health profession the Second Attendant is also accountable to her/his regulatory authority and is required to contact her/his regulatory authority for advice regarding this role. There may be additional issues that need to be considered by the professional.
• The presence of a second attendant does not preclude the attendance of other support persons.

GUIDELINE

1. The midwife is the most responsible person (MRP) for the care provided throughout the labour, delivery and immediate postpartum period.
2. The midwife must ensure that the care provided is in accordance with The Midwifery Act, 1999, the Code of Ethics, standards of the Saskatchewan College of Midwives and any other relevant documents.
3. The midwife must ensure that the second attendant is competent to assist the midwife during the labour, birth and the immediate postpartum period, by confirming with the employer that the second attendant employee possesses the following competencies:
   1. Current certification in:
      1. Neonatal resuscitation (NRP)
      2. Cardiopulmonary resuscitation (CPR)
   2. Education, knowledge and competence in the following:
      1. Assessment of vital signs (blood pressure, pulse, temperature, respirations, fetal heart tones);
      2. Postpartum assessment of uterine tone and position, blood loss and bladder;
      3. Universal precautions;
      4. Basic knowledge of labour and birth;
      5. Basic knowledge of instruments, supplies and drugs used by midwives;
      6. Appropriate documentation; and,
      7. Observation, assessment and care of the newborn.
4. The midwife may not delegate tasks to a second attendant who is not otherwise legally authorized to perform them.
5. In circumstances where a midwife has safety concerns with respect to a second attendant employee, the midwife may insist on having a midwife attend the out-of-hospital birth.

Specific Duties of Second Attendants

Sole attendance with a woman in labour is not considered an appropriate responsibility for the second attendant who is not a midwife or licensed physician.

The second attendant is to be present for the second stage of labour, birth and the immediate postpartum period, as required. The duties of the second attendant may include the following provided that the duties are within her/his scope of practice.

First stage of labour

• Is present at the discretion of the primary midwife.

Second stage of labour

• Provides assistance to the midwife.
• Provides support to the woman.
• Checks layout of supplies to ensure safe and appropriate accessibility of drugs, instruments (e.g. sharps out of reach of children) and functioning of equipment.
• Auscultates fetal heart rate.
• Documents in the health care record.

Birth

• Provides assistance to the midwife.
• Ensures warmth and safety of the newborn.
• Checks, reports and records the condition of the newborn.
• Assesses Apgar scores.
• Administers medications as directed by the midwife.

Postpartum

• Provides assistance to the midwife.
• Assists the midwife during suturing, if required.
• Provides support and assistance to the woman.
• Checks maternal blood pressure, pulse, fundus, lochia and bladder.
• Helps clean up after birth.

Emergencies

• Phones Emergency Medical Services.
• Phones the receiving hospital.
• Assists midwife in setting up or establish intravenous/drug therapy.
• Checks maternal blood pressure and pulse.
• Assists with CPR and/or neonatal resuscitation.
• Assists in preparation for transport.
• Administers medications as directed by the midwife.
• Assist midwives with emergency procedures.