The process of obstetric triage: management by certified nurse-midwives

The roles for certified nurse-midwives are growing, changing, and becoming more varied with the reform of health care systems. Versatility of clinical knowledge in antepartum, intrapartum, postpartum, and gynecologic care along with advanced practice skills of assessment, diagnosis, and treatment make nurse-midwives ideal providers to perform triage for a busy obstetric service. With health care dollars more limited and more scrutinized than ever before, it becomes essential to prioritize patient needs and match them with the most appropriate resources. The article demonstrates the process of triage provided by certified nurse-midwives in a high-volume university hospital setting. It describes management guidelines and admission criteria for the birth center, high-risk labor and delivery, and the observation unit. Examples of clinical evaluations and judgments as well as scenarios are included to illustrate how triage is unique and differs from care provided in other settings.