The weeks before a baby is born are an exciting yet sometimes anxious time. During development, mother and baby are especially susceptible to external and internal stimuli, and it is important that any problems be addressed in the appropriate time frame. This makes obstetric triage—and understanding that process—so critical for both mother and child.

What is Obstetric Triage?

AWHONN, the Association of Women’s Health, Obstetric, and Neonatal Nurses, defines obstetric triage as “the brief, thorough and systematic maternal and fetal assessment performed when a pregnant woman presents for care, to determine priority for full evaluation.” Their methods of triage prioritize the timeliness of initial assessment; response from nurses, obstetricians, and other medical personnel; and transfer of patients classified as high risk to facilities appropriately equipped to provide the specialized care required.

In a perfect world, all expecting mothers would be able to receive care immediately upon coming to a care facility. However, the reality is that obstetric triage demand typically exceeds the total birth volume hospitals have available by up to 50%. Accordingly, some methods of prioritizing are essential, so when a pregnant woman solicits medical care, attendant nurses or over-the-phone triage dispatchers follow the Maternal Fetal Triage Index (MFTI).

AWHONN’s Maternal Fetal Triage Index 

The MFTI has five levels of necessitated immediacy and helps medical personnel know the order in which to treat expecting mothers. The OB triage nurse or dispatcher conducting the triage session determines a woman’s priority level not by the time she arrived but by her condition, by asking a series of questions and performing practical medical assessments. The MFTI focuses on attending to both mother and baby and offers multidisciplinary input by monitoring maternal vital signs, fetal heart rate and movement, status of labor, and presenting maternal condition. 

Priority 1: Stat

At this level, mother or fetus require immediate lifesaving intervention or birth is imminent. Maternal hemorrhage, prolapsed cord, or signs of placental abruption are conditions that fall under priority one.

Priority 2: Urgent

A mother requiring urgent attention experiences pain unrelated to contractions, and she or her  newborn requires a higher than normal level of care. Other high-risk situations that may necessitate urgent status are difficulty breathing, high blood pressure, active vaginal bleeding, placenta previa, decreased fetal movement, altered mental acuity or suicidal liability, or recent trauma.

Priority 3: Prompt 

Incoming cases are classified as priority three if they have a temperature above 100.4°F, signs of active labor at or after 34 weeks, or spontaneous rupture of membranes (SROM) or vaginal leaking between the 34–36 week point.

Priority 4: Non-urgent

Obstetric triage designates the common discomforts of pregnancy, including nausea, vaginal discharge, constipation, ligament pain, and anxiety, to be non-urgent. 

Priority 5: Scheduled/Requesting  

Priority five is given to expectant mothers that have not called or come in with a complaint. These women have called or come in for a scheduled visit or a prescription refill or to request a procedure.

A Delicate Process

The MFTI is applied when an expectant mother presents herself for care. This can occur early in the pregnancy or during the labor process. During the obstetric triage evaluation, the medical professionals conducting it make the decision to either admit the patient to the labor and delivery unit, attend to some treatment in triage, or send the woman home to continue labor there for a time. Once obstetric triage is complete, expecting mothers are treated by medical personnel that can best attend to their concerns. 

As previously stated, attending to pregnant women in the appropriate time frame is essential for the health of both mother and child. Failed obstetric triage can result in extreme prematurity, known congenital anomalies, complicated twin gestations, or even triplets or higher orders. Because of the delicate nature of the process, under the federal Emergency Medical Treatment and Labor Act (EMTALA), it is prohibited by law to delay proper medical screening to inquire about insurance status or payment methods.

While the gift of bringing new life into the world is reserved for mothers, the medical staff that attend the process feel keenly the privilege of being a part of the process. You can be assured that your regular obstetrician and other obstetric triage providers have your best interest in mind as they attend to your triage. Do not be afraid to ask questions of your own during the process and allow medical staff to do what they do best. While you prioritize your baby, they will prioritize healthy gestation, labor, and delivery processes.