Maternity Shadow Health Assessments — Jennifer Wu, Daanis LaFontaine, Naomi Adebayo, Gloria Hernandez & Luna Morales

Shadow Health's maternity module includes five distinct focused examinations covering the full perinatal continuum — from prenatal diagnosis through labour, delivery, complications and postpartum recovery. Each patient presents a different clinical scenario that tests a specific set of maternity nursing competencies.

All five assessments follow the same platform structure: subjective data collection using the Question tab, education using the Educate tab, empathy using the Empathize tab, objective data documented in the EHR, and either an SBAR handoff to Preceptor Diana or a Care Plan depending on what your instructor has enabled. Understanding this structure before you start saves significant time.

Jennifer Wu is a 41-year-old Chinese American woman at 27 weeks gestation who was diagnosed with gestational diabetes after failing the glucose tolerance test at a routine prenatal visit. She denies any symptoms of gestational diabetes.

Her history is significant for one prior miscarriage, latex allergy, seasonal allergies and a fast-paced work environment as an editor. She exercises 2-3 times per week and denies alcohol, tobacco and illicit drug use. Her diet is generally balanced but her carbohydrate intake needs clinical assessment.

Key clinical points to document: Advanced maternal age (41) as a risk factor for GDM. GTT result and interpretation. Current dietary pattern and carbohydrate load assessment. Education provided on carbohydrate counting — the goal is 175g/day total with no more than 45g per meal. Blood glucose monitoring targets: fasting below 95 mg/dL, 1-hour post-meal below 140 mg/dL. Exercise safety in pregnancy. Signs requiring immediate attention — hyperglycaemic symptoms, decreased fetal movement.

Common mistakes: Not documenting the GTT result explicitly. Failing to address the advanced maternal age risk factor. Generic dietary education instead of specific carbohydrate counting guidance. Missing the endocrinology referral in the management plan.

Daanis LaFontaine is a pregnant woman in the intrapartum phase presenting for an uncomplicated vaginal delivery. This focused exam tests your ability to conduct a complete labour assessment and prepare a safe SBAR handoff to Preceptor Diana.

Subjective assessment covers: Onset and progression of contractions (frequency, duration, intensity), rupture of membranes (spontaneous or artificial, time, colour and odour of fluid), fetal movement since labour began, pain level using a validated scale, birth plan preferences and GBS status.

Objective assessment covers: Maternal vital signs, contraction pattern on external monitoring (frequency, duration, strength), fetal heart rate baseline and variability on CTG, cervical examination findings (dilation, effacement, station, presenting part), and membranes status.

SBAR to Preceptor Diana: Situation — patient in active labour, uncomplicated progression. Background — obstetric history, GBS status, current gestational age, prenatal complications if any. Assessment — current cervical dilation, FHR pattern (reassuring), maternal vital signs stable, pain managed. Recommendation — continue labour support, prepare for delivery, notify when pushing urge felt.

Common mistakes: Skipping GBS status documentation. Incomplete CTG interpretation — must document baseline rate, variability, accelerations and decelerations. Failing to document the patient's birth plan preferences in the education section.

Naomi Adebayo presents with preeclampsia — one of the most clinically serious conditions in maternity nursing and a frequent source of lost marks because students miss the severe features screening.

Preeclampsia is defined as: BP ≥140/90 mmHg on two occasions at least 4 hours apart after 20 weeks, plus either proteinuria (≥300mg in 24-hour urine or protein:creatinine ratio ≥0.3) OR severe features.

Severe features screening — ALL must be documented: BP ≥160/110, thrombocytopenia (platelets below 100,000), renal insufficiency (creatinine above 1.1), liver enzyme elevation (twice normal), pulmonary oedema, new-onset headache unresponsive to medication, visual disturbances.

Subjective assessment covers: Headache (severity, location, response to analgesia), visual disturbances (blurred vision, scotomata, photopsia), epigastric or right upper quadrant pain (liver capsule stretching), oedema progression (face, hands, sudden weight gain), fetal movement and understanding of diagnosis.

Magnesium sulfate protocol: If severe features are present, MgSO4 is initiated for seizure prophylaxis. Document the loading dose (4-6g IV over 15-20 minutes) and maintenance infusion (1-2g/hour). Monitor for toxicity — loss of deep tendon reflexes is the first sign. Calcium gluconate is the antidote and must be at bedside.

SBAR: Always state whether severe features are present or absent — this determines urgency of delivery.

Gloria Hernandez is a postpartum woman requiring systematic nursing assessment following delivery. The BUBBLE-HE framework is the structured approach Shadow Health expects — any component missed will cost marks.

B — Breasts: Assess for engorgement, nipple integrity (cracks, blisters), milk let-down reflex if breastfeeding, latch assessment if the patient is nursing, and formula feeding support if bottle feeding.

U — Uterus: Fundal height (should decrease approximately 1cm per day — day 1 at the umbilicus, day 2 one finger below, etc.), position (midline vs deviated — deviation suggests bladder distension), and consistency (firm = contracted appropriately, boggy = uterine atony).

B — Bowel: Last bowel movement, bowel sounds in all four quadrants, flatus passed, diet progressed, stool softener offered.

B — Bladder: First void post-delivery documented, urinary output adequate (minimum 30mL/hour), bladder distension assessed, catheter if present — output and colour.

L — Lochia: Colour (rubra = red, serosa = pink, alba = white — progresses over days), amount (scant, light, moderate, heavy), odour (foul odour indicates infection), clots (>golf ball size is abnormal).

E — Episiotomy/Incision: REEDA assessment — Redness, Oedema, Ecchymosis, Discharge, Approximation. Document each on a 0-3 scale.

H — Homans sign: Calf pain on dorsiflexion — screens for DVT. Note: current evidence questions its sensitivity, so also assess for unilateral leg swelling, warmth and erythema.

E — Emotional wellbeing: Edinburgh Postnatal Depression Scale (EPDS), bonding with infant, support system at home, plans for infant care.

Luna Morales is a pregnant woman in early labour presenting with non-reassuring fetal status — one of the most high-stakes scenarios in maternity nursing because it requires rapid recognition and immediate intervention.

Recognising non-reassuring fetal status on CTG:

Late decelerations — deceleration begins after the peak of the contraction and returns to baseline after the contraction ends. This indicates uteroplacental insufficiency and is always non-reassuring.

Variable decelerations — abrupt drops in FHR, variable in shape and timing. Related to cord compression. Non-reassuring when lasting more than 60 seconds, dropping below 70 bpm, or slow return to baseline.

Prolonged deceleration — FHR drops below baseline for more than 2 minutes. Always requires immediate intervention.

Decreased variability — baseline FHR variability less than 5 bpm for more than 40 minutes is non-reassuring.

Nursing interventions — perform in this order: 1. Reposition patient to left lateral (takes cord off inferior vena cava, improves placental perfusion) 2. Supplemental oxygen via non-rebreather mask at 8-10L/min 3. IV fluid bolus (correct maternal hypotension which reduces placental perfusion) 4. Discontinue oxytocin if infusing (removes uterine hyperstimulation) 5. Notify provider immediately — this is not optional, document the exact time

SBAR to Preceptor Diana: Situation — non-reassuring FHR pattern identified (specify type). Background — gestational age, labour progress, relevant history, GBS status. Assessment — current FHR pattern, interventions performed, patient response, maternal vital signs. Recommendation — urgent evaluation at bedside, consider amnioinfusion if variable decelerations, delivery planning.

NursingProxy has completed, A-grade verified assessments for all five maternity Shadow Health patients. Each document includes the full interview transcript, all scored subjective and objective findings, therapeutic communication documentation, SBAR handoff and Care Plan. Preview the first pages free before purchasing — download the full PDF instantly after payment.