Midwifery Triage and Management of Trauma and Second/Third Trimester Bleeding


  • Jackie Tillett CNM, ND,

    Corresponding authorSearch for more papers by this author
    • Jackie Tillett is the director of the Nurse-Midwifery Center and an assistant clinical professor at the University of Wisconsin Medical School, Milwaukee Clinical Campus at Sinai Samaritan Medical Center, Milwaukee, Wisconsin. Dr. Tillett completed her Doctor of Nursing degree and nurse-midwifery education at Rush University, Chicago, She has practiced clinical nurse-midwifery for 12 years. Jackie has an adjunct appointment with the nurse-midwifery program at Marquette University, in Milwaukee. Dr. Tillett enjoys her full-scope clinical practice, which includes nurse-midwifery and medical education.

  • Lisa Hanson CNM, DNSc

    Search for more papers by this author
    • Lisa Hanson is an assistant professor in the Marquette University College of Nursing Nurse-Midwifery Program. She completed her nurse-midwifery education and doctorate in nursing science at Rush University in Chicago. Dr. Hanson also maintains a full-scope practice at the Nurse-Midwifery Center at Sinai Samaritan Medical Center in Milwaukee, Wisconsin. She co-founded the Nurse-Midwifery Center practice 12 years ago. Her research interests include midwifery practice, specifically practices that limit technology and intervention.

Nurse-Midwifery Center, Sinai Samaritan Medical Center, 945 N. 12th Street, Milwaukee, WI 53201


Trauma affects approximately 8% of all pregnancies, and bleeding affects nearly 5% of gestations. These two conditions are potentially life-threatening and require immediate management by the midwife.

Trauma in pregnancy is commonly caused by motor vehicle accidents, falls, and assault. Although abruption resulting from trauma is a rare occurrence, injury caused by domestic violence, is associated with the greatest risk of obstetric complications.

Bleeding in pregnancy has a number of etiologies. Midwives are well-prepared to safely and competently make a differential diagnosis of bleeding in the second and third trimesters.

A sequence for midwifery triage of clients who present to the emergency room/triage area for trauma and bleeding is presented. Considerations for stabilization, history, physical examinations, diagnostic testing, initial management, and follow-up are described. Practical considerations for midwifery services incorporating provisions for triage into their caseloads are also provided.