Ahpra Midwifery OBA cheat sheet

Normal labour is defined as spontaneous onset at 37+0 to 41+6 weeks, single cephalic fetus, in a woman with no identified risk factors, progressing without intervention to vaginal birth.

The first stage of labour has a latent phase (cervical dilatation to about 4-5 cm, variable duration) and an active phase (from 4-5 cm to full dilatation, typically about 0.5-1 cm/hour in nulliparae).

Second stage: full dilatation to birth of the baby; passive (descent without urge) and active (urge to push) phases; a diagnosis of delay is made after 2 hours in nulliparae and 1 hour in multiparae without progress (local guidelines may vary).

Third stage: birth of the baby to expulsion of the placenta; active management includes a prophylactic uterotonic (commonly 10 IU IM oxytocin), controlled cord traction and assessment of uterine tone and blood loss.

Estimated blood loss: 500 mL or more after vaginal birth and 1000 mL or more after caesarean birth defines postpartum haemorrhage; the four Ts are tone, trauma, tissue and thrombin.

Cardiotocography interpretation: baseline rate 110-160 bpm, variability 5-25 bpm, accelerations, and decelerations classified as early, variable or late; late and complicated variable decelerations suggest fetal hypoxaemia.

Fetal position and presentation are described by lie, presenting part, position (e.g. left occipito-anterior) and station relative to the ischial spines (-5 to +5).

The Apgar score is assessed at 1 and 5 minutes across five components (appearance, pulse, grimace, activity, respiration), each scored 0-2; scores of 7-10 are generally normal.

Ahpra-registered midwives are bound by the shared Code of conduct and the Registered midwife standards for practice, which set expectations for person-centred, evidence-based, culturally safe care.

Mandatory notifications: a registered health practitioner must notify Ahpra if they form a reasonable belief another practitioner has practised in a way that places the public at substantial risk of harm (with limited exceptions).

The National Law requires registered practitioners to hold professional indemnity insurance, meet continuing professional development (20 hours per year for midwives) and complete recency of practice requirements.

Informed consent requires capacity, adequate information about risks, benefits and alternatives, and voluntary decision-making; consent is a process, not a signature, and can be withdrawn at any time.

Confidentiality is a legal and ethical duty with exceptions including the patient's consent, statutory reporting obligations (e.g. child protection), court orders and serious public health risk.

Scope of practice is dynamic: a midwife may work outside usual scope only after gaining the competence and authority, and must refer or consult when care needs exceed their capability.

Cultural safety requires the midwife to examine their own biases and power, and to provide care that is respectful of Aboriginal and Torres Strait Islander and other cultural identities.

Open disclosure after an adverse event involves an apology, a factual explanation, discussion of consequences and what will happen next, and is a professional obligation, not an admission of liability.