EHPLE Midwifery common mistakes
EHPLE Midwifery · Understand the traps and how to avoid them.
When a cardiotocography (CTG) question gives a baseline, variability, decelerations and contraction pattern, the candidate labels the trace from a single feature (for example calling every variable deceleration 'pathological') instead of applying the full DR C BRAVAD systematic framework and classifying the trace as normal, suspicious or pathological.
Candidates memorise individual definitions in isolation and, under time pressure, anchor on the most visually striking feature. They also confuse deceleration timing relative to contractions, which is what determines whether a deceleration is a head-compression variable pattern or a uteroplacental-insufficiency late pattern.
What to do instead
Before answering, write out DR C BRAVAD (Define Risk, Contractions, Baseline Rate, Variability, Accelerations, Decelerations) and score each element. State the category using the standard three-tier system, then choose the management that matches that category (expectant with review versus urgent obstetric review and intrauterine resuscitation). Practise at least 20 full traces, not isolated definitions.
In postpartum haemorrhage scenarios the candidate gives a fluid bolus or uterotonic as the first action and omits the simultaneous mechanical steps (uterine massage, bimanual compression, emptying the bladder, calling for help) and the structured cause review of the four Ts (tone, trauma, tissue, thrombin).
Textbook lists of uterotonics are easier to recall than an ordered emergency algorithm, and candidates underestimate how quickly hypovolaemic shock progresses, so they treat haemorrhage as a prescribing question rather than a resuscitation sequence.
What to do instead
Learn a single timed sequence: call for help and start basic resuscitation, massage the uterus, assess tone and give oxytocin, then escalate to ergometrine, carboprost and misoprostol in order while arranging tranexamic acid, blood products and theatre. Rehearse the four Ts aloud for each scenario so the answer names the cause being excluded, not just the drug given.
The candidate answers a newborn resuscitation stem by starting with prolonged positive pressure ventilation or by assigning an Apgar score before assessing tone, breathing and heart rate, and fails to state that effective ventilation is the single most important step.
Apgar scoring is heavily taught and easy to recall, so candidates default to it, forgetting that Apgar is a descriptive score at one and five minutes and never guides resuscitation. They also skip the initial steps of warmth, drying, stimulation and airway positioning.
What to do instead
Anchor every neonatal resuscitation answer on the sequence: dry and stimulate, assess tone and breathing, if apnoeic or gasping apply positive pressure ventilation with a correctly sized mask, reassess heart rate, and only then consider compressions or drugs. Explicitly state that ventilation of the lungs is the priority and that Apgar does not direct treatment.
When asked about a drug in pregnancy or lactation, the candidate gives the standard adult dose and route without stating the pregnancy or lactation safety category, the trimester-specific risk, or the need for specialist review before prescribing.
Pharmacology is learned as adult general medicine, and candidates treat midwifery prescribing as dose recall. They also forget that midwives prescribe from a limited formulary and that some drugs require obstetric or neonatal team involvement rather than independent midwife initiation.
What to do instead
For every drug answer, include four elements: indication, dose and route, safety in pregnancy and breastfeeding with the specific risk named, and the prescribing authority or referral threshold. Learn the recognised high-risk examples (for example sodium valproate, isotretinoic acid, warfarin, angiotensin-converting-enzyme inhibitors, live vaccines) and the drugs needing caution in lactation.
The candidate manages a safeguarding or consent scenario by acting on the clinical facts alone, without naming the legal framework, the mental capacity assessment, or the referral pathway to the safeguarding lead and statutory agencies.
Candidates treat ethics and law as abstract essay topics and do not connect them to clinical vignettes. They also conflate confidentiality with absolute secrecy and are unsure when disclosure without consent is justified.
What to do instead
For each scenario, identify the specific legal test (capacity, best interests, Gillick competence for a minor, female genital mutilation mandatory reporting, domestic abuse pathway) and state the action, the person to inform and the record to keep. Practise writing answers that name the statute or guidance and the referral route, not just 'inform the consultant'.
In antenatal assessment questions the candidate interprets a single abnormal value (for example a blood pressure of 140/90 or a fundal height plotting below the centile) as a diagnosis, rather than describing the repeat measurement, the additional investigations and the referral threshold required.
Exam stems often present one number to test whether the candidate knows the definition, but candidates jump to pre-eclampsia or growth restriction without the confirmatory steps. They also forget that fundal height should be plotted on a customised chart and that a single reading is not diagnostic.
What to do instead
Answer in three moves: repeat and confirm the measurement with correct technique, name the investigations that establish or exclude the diagnosis (urine protein-to-creatinine ratio, blood pressure trend, serial growth scans, umbilical artery Doppler), and state the referral and review interval. Never give a diagnosis from one reading without saying how it is confirmed.
The candidate supports breastfeeding by advising a fixed feeding schedule or by telling a mother with nipple trauma to stop feeding, instead of assessing latch and position, correcting attachment and explaining supply and demand.
Infant feeding is often revised superficially, and candidates default to bottle-feeding logic of timed intervals. They also lack a structured breastfeeding assessment, so they cannot describe what a poor latch looks like or how to correct it.
What to do instead
Use a named assessment framework covering position, attachment, suck and swallow, and output (wet and dirty nappies, weight). For each problem, give the corrective action: improve attachment for trauma, feed responsively on demand for low supply, and refer to a lactation specialist or tongue-tie assessment when the basic correction fails. State that abrupt cessation is rarely the answer.
The candidate answers a health promotion or sexual and reproductive health question with generic advice ('eat well, attend appointments') rather than naming the specific intervention, the target group, the timing and the evidence base, such as folic acid dose and timing, pertussis and influenza vaccination in pregnancy, or contraceptive effectiveness and the quick-start rule.
Health promotion is perceived as common sense, so candidates do not prepare the specific numbers and timings. In contraception questions they confuse typical-use and perfect-use failure rates and forget the criteria for emergency contraception and when a pregnancy test is needed.
What to do instead
Build a table of specific facts: folic acid 400 micrograms daily pre-conception and 5 milligrams for higher-risk groups, vaccination schedule in pregnancy, vitamin D, smoking and alcohol advice, and for contraception the method, failure rate, contraindications and follow-up. Answer with the exact dose, timing and target group rather than general lifestyle advice.
In labour progress questions the candidate relies on the traditional latent and active phase timings and a single vaginal examination finding, without applying the partogram, the recognition of obstructed labour, or the criteria for referral and transfer.
Candidates memorise outdated progress definitions and do not integrate cervical dilatation with descent, station, moulding and caput. They also answer as if the midwife works alone, omitting the escalation pathway.
What to do instead
Interpret progress using the partogram with alert and action lines, combine dilatation with descent and fetal condition, and name the signs of obstructed labour (bandl ring, maternal distress, meconium, caput and moulding). State the referral threshold and the transfer plan explicitly in every answer.
The candidate writes the clinical action but omits the documentation and communication step, for example not stating what is recorded, who is informed and within what timeframe, in a scenario involving a deteriorating woman, a fetal concern or a safeguarding issue.
Candidates treat record-keeping as administrative and focus only on the intervention. They also forget that clear, contemporaneous records and structured handover are themselves professional obligations and evidence of safe practice.
What to do instead
End every scenario answer with a documentation and escalation sentence: what is recorded (observations, time, decisions, discussions), who is informed (senior midwife, obstetrician, neonatologist, safeguarding lead), and the timeframe. Use a structured handover format so the communication step is concrete, not implied.