Intrapartum Care and Normal Labour
This domain tests labour diagnosis, use of the partograph, respectful supportive care, active management of the third stage and immediate newborn handling.
Core rules
- Diagnose labour by regular painful contractions with cervical change. Do not keep women in the latent phase in a labour ward bed; encourage mobility, oral fluids and a companion.
- Start the partograph in active labour (usually 4 cm). Plot cervical dilatation, fetal heart rate, contractions, membranes and urine every 30 minutes to 4 hours as required. The alert line is 1 cm/hour; the action line is 4 hours to the right.
- Listen to the fetal heart every 30 minutes in the first stage and every 5 minutes in the second stage.
- Avoid routine enema, shaving, amniotomy, episiotomy and fundal pressure.
- Give active management of the third stage: oxytocin 10 IU IM within 1 minute of birth, controlled cord traction and uterine massage.
Worked example
A primigravida is 6 cm dilated, contractions 3 in 10 minutes, fetal heart 140, membranes intact. The partograph sits on the alert line. Reasoning: this is active labour with no obstruction or fetal distress. Keep her mobile, hydrate, monitor and reassess in 4 hours or sooner if the line crosses the action line. If dilatation stops or the fetal heart falls, reassess for obstruction and refer; do not give oxytocin to hurry a woman who has not been assessed.
Traps
- Starting the partograph before active labour and over-diagnosing poor progress.
- Ignoring a fetal heart below 110 or above 160.
- Pulling the cord before signs of placental separation.
- Using oxytocin for AMTSL before the baby is born.