Intrapartum Care and Normal Birth
What this domain tests
This domain tests recognition of normal labour progress, supportive care, fetal surveillance, and safe conduct of the second and third stages. The exam favours practical decisions: when to plot the partograph, when to auscultate, and when to escalate.
Core rules
- Labour has three stages: cervical dilatation and descent, birth of the baby, and delivery of the placenta. The latent phase is up to about 5 cm in a first labour; active labour is from 5 cm with regular contractions.
- Use a partograph once active labour is confirmed. Plot cervical dilatation, descent, contractions, fetal heart rate, membranes, and urine output. The alert line represents 1 cm per hour from 4 cm; crossing it requires review.
- In low-risk labour, auscultate the fetal heart every 15–30 minutes in the first stage and every 5 minutes in the second stage, before and after contractions.
- Encourage mobility, upright positions, oral fluids, and continuous supportive companionship. Do not perform routine episiotomy.
- For a normal birth, support spontaneous pushing, avoid directed breath-holding, and use a warm, dry towel for the newborn. Delayed cord clamping for 1–3 minutes is recommended for term infants who are breathing.
- Actively manage the third stage with a uterotonic, controlled cord traction, and uterine assessment.
Worked example
A primigravida at 5 cm has three contractions in 10 minutes, a fetal heart rate of 140 beats per minute, and intact membranes. Plot the findings on the partograph. At the next vaginal examination, dilatation is 5 cm after 4 hours. The plot has not crossed the alert line, but progress is slow. Review contraction strength, bladder, position, and hydration, and involve the obstetric team rather than rupturing membranes routinely.
Traps that cost marks
Do not use the partograph to diagnose prolonged latent phase. Continuous cardiotocography is not routine for low-risk labour. A single deceleration is not automatically fetal distress, but repetitive late or variable decelerations need review. Do not give routine enemas or shave the perineum.
Key points
- Active labour starts at about 5 cm with regular contractions.
- Plot the partograph and act when the alert line is crossed.
- Intermittent auscultation is appropriate for low-risk labour.
- Routine episiotomy is not recommended.
- Delayed cord clamping benefits term infants who are breathing.
- Active third-stage management reduces postpartum haemorrhage.