Intrapartum Care and Normal Birth
Intrapartum questions test whether you can separate normal progress from the first sign of obstruction, and describe care that helps labour rather than interfering with it.
Defining progress
Labour begins with regular painful contractions plus progressive cervical change. The latent phase extends to 5 cm; the active phase runs from 5 cm to full dilatation at roughly 1 cm per hour. Plot every examination on the partograph with descent, contractions per 10 minutes, fetal heart rate, maternal pulse, blood pressure, urine and any oxytocin.
Care that improves outcomes
- Continuous companionship; encourage movement, upright positions, food and fluids.
- Intermittent auscultation every 30 minutes in the first stage and every 5 minutes in the second for low-risk labour; continuous cardiotocography only when risk is present.
- No routine episiotomy, amniotomy, enema, shaving or fundal pressure.
- Third stage: oxytocin 10 IU intramuscularly within one minute, controlled cord traction, perineal inspection and a documented placental delivery time.
Worked example
Cervix is 5 cm at 08:00 and 6 cm at 12:00; membranes intact, three contractions in ten minutes, vertex at −1. Reasoning: active-phase slow progress. Exclude obstruction first - moulding, caput, Bandl's ring, distended bladder - and check position and station. If all is reassuring, offer amniotomy and reassess in two hours; start oxytocin only where monitoring capacity exists, otherwise refer.
Traps
Applying the 1 cm/hour rule in the latent phase; dating labour onset from the first examination; starting oxytocin before excluding obstruction; and calling labour prolonged without a partograph to prove it.