Normal Labour and Birth
Normal Labour and Birth
This domain tests recognition of normal labour, correct use of the partograph, supportive care, fetal monitoring, and active management of the third stage. The exam expects you to distinguish latent from active first stage and to know when a finding is a variation rather than an abnormality.
Core rules
- Diagnose active labour from regular painful contractions plus progressive cervical change; active first stage is usually 4–10 cm.
- Plot cervical dilatation, descent, contractions, fetal heart, and maternal observations on the partograph. The alert line runs from 4 to 10 cm at 1 cm/hour; crossing it mandates reassessment, not immediate cesarean.
- Offer continuous support, oral fluids, freedom of position, and respectful privacy. Do not routinely restrict position or perform amniotomy.
- Monitor fetal heart every 15–30 minutes in first stage and every 5 minutes in second stage; act on persistent decelerations.
- Third stage: give oxytocin 10 IU IM within 1 minute, controlled cord traction, and assess uterine tone; delay cord clamping for 1–3 minutes where the baby is stable.
Worked example
A nullipara at 5 cm has not dilated after 4 hours. Her partograph plot crosses the alert line. Reasoning: reassess contractions, bladder, hydration, position, and fetal heart; exclude obstruction and malpresentation. Do not diagnose failure to progress from one reading; escalate to the action line or a skilled review if progress remains absent.
Traps
Calling latent labour "prolonged" too early; plotting the partograph retrospectively; routine episiotomy; supine birth; and using oxytocin before excluding obstruction.