Intrapartal Care
Intrapartal Care tests your ability to distinguish normal from abnormal labor, plot progress objectively, interpret fetal status, and act within midwifery scope and referral rules.
Core rules
- True labor produces regular contractions that increase in frequency, duration, and intensity, with progressive cervical dilation and descent; false labor does not change the cervix.
- Stages: first stage from onset of true labor to full dilation; second stage from full dilation to birth; third stage from birth to placental delivery; fourth stage the first 1–2 hours after delivery.
- Partograph: plot cervical dilation, fetal descent, contractions, fetal heart rate, membranes, and fluids. The alert line signals transfer; the action line signals the need for decision or referral.
- Fetal heart rate baseline is 110–160 beats/min. Early decelerations reflect head compression; variable decelerations reflect cord compression; late decelerations reflect placental insufficiency.
- Active management of the third stage includes oxytocin 10 IU IM within 1 minute of birth, controlled cord traction, and uterine massage, per protocol.
Worked example
At 10:00 the cervix is 6 cm; at 14:00 it is still 6 cm despite strong contractions. This is 4 hours without cervical change in active labor, so the plot has reached the action line. The safe response is to reassess fetal and maternal status, check for obstruction, and refer rather than stimulate labor at home.
Traps
Bloody show alone does not prove true labor; station is not dilation; do not give oxytocin without a clear indication and fetal assessment; record the time of membrane rupture; do not label every early deceleration as hypoxia.