Topic outline
Topic 1
Recognition of Normal Labour
What is adequate uterine contraction?
Show and leakage of amniotic fluid
Helping the mother recognise a true labour
Stages of labour
First stage of labour
Second stage of labour
Third stage of labour
Fourth stage of labour
Mechanisms of normal labour
Engagement
Descent
Flexion
Internal rotation
Extension
External rotation (restitution)
Expulsion
In conclusion
Topic 2
Assessing the Woman in Labour
Rapid evaluation of a woman in labour
What you must do for a rapid assessment
History-taking in labour
The importance of woman-friendly care
Recording socio-demographic data
History of past and present pregnancy
Danger signs and symptoms
Inspection of the abdomen
Palpation of the abdomen
Measuring fetal heart rate
Vaginal examination
Assess the external genitalia and vagina
Topic 3
Care of the Woman in Labour
Assessing the needs of the woman in labour
Support the labour
Guard the labour
Position and mobility
Touch
Sounds
Breathing
Drinking fluids during labour
Bladder care
Assessing the progress of labour
Fetal condition
Maternal condition
Preparing the birthing place
Equipment and supplies needed to conduct delivery
Handwashing
Wear protective clothing
Topic 4
Using the Partograph
Finding your way around of the partograph
The graph sections of the partograph
The Alert and Action lines
Recording and interpreting the progress of labour
Cervical dilatation
Descent of the fetal head
Assessing moulding and caput formation
Uterine contractions
Assessment and recording of fetal wellbeing
Fetal heart rate as an indicator of fetal distress
Causes of fetal distress
Recording fetal heart rate on the partograph
Amniotic fluid as an indicator of fetal distress
Assessment of maternal wellbeing
Topic 5
Conducting a Normal Delivery
What happens during second stage of labour?
How does the baby move through the birth canal?
Help the mother and baby have a safe birth
Check the baby’s heart beat
Support the mother’s pushing
Conducting delivery of the baby
Prevent tears in the vaginal opening
Delivery of the head
Check if the cord is around the baby’s neck
Delivery of the shoulders
Delivery of the baby’s body
Cutting the cord
Immediate care of the newborn baby
Clean childbirth and cord care
Check the newborn
Warmth and bonding
Early breastfeeding
Topic 6
Active Management of the Third Stage of Labour
Natural processes during the third stage
Complications occurring during the third stage of labour
Active management of third stage of labour (AMTSL)
Excessive bleeding (postpartum haemorrhage or PPH)
Topic 7
Neonatal Resuscitation
Breathing in a healthy newborn
Newborn asphyxia
Types of neonatal resuscitation
Before you start resuscitation
Assessing the degree of asphyxia
The first five seconds
Checking the newborn's heart rate
Dry the baby quickly and keep it warm
Clearing the mouth and nose
Apply gentle tactile stimulation to initiate or enhance breathing
If you diagnose asphyxia, start resuscitation!
Ventilate at 40 breaths per minute
Evaluate the baby during ventilation
Topic 8
Abnormal Presentations and Multiple Pregnancies
Management of women with malpresentation or multiple pregnancy
Vertex presentation
Malpresentations
Malposition
Causes and consequences of malpresentations and malpositions
Breech presentation
Causes of breech presentation
Diagnosis of breech presentation
Types of breech presentation
Risks of breech presentation
Face presentation
Brow presentation
Diagnosis of brow presentation
Complications of brow presentation
Shoulder presentation
Causes of shoulder presentation
Complications of shoulder presentation
Types of twin pregnancy
Diagnosis of twin pregnancy
Consequences of twin pregnancy
Topic 9
Obstructed Labour
Defining obstructed labour
Abnormal presentations and multiple pregnancies
Abnormalities of the reproductive tract
Bandl's ring
Evidence from the partograph
Management of obstructed labour
Fistula
Other common complications of obstructed labour
Using the partograph
Delaying early marriage
Topic 10
Ruptured Uterus
Predisposing factors for a ruptured uterus
Scarred cervix
Previously repaired fistula
Inappropriate use of uterotonic agents
Warning signs of imminent uterine rupture
Consequences for the mother
Referral criteria for prolonged labour
Primary prevention: getting to a health facility for emergency care before uterine rupture
Secondary prevention: emergency care for a woman in shock
Topic 11
Postpartum Haemorrhage
What is postpartum haemorrhage?
How much bleeding is 'excessive'?
Causes of atonic PPH
Interventions during antenatal care
Interventions during and after the third stage of labour
Emergency management of postpartum haemorrhage
Uterotonic drugs and IV fluids to manage atonic PPH
Use two-handed pressure on the uterus
A checklist for emergency referral