OG13.5-7 | Normal Labour Skills — Summary & Reflection

KEY TAKEAWAYS

The WHO partograph has three sections: fetal condition (FHR, liquor, moulding), labour progress (cervicograph with alert and action lines, descent, contractions), and maternal condition. Alert line starts at 4 cm, 1 cm/h; action line is 4 h to the right — crossing it mandates senior review and delivery decision. FHR monitoring: every 30 min in first stage, every 5 min in second stage; late decelerations = uteroplacental insufficiency. ARM (OG13.5, SH level): indications (slow labour with engaged head, liquor assessment, induction); contraindications (unengaged head, placenta praevia, cord presentation, active herpes); post-ARM FHR check mandatory; bradycardia = cord prolapse check. Conduct of normal delivery (OG13.6 SH, OG13.7 P): delivery of head with modified Ritgen manoeuvre; check nuchal cord; wait for external rotation; deliver anterior then posterior shoulder; AMTSL = oxytocin 10 IU IM with anterior shoulder, CCT, uterine massage. Meconium grade III + late decelerations = emergency delivery. Delayed cord clamping 1–3 min recommended for term neonates.

REFLECT

Think back to any delivery you have observed — or if not yet, to the simulation session in the skill lab. What part of the sequence did you find most difficult to visualise? Was it the moment of internal rotation (an invisible event that you can only feel on examination, not see from outside)? Was it the timing of AMTSL — when exactly the oxytocin should have been given? Was it the decision to call for help when the CTG showed decelerations? Kolb's reflective learning asks you to identify the gap between what you observed and what you now know. Write down the one moment in a delivery that you feel least confident about, and plan a specific action to address it — a skill-lab session, a deliberate observation at your next delivery, or a question to your registrar. Confidence in the delivery room is built one observed, reflected-upon event at a time.