Safe Intra-Partum Care for Mother and Baby Training

Objectives:
• Understand the scope and importance of safe intra-partum care
• Describe the physiological changes in mother and fetus during labour
• Identify key anatomical structures involved in childbirth
• Recognise the stages of labour and their clinical significance
• Appreciate the principles of respectful maternity care

Topics:
• Overview of intra-partum care: definitions and key concepts
• Maternal physiological adaptations in labour
• Fetal physiology and the transition to extra-uterine life
• Anatomy of the pelvis, birth canal, and fetal skull
• Stages of labour: latent, active, transition, and expulsion
• Principles of respectful and culturally sensitive care

Objectives:
• Perform a comprehensive antenatal history and examination
• Identify risk factors for complicated labour
• Use partogram effectively to monitor labour progress
• Apply screening tools for maternal and fetal well-being
• Develop a birth plan in collaboration with the mother

Topics:
• Taking a focused antenatal history
• Abdominal examination: Leopold's manoeuvres
• Pelvic assessment and estimation of fetal weight
• Risk stratification: medical, obstetric, and social factors
• Introduction to the partogram: components and interpretation
• Shared decision-making and birth planning

Objectives:
• Measure and interpret maternal vital signs accurately
• Recognise signs of maternal distress and dehydration
• Monitor uterine contractions: frequency, duration, and strength
• Assess pain and provide non-pharmacological relief
• Document observations correctly on the partogram

Topics:
• Maternal vital signs: pulse, blood pressure, temperature, respiratory rate
• Signs of infection, haemorrhage, and pre-eclampsia
• Uterine activity monitoring: palpation and tocography
• Pain assessment scales and comfort measures
• Documentation standards for maternal observations

Objectives:
• Perform intermittent auscultation of fetal heart rate
• Interpret fetal heart rate patterns using a cardiotocograph (CTG)
• Identify signs of fetal distress
• Assess fetal descent and position during labour
• Respond appropriately to abnormal fetal monitoring findings

Topics:
• Intermittent auscultation: technique and interpretation
• Introduction to CTG: baseline, variability, accelerations, decelerations
• Classification of CTG traces: normal, suspicious, pathological
• Fetal scalp stimulation and pH sampling (theory)
• Clinical assessment of fetal descent and station
• Escalation protocols for fetal distress

Objectives:
• Discuss the physiology of labour pain
• Offer non-pharmacological pain relief options
• Explain pharmacological analgesia: safety and side effects
• Support maternal choice and informed consent
• Monitor for complications of analgesia

Topics:
• Pain pathways in labour
• Non-pharmacological methods: breathing, positioning, water immersion, massage
• Systemic analgesia: opioids and inhalational agents
• Regional analgesia: epidural and spinal blocks
• Contraindications and risks of analgesia
• Maternal monitoring during analgesia

Objectives:
• Define the phases of the first stage of labour
• Provide supportive care during latent and active phases
• Encourage optimal maternal positions and mobility
• Maintain hydration and nutrition
• Recognise prolonged labour and initiate appropriate action

Topics:
• Latent phase: duration, support, and when to transfer
• Active phase: cervical dilatation and descent
• Partogram use: alert and action lines
• Maternal positioning and mobility
• Fluid and nutritional support
• Diagnosis of prolonged labour and initial interventions

Objectives:
• Recognise the onset of the second stage
• Coach maternal pushing efforts effectively
• Perform perineal care and support
• Deliver the baby safely and assess immediate condition
• Manage the cord and facilitate skin-to-skin contact

Topics:
• Signs of full dilatation and descent
• Pushing techniques: directed vs spontaneous
• Perineal massage and warm compresses
• Mechanisms of labour: cardinal movements
• Controlled delivery of the head and shoulders
• Immediate newborn care: drying, stimulation, cord clamping
• Skin-to-skin contact and early breastfeeding initiation

Objectives:
• Describe the physiology of placental separation
• Perform active management of the third stage
• Assess completeness of placenta and membranes
• Estimate blood loss and prevent postpartum haemorrhage
• Document third stage events

Topics:
• Signs of placental separation
• Active management: oxytocin, controlled cord traction, uterine massage
• Physiological management: risks and benefits
• Inspection of placenta and membranes
• Estimation and documentation of blood loss
• Immediate postpartum observation

Objectives:
• Monitor mother for complications in the first hour
• Assess uterine tone and lochia
• Support breastfeeding initiation
• Perform initial newborn examination
• Provide postpartum advice and family planning

Topics:
• Maternal observations: pulse, BP, uterine fundus, lochia
• Prevention of postpartum haemorrhage
• Breastfeeding support: latch and positioning
• Newborn assessment: APGAR, weight, temperature, vital signs
• Vitamin K and immunisations
• Postpartum counselling: danger signs, contraception, hygiene

Objectives:
• Identify risk factors and early signs of PPH
• Execute immediate first-line interventions
• Administer uterotonic drugs correctly
• Perform bimanual compression and intrauterine balloon placement
• Organise team response and transfer if needed

Topics:
• Definition, causes (4 Ts), and risk assessment
• Recognition: vital signs, blood loss estimation
• Uterotonics: oxytocin, ergometrine, misoprostol
• Mechanical methods: bimanual compression, balloon tamponade
• Surgical interventions: compression sutures, hysterectomy (theory)
• Communication and teamwork in emergencies

Objectives:
• Recognise hypertensive disorders in labour
• Manage severe pre-eclampsia and eclampsia
• Administer magnesium sulfate safely
• Monitor for complications: pulmonary oedema, renal failure
• Plan safe delivery and postpartum care

Topics:
• Classification of hypertensive disorders
• Signs of severe pre-eclampsia: BP, proteinuria, symptoms
• Eclampsia: seizure management and prevention
• Magnesium sulfate: loading dose, maintenance, monitoring
• Antihypertensive therapy: labetalol, nifedipine
• Fluid balance and monitoring for complications

Objectives:
• Recognise shoulder dystocia and cord prolapse promptly
• Execute McRoberts' manoeuvre and suprapubic pressure
• Perform other manoeuvres: Rubin, Woods, Gaskin
• Manage cord prolapse: knee-chest position, bladder filling
• Document and debrief after the event

Topics:
• Risk factors for shoulder dystocia
• McRoberts' manoeuvre and suprapubic pressure
• Internal rotational manoeuvres: Rubin, Woods, reverse Woods
• Posterior arm delivery and Gaskin position
• Cord prolapse: diagnosis and immediate actions
• Emergency cesarean preparation for cord prolapse

Objectives:
• Identify signs of uterine rupture and AFE
• Initiate emergency management and resuscitation
• Coordinate multidisciplinary team response
• Understand maternal collapse protocols
• Provide psychological support to mother and family

Topics:
• Uterine rupture: causes, symptoms, diagnosis
• Emergency laparotomy and repair (theory)
• Amniotic fluid embolism: pathophysiology and presentation
• CPR in pregnancy: left lateral tilt, perimortem cesarean
• Team roles and communication in maternal collapse
• Debriefing and counselling after critical events

Objectives:
• Identify indications and contraindications for assisted delivery
• Apply vacuum cup correctly and safely
• Perform forceps delivery under supervision
• Recognise complications and manage them
• Document procedure accurately

Topics:
• Indications: prolonged second stage, fetal distress, maternal exhaustion
• Prerequisites: full dilatation, engaged head, ruptured membranes
• Vacuum extraction: cup placement, traction technique, safety checks
• Forceps delivery: types of forceps, application, traction
• Episiotomy: indications and repair
• Complications: scalp trauma, vaginal tears, failed procedure

Objectives:
• List indications for induction and augmentation
• Administer prostaglandins and oxytocin safely
• Monitor maternal and fetal response
• Recognise hyperstimulation and manage it
• Counsel women about induction methods

Topics:
• Indications: post-term, PROM, hypertensive disorders, IUGR
• Bishop score and cervical ripening
• Prostaglandins: dinoprostone, misoprostol – doses and routes
• Oxytocin infusion: preparation, titration, monitoring
• Hyperstimulation: definition and management
• Contraindications and failed induction

Objectives:
• Prepare a woman for emergency or elective cesarean
• Assist in the operating theatre
• Understand surgical steps and infection prevention
• Monitor mother and baby during surgery
• Manage immediate postoperative care

Topics:
• Indications for cesarean section
• Preoperative preparation: consent, fasting, antibiotics
• Anaesthesia options: spinal, epidural, general
• Surgical steps: skin incision, uterine incision, delivery, closure
• Infection prevention: sterile technique, prophylactic antibiotics
• Immediate postoperative monitoring and newborn care

Objectives:
• Manage pain and promote mobility after cesarean
• Monitor wound healing and detect infection
• Support breastfeeding after surgery
• Provide discharge planning and follow-up
• Recognise delayed complications

Topics:
• Pain management: multimodal analgesia
• Early mobilisation and thromboprophylaxis
• Wound care: inspection, dressing, signs of infection
• Breastfeeding positions after cesarean
• Contraception counselling
• Signs of complications: wound infection, endometritis, thromboembolism

Objectives:
• Assess newborn transition and need for resuscitation
• Perform basic resuscitation: warming, drying, stimulation
• Administer positive pressure ventilation with bag-mask
• Perform chest compressions and coordinate with ventilation
• Recognise need for advanced resuscitation and call for help

Topics:
• Newborn physiology and transition
• Steps of resuscitation: algorithm (dry, stimulate, ventilate, compress)
• Bag-mask ventilation: technique and troubleshooting
• Chest compressions: ratio and technique
• Medications: epinephrine, volume expanders
• Team roles and documentation

Objectives:
• Apply standard precautions in labour ward
• Identify signs of maternal and neonatal sepsis
• Initiate sepsis care bundles
• Manage chorioamnionitis and puerperal sepsis
• Promote hand hygiene and sterile procedures

Topics:
• Standard precautions: hand hygiene, PPE, waste management
• Maternal sepsis: diagnosis and management (SOFA, qSOFA)
• Chorioamnionitis: risk factors, treatment, implications for newborn
• Neonatal sepsis: early-onset and prevention
• Antibiotic stewardship
• Audits and quality improvement in infection control

Objectives:
• Apply clinical governance principles in intra-partum care
• Use communication tools (SBAR, TeamSTEPPS) effectively
• Understand medicolegal responsibilities and documentation
• Participate in incident reporting and audits
• Develop a personal action plan for safe practice

Topics:
• Clinical governance: audit, risk management, patient safety
• Communication tools: SBAR, closed-loop communication
• Informed consent and refusal of care
• Documentation standards: partogram, notes, legal implications
• Incident reporting and root cause analysis
• Self-care and debriefing after critical incidents