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A gutter-shaped structure which is higher anteriorly than posteriorly. This aids rotation of the fetus during the mechanism of labour.

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The Apgar score is a tool to assess the condition of a newborn.

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For extra ideas, consider the midwifery care in labour guidance for all women in all settings. Blue top guidance no. 1 produced by the Royal College of Midwives (RCM 2018).

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Thyroid-stimulating hormone (TSH) https://www.w3.org/1998/Math/MathML" display="inline"> 1 – 11   mU / L

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There are a number of approaches that can be used to categorise LSCS dependent on the degree of urgency.

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Introduce yourself and obtain verbal consent from the patient after explaining the procedure.

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Obtain consent/ensure privacy.

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Blood will be taken from the umbilical cord after the birth of the placenta for two main reasons: Direct Coombs – taken alongside a sample of the mother’s blood to test for maternal antibodies in the fetal circulation. If present, these could potentially lead to rhesus incompatibility, resulting in pathological jaundice. Only a sample of blood from the umbilical vein is required here. Maternal blood is sent for the Kleihauer test. Blood samples from the vein and artery may be taken using pre-heparinised syringes to assess the degree of acidosis in the fetal blood. These are usually taken after an assisted vaginal birth and after any suspected fetal compromise during a labour. Notes A https://www.w3.org/1998/Math/MathML" display="inline"> pH above 7.25 is normal. Below this suggests some fetal acidosis has occurred. Respiratory acidosis is due to a buildup of https://www.w3.org/1998/Math/MathML" display="inline"> CO 2 https://www.w3.org/1999/xlink" xlink:href="https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003632436/ace52de4-79a0-425f-b6f6-2ac10bc64478/content/ieq0034.tif"/> and a drop in oxygen levels. Usually, aerobic metabolism can continue. However, metabolic acidosis occurs when the level of oxygen continues to fall. A resulting buildup of lactic acid leads to a high level of hydrogen ions, which need buffers to be absorbed. As the buffers are used up, the degree of acidosis increases. The greater the amount of buffers used, the higher the base deficit. Therefore, if metabolic respiration has occurred, there is more likely to be a higher base excess reading, as well as a low https://www.w3.org/1998/Math/MathML" display="inline"> pH . N.B. Care must be taken to prevent any air bubbles occurring in the samples, as this will alter the result.

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Historically, if conducting active management of the third stage of labour, the umbilical cord would be clamped and cut immediately following the birth of the baby. Current practice as recommended by NICE is to delay clamping the cord for between one to five minutes unless there is a clinical reason to do so, such as the baby requires transfer for resuscitation or the placenta needs to be delivered due to maternal haemorrhage. Delaying cord clamping enables the baby to receive valuable blood flow, which can reduce risks of anaemia and iron deficiency resulting in affected growth and development. If left, the cord will naturally shut down and blood flow will cease. McDonald and Middleton (2009)

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There are various ways of interpreting a cardiotocograph trace; however, they all consider the same components. The following (DRCBRAVADO) is only one way, and trust policy should be adhered to. Refer to NICE (2017 updated 2025) Fetal Monitoring in Labour.

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Management will depend on the type of diabetes; therefore, review NICE 2020, RCOG and trust guidelines to ensure you provide the best individualised care. Women may be advised to be induced or have an elective LSCS from 37 weeks gestation. N.B. Some GEM groups have a higher likelihood of having diabetes alongside hypertension.

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This procedure is offered to women usually between 37–38 weeks gestation if their fetus is in breech presentation at 36 weeks. With the additional risks associated with breech vaginal births, one way of reducing the need for a caesarean section is to turn the fetus into a cephalic presentation and aim for a normal labour and birth with less associated risks. It is suggested that around 50% are successful. Some babies may move back into the breech position. Rarely, the procedure can lead to the need for an urgent caesarean due to fetal distress or placental abruption during the procedure.

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Women can give birth at anytime and anywhere, so it’s useful to give some thought as to how you would deal with a birth outside of the home or a maternity unit.

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An epidural can be sited at any point during established labour as long as the anaesthetist is able to carry out the procedure and the woman is able to maintain the required position for long enough. It is also possible that an epidural could be sited prior to the commencement of an oxytocin infusion for induction of labour, although in these cases, it can be very difficult to ascertain whether the epidural is working effectively until contractions are occurring. It is also recommended that women with high BMIs have an anaesthetic review during the antenatal period and have an epidural sited early.

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A surgical incision of the perineum used to expedite birth. Reasons include assisted vaginal birth, breech, shoulder dystocia if internal manoeuvres are used, female genital mutilation (FGM) and fetal distress. Little evidence supports routine episiotomy for premature births or previous third- or fourth-degree tears.

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It is vital that the placenta and membranes are examined after every birth. If there is any suspicion that they are incomplete, then staff must be extra vigilant when monitoring the mother’s well-being, as she is more at risk of experiencing a postpartum haemorrhage.

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Current fetal monitoring guidelines (NICE 2017, updated 2025) recommend assessment of fetal response through digital stimulation of the fetal head via vaginal examination. An acceleration of the fetal heart rate indicates well-being. No acceleration is a cause for concern.

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Home birth can be considered as safe as a hospital birth as long as there is adequate preparation. Olsen and Clausen (2023).

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Membrane sweep performed by midwife or obstetrician between 40 and 42 weeks gestation.

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This top-to-toe examination should be conducted in a warm, draught-free, well-lit environment and in the presence of the parents. Consent should be obtained.

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Types include ventouse/kiwi cup (see Figure 19).

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Ideally, longitudinal lie, cephalic presentation, LOA or ROA.

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At the start of labour or at any changeover of staff, a review of the medical and obstetric history should be undertaken. It is worth noting that due to an increased risk of morbidity and mortality amongst the GEM women, additional vigilance may be necessary. Use of interpreters where appropriate, rather than family members, would be ideal if required

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Women with a high BMI in labour still need the routine care any woman in labour requires (NICE 2019 NG 121). However, there are a few extra considerations: Due to the greater risk, these women should give birth under consultant-led care. Obesity itself is not an indication for induction of labour. Early assessment by the anaesthetist and obstetrician (prior to labour preferably) is optimal. If requested, the insertion of an epidural by a senior anaesthetist earlier in the labour is preferable. However, the benefits of encouraging mobility to promote normal labour and reduce the risks of thrombosis should also be considered. Equipment, including beds and birthing balls, blood pressure cuffs, etc., should be able to accommodate the woman’s weight. One-to-one continuous care is vital. Manual handling and health and safety issues must be considered. Use elastic support stockings if mobility is restricted. Venous access if BMI over 40. Active management of the third stage is advocated. Continuous monitoring may be required but can be difficult. There may be a case for the use of a fetal scalp electrode (FSE). Remember! Women with a high BMI may have been on heparin during the antenatal period and so are at a higher risk of haemorrhage. There is an increased risk of shoulder dystocia, so consider adopting alternative positions for the birth where possible (RCOG 2018; Rees et al. 2008).

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The options for pain relief in labour are numerous, and the decision as to which to use should be the woman’s. Every individual will manage the discomfort of labour differently and may change their minds at any point as labour progresses. It is highly possible that more than one of the following options listed are selected. Other women, however, may opt to have a completely natural birth. The role of the midwife is, therefore, to support and guide the woman using appropriate information and administer, where possible, the method of choice.

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Labial, clitoral lacerations/tears

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The SBAR tool has been designed to aid effective communication between professionals, especially during critical situations. The main principles to work to are as follows: S – SITUATION – What is happening now? B – BACKGROUND – What has happened that is relevant to this situation? A – ASSESSMENT – In your view, what is the problem/issue? R – RECOMMENDATIONS – What do you think needs to happen now? What actions do you propose?

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Latent phase – the buildup prior to active first stage of labour which can last for a few days. During this time irregular niggles, backache and mild contractions occur. The cervix also begins to soften and efface (flatten out from a tube to a ring) and dilate. There may be a blood-streaked mucousy show and possibly a spontaneous rupture of membranes.

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Can take up to 60 minutes.

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Before you start, make sure you have a good reason for undertaking the assessment. Ask yourself: Is there another way of assessing progress?

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Around 75% of VBAC, women will successfully have a vaginal birth after CS, within a hospital or home environment; some even have pool births. Rarely, the reason for a repeat CS in the remaining 25% is uterine rupture; however, the risks still exist (Horn 2003).

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Routine care in labour plus the following: One-to-one care is necessary. Never leave a woman alone when she is using the pool. Remember to have training in using the pool and dealing with any emergencies that may occur. Remember manual handling issues and your personal health and safety. Check the woman’s temperature hourly. Encourage the intake of fluids as dieresis increases when in water. Test the water temperature every 30 minutes and adjusted to between 35 and 37°C. Abdominal and vaginal assessments can be carried out in the pool. Fetal heart monitoring can be intermittent using a waterproof Doppler device or using telemetry continuous monitoring if available. For the second stage, the water temperature should be maintained at 37°C. A mirror can be used to view progress. Hands off the birth unless assistance is deemed necessary! The woman can raise the baby to the surface herself or the midwife can do so. The baby’s face should leave the water first. Assess baby’s condition, but remember that these babies don’t often cry straight away. Avoid putting baby back under the water once the head is above the surface. The third stage can be conducted either in the pool or on dry land. Allow approximately one hour, unless there is excessive bleeding, before any perineal repair to allow the tissues to become less waterlogged (Garland 2017).