Normal Birth

Question 1

Recite the CPG for Normal Birth

Part 1

Answer 1

Question 2

Recite the CPG for Normal Birth

Part 2

Answer 2

Question 4

What clinical status must be identified to begin this guideline?

Answer 4

Imminent normal birth

Question 5

What two areas should be assessed initially?

Answer 5

• Maternity history
• Labour progression

Question 6

Why must opioid analgesics be avoided?

Answer 6

They are contraindicated in late second stage labour

Question 7

What actions are required if birth is not yet imminent?

Answer 7

• Reassure the mother
• Monitor regularly
• Transport using left lateral tilt
• Provide pain relief as per CPG A0501

Question 8

What are the four key preparation steps for an imminent normal birth?

Answer 8

• Reassure (including cultural considerations)
• Prepare equipment
• Provide a warm and clean environment
• Provide analgesia as per CPG A0501

Question 9

What should you encourage during contractions as the head descends?

Answer 9

Encourage the mother to push with each contraction

Question 10

What if the head is birthing too fast?

Answer 10

Ask the mother to pant with an open mouth during contractions

Question 11

What should you do with your fingers during crowning?

Answer 11

Place them on the baby’s head to feel the strength of descent

Question 12

How do you reduce the risk of perineal tears?

Answer 12

Apply gentle pressure to the perineum

Question 13

How do you control rapid expulsion of the head in precipitous birth?

Answer 13

Apply gentle backward and downward pressure—do not forcibly hold the head back

Question 14

What should be noted after the head is delivered?

Answer 14

The time of birth of the head

Question 15

When should you check for nuchal cord?

Answer 15

Immediately after the head is born

Question 16

What do you do if the cord is loose around the neck?

Answer 16

Slip it over the baby’s head using gentle traction

Question 17

What do you do if the cord is tight?

Answer 17

• Encourage the mother to push
• If the baby doesn’t descend and the cord can’t be loosened, clamp and cut the cord

Question 18

What occurs during the next contraction after the head is born?

Answer 18

The head rotates to face one of the mother’s thighs (restitution)

Question 19

What does restitution indicate?

Answer 19

Internal rotation of the shoulders in preparation for delivery of the body

Question 20

How should the birth of the shoulders and body be managed?

Answer 20

It may be passive or guided.

Question 21

What should you do to assist anterior shoulder delivery?

Answer 21

Apply gentle downwards pressure on the baby’s head.

Question 22

How do you assist the posterior shoulder if needed?

Answer 22

Apply gentle upwards pressure under the baby’s armpit.

Question 23

What should you do immediately after birth?

Answer 23

Support the baby
Note the time of birth
Place baby skin to skin on mother’s chest if vigorous
Manage per relevant CPG depending on baby’s condition

Question 24

Which CPG applies to a vigorous newborn?

Answer 24

CPG N0101 Newborn Baby.

Question 25

Which CPG applies to a non-vigorous newborn?

Answer 25

CPG N0201 Newborn Resuscitation.

Question 26

What action should be taken if the body fails to deliver within 60 seconds of the head?

Answer 26

Manage as per CPG M0305 Shoulder Dystocia.

Question 27

What should be done after birth to check for a second twin?

Answer 27

Gently palpate the abdomen.

Question 28

Is there urgency to cut the cord?

Answer 28

No, wait for pulsation to stop (usually 1–2 minutes).

Question 29

Who may cut the cord if appropriate?

Answer 29

The birthing partner, if they wish.

Question 30

What is the correct method to clamp and cut the cord?

Answer 30

First clamp: 10 cm from baby Second clamp: 5 cm from first clamp Cut between clamps

Question 31

What birthing preference is permitted for uncomplicated births?

Answer 31

Cord may remain attached for transport (e.g. lotus births).

Question 32

What type of management is used in this guideline for the placenta?

Answer 32

Passive (expectant) management.

Question 33

How long can placental delivery take?

Answer 33

15 minutes to 1 hour.

Question 34

What position may assist with placenta delivery?

Answer 34

Sitting or squatting to allow gravity to help.

Question 35

What non-pharmacological method may aid separation or expulsion?

Answer 35

Breastfeeding.

Question 36

What must you not do to the cord?

Answer 36

Do not pull—wait for signs of separation.

Question 37

What are signs of placental separation?

Answer 37

Lengthening of the cord Fundus becomes firm, rounded Gush or trickle of blood Cramping/contractions return

Question 38

How should the placenta and membranes be delivered?

Answer 38

Use two hands in a twisting 'see-saw' motion to ease it out slowly.

Question 39

What should be noted and done post-delivery of placenta?

Answer 39

Note the time Place placenta and clots into container Inspect for completeness Confirm uterus is firm and central

Question 40

What should you avoid once the uterus is firm?

Answer 40

Do not massage once fundus is firm.

Question 41

What should be done if fundus is not firm or blood loss exceeds 500 mL?

Answer 41

Manage as per CPG M0401 Primary Postpartum Haemorrhage (PPH).