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SUBJECT- Normal Labour & Birth and AMTSL
PART 1 – TOTAL 5
QUESTIONS’
Q1 What is true about labour pain?
(More than one
answer possible)
It often
disappears if the woman goes to sleep.
It achieves
cervical dilation. ✔️
It is felt first
on the abdomen.
It increases in
duration, frequency, and intensity over time. ✔️
Q2. What are the four components
influencing labour (also known as the 4p’s)?
Power, Passenger, Passage, Psyche
✔️
Pelvis, Pain, Power, Presentation
Psychology, Progress, Physiology, Pain
Process, Power, Provider, Positivity
Q3- A child born in week 36 is born in a
normal birth. True or false?
True
False ✔️
Q4- What is included in the definition
of a normal birth?
(More than one answer possible)
It is spontaneous in onset. ✔️
No complications ✔️
Single infant ✔️
Breech position
Q5- How can a spontaneous normal birth
start?
(More than one answer possible)
Spontaneous rupture of membranes and no
contractions later
Spontaneous rupture of membranes and
contractions soon after✔️
Contractions with shorter and shorter
intervals✔️
PART 2 – TOTAL 14
QUESTIONS’
Q1-
Among other things, what should you remember when performing a VE?
(More than one answer possible)
To do it every hour
To do it only after the woman has given
her permission. ✔️
To do it during a contraction
To find out how soft and dilated the
cervix is. ✔️
Q2 A woman tells you that she had her
last period on March 7, 2020, when is her due date?
January 1
February 7
December 14 ✔️
Q3 What describes the 1st stage of
labour?
It is from onset of true labour pain to
4 cm dilatation.
It is from onset of true labour pain to
full dilatation of cervix. ✔️
It is from onset of true labour pain to
birth of newborn.
It is from onset of true labour pain to
delivery of the placenta.
Q4 When you do the abdominal
examination, what will you do?
(More than one answer possible)
Tell her to be on the side✔️
Look for scars
Measure from symphysis to fundus✔️
Ask her to have a full bladder
Q5 The documentation on the partograph
starts when woman’s cervix is 3 cm. True or false?
True
False ✔️
Q6 The cervix is 8 cm, but the labour
has lasted 12 hours, what could you do?
Rupture the membranes
Put up an oxytocin drip
Ask the woman to push during the
contractions
Support her to continue if labour
progresses, and mother and newborn are well. ✔️
Q7 What is respectful care?
The woman is left by herself.
The woman is treated with kindness and
respect. ✔️
The woman is told to be quiet.
The woman is asked to do what she is
told.
Q8 Fear of being mistreated or previous
bad experiences can keep a woman away from seeking help at the hospital when
giving birth. True or false?
True ✔️
False
Q9 The midwife has invited a woman to
stay at the health facility as the birth is now established. Contractions 3-5
minutes apart, membranes intact and the cervix is 5 cm open. How will you
monitor the woman and the foetus?
(More than one answer possible)
FHR every 30 minutes ✔️
BP, pulse and tp once and then no more.
Vaginal examination every hour
Vaginal examination every 4 hours
depending on the progress. ✔️
Q10 A woman’s cervix is 3 cm open, and
the membranes are intact. She has 5- 7 minutes between the contractions and
lives close by. She is very afraid and tells the midwife about her previous
horrible birth. Will you send her home?
Yes
No ✔️
Q11. What should you observe and note
down when monitoring contractions?
(More than one answer possible)
Intensity ✔️
Movements of the foetus
Duration ✔️
Interval ✔️
Q12 A woman in the labour ward is having
good contractions with 3 minutes apart, her cervix is 7 cm, head engaged,
intact membranes. She is having her first child; she has a lot of pain and has
been in labour for 11 hours. What will you do now?
(More than one answer possible)
Help her to breathe deeply during the
contractions and to find a good position✔️
Suggest that the partner/companion gives
her some massage on the back where it hurts✔️
Listen to the FHR every 30 minutes✔️
Rupture the membranes
Q13 What kind of danger signs should be
examined?
(More than one answer possible)
Severe headache✔️
Bleeding✔️
Pain in the back
Blurred vision✔️
Q14 A pregnant woman comes to a health
facility, she tells you that she has strong contractions 5-6 minutes apart.
What will you do as the most important?
(More than one answer possible)
Help her to be comfortable. ✔️
Tell her to go home and come back when
there is 3 minutes between the contractions.
Do a vaginal examination and listen to
the FHR. ✔️
Tell her that as long as the membranes
are intact, she can go home and wait
PART 3 – TOTAL 13
QUESTIONS’
Q1- Just after the birth of the newborn,
what will you do?
Weigh and measure the newborn as fast as
possible.
Suction the newborn again.
Check that the newborn is breathing
well. ✔️
Q2- What do you do after the head is
born?
(More than one answer possible)
Pull in head so that the shoulder is
born
Stretch the perineum to make room for
the baby
Support the perineum until shoulder is
born spontaneously✔️
Gently support the birth by placing one
hand against the baby’s head✔️
Q3- What kind of non- pharmacological
pain relief can be given during labour and birth?
(More than one answer possible)
Moving✔️
Shower✔️
Massage✔️
Being on the back all the time
Q4- The woman can push when:
The cervix is 8 cm
The cervix is 9 cm and the woman wants
to push
The cervix is 10 cm, and the woman
cannot stop herself from pushing and the fetus is on the pelvic floor ✔️
Q5- What is the normal duration of the
second stage of labour?
2 hours for nullipara and ½ hour for
multipara✔️
4 hours for nullipara and 1 hour for
multipara
6 hours for nullipara and 2 hours for
multipara
Q6- What happens when the woman is in an
upright position during labour and birth?
(More than one answer possible)
She gets very tired
The membranes will rupture easier
The gravity and the more flexible
ligaments help the foetus to descent ✔️
She is more likely to have a placental
abruption
Q7- What needs to be ready for the
birth?
(More than one answer possible)
Oxytocin 10IU✔️
Scissor and pean and gloves✔️
Chlorine water for the woman
Resuscitation equipment for the newborn✔️
Q8- What do you do when the baby is
born?
(More than one answer possible)
Place the newborn on the mother’s
abdomen and give oxytocin 10IU IM.
Dry the newborn.
Separate the mother and the newborn and
keep them both under observational care
Document the birth.
Q9- How would you help the woman to
push?
Tell her to take in air and to do 3 long
pushes during the contractions.
Support her in pushing the way she
wants. ✔️
Q10 It is not possible to be on all
fours and give birth. True or false?
True
False ✔️
Q11
The woman can give birth in any position she wants. True or false?
True ✔️
False
Q12 How do you describe the second stage
of labour?
It is the period from full dilatation of
the cervix to delivery of the placenta.
It is the period from full dilatation of
the cervix to delivery of the fetus. ✔️
It is the period from full dilatation of
the cervix to crowning of the head of the fetus.
Q13 What should you do during the second
stage?
(More than one answer possible)
Listen to the FHR every 15 minutes
Make sure the bladder is empty ✔️
Listen to the FHR every 5 minutes✔️
Be aware of the time limits and suggest
a change of position if needed✔️
PART 4 – TOTAL 5 QUESTIONS’
Q1 Which
of the following steps are critical steps of AMTSL?
(More than one answer possible)
Uterine massage.
✔️
Emptying the bladder.
Controlled cord traction.
✔️
Administration of uterotonic drug.
✔️
Q2- You should assess the mother and the
newborn every 15 minutes within the first 2 hours. True or false?
True✔️
False
Q3- What are classical signs indicating
that the placenta has separated from the uterus?
(More than one answer possible)
The uterus contracts and rises.
✔️
The umbilical cord suddenly lengthens.
✔️
A gush of blood occurs.
✔️
Pain in the upper part of the abdomen.
Q4-What is true about the third stage of
labour?
(More than one answer possible)
It is the time from delivery of the baby
to delivery of the placenta. ✔️
The duration is 15 minutes to half an
hour. ✔️
It includes separation, descend and
expulsion of the placenta. ✔️
It is the time from expulsion of the
placenta to 2 hours after birth.
Q5- What is true about the 4th stage of
labour?
(More than one answer possible)
It is the first two hours after the
delivery of the placenta. ✔️
In this stage the mother should be send
home.
The mother and the newborn should be
separated and kept under observation
It is also called the stage of recovery
✔️
PART 5 – TOTAL 20
QUESTIONS’
Q1. What will you do when the woman wants to stand up during the
contractions?
(More than one answer possible)
Tell her to lie down
Encourage her to find a good position and to use
gravity ✔️
Support her in her choice and offer to massage her
back✔️
Q2- The woman cannot eat or drink during labour and
birth. True or false?
True
False ✔️
Q3- What is true about descent of the foetus?
(More than one answer possible)
In primigravida descent starts in the last weeks of
pregnancy and continues until delivery
In multigravida descent and engagement occur once
labour begins
Contraction and retraction of the uterine muscles
exert pressure on the fetus allowing it to descend. ✔️
In both primigravida and multigravida descent and
engagement occur once labour begins✔️
Q4- What should you look for when you examine the
placenta?
(More than one answer possible)
Completeness of all the lobules or cotyledons
If the umbilical vessels are visible
If the weight of the placenta is above 600 g
If membranes are continuous and complete
Q5- What do you notice during a vaginal examination?
(More than one answer possible)
Bleeding ✔️
The amount of hair on the foetus' head
Fetal presentation and position ✔️
Membranes’ status✔️
Q6- What is the correct order of the following changes
in position that the presenting part has to make during its journey through the
pelvis?
Flexion, Restitution, Descend,
Crowning.
Descend, Flexion, Internal
rotation of the head, Crowning. ✔️
Extension of the head, Lateral
flexion, Internal rotation of shoulders, Restitution.
Crowning, Flexion, External
rotation of the head, Internal rotation of shoulders.
Q7- When the baby’s head is crowning what do you
do?
Nothing
Ask the woman to breathe with
short quick breaths ✔️
Ask the woman to push as hard as
she can
Q8- What are some of the “do’s” of the labour room?
(More than one answer possible)
The presence of a birth companion during the labour
Immediate clamping and cutting of the umbilical
cord
Separating newborn from the mother for routine care
Initiation of breastfeeding within one hour of
birth
Q9- What kind of practices should not be
performed?
(More than one answer possible)
Fundal pressure✔️
Routine episiotomy✔️
Rectal examination after suturing
Manipulate and stretch the perineum and turn the
baby’s head✔️
Q10- The SF measurement in cm should correspond the
gestational age (with allowance of +/- 2 cm). True or false?
True ✔️
False
Q11- AMTSL should be initiated within 1 minute of birth.
True or false?
(More than one answer possible)
True✔️
False
Q12- What are the elements of true respectful care at a
birth?
(More than one answer possible)
Good and clear communication, explain all medical
procedures. ✔️
Ask for permission before any intervention.
Let the woman do what she wants without giving her
information, it is her body.
Make sure the woman feels safe and in control.
✔️
Q13- What is the first thing you do when a woman in
labour comes to your health facility?
Tell her to go and wash herself.
Determine the stage of labour
and listen to the FHR. ✔️
Ask her about her previous
births.
Ask her if she takes medicine.
Q14 The baby is born with thick meconium and does not breathe. What do you
do?
(More than one answer possible)
Nothing
Wipe the face gently✔️
Suction first in mouth and then in nose✔️
Start resuscitation✔️
Q15- If you feel a lose cord around the neck, what
should you do?
Cut it and clamp it
Nothing
Slip it over the baby’s head or
deliver the baby through the cord
Q16- What are the normal ranges for the following
vitals?
(More than one answer possible)
Tp: 37,5° ✔️
Pulse: 60-110bpm
Systolic BP:70-110
Diastolic BP: 60-89✔️xx da
/”:\un s
Q17 What do you do before the baby’s head is about to be born?
(More than one answer possible)
Nothing
Perform hand hygiene and put on double gloves✔️
Support the perineum✔️
Q18 What will help the woman to get good contractions in the active
phase?
(More than one answer possible)
That the woman feels safe and supported by a
companion of her choice ✔️
That the surroundings are peaceful and private✔️
That the woman does not drink and eat during the
birth
That the woman is supported by the midwife during
the labour and birth✔️
Q19 What do you do when the baby is born with meconium
and is breathing?
Nothing
Wipe the face of the newborn ✔️
Deep suctioning of the newborn
Q20 What is important to know when a labouring woman
comes to your health facility?
(More than one answer possible)
Her due date✔️
Her address
Does she have contractions
Did the water break✔️
PART 06– TOTAL 7 QUESTIONS’
post Test
1. CASE 1:
A labouring woman comes for care at your health facility. She is in a lot of
pain. Contractions are 3-5 minutes apart and membranes are intact.
Question 1:
What are important actions in the initial assessment of the woman?
(More than one answer possible)
Calculate due date and gestational age.
✔️
Perform an abdominal examination.
✔️
Examine for danger signs such as: severe headache,
fever, and bleeding. ✔️
Empty the bladder.
Rupture the membranes to avoid prolonged labour.
3/7
2. CASE 1:
A labouring woman comes for care at your health facility. She is in a lot of
pain. Contractions are 3-5 minutes apart and membranes are intact.
Question 2:
How would you determine if the woman is in active labour?
(More than one answer possible)
Ask the woman how many hours she has had painful
contractions.
If membranes are still intact, she is not in active
labour.
Perform vaginal examination to examine if the
cervix is dilated at least 4 centimeters. ✔️
Feel for contractions and note down frequency,
duration, and intensity. They should be regular with increasing intensity.
✔️
3. CASE 2:
A young woman is giving birth for the first time. The gestational age is around
39 weeks. She is alone, very scared and has started to cry. Contractions are 3
minutes apart and cervix is 8 centimetres dilated. Amniotic fluid is clear. You
have admitted her and started labour care.
Question 1:
What kind of support would you give the woman to make her feel safe?
(More than one answer possible)
Tell her to call someone that can be with her
during the labour, because you cannot be there all the time.
Tell her to stop crying because it will prolong the
labour.
Explain what to expect and inform her continuously
and respectfully. ✔️
Make sure, that the environment around the woman is
clean and private✔️.
Ask her to go for a walk and come back when she is
feeling better.
Encourage the woman and talk her through the
contractions. ✔️
4. CASE 2:
A young woman is giving birth for the first time. The gestational age is around
39 weeks. She is alone, very scared and has started to cry. Contractions are 3
minutes apart and cervix is 8 centimetres dilated. Amniotic fluid is clear. You
have admitted her and started labour care.
Question 2:
What can you do at this stage to support the descent of the fetus?
(More than one answer possible)
Make sure the woman lies down on the bed to relax
and make sure she does not use all her energy.
Give pain relief.
Encourage the woman to empty her bladder.
✔️
Ask the woman to stay in the same position for as
long as possible.
It can be beneficial to utilize gravity by adopting
an upright position. ✔️
Make sure the woman is in motion and changes
positions throughout labour. ✔️
CASE 3:
A 25-year-old woman is about to give birth to her 2nd child. Cervix is fully
dilated and the fetus has reached the pelvic floor. You have prepared for birth
and checked items for newborn resuscitation.
Question 1:
The woman asks you if she can start to push. What do you do?
(More than one answer possible)
You tell the woman to wait until you have emptied
the bladder.
You encourage the woman to give birth in the
position she chooses.
You instruct the woman in how to push and tell her
to follow your instructions carefully.
You tell the woman to lay down on her back before
she starts to push, so you have a good overview of the perineum.
You support the woman to push according to her own
urge with legs relaxed and open to allow slow and progressive stretching of the
perineum.
You set up an oxytocin drip to avoid insufficient
contractions and to ensure that the pushing stage will be as short as possible.
CASE 3:
A 25-year-old woman is about to give birth to her 2nd child. Cervix is fully
dilated and the fetus has reached the pelvic floor. You have prepared for birth
and checked items for newborn resuscitation.
Question 2:
After 10 minutes of pushing the head is about to be delivered. What do you do?
(More than one answer possible)
Perform hand hygiene and put on double gloves.
Instruct the woman to push as soon as she feels the
next contraction. ✔️
Instruct the woman not to push during contractions
to reduce the risk of trauma to the perineum and allow the head to deliver
gradually.
Let go of the perineum and use both hands to keep
the baby’s head flexed towards the woman’s back.
Perform a routine episiotomy to avoid severe trauma
to the perineum.
Support the perineum until the posterior shoulder is delivered as it can also cause damage to the perineum. ✔️
CASE 3:
A 25-year-old woman is about to give birth to her 2nd child. Cervix is fully
dilated and the fetus has reached the pelvic floor. You have prepared for birth
and checked items for newborn resuscitation.
Question 3:
The head is now born, and you have allowed it to rotate naturally. What do you
do now?
(More than one answer possible)
You wipe the newborn’s face with a clean cloth and
perform routine suction of the nose and mouth.
You check for the umbilical cord around the neck.
✔️
You stretch the perineum to prepare for delivery of
the shoulders.
You pull the head gently downwards to deliver the
anterior shoulder and then lift the head upwards to deliver the posterior
shoulder. ✔️
You reach in to deliver the arms after the shoulder
is born.
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