Contents

1. Acknowledgements
2. Introduction
   1. About Bettercare
   2. Why decentralised learning?
   3. Free Bettercare Online Learning Station
   4. Learning programmes
   5. Format of the courses
   6. Contributors
   7. Updating the course material
   8. Contact information
   9. Registration
3. 1. Monitoring the condition of the mother during the first stage of labour
   1. Objectives
   2. Monitoring labour
   3. Assessing the general condition of the patient
   4. Assessing the temperature
   5. Assessing the pulse rate
   6. Assessing the blood pressure
   7. Assessing the urine
   8. Maternal exhaustion
   9. Case studies
4. 2. Monitoring the condition of the fetus during the first stage of labour
   1. Objectives
   2. Monitoring the fetus
   3. Fetal heart rate patterns
   4. The liquor
   5. Case studies
5. 3. Monitoring and managing the first stage of labour
   1. Objectives
   2. The diagnosis of labour
   3. The two phases of the first stage of labour
   4. Monitoring of the first stage of labour
   5. Management of a patient in the latent phase of the first stage of labour
   6. Management of a patient in the active phase of the first stage of labour
   7. Poor progress in the active phase of the first stage of labour
   8. Cephalopelvic disproportion
   9. Inadequate uterine action
   10. The referral of patients with poor progress during the active phase of the first stage of labour
   11. Prolapse of the umbilical cord
   12. Women living with HIV
   13. Case studies
6. Skills: Examination of the abdomen in labour
   1. Objectives
   2. Abdominal palpation
   3. Assessing contractions
   4. Assessing the fetal heart rate
7. Skills: Vaginal examination in labour
   1. Objectives
   2. Preparation for a vaginal examination in labour
   3. Procedure of examination
   4. The vulva and vagina
   5. The cervix
   6. The membranes and liquor
   7. The presenting part
   8. Moulding
8. Skills: Recording observations on the partogram
   1. Objectives
   2. The partogram
   3. Recording the condition of the mother
   4. Recording the condition of the fetus
   5. Recording the progress of labour
   6. Exercises on the correct use of the partogram
   7. Case studies
9. 4. The second stage of labour
   1. Objectives
   2. The normal second stage of labour
   3. Managing the second stage of labour
   4. Episiotomy
   5. Prolonged second stage of labour
   6. Management of impacted shoulders
   7. Managing the newborn infant
   8. Case studies
10. Skills: Performing and repairing an episiotomy
    1. Objectives
    2. Repairing an episiotomy
11. 5. The third stage of labour
    1. Objectives
    2. The normal third stage of labour
    3. Managing the third stage of labour
    4. Examination of the placenta after birth
    5. The abnormal third stage of labour
    6. Managing postpartum haemorrhage
    7. Protecting the staff from HIV infection
    8. Case studies
12. Skills: Inserting and using intra-uterine balloon tamponade to treat postpartum haemorrhage
    1. Objectives
    2. Unique features of the Ellavi intra-uterine balloon
    3. Prerequisites for use
    4. Preparation prior to use
    5. Insertion into the uterus
    6. Antibiotic prophylaxis
    7. Transfer
    8. Intra-uterine pressure control
    9. Monitoring for bleeding
    10. Abdominal discomfort
    11. Removal
    12. Cautions and warnings
13. 6. Managing pain during labour
    1. Objectives
    2. Pain relief in labour
    3. Use of analgesics in labour
    4. Naloxone
    5. Sedation during labour
    6. Inhalational analgesia
    7. Local anaesthesia
    8. Epidural anaesthesia
    9. General anaesthesia
    10. Case studies
14. 7. The puerperium
    1. Objectives
    2. The normal puerperium
    3. Management of the puerperium
    4. The six week postnatal visit
    5. Puerperal pyrexia
    6. Genital tract infection
    7. Urinary tract infections
    8. Thrombophlebitis
    9. Respiratory tract infection
    10. Puerperal psychiatric disorders
    11. Secondary postpartum haemorrhage
    12. Self-monitoring
    13. HIV positive mothers
    14. Case studies
15. 8. Family planning after pregnancy
    1. Objectives
    2. Contraceptive counselling
    3. Case studies