Contents

1. Acknowledgements
2. Introduction
   1. About the Bettercare series
   2. Why decentralised learning?
   3. Bettercare Online Learning Station
   4. Books in the Bettercare series
   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 study 1
   10. Case study 2
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 study 1
   6. Case study 2
   7. Case study 3
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. HIV positive women
   13. Case study 1
   14. Case study 2
   15. Case study 3
   16. Case study 4
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 study 1
   8. Case study 2
   9. Case study 3
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 study 1
   9. Case study 2
   10. Case study 3
   11. Case study 4
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 a postpartum haemorrhage
    7. Protecting the staff from HIV infection during labour
    8. Case study 1
    9. Case study 2
    10. Case study 3
    11. Case study 4
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. Removal
    11. 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 study 1
    11. Case study 2
    12. Case study 3
    13. Case study 4
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 study 1
    15. Case study 2
    16. Case study 3
    17. Case study 4
15. 8. Family planning after pregnancy
    1. Objectives
    2. Contraceptive counselling
    3. Contraception after delivery
    4. Case study 1
    5. Case study 2
    6. Case study 3
    7. Case study 4