First actions!
Emergencies!
CTG confidence!
The trap round!
you are a midwife!
100

YOU ARE NOW A PRECEPTEE

“You are the only midwife in the room. A woman is 6cm and says she needs to push.
👉 What do you do first, and why? What are you worried about?”

  • Check cervix to confirm dilation and rule out premature urge to push
  • Concern: pushing too early risks cervical swelling or trauma
  • could be OP
  • Escalate if unsure or if cervix not fully dilated 
100

“A woman becomes suddenly breathless and tachycardic postnatally.
👉 What are you thinking, and what do you do next?”

  • Consider pulmonary embolism or other cardio-respiratory causes
  • Call for emergency help
  • Provide oxygen, monitor vital signs
  • Prepare for transfer or advanced interventions
100

“You see early decelerations.
👉 What do they mean, and what (if anything) do you do?”

  • Caused by head compression
  • Usually benign and don’t require intervention beyond monitoring 
100


“A woman reports reduced fetal movements near term.
👉 What do you do and why?


  • immediate ctg with prior pinnard auscultation
  • how many episodes has she had
  • how long have they been reduced for?
  • Dr review
  • offer IOL leaflet as this will be discussed
100

“A woman is anxious and her partner is panicking, appearing to be aggressive (but isn't actually aggressive).
👉 What do you do?”

  • Reassure and communicate clearly
  • Assess situation calmly and involve partner appropriately 
  • allow the patient and partner to be heard. 
  • maintain professionalism, and calmness. 
  • document
200


“Baby is born floppy and not crying.
👉 Talk me through your first 3 actions and your reasoning.”

  • CALL FOR HELP
  • Dry and stimulate baby immediately
  • Assess airway and breathing, provide warmth
200

“Shoulder dystocia is declared.
👉 What is your immediate action, and why?”

  • Call for help early, prepare for possible further manoeuvres or emergency delivery
  • continuous ctg
  • Immediate McRoberts
  • Apply suprapubic pressure if needed
  • ASSESS FOR EPIS +INTERNAL MANOUVRES if does not deliver
200

“You see late decelerations.
👉 Explain the physiology and your management.”

  • Due to uteroplacental insufficiency causing fetal hypoxia
  • Requires prompt assessment and intervention (maternal repositioning, oxygen, fluids)
  • Consider expedited delivery if persists 
200

“Placenta not delivered after 30 minutes.
👉 What are your options and what guides your decision?”

  • if physiological: she has another 30 minutes: empty bladder. deep squat, skin to skin breastfeeding.
  • if active: All of the above before 30 minutes, inform senior staff member, gentle cord traction - dr review. will this be a MROP, estimate EBL so far
200

“You are unsure what is happening clinically.
👉 What is the safest approach?”

  • Escalate early to more experienced staff
  • Prioritize safety and clear communication
  • check policies
300


“Heavy bleeding starts immediately after birth.
👉 What are your first actions, and what are you assessing at the same time?”

  • Call for help immediately
  • Perform uterine massage to stimulate contraction
  • Assess uterine tone (most common cause = atony)
  • Monitor vital signs and prepare for further management
300

“A woman is having a seizure antenatally.
👉 What is your priority, management and rationale?”

  • Call emergency help
  • protect the woman in her surroundings
  • Administer magnesium sulphate if eclampsia is confirmed
  • displace uterus
  • Monitor airway and breathing, prepare for emergency delivery
300

“You see variable decelerations.
👉 What is the cause and what are your first actions?”

  • Due to cord compression causing transient hypoxia
  • Manage by changing maternal position, amnioinfusion if appropriate
300

baby is day 1 old on the ward, collapses and stops breathing what do you do? 

  • call for help
  • take baby to resus
  • expose chest 
  • observations TONE, BREATHING, HR
  • INFLATION BEATHS! 
  • You have to start again as if the baby has just been born!
300

“you are in community and there is staff sickness.  You have multiple home visits and a clinic - you can't manage everything....
 👉 What do you do next?” 

  • inform community manager

400

“Cord prolapse is suspected.
👉 What are you doing immediately, and why does each step matter?”

  • Call emergency help urgently
  • Elevate presenting part (e.g., with fingers or position woman) to relieve pressure on cord
  • Prepare for emergency delivery, monitor fetal heart rate closely
400

“Bleeding continues but the uterus feels firm (antenatal, 29 weeks).
👉 What does this suggest and what is your plan?”

  • Abruption
  • placental location? is it a praevia
  • if heavy bleeding - call for help
  • ctg
  • dr review
  • speculum
  • group and save 
  • inform neonatal team
  • mgso4
  • ?? steroids
400

“CTG is ‘suspicious’ but not pathological.
👉 What factors influence your decision making?”

  • Assess whole clinical picture, maternal and fetal wellbeing
  • Consider conservative measures and increased monitoring
400

“A woman is fully dilated but has no urge to push. She has an epidural on board.
👉 What do you do and what’s the risk of doing the wrong thing?”

  • inform senior staff of VE findings
  • allow 1-2 hours for descent. 
  • Support and monitor ctg continuously. 
  • encouraging 2nd stage too soon could result in fetal distress, lack of descent, +/- trial/ cs
400

“You have multiple concerns about your unwell patient.
👉 How do you prioritise?”

  • ask for help
  • Prioritize ABC—airway, breathing, circulation
  • inform team leader/
  • Call PARRT team 
  • martha's rule
500

“A woman collapses postnatally and you don’t yet know why.
👉 Talk me through your first minute of management.”

  • Follow ABC approach (Airway, Breathing, Circulation) immediately
  • Call emergency team
  • Consider causes like pulmonary embolism, haemorrhage, sepsis
  • Monitor observations and prepare for transfer if needed
500

“You are managing an emergency but things are not improving health wise for the patient.
👉 When do you escalate and how far do you go?”

  • Escalate urgently to senior staff potential need to transfer to higher level care setting
  • Continue monitoring and supportive measures
  • Document all interventions and communicate clearly with team
  • does another call need to be put out? ? MOH/ adult emergency/ 2nd paediatrics team
500

“CTG is abnormal but the woman appears clinically well.
👉 Do you act or wait? Defend your decision.”

  • Act promptly—abnormal CTG can precede fetal compromise
  • Escalate and prepare for delivery if needed 
500

Baby observations are normal but you feel something isn’t right. 
👉 What do you do? Defend it.”

  • Escalate based on clinical judgment
  • Trust intuition, repeat assessments and advocate for patient - 
  • take in the whole holistic picture, by performing a full newborn assessments. 
500

“You feel out of your depth as a newly qualified midwife.
👉 What makes your next actions safe vs unsafe?”

  • safe: asking for help, escalation, asking for more training, realising you are human and cant do everything. 
  • unsafe: thinking you can do it all, that you know everything, not taking responsibility, not asking for help. not accepting feedback and not reflecting on your practice. 
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