Show:
First actions
Emergencies
CTG confidence
The trap round
You're in charge!
100

“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
  • 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

100
“A woman reports reduced fetal movements near term.
👉 What do you do and why is delay dangerous?”

  • Immediate assessment required—delays increase risk of stillbirth
  • Perform fetal heart rate monitoring, ultrasound if indicated
100

“A woman is anxious and her partner is panicking.
👉 What are you doing as the midwife in charge?”

  • Reassure and communicate clearly
  • Assess situation calmly and involve partner appropriately 
200

200
“Baby is born floppy and not crying.
👉 Talk me through your first 3 actions and your reasoning.”

  • Dry and stimulate baby immediately
  • Assess airway and breathing, provide warmth
  • Prepare for ventilation if no improvement
200

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

  • Immediate McRoberts manoeuvre to flex mother’s legs and widen pelvis
  • Apply suprapubic pressure if needed
  • Call for help early, prepare for possible further manoeuvres or emergency delivery
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?”

  • Consider controlled cord traction if no contraindications
  • Prepare for manual removal if needed
  • Call for help early 
200

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

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

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 fitting.
👉 What is your priority management and rationale?”

  • Protect woman from injury during seizure
  • Call emergency help
  • Administer magnesium sulphate if eclampsia suspected
  • 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 breathing but heart rate is 90 bpm.
👉 What do you do and why might people get this wrong?”

  • Provide ventilation rather than chest compressions first
  • Mistake often made: compressions too early without adequate ventilation
300

“You cannot immediately get hold of senior support.
 👉 What do you do next?” 

  • Continue monitoring and escalating through available channels
  • Document clearly and prepare for emergencies 
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.
👉 What does this suggest and what is your plan?”

  • Suggests trauma (e.g., vaginal/cervical tear) rather than atony
  • Inspect for lacerations, suture if trained
  • Call for help and consider surgical intervention if bleeding persists
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.
👉 What do you do and what’s the risk of doing the wrong thing?”

  • Avoid forced pushing to prevent maternal and fetal trauma
  • Support and monitor, consider analgesia or reassessment
400

“You have multiple concerns at once.
👉 How do you prioritise?”

  • Prioritize ABC—airway, breathing, circulation
  • Delegate tasks and communicate with team
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.
👉 When do you escalate and how far do you go?”

  • Escalate urgently to senior staff or transfer to higher level care
  • Continue monitoring and supportive measures
  • Document all interventions and communicate clearly with 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

“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 woman
500

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

  • Call for help early, escalate concerns without hesitation
  • Follow protocols and guidelines strictly