Course Syllabus ©National College of Midwifery 2012
01/2012
Course Title: Intrapartum Physical Assessment
Credits: 0.5
Course Description: This course is designed for students to gain a thorough understanding of
the structures most involved with labor and delivery: the female pelvis, the uterus and the fetal
skull. Students learn the anatomy of the soft and bony structures of the female pelvis, how they
adapt to the process of labor and how the midwife evaluates the presentation and progression
of the fetal skull through these structures. The structure of the fetal skull is reviewed in detail
including how it adapts to the pelvis during labor, cardinal movements of the baby during labor
and how these factors may affect progress of labor. Students also learn how the midwife
identifies and evaluates malpresentation. This course uses current research in midwifery and
obstetrics to broaden the student’s understanding of the following NARM skills and MANA core
competencies learned under clinical supervision:
NARM Skills
III. Maternal Health Assessment
(65)-III A. Obtains and maintains records of health, reproductive and family medical history
(66)-III *B. Performs an initial history and physical examination including vital signs
IV. Labor, Birth and Immediate Postpartum
(94)-IV B. Evaluates and supports a laboring mother during the first stage of labor by
assessing a variety of factors
(96)-IV D. Demonstrates the ability to evaluate and support a laboring mother during the
second stage of labor
IV E 3. Variations in presentation such as:
(99)-IV E 3 a) Breech presentation
(102)-IV E 3 d) Face and brow presentation
MANA Core Competencies:
I. Guiding Principles of Practice.
The midwife provides care according to the following principles:
1 I. Midwives strive to insure vaginal birth and provide guidance and support when appropriate
to facilitate the spontaneous process of pregnancy, labor and birth, utilizing medical
intervention only as necessary.
1 J. Midwives synthesize clinical observations, theoretical knowledge, intuitive assessment and
spiritual awareness as components of a competent decision making process.
II. General Knowledge and Skills
The midwife provides care incorporating certain concepts, skills and knowledge from a
variety of health and social sciences including, but not limited to:
2 B. Human anatomy and physiology relevant to childbearing
2 C. Community standards of care for women and their developing infants during the
childbearing cycle, including midwifery and bio-technical medical standards and the rationale
for and limitations of such standards
2 M. The ability to develop, implement and evaluate an individualized plan for midwifery care.
2 O. Knowledge and application of various health care modalities as they apply to the
childbearing cycle
IV. Care During Labor, Birth and Immediately Thereafter
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Course Syllabus ©National College of Midwifery 2012
01/2012
The midwife provides health care, support, and information to women throughout labor, birth
and the hours immediately thereafter. She determines the need for consultation or referral as
appropriate. The midwife uses a foundation of knowledge and/or skill which includes the
following:
4 A. The normal process of labor and birth.
4 B. Parameters and methods for evaluating maternal and fetal well-being during labor, birth
and immediately thereafter, including relevant historical data.
4 F. Fetal and maternal anatomy and their interactions as relevant to assessing fetal position
and the progress of labor.
4 G. Techniques to assist and support the spontaneous vaginal birth of the baby and placenta.
Learning Activities:
A. Student reads appropriate sections from the Learning Materials/Resources.
B. Student answers the questions listed in the Learning Objectives by researching the
Learning Materials/Resources for the course and correctly cites the sources and page
numbers for each of their answers.
C. Student presents answers the questions listed in the Learning Objectives for review by
preceptor.
D. Student participates in preceptor elaboration/discussion of Learning Objectives.
E. In the case that the required texts are more than 5 years old, the student must research,
prepare & present a summary of current best midwifery care/practices appropriate to a
topic covered in this course from a current journal article/study, less than 5 years old.
F. Recommended Role-playing and/or Clinical Interactions
Note: The clinical requirement of NARM /Clinical Skills is completed at any time
throughout the ASM apprenticeship during actual clinical practice and is NOT a
requirement to complete this academic course.
Activities specific to NARM skills learned in this section:
1. Practice identifying the important bones and fontanels of the fetal skull on a model.
2. Practice identifying all the possible presentations of the fetal head using a model
fetal skull and model pelvis.
3. Practice the mechanisms of labor for various presentations, including breech
presentation, face presentation, posterior presentation, and brow presentation using
a model fetal skull and model pelvis.
4. Practice identifying the landmarks in the model pelvis that will help you assess
station of the fetus.
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Course Syllabus ©National College of Midwifery 2012
01/2012
5. Practice identifying fetal position and size using a doll under a blanket or on a
pregnant client.
Learning Materials / Resources:
Please use textbooks less than 5 years old or most recent edition.
1. Chapman, Vicky and Charles, Cathy. The midwife’s labour and birth handbook. 2nd
edition. Blackwell Publishing. 2009
2. Frye, Anne. Holistic Midwifery: A Comprehensive Textbook for Midwives in Homebirth
Practice, Vol. 2. Labrys Press. 2004.
3. Wylie, Linda. Essential Anatomy and physiology in maternity care. Second edition.
Elsevier. 2005
4. Varney, Helen. Varney’s Midwifery. Fourth edition. Jones and Bartlett Publishers. 2004
5. Johnson, Ruth and Taylor, Wendy. Skills for Midwifery Practice. Second edition.
Elsevier Churchill Livingston. 2006.
6. Weaver, Pam and Evans, Sharon K. Practical Skills Guide for Midwifery, 4th Edition.
Morningstar Publishing Co. Wasilla. 2007
7. Davis, Elizabeth. Heart and Hands: A midwife’s guide to pregnancy and birth. 4th
Edition. Celestial Arts Press. 2004
8. MEAC Abbreviated NARM Skills Form.
9. MANA Core Competencies for Midwives
10. Midwives Model of Care®.
11. Students must find 1 article/study less than 5 years old. Recommended internet links
as needed for latest developments in midwifery care:
The Cochrane Collaboration
EBSCO
National Library of Medicine
PubMed
Medline
SCIRUS
Medscape
World Health Organization
Evaluation Tools / Methods:
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Course Syllabus ©National College of Midwifery 2012
01/2012
Minimum passing grade for each course is a cumulative 80% / B-. Students and preceptors
are encouraged to work together until the student masters the information.
Final grade for the course is based on preceptor evaluation of the following:
A. Learning Objectives count for 80-90% of the final grade.
The preceptor evaluates each answer based on three elements:
1. Answers should reflect a thorough review of current literature regarding best
current practices in midwifery care.
2. Each answer should be formed in the student’s own words or paraphrased
from the text. The answer should be minimal, not a re-write of the entire text,
but enough to show appropriate comprehension of the learning objective.
3. Student identification of sources and page numbers for each of the Learning
Objectives. (Preceptor should do a random check to determine that sources
cited are correctly identified.)
B. Summary of current journal article / study counts for 10% of the final grade in the case that
other scholarly resources used are more than five years old.
C. Exam counts for 10% of the final grade.
Course credit:
One Academic credit equals approximately 15 hours of formal time plus 30 hours of additional
study or homework. Formal time is defined as the amount of time taken to answer the Learning
Objectives to the level of 80% and to complete any learning activities to the preceptor's
satisfaction, including any time spent face to face with the preceptor. Informal time includes
any time spent actively reading relevant sources and textbook/s, researching Learning
Objectives, and studying for examinations.
Learning Objectives:
A. The student must research, prepare & present a summary of an aspect of current best
midwifery care/practices appropriate a topic from this course from a current journal
article/study.
B. Student answers the questions below and cites the sources and page numbers.
1. Why is accurate physical assessment of the orientation of fetal and maternal anatomy
an essential skill for midwives to have when managing labor and birth?
2. List the five bones of the pelvis.
3. Describe the muscles of the pelvic floor and the functions of the pelvic floor.
4. Describe briefly how the process of birth affects the pelvic floor.
5. Describe the musculature of the uterus and the uterine divisions.
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Course Syllabus ©National College of Midwifery 2012
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6. Describe how the myometrium changes during pregnancy and how these changes
function in labor.
7. Describe the pelvic inlet and outlet.
8. Describe how each of the four different pelvis structures can affect labor.
9. Name the important bones of the fetal skull.
10. Name the sutures on the fetal skull and describe their location.
11. Name the fontanels on the fetal skull and describe their locations.
12. Describe the diameters of the fetal skull.
13. How are the landmarks of the fetal skull important in assessing fetal rotation and
descent during labor?
14. Discuss what diameters will present in face presentation, brow presentation, vertex
presentation, and military presentation.
15. Discuss the mechanics of the descent of a baby in a vertex, extended (not flexed)
cephalic presentation.
16. Name the largest anteroposterior diameter of the fetal head.
17. Discuss molding and how it affects the progress of labor.
18. Discuss how molding of the head indicates fetal presentation in the birth canal.
19. Name some causes of caput succedaneum, how this affects fetal well-being, and what it
indicates about the progress of labor.
20. Define cephalohematoma. Explain its cause. Discuss how it reflects progress in labor.
21. Explain why a meningocele must be differentiated from a caput or a cephalohematoma.
22. Discuss what percentages of labors begin with the cephalic presentation where the
denominator is the occiput and how this affects the outcome of labor.
23. Discuss the identification of a breech presentation. What tools and techniques can be
used?
24. Describe the different breech presentations. Name the percentage of times that breech
presentations occur.
25. Explain how to identify transverse and oblique lie and how these affect labor.
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Course Syllabus ©National College of Midwifery 2012
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26. Discuss how to evaluate head flexion and extension and how these affect labor.
27. Explain the differences between lightening and engagement and how these affect labor.
28. Explain how to identify station. Describe expected progress and timing of progress
depending on maternal parity and fetal position.
29. Explain how synclitism and asynclitism affect labor. Discuss how to identify these.
30. Discuss how to manually assess the strength of a contraction during labor.
31. Discuss two methods for assess maternal hydration during labor.
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