Midwife Licensure Exam Independent Delivery & Emergency Obstetric Care — Normal Spontaneous Delivery — Independent Conduct & Hands-On TechniqueMemory Anchors

Tags

• sequence
• process
• cardinal movements
• labor

Topic

Cardinal Movements of Labor

Concept

The 7 Cardinal Movements of Labor in correct order

Anchor Id

A1

Difficulty

medium

Memory Aid

EDFIERE — 'Every Delivery Feels Incredibly Exciting, Really Extraordinary!' Engagement, Descent, Flexion, Internal rotation, Extension, Restitution (external rotation), Expulsion. Say it like a cheer: 'E-D-F-I-E-R-E, ang baby ay papalabas na!'

Anchor Type

acronym

Why It Works

Acronyms reduce 7 separate words into one memorable string. Adding an emotional exclamation phrase (like a cheer at a birth) links the acronym to the joyful context of delivery, making it emotionally encoded — the strongest kind of memory.

Example Usage

Exam question: 'What is the correct order of the cardinal movements?' — Close your eyes, hear the cheer 'Every Delivery Feels Incredibly Exciting, Really Extraordinary' — Engagement, Descent, Flexion, Internal rotation, Extension, Restitution, Expulsion.

Recall Trigger

Think of a midwife cheering: 'EDFIERE!' the moment the baby is born.

Tags

• process
• cardinal movements
• extension
• mechanism of labor

Topic

Cardinal Movements — Extension

Concept

Extension — how the head is actually born

Anchor Id

A2

Difficulty

easy

Memory Aid

Imagine a turtle slowly poking its head out from under a log (the pubic arch). The head does NOT come out like it went in — it tilts UP and EXTENDS under the bone, just like the turtle lifting its chin to get under the log. Occiput first, then bregma, then forehead, then face, then chin — the turtle's head gradually appears.

Anchor Type

analogy

Why It Works

The turtle analogy creates a vivid animal image that maps perfectly to the mechanics of head extension. Visual analogies engage the brain's spatial processing, making abstract anatomy concrete and easy to recall.

Example Usage

Exam: 'The fetal head is born by which mechanism?' — Remember the turtle extending its chin under the log. Answer: Extension.

Recall Trigger

Picture a turtle head extending under a log whenever you think about 'how is the head born?'

Tags

• definition
• mechanism
• flexion
• diameter

Topic

Cardinal Movements — Flexion

Concept

Flexion reduces the presenting diameter to suboccipitobregmatic ~9.5 cm

Anchor Id

A3

Difficulty

medium

Memory Aid

Think of a coconut trying to fit through a small window. If you hold it upright (poor flexion = larger diameter), it won't pass. But if you tuck the top of the coconut down — FLEX it — it presents a smaller, rounder surface and slides right through. The baby's chin tucking to the chest is the baby 'flexing' to become smaller (9.5 cm instead of 13.5 cm!).

Anchor Type

analogy

Why It Works

A tangible, familiar object (coconut) with a spatial problem makes abstract pelvic diameter concepts immediately relatable. The size difference feels real when you imagine the coconut.

Example Usage

Exam: 'What is the benefit of good flexion during labor?' — Coconut in the window: flexion presents the suboccipitobregmatic diameter (~9.5 cm), the smallest diameter. Baby passes more easily.

Recall Trigger

Coconut fitting through a window = Flexion = smaller 9.5 cm diameter.

Tags

• process
• AMTSL
• PPH prevention
• formula

Topic

Active Management of Third Stage (AMTSL)

Concept

AMTSL — 3 components: Oxytocin + Controlled Cord Traction + Uterine Massage

Anchor Id

A4

Difficulty

medium

Memory Aid

Remember the phrase: 'OCM — One Cool Midwife!' O = Oxytocin 10 IU IM within 1 minute; C = Controlled Cord Traction (Brandt-Andrews); M = Massage the fundus after placenta delivers. Ang isang Cool Midwife always does OCM after every birth!

Anchor Type

mnemonic

Why It Works

Three-letter acronyms are easy to retrieve under pressure. Adding the identity hook 'One Cool Midwife' creates pride and emotional engagement — the student WANTS to remember it because it defines who they are.

Example Usage

Exam: 'What are the three components of AMTSL?' — OCM: Oxytocin + Controlled Cord Traction + Massage. Give Oxytocin 10 IU IM within 1 minute, perform CCT (Brandt-Andrews), massage fundus after delivery.

Recall Trigger

Think 'OCM — One Cool Midwife!' every time you think about AMTSL.

Tags

• process
• safety
• oxytocin
• AMTSL

Topic

AMTSL — Oxytocin

Concept

Oxytocin 10 IU IM — rule out second twin BEFORE giving

Anchor Id

A5

Difficulty

easy

Memory Aid

Dra. Lourdes gave oxytocin too fast and didn't feel for a second baby first. The uterus clamped shut — and the second twin couldn't come out. Chaos at the RHU. She never forgot: 'FEEL FIRST, INJECT AFTER.' The baby inside was fine, but Dra. Lourdes had nightmares about that night. Now she always says: 'Baka dalawa pa! Palpate muna bago mag-inject!'

Anchor Type

micro_story

Why It Works

A micro-story with a crisis and consequence creates emotional encoding — fear of making the same mistake. The Filipino phrase at the end creates cultural resonance and a verbal trigger for recall.

Example Usage

Exam: 'Before administering the uterotonic in AMTSL, the midwife should first:' — Remember Dra. Lourdes: palpate the abdomen to rule out an undiagnosed second twin. Then give oxytocin.

Recall Trigger

'Baka dalawa pa!' — Palpate abdomen before oxytocin!

Tags

• contraindication
• pharmacology
• oxytocin
• ergometrine

Topic

AMTSL — Uterotonic Alternatives

Concept

Ergometrine is CONTRAINDICATED in hypertension/pre-eclampsia

Anchor Id

A6

Difficulty

easy

Memory Aid

Picture a bright RED STOP sign painted with a blood pressure cuff on it, and the word 'ERGO' crossed out in red. The red cuff = high BP. Red STOP sign = STOP giving ergometrine. Whenever you see 'ergometrine' on the exam, instantly see that red stop sign with the BP cuff. If the patient has hypertension — ERGO is a NO-GO.

Anchor Type

visual_association

Why It Works

Color-coded visual symbols (red = danger/stop) are processed faster than words. The dual image (stop sign + BP cuff) creates a rapid automatic association between 'ergometrine' and 'contraindicated in hypertension'.

Example Usage

Exam: 'A patient has severe pre-eclampsia. Which uterotonic is CONTRAINDICATED?' — See the red stop sign: Ergometrine/Methylergometrine. Give oxytocin instead.

Recall Trigger

Red stop sign with a BP cuff = Ergometrine STOP in hypertension.

Tags

• process
• CCT
• AMTSL
• technique

Topic

AMTSL — Controlled Cord Traction (Brandt-Andrews)

Concept

Controlled Cord Traction — counter-traction above symphysis prevents uterine inversion

Anchor Id

A7

Difficulty

medium

Memory Aid

Think of pulling a sock inside-out. If you pull the sock (cord) without holding the top (uterus), the sock turns inside-out (UTERINE INVERSION — emergency!). But if you hold the ankle (counter-traction above symphysis pubis) and gently pull the toe (cord), the sock stays the right way. Two hands: one stabilizes, one pulls gently. 'Hold the ankle, pull the toe — the sock won't flip upside-down!'

Anchor Type

analogy

Why It Works

Socks are universally familiar. The sock-inversion image is viscerally uncomfortable (nobody likes a sock turned inside out), and the mechanical analogy maps perfectly to the physics of uterine inversion prevention.

Example Usage

Exam: 'During controlled cord traction, the other hand is placed:' — Remember the sock: above the symphysis pubis for counter-traction, to prevent uterine inversion.

Recall Trigger

Pulling a sock inside-out = what happens if you forget counter-traction during CCT!

Tags

• definition
• placenta
• cord
• inspection

Topic

Placental Inspection — Cord

Concept

Normal umbilical cord has 2 arteries and 1 vein (total 3 vessels)

Anchor Id

A8

Difficulty

easy

Memory Aid

'Two arteries, one vein — remember this or feel the pain! Two A's, one V, that's how you see — a normal cord has vessels three!' Or use: AVA — Artery, Vein, Artery. Like an AVA-cado has three parts (skin, flesh, seed) — and the cord has AVA: Artery-Vein-Artery. 'Check the cord, count to three — AVA is what it should be!'

Anchor Type

rhyme

Why It Works

Rhymes use the brain's phonological loop for effortless recall. The AVA-cado word play adds humor and a visual food image that Filipino students relate to easily, creating dual encoding.

Example Usage

Exam: 'On inspection of the umbilical cord, the normal number of vessels is:' — AVA-cado: 2 arteries + 1 vein = 3 vessels total.

Recall Trigger

'AVA-cado cord' — Artery, Vein, Artery = 3 vessels = normal.

Tags

• definition
• PPH
• hemorrhage
• referral

Topic

Postpartum Hemorrhage — Detection

Concept

PPH defined as ≥500 mL blood loss after vaginal delivery

Anchor Id

A9

Difficulty

easy

Memory Aid

Visualize a standard 500 mL Coke bottle FULL of blood beside a woman who just delivered. If you see that much blood — it's PPH. '500 mL = one Coke bottle = POSTPARTUM HEMORRHAGE — REFER NOW!' That clear plastic bottle makes 500 mL very real and very visual. You will never forget that number again.

Anchor Type

visual_association

Why It Works

A specific, familiar object with exact volume (500 mL drink bottle) makes an abstract measurement concrete and emotionally charged. The fear response to 'a bottle of blood' ensures it is remembered.

Example Usage

Exam: 'Postpartum hemorrhage after a vaginal birth is defined as blood loss of:' — Picture the Coke bottle: ≥500 mL.

Recall Trigger

One 500 mL Coke bottle of blood = PPH threshold after vaginal delivery.

Tags

• process
• monitoring
• postpartum
• PPH

Topic

Immediate Postpartum Monitoring

Concept

Monitor fundal tone and lochia every 15 minutes for the first 2 hours postpartum

Anchor Id

A10

Difficulty

easy

Memory Aid

Remember '15-2' like a basketball score: '15 minutes, 2 hours — the game of keeping mom safe!' Say it rhythmically: 'Every 15 every 15 — for TWO hours, TWO hours — check vitals, fundus, lochia — ang PPH ay mahaharang natin!' Think of setting a timer alarm every 15 minutes for 2 hours — like a basketball shot clock that never stops.

Anchor Type

chunking

Why It Works

Chunking two numbers (15 and 2) into a sports reference creates a rhythm and a familiar Filipino cultural context (basketball is hugely popular in the Philippines), making the monitoring interval feel natural.

Example Usage

Exam: 'After placental delivery, the midwife should monitor the postpartum mother's fundal tone and lochia:' — '15-2': every 15 minutes for the first 2 hours.

Recall Trigger

'15-2 basketball' — check every 15 minutes for 2 hours postpartum.

Tags

• process
• placenta
• inspection
• checklist

Topic

Placental Inspection

Concept

Placental inspection: cotyledons (maternal side), shiny fetal side, membranes, cord vessels

Anchor Id

A11

Difficulty

medium

Memory Aid

Use 'CMMC' — 'Check My Mama's Cord!' C = Cotyledons (all present, maternal side — no missing pieces); M = Membranes (complete, intact amnion and chorion); M = Missing lobe check (vessel running to membrane edge = succenturiate lobe left inside); C = Cord (count vessels — AVA: 2 arteries, 1 vein). 'Check My Mama's Cord — bago ipalayo ang inunan!'

Anchor Type

mnemonic

Why It Works

A Filipino-flavored phrase ('bago ipalayo ang inunan' = before disposing of the placenta) roots the mnemonic in actual clinical practice context. The filial phrase 'Check My Mama's Cord' creates an emotional bond with the concept.

Example Usage

Exam: 'After placental delivery, systematic inspection includes:' — CMMC: Cotyledons, Membranes, Missing lobe check, Cord vessels (2 arteries + 1 vein).

Recall Trigger

'Check My Mama's Cord!' — Cotyledons, Membranes, Missing lobe, Cord vessels.

Tags

• complication
• placenta
• inspection
• referral

Topic

Placental Inspection — Succenturiate Lobe

Concept

Succenturiate (accessory) lobe — suspect if vessel runs to membrane edge and stops

Anchor Id

A12

Difficulty

hard

Memory Aid

Midwife Perla was inspecting a placenta at the BHS. She traced the blood vessels on the shiny fetal side and noticed one vessel running off the edge of the placenta into the membrane — then stopping abruptly, like a road that suddenly ends in a cliff. 'Saan pumunta ang daanan?' she thought. Answer: it went to a MISSING LOBE still inside the uterus. She referred immediately. 'Road that ends in the membrane = lobe left behind!'

Anchor Type

micro_story

Why It Works

The 'road that ends at a cliff' image is vivid and alarming. The micro-story in a community health setting (BHS) makes it contextually real for Filipino midwifery candidates who will work in exactly these settings.

Example Usage

Exam: 'During placental inspection, a vessel is noted to run to the membrane edge and stop. This suggests:' — Remember Midwife Perla's road ending at a cliff: succenturiate (accessory) lobe — refer for retained tissue.

Recall Trigger

'Blood vessel road that ends in the membrane' = succenturiate lobe = refer!

Tags

• EINC
• policy
• practice
• elimination

Topic

EINC — Eliminated Practices

Concept

EINC: NO routine episiotomy, NO routine suctioning

Anchor Id

A13

Difficulty

easy

Memory Aid

EINC says 'NIN — Not IN Naman!' No Incision (no routine episiotomy), No suction In Naman (no routine nasopharyngeal/oropharyngeal suctioning for crying baby with clear liquor). 'Hindi na kailangan — EINC says NIN!' This is an ELIMINATION of old practice. The two things you do NOT do routinely anymore = NIN.

Anchor Type

mnemonic

Why It Works

The colloquial Filipino phrase 'Hindi na kailangan' (It's no longer needed) maps perfectly to the concept of eliminated practices. Negative rules are harder to remember — the NIN acronym makes both negatives stick together.

Example Usage

Exam: 'According to EINC, which of the following is NOT routinely performed during normal delivery?' — NIN: No routine episiotomy, no routine suctioning of the mouth and nose for a vigorous baby with clear amniotic fluid.

Recall Trigger

'EINC says NIN!' — No routine Incision, No routine suctioN (for vigorous baby).

Tags

• process
• nuchal cord
• EINC
• technique

Topic

Nuchal Cord Management

Concept

Nuchal cord — if loose, slip over; if tight, try somersault maneuver (EINC); avoid early double-clamp-and-cut

Anchor Id

A14

Difficulty

medium

Memory Aid

Think of a lasso around a horse's neck. If it's loose — just slip it off the horse's head (loosen and reduce). If it's tight — don't cut the lasso (cord) right away! Instead, have the horse SOMERSAULT THROUGH the loop (somersault maneuver — keep baby close and deliver through the loop). Cutting too early loses the placental transfusion. 'Loose = slip it; Tight = try to somersault first!'

Anchor Type

analogy

Why It Works

The lasso-horse image is vivid and kinesthetic. The somersault instruction is counterintuitive (therefore memorable), and the analogy explains the WHY (protecting placental transfusion) naturally.

Example Usage

Exam: 'A tight nuchal cord is noted after the head is delivered. The EINC-recommended first action is:' — Tight lasso: try the somersault maneuver; avoid early clamping-cutting to protect placental transfusion.

Recall Trigger

Lasso around horse neck: loose = slip off, tight = somersault first.

Tags

• safety
• technique
• contraindication
• delivery

Topic

Safe Delivery Technique

Concept

NEVER apply fundal pressure to deliver the baby or placenta

Anchor Id

A15

Difficulty

easy

Memory Aid

Manong Ruben watched his carabao try to push a stuck cart wheel by pressing on the wheel itself — the wheel just bent and broke. The smarter farmer lifted from underneath instead. Moral: Pressing DOWN on the fundus to push out the baby is like pressing on the wheel — it causes damage (uterine rupture, uterine inversion, worsened shoulder dystocia). 'Huwag itulak ang puson — maniwala kay Manong Ruben!'

Anchor Type

micro_story

Why It Works

The rural farming analogy is culturally resonant with Filipino students from provincial backgrounds. The physical image of a broken wheel communicates the danger of fundal pressure vividly. The humorous Filipino moral adds charm.

Example Usage

Exam: 'Fundal pressure during delivery of the baby or placenta is:' — Remember the broken wheel: contraindicated. Risks include uterine rupture, inversion, and worsened shoulder dystocia.

Recall Trigger

Broken cart wheel = fundal pressure = DANGER. Huwag itulak ang puson!

Tags

• definition
• cardinal movements
• restitution
• rotation

Topic

Cardinal Movements — Restitution

Concept

Restitution (external rotation) — head realigns with shoulders after birth

Anchor Id

A16

Difficulty

easy

Memory Aid

Picture a dancer who turns her head to look over her shoulder while her body faces forward. After the baby's head is born, it 'turns' to realign with the shoulders — like the dancer snapping back to natural alignment. 'Restitution = RESToring natural alignment.' Head + shoulders come back into line, like snapping a Lego piece back into correct position.

Anchor Type

visual_association

Why It Works

The dancer turn is a graceful, visual image that captures the rotational nature of restitution. The Lego 'snap' adds a tactile-kinesthetic component for students who think in hands-on terms.

Example Usage

Exam: 'After the head is born and the baby turns to face the mother's thigh, this is called:' — Dancer aligning: Restitution or external rotation.

Recall Trigger

Dancer turning head to realign with body = Restitution (external rotation).

Tags

• technique
• delivery
• shoulders
• traction

Topic

Delivery of Shoulders

Concept

Shoulder delivery — downward traction for anterior, upward traction for posterior

Anchor Id

A17

Difficulty

medium

Memory Aid

'Pull DOWN for the front, pull UP for the back — anterior shoulder down, posterior shoulder up, that's the knack! Baba ang una, taas ang ikalawa — alalahanin mo 'yan, midwife ka na!' Anterior = DOWN (toward the floor); Posterior = UP (toward the ceiling/mother's abdomen).

Anchor Type

rhyme

Why It Works

The rhyme uses direction words (down/up, front/back) paired with Filipino reinforcement. Directional opposites are classically confusing — making them into a rhyme with body-position logic ('anterior is toward the floor when lying down') anchors the memory strongly.

Example Usage

Exam: 'To deliver the anterior shoulder, the midwife applies:' — Baba ang una: gentle DOWNWARD traction. For posterior shoulder: gentle UPWARD traction.

Recall Trigger

'Baba ang una, taas ang ikalawa' — DOWN for anterior, UP for posterior shoulder.

Tags

• signs
• placenta
• third stage
• assessment

Topic

Third Stage — Signs of Placental Separation

Concept

Signs of placental separation: gush of blood, cord lengthening, uterus becomes globular and rises

Anchor Id

A18

Difficulty

medium

Memory Aid

Remember 'GLC' — 'Gushing, Lengthening, Climbing!' G = Gush of blood (sudden small gush); L = Lengthening of the cord (cord appears longer at the vulva); C = Climbing uterus (rises and becomes globular/firmer). Before you do CCT, wait for GLC! 'Hindi pa, hintayin ang GLC bago hilahin ang tali!'

Anchor Type

mnemonic

Why It Works

Three-letter GLC with action words (Gushing, Lengthening, Climbing) gives three distinct physical observations that all start with different letters. The Filipino reminder 'hintayin' (wait for it) reinforces the clinical patience required.

Example Usage

Exam: 'Signs that the placenta has separated include:' — GLC: sudden gush of blood, cord lengthening, uterus becomes firm and globular and rises.

Recall Trigger

GLC — Gush, Lengthen, Climb = placenta separated = ready for CCT.

Tags

• pharmacology
• AMTSL
• misoprostol
• alternative

Topic

AMTSL — Uterotonic Alternatives

Concept

Misoprostol 600 mcg orally — alternative if oxytocin unavailable

Anchor Id

A19

Difficulty

medium

Memory Aid

Remember: 'MISO 600!' Like ordering miso soup at 600 pesos — expensive backup! Miso = MISOproStol; 600 = 600 mcg; orally = swallow it like soup. If there's no 'OXY' (oxytocin) at the RHU, you order the backup 'MISO 600 soup' by mouth. It's the fallback, not the first choice — like ordering the backup meal when your first choice is out of stock.

Anchor Type

chunking

Why It Works

Food mnemonics are universally sticky. The restaurant ordering metaphor maps perfectly: oxytocin is the 'first choice menu item' and misoprostol is the 'backup.' The dose (600) is embedded in the food name (like a menu price).

Example Usage

Exam: 'If oxytocin is not available for AMTSL, the alternative uterotonic is:' — MISO 600: misoprostol 600 mcg given orally.

Recall Trigger

'MISO 600 soup by mouth' — misoprostol 600 mcg PO when oxytocin unavailable.

Tags

• referral
• danger signs
• postpartum
• PPH

Topic

Danger Signs — Referral

Concept

Danger signs requiring immediate referral postpartum

Anchor Id

A20

Difficulty

medium

Memory Aid

Use 'SHIRT' to remember danger signs: S = Soft/boggy uterus that won't contract; H = Heavy or continuous bleeding; I = Incomplete placenta/membranes retained; R = Rising pulse, falling BP, pallor (shock signs); T = Tear extending into anal sphincter/rectum (3rd/4th degree). 'If you see SHIRT signs — ipapadala mo na sa ospital! Wag na hintayin pa!'

Anchor Type

acronym

Why It Works

SHIRT is a common, familiar object with strong visual recall. The Filipino urgency phrase reinforces the action step (refer immediately). Listing danger signs as a group helps the student recognize any single one as a red flag.

Example Usage

Exam: 'A postpartum client has a soft, boggy uterus with continuous heavy bleeding. The midwife should:' — SHIRT sign (Soft + Heavy): refer immediately. This is PPH.

Recall Trigger

SHIRT — any one of these signs = refer NOW. Ipapadala sa ospital!

Formula

AMTSL = Oxytocin 10 IU IM (within 1 min of birth) + CCT (Brandt-Andrews) + Uterine Massage

Mnemonic

OCM — 'One Cool Midwife' always does: O (Oxytocin 10 IU IM in 1 minute) + C (Controlled Cord Traction with counter-traction) + M (Massage fundus after placenta).

When To Use

Immediately after every normal vaginal delivery to prevent postpartum hemorrhage (PPH). This is the standard of care for ALL vaginal births attended by a midwife.

What Each Part Means

O = Oxytocin 10 IU given intramuscularly within 1 minute after baby is born (AFTER ruling out a second twin); C = Controlled Cord Traction with the Brandt-Andrews maneuver — one hand does counter-traction above symphysis pubis, other hand applies steady downward cord traction during a uterine contraction; M = Uterine fundus massage immediately after placenta delivers until uterus is firm, repeated every 15 minutes for 2 hours.

Formula

PPH Threshold (vaginal) = Blood Loss ≥ 500 mL

Mnemonic

'500 = one Coke bottle of blood = PPH = REFER.' Five-hundred is the number, the bottle is the image, PPH is the diagnosis, REFER is the action.

When To Use

Use to evaluate blood loss whenever estimating lochia or bleeding after delivery. If you estimate ≥500 mL after vaginal birth — act immediately: massage uterus, give additional oxytocin if ordered, and refer.

What Each Part Means

500 mL = approximately one standard 500 mL plastic soft-drink bottle full of blood. This amount lost after a vaginal birth defines postpartum hemorrhage and mandates urgent action/referral from the community setting.

Formula

Suboccipitobregmatic Diameter ≈ 9.5 cm (presenting diameter with good flexion)

Mnemonic

'FLEX to 9.5 — the coconut fits!' Good flexion = chin on chest = suboccipitobregmatic = 9.5 cm = smallest, best diameter for delivery through the pelvis.

When To Use

Use when answering questions about which mechanism REDUCES the presenting diameter (Flexion) or which diameter is presented with a well-flexed OA vertex presentation.

What Each Part Means

Suboccipito = from the subocciput (nape of neck); Bregmatic = to the bregma (anterior fontanelle). When the baby tucks its chin (flexion), this is the diameter that presents to the pelvis — approximately 9.5 cm. Compare to the occipitofrontal (11.5 cm) or occipitomental (13.5 cm) diameters seen with deflexed or extended heads.

Formula

Monitoring interval: Every 15 minutes × First 2 hours postpartum

Mnemonic

'15-2 Basketball Rule' — every 15-minute shot-clock for 2 hours of the game (the highest-risk postpartum window). Check: vital signs + fundal tone + lochia + bladder.

When To Use

Immediately after placenta and membranes are delivered and any lacerations are repaired, begin the 15-2 monitoring schedule for ALL postpartum clients in the RHU, BHS, or lying-in clinic.

What Each Part Means

15 minutes = frequency of monitoring checks; 2 hours = total duration of the highest-risk postpartum window for hemorrhage. At each check: assess BP and PR, palpate fundal height and tone, assess lochia amount and character, and ensure bladder is not distended (a full bladder displaces the uterus and prevents contraction).

Formula

Normal Cord Vessels: 2 Arteries + 1 Vein = 3 total (AVA)

Mnemonic

'AVA-cado cord!' A (Artery) + V (Vein) + A (Artery) = 3 vessels. A single umbilical artery (only 1 artery instead of 2) may be associated with renal/cardiac defects — document and note for referral.

When To Use

Use during systematic placental inspection after every delivery. Count cord vessels on the freshly cut cord cross-section or by running fingers along the cord.

What Each Part Means

Two umbilical arteries carry deoxygenated blood FROM the fetus TO the placenta; one umbilical vein carries oxygenated blood FROM the placenta TO the fetus. A single umbilical artery (SUA) found on cord inspection should be documented and the newborn referred for further evaluation.

Chain Title

7 Cardinal Movements of Labor (EDFIERE Chain)

Recall Test

Cover this page. Recite the 7 cardinal movements in order without looking. Can you name all 7 and what each achieves? Check: Engagement → Descent → Flexion → Internal rotation → Extension → Restitution → Expulsion.

Memory Chain

Story: 'Aling Engagement naglakad (Descent) sa tindahan at nag-flex (Flexion) ng muscles niya. Nag-i-rotante internally (Internal rotation) ang kanyang ulo habang lumalabas, na-extend (Extension) ng neck niya, bumalik sa dati (Restitution), at lumabas na siya (Expulsion)!' — Or use the cheer: EVERY (Engagement) DESCENT (Descent) FEELS (Flexion) INCREDIBLY (Internal rotation) EXCITING (Extension) REALLY (Restitution) EXTRAORDINARY (Expulsion)! Say it 3 times fast and the order is locked in.

Items To Remember

• Engagement
• Descent
• Flexion
• Internal rotation
• Extension
• Restitution (External rotation)
• Expulsion

Chain Title

AMTSL Steps in Order (OCM Chain)

Recall Test

A baby is just born. Walk through EVERY step of AMTSL in order from the first action to the last monitoring check. Time yourself — can you do it in under 60 seconds?

Memory Chain

Story chain: 'Before I give OXY (Oxytocin), I FEEL the tummy first (palpate for twin). Then I wait for GLC (Gush-Lengthen-Climb) before I do CCT with the sock-ankle counter-traction (Brandt-Andrews). I catch the placenta, twist the membranes like a rope, and then I MASSAGE the fundus like kneading dough. Then every 15 minutes for 2 hours I check — 15-2 basketball!' FEEL → OXY → GLC → CCT → CATCH & TWIST → MASSAGE → 15-2.

Items To Remember

• Palpate abdomen to rule out second twin
• Give Oxytocin 10 IU IM within 1 minute of birth
• Wait for signs of placental separation (GLC)
• Apply CCT with counter-traction during a contraction
• Deliver placenta, twist membranes to rope
• Massage fundus immediately after placenta delivers
• Re-massage every 15 minutes for 2 hours

Chain Title

Placental Inspection Sequence (CMMC Chain)

Recall Test

You just delivered a placenta. List the 4 things you inspect and what abnormality you look for in each. Check: Cotyledons (missing piece = retained fragment), Membranes (holes = incomplete), vessel to membrane edge (succenturiate lobe), Cord (only 1 artery = single umbilical artery).

Memory Chain

'Check My Mama's Cord!' — C: flip to rough maternal side, count ALL cotyledons (no missing pieces like a jigsaw puzzle); M: hold membranes up to light, check for holes (complete?); M: trace vessels on shiny fetal side — does any road end at the membrane edge? (succenturiate lobe!); C: count cord vessels — AVA-cado = 3. If anything is incomplete or missing — REFER!

Items To Remember

• Cotyledons — all present on maternal side
• Membranes — complete amnion and chorion
• Missing lobe — check for vessel running to membrane edge
• Cord — count vessels (AVA: 2 arteries + 1 vein)

Chain Title

Danger Signs for Referral After Delivery (SHIRT Chain)

Recall Test

List all 5 SHIRT danger signs from memory. For each one, state the clinical finding and the action. Remember: the midwife's role for ALL of these is DETECT and REFER — not independently manage.

Memory Chain

'SHIRT check before sending mom home!' S: feel the fundus — soft and won't stay firm? REFER. H: heavy non-stop bleeding? REFER. I: incomplete placenta or missing pieces? REFER. R: rising pulse, dropping BP, pale and dizzy (shock signs)? REFER FAST. T: tear that goes into the anus or rectum? REFER for repair by an obstetrician. Any SHIRT sign = send to the hospital.

Items To Remember

• Soft/boggy uterus not contracting
• Heavy or continuous bleeding
• Incomplete placenta or retained membranes
• Rising pulse, falling BP, pallor (shock)
• Tear into anal sphincter or rectum (3rd/4th degree)

Chain Title

EINC Eliminated Practices (NIN Chain)

Recall Test

Name 5 practices that EINC eliminated or discourages as routine. Which ones are still performed but only on INDICATION (not routinely)? Answer: Episiotomy and suctioning are done only when specifically indicated, not by default.

Memory Chain

'EINC says HINDI NA KAILANGAN (not needed anymore)!' Think of old practices being crossed out one by one: X on the scissors (no episiotomy), X on the suction bulb (no routine suctioning), X on the flat bed (no forced lithotomy), X on pushing the tummy (no fundal pressure), X on cutting the cord immediately (no early clamping). EINC freed the birth from unnecessary interventions — remember what was ELIMINATED!

Items To Remember

• No routine episiotomy
• No routine suctioning (for vigorous baby with clear liquor)
• No routine flat lithotomy position
• No fundal pressure
• No early cord clamping (delayed cord clamping preferred)