Normal Spontaneous Delivery — Independent Conduct & Hands-On Technique - Memory Anchors
Memory techniques transform raw information into vivid mental hooks that your brain retrieves automatically under exam pressure. In this set, every key fact about Normal Spontaneous Delivery is attached to a memorable trigger: a funny story at a fiesta, a jeepney ride analogy, a catchy chant, or a visual scene. When you see an exam question about cardinal movements, AMTSL, or placental inspection, your brain will automatically replay the story, not a textbook page. Study these anchors once, review them twice, and the concepts will stick until after the PRC board exam — and beyond.
Memory anchors
The 7 Cardinal Movements of Labor in correct order
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!'
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.
Extension — how the head is actually born
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.
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?'
Flexion reduces the presenting diameter to suboccipitobregmatic ~9.5 cm
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!).
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.
AMTSL — 3 components: Oxytocin + Controlled Cord Traction + Uterine Massage
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!
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.
Oxytocin 10 IU IM — rule out second twin BEFORE giving
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!'
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!
Ergometrine is CONTRAINDICATED in hypertension/pre-eclampsia
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.
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.
Controlled Cord Traction — counter-traction above symphysis prevents uterine inversion
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!'
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!
Normal umbilical cord has 2 arteries and 1 vein (total 3 vessels)
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!'
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.
PPH defined as ≥500 mL blood loss after vaginal delivery
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.
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.
Monitor fundal tone and lochia every 15 minutes for the first 2 hours postpartum
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.
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.
Placental inspection: cotyledons (maternal side), shiny fetal side, membranes, cord vessels
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!'
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.
Succenturiate (accessory) lobe — suspect if vessel runs to membrane edge and stops
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!'
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!
EINC: NO routine episiotomy, NO routine suctioning
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.
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).
Nuchal cord — if loose, slip over; if tight, try somersault maneuver (EINC); avoid early double-clamp-and-cut
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!'
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.
NEVER apply fundal pressure to deliver the baby or placenta
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!'
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!
Restitution (external rotation) — head realigns with shoulders after birth
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.
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).
Shoulder delivery — downward traction for anterior, upward traction for posterior
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).
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.
Signs of placental separation: gush of blood, cord lengthening, uterus becomes globular and rises
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!'
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.
Misoprostol 600 mcg orally — alternative if oxytocin unavailable
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.
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.
Danger signs requiring immediate referral postpartum
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!'
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!
Revision game
I am the movement where the baby's head tucks its chin to the chest, presenting the smallest diameter of about 9.5 centimeters. Without me, the baby presents a bigger head and labor becomes harder. What am I?
Answer
Flexion
Memory link
A3 — Coconut fitting through a window. Flex the coconut = smaller surface = passes easier.
I am a three-letter team that saves mothers from postpartum hemorrhage. One of my members is a drug given within one minute of birth, another needs two hands and steady traction, and the third is a firm rub on the belly. What team am I?
Answer
AMTSL — Oxytocin + Controlled Cord Traction + Uterine Massage (OCM)
Memory link
A4 — One Cool Midwife! OCM = Oxytocin + CCT + Massage.
I am a blood pressure cuff painted on a red stop sign. I warn you never to give a certain drug to a mother with high blood pressure. What drug am I forbidding?
Answer
Ergometrine (Methylergometrine) — contraindicated in hypertension/pre-eclampsia
Memory link
A6 — Red stop sign with BP cuff = Ergo NO-GO in hypertension.
I am a fruit with three parts — skin, flesh, and seed — and my name sounds like the three vessels in the umbilical cord. What am I, and how many vessels does a normal cord have?
Answer
AVA-cado — 2 Arteries + 1 Vein = 3 vessels total
Memory link
A8 — AVA-cado cord rhyme: Artery-Vein-Artery = 3 vessels = normal.
I am a Coke bottle filled with a red liquid. If a mother loses this much blood after a vaginal delivery, her midwife must act immediately. How much do I hold, and what is the condition I represent?
Answer
500 mL = Postpartum Hemorrhage (PPH) after vaginal delivery
Memory link
A9 — 500 mL Coke bottle of blood = PPH = refer now!
I am a road drawn on the shiny side of a placenta. I run from the center all the way to the membrane edge — and then I stop abruptly, like a cliff. I am pointing to something left inside the uterus. What am I pointing to?
Answer
A succenturiate (accessory) lobe — retained inside the uterus; requires referral
Memory link
A12 — Midwife Perla's road ending at a cliff = succenturiate lobe = refer.
I am a farmer's carabao pushing on a stuck cart wheel — but instead of helping, the wheel BENDS and BREAKS. The farmer should have lifted from underneath instead. In delivery, I represent a dangerous technique that midwives must NEVER perform. What am I?
Answer
Fundal pressure — NEVER apply fundal pressure to deliver the baby or placenta
Memory link
A15 — Broken cart wheel = fundal pressure = contraindicated. Huwag itulak ang puson!
I am a basketball game where every shot-clock buzzer sounds every 15 minutes, and the entire game lasts exactly 2 hours. I represent how often and how long a midwife must check a postpartum mother's fundus and lochia. What is my rule?
Answer
Monitor every 15 minutes for the first 2 hours postpartum (15-2 Rule)
Memory link
A10 — 15-2 Basketball Rule for postpartum monitoring.
Formula mnemonics
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.
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.
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.
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).
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.
Quick recall chains
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
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
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)
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)
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)
Diagrams
AMTSL — Active Management of Third Stage: Step-by-Step Flowchart
This step-by-step flowchart walks through the complete AMTSL protocol from the moment the baby is born to the 2-hour postpartum monitoring period. It includes the critical decision point of ruling out a second twin before giving oxytocin, the GLC signs of placental separation, Brandt-Andrews CCT technique, fundal massage, placental inspection, and the SHIRT danger signs for referral. Use this as a mental script to run through during the exam.
Normal Spontaneous Delivery — Complete Concept Mind Map
This comprehensive mind map organizes ALL key concepts in the NSD chapter into one visual memory structure. The central topic branches into 8 major areas: Cardinal Movements, Head Delivery Technique, Nuchal Cord, Shoulder Delivery, AMTSL, Placental Inspection, Postpartum Monitoring, and Danger Signs/Referral. Use this as your final review tool — trace each branch to confirm you can recall the details under each leaf before the board exam.
Cardinal Movements — State Transitions of the Fetal Head
This state diagram shows the cardinal movements as a series of transitions — each movement is triggered by a specific force or anatomical landmark. Seeing the movements as STATES that transition into each other (rather than a flat list) helps students understand that each movement has a cause and that they must happen in sequence. The arrows remind students that these movements are not separate events but a flowing, continuous process.
Placental Inspection — CMMC Systematic Approach
This flowchart turns the systematic CMMC placental inspection into a clinical decision tree. Each step has a YES/NO decision: are the cotyledons complete? are membranes intact? does any vessel run to the membrane edge (succenturiate lobe)? are cord vessels AVA normal? Every abnormal finding leads to a referral box highlighted with a warning icon. The final step connects to blood loss estimation and the PPH threshold, linking placental inspection to PPH detection.