As you learned in Study Session 1 of this Module, a normally progressing labour is characterised by at least 1 cm per hour cervical dilatation, once the labour has entered the active first stage of labour.

Another important point is that (unless you detect any maternal or fetal problems), every 30 minutes you will be counting fetal heart beats for one full minute, and uterine contractions for 10 minutes.

You should do a digital vaginal examination initially to assess:

• The extent of cervical effacement (look back at Figure 1.1) and cervical dilatation
• The presenting part of the fetus
• The status of the fetal membranes (intact or ruptured) and amniotic fluid
• The relative size of the mother's pelvis to check if the brim is wide enough for the baby to pass through.

Thereafter, in every 4 hours you should check the change in:

• Cervical dilatation
• Development of cervical oedema (an initially thin cervix may become thicker if the woman starts to push too early, or if the labour is too prolonged with minimal change in cervical dilatation)
• Position (of the fetus, if you are able to identify it)
• Fetal head descent
• Development of moulding and caput (Study Session 2 in this Module)
• Amniotic fluid colour (if the fetal membranes have already ruptured).

You should record each of your findings on the partograph at the stated time intervals as labour, progresses. The graphs you plot will show you whether everything is going well or one or more of the measurements is a cause for concern. When you record the findings on the partograph, make sure that:

• You use one partograph form per each labouring mother. (Occasionally, you may make a diagnosis of true labour and start recording on the partograph, but then you realise later that it was actually a false labour. You may decide to send the woman home or advise her to continue her normal daily activities. When true labour is finally established, use a new partograph and not the previously started one).
• You start recording on the partograph when the labour is in active first stage (cervical dilation of 4 cm and above).
• Your recordings should be clearly visible so that anybody who knows about the partograph can understand and interpret the marks you have made.

If you have to refer the mother to a higher level health facility, you should send the partograph with your referral note and record your interpretation of the partograph in the note.