Women are monitored for their progress in the first stage of labour using a partogram.

Recorded on a partogram are:

• Cervical dilatation (measured by a 4-hourly vaginal examination)
• Descent of the fetal head (in relation to the ischial spines)
• Maternal pulse, blood pressure, temperature and urine output
• Fetal heart rate
• Frequency of contractions
• Status of the membranes, presence of liquor and whether the liquor is stained by blood or meconium
• Drugs and fluids that have been given

Uterine contractions are measure in contractions per 10 minutes. When the midwife says “she is contracting 2 in 10”, it means she is having 2 uterine contractions in a 10 minute period.

There are two lines on the partogram that indicate when labour may not be progressing adequately. These are labelled “alert” and “action”. The dilation of the cervix is plotted against the duration of labour (time). When it takes too long for the cervix to dilate, the readings will cross to the right of the alert and action lines.

Crossing the alert line is an indication for amniotomy (artificially rupturing the membranes) and a repeat examination in 2 hours. Crossing the action line means care needs to be escalated to obstetric-led care and senior decision-makers for appropriate action.