Intrapartum Care

Description 

General measures

Medicine treatment

Referral

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O80.0-1/O80.8-9

For the comprehensive management of women in labour refer to the most recent National Maternity Care and Intrapartum Care Guidelines.

DESCRIPTION

Labour is divided into 4 stages:

• First stage
  • onset of regular painful uterine contractions at term to full dilatation of cervix.
• Second stage
  • full dilatation to delivery of the baby.
• Third stage
  • delivery of the baby to delivery of the placenta.
• Fourth stage
  • 1 hour post-delivery of the placenta.

GENERAL MEASURES

• Encourage companion support.
• Ensure that the mother is adequately hydrated (can be done orally).
• Monitor progress of labour on partogram.

MEDICINE TREATMENT

First stage with cervical dilatation <10 cm:

Analgesia:

O62.9 + (Z51.2)

• Morphine, IM, 0.1 mg/kg to a maximum of 10 mg, 4 hourly.

LoE:IVb³⁵

OR

Especially in advanced first stage of labour:

• Nitrous oxide 50% mixed with oxygen 50%, given by mask.

AND

For nausea and sedation, if needed:

• Promethazine, IM, 25 mg 4 hourly.

Second stage

If episiotomy is needed, local anaesthetic:

O62.9 +(R10.2+Z51.2)

• Lidocaine 1%.
  • Do not exceed 20 mL.

Foetal distress during labour

O68.0-3/O68.8-9/O75.9

Place the woman in the left lateral position.

Tocolysis, then refer:

• Salbutamol, IV, 0.5 mg/mL, 250 mcg administered slowly over 2 minutes.
  • Reconstitute as follows:
  • Salbutamol 1 mL (0.5 mg/mL) added to 9 mL of water for injection, to make a 50 mcg/mL solution. Monitor pulse.
  • Inject 5 mL (250 mcg) over at least 2 minutes. Monitor pulse.
  • If pulse increases > 120 beats/minute, discontinue the injection.
  • Do not administer if mother has cardiac disease.

Third stage

Prevention of post-partum haemorrhage (PPH):

Z29.2

• Check for twins.
  • Oxytocin, IM, 10 units.
• Clamp and cut cord after 1 minute.
• Controlled cord traction of the placenta.

If > 500 mL blood loss, manage as postpartum haemorrhage (see: Postpartum haemorrhage (PPH)).

Rh-negative mother

O36.0

• Check baby’s Rh status; do not give anti-D if the baby is Rh-negative, or if the mother has Anti-Rh antibodies.

Administer to Rh-negative mother, if baby is Rh-positive or baby's Rh group is unknown:

• Anti-D immunoglobulin, IM, 100 mcg, preferably within 72 hours but can be given up to 7 days after delivery.

Care of the newborn baby

If baby not crying/breathing well, see: Neonatal Resuscitation.
For routine care of the neonate, see: Routine care of the neonate.
Observe mother and neonate for 1–2 hours before transfer to the postnatal ward.

For pain after delivery

• Paracetamol, oral, 500 mg to 1 g, 4 to 6 hourly as required (to a maximum of 4 g in 24 hours).
  • Maximum dose: 15 mg/kg/dose.

If needed

• Ibuprofen, oral, 400 mg 8 hourly with or after a meal as needed for up to 5 days.

LoE:IVb

REFERRAL

• Prolonged labour according to charting on partogram.
• Foetal distress during labour
• Post-partum haemorrhage.
• Retained placenta.
• Other complications of mother or baby.

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2025-9_Version 1.0_26 March 2026

Chapter 6: Obstetrics and Gynaecology_6.5 Intrapartum Care