Training in perinatal care--management of patients in labour

Training in perinatal care involves many different areas, and care around the time of labour forms a core part of training. Our senior residency programme involves 6 months supervised work in the labour ward. During this period, management of spontaneous, induced and augmented labour, methods of fetal monitoring and pain relief are taught. A log book and a check list are maintained to ensure the necessary manipulative and operative obstetric procedures have been followed. Limited scanning experience is provided to enable management of emergencies such as APH, multiple pregnancies, etc. Preparation and presentation of monthly statistics become a responsibility. Daily neonatal ward rounds are performed so that neonatal morbidity in relation to obstetric events are correlated. This exercise provides adequate knowledge to prognosticate and counsel patients whose babies are low birthweight or have malformations. Two to three new research projects are entrusted to trainees in order to acquire skills in writing research protocols, applications for research grants and later to enter research and write manuscripts. Discussion regarding research, working protocols and management problems are carried out after the daily ward rounds. Relevant reference papers or chapters are read, discussed and compiled in a file for further reading and for the benefit of other residents in training. This posting is followed or preceded by 6 months posting in ultrasound, high risk, medical disorder, diabetic and endocrine clinics. They also manage the antenatal and postnatal wards during these 6 months. At the end of 1 year training those interested in fetomaternal medicine do a further 2 years training in these areas at an advanced level.