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Care for the mother during labor

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HealthWiki > A Book for Midwives > Chapter 10: Giving good care during labor and birth > Care for the mother during labor


This part of the chapter explains the ways that a midwife can support, guard, and guide a birth to make it safer and easier. The ideas in this section are useful during all the stages of labor and birth.

The 3 chapters after this one will explain more specific ways to help in each stage of labor and birth.

a pregnant woman speaking with another woman.
It's too strong! I'm scared!
You are doing fine! Labor is supposed to be strong.

Contents

Support the labor

When you support the mother’s labor, you help her relax instead of fighting against it. Although labor support will not make labor painless, it can make labor easier, shorter, and safer.

Every woman needs a different kind of support. But all women need kindness, respect, and attention. Watch and listen to her to see how she is feeling. Encourage her, so she can feel strong and confident in labor. Help her relax and welcome her labor.

a man speaking with a woman.
I didn't know that there was a way I could help you during the birth.
Yes! I will
feel so much calmer if you are with me.

You do not have to work alone to support the mother. Labor support can help the most when it is given by the mother’s husband, family, or friends. There is no rule about who should support the mother. It is only important that they care about the mother and are willing to help her. Most important, they should be people the mother wants to have at the birth.

Guard the labor

When you guard the labor, you protect it from interference. Here are some examples:

Keep rude and unkind people away. The mother should not have to worry about family problems. Sometimes even supportive and loving friends can interfere with the labor. At some births, the best way to help is to ask everyone to leave the room so the mother can labor without being distracted.

Do not use unnecessary drugs or procedures. Some midwives (and doctors) believe that more drugs, tools, and exams will make the birth safer. But that is usually not true. They can make the birth harder or cause problems.

WARNING! Do not give the mother drugs to hurry the labor — they add useless risks. Injections or pills that are supposed to hurry the birth can make labor more painful, and can kill both the mother and the baby. See ways to strengthen labor safely.

2 women speaking.
Can we give an injection to hurry the birth?
Injections are dangerous. It is not worth the risk.

Guide the labor

When you guide the labor, you help the labor stay on a healthy path. You can guide the labor by helping the woman care for her body. At different points you might suggest that she drinks, urinates, rests, or moves. In the next 3 chapters, there will be many more suggestions about how to guide the labor to stay on a healthy path.

a woman holding a glass while speaking to a woman who lies on a bed.
If the contraction is over, I'd like you to take a sip.

Help her drink at least at least 1 cup of liquid each hour

A woman in labor uses up the water in her body quickly. She should drink at least 1 cup of liquid each hour. If she does not drink enough, she may get dehydrated (not enough water in the body). This can make her labor much longer and harder. Dehydration can also make a woman feel exhausted.

Lift the skin on the back of her hand with 2 fingers. Then let go. If the skin does not fall right back to normal, the woman is dehydrated.

Signs of dehydration:

  • dry lips
  • sunken eyes
  • loss of stretchiness of the skin
  • mild fever (up to 38°C or 100.4°F)
  • fast, deep breathing (more than 20 breaths a minute)
  • fast, weak pulse (more than 100 beats a minute)
  • baby’s heartbeat is faster than 160 beats a minute


If you think the mother may be dehydrated, immediately give her water with sugar or honey, fruit juice, or a rehydration drink (see below).

Some women cannot drink much in labor. It makes them feel sick, or they vomit it up. If the mother is vomiting and cannot drink a whole cup of liquid at once, let her take small sips after every contraction. This way she will get liquid without upsetting her stomach. These liquids may be easier to drink for women who feel sick: coconut water, fruit juice mixed with water, water with sugar or honey in it, or peppermint, ginger, or chamomile tea with honey or sugar.

If the mother cannot drink at all, or if she is already very dehydrated, give her rectal fluids or IV fluids.

Rehydration drink

If the labor is long, or if the mother has not been eating or drinking much, give her rehydration drink. (In fact, any woman in labor can drink this.) This drink helps keep the chemicals in the mother’s blood balanced so she does not get sick.

You may be able to get premixed packets of salts and sugar, such as Oresal, for making rehydration drink. If you use premixed packets, be careful to mix them correctly and taste the drink yourself first. It should be no saltier than tears.

You can also make the rehydration drink yourself at the labor, or carry the dry ingredients already measured and mixed in little packets.

2 ways to make rehydration drink
With sugar and salt
(Molasses or honey can be used instead of sugar.)
In 1 liter of clean water, mix:
  • half a level teaspoon of salt
with 8 level teaspoons of sugar
(Before you add the sugar, taste the drink to be sure it is no saltier than tears.)
With powdered cereal and salt
(Powdered rice is best. Or use finely ground maize, wheat flour, sorghum, or cooked and mashed potatoes.)
In 1 liter of clean water, mix:
  • half a level teaspoon of salt
with 8 heaping teaspoons (or
2 handfuls) of powdered cereal.
(Before you add the cereal, taste the drink
to be sure it is no saltier than tears.)
Boil for 5 to 7 minutes to form a watery porridge. Cool the drink quickly to give to the mother.
Taste the drink each time before you give it, to be sure it is not spoiled. Cereal drinks can spoil in a few hours in hot weather.
  • If possible, add half of a cup of fruit juice, coconut water, or mashed ripe banana to either drink. This provides potassium, which may help the mother drink more liquid.


If you need to, change the drink to work in your area. If liter containers are not used, adjust quantities to local forms of measurement. If you do not have a measuring cup or spoons, use a pinch of salt and a small handful of sugar. If you have cereal gruel for young children, add enough water to make it liquid and a pinch of salt, and use that.
Note: If the mother feels hungry during labor, it is good for her to eat. Choose foods that are easy to digest, like bread, rice, or yogurt.

Have the woman urinate at least once every 2 hours

a pregnant woman speaking with a woman who is looking at her watch.
Oh, oh, oh! Ahhh... This one's over.
You have not urinated for almost 2 hours. Why don't you try now?

If the mother’s bladder is full, her contractions may get weaker and her labor longer. A full bladder can also cause pain, problems with pushing out the placenta, and bleeding after childbirth. Remind the mother to urinate — she may not remember.

To check if the bladder is full, feel the mother’s lower belly. A full bladder feels like a plastic bag full of water. When the bladder is very full, you can see the shape of it under the mother’s skin. Do not wait until the bladder gets this big.

If the mother’s bladder is full, she must urinate. If she cannot walk, try putting a pan or extra padding under her bottom and let her urinate where she is. It may help her to dip a hand in warm water.

a pregnant woman on her back; an arrow shows the full bladder in her lower belly.
This bladder is too full.

If the mother cannot urinate at all, she needs to have a catheter (a sterile tube) inserted into her bladder to let the urine out. See more information on how to insert a catheter. If you have not been trained to insert a catheter, get medical help.

Rest between contractions

To save her strength, the mother should rest between contractions, even when labor first begins. This means that when she is not having a contraction, she should let her body relax, take deep breaths, and sometimes sit or lie down. In early labor she may be able to sleep.

Many women feel very tired when their contractions are strong. They may fear they will not have the strength to push the baby out. But feeling tired is the body’s way of making the mother rest and relax. If everything is well, she will have the strength to give birth when the time comes. See ways to help the mother relax.

a pregnant woman speaking to another woman, who then sits behind her and speaks.
I have to sit up for the contractions — or they hurt too much.
I'm so tired! But every time I start to fall asleep my head falls forward and wakes me up!
I will hold your head up so you can sleep between contractions.
Thank you!

Change position every hour

Help the woman move during labor. She can squat, sit, kneel, or take other positions. All these positions are good. Changing positions helps the cervix open more evenly.

Standing and walking can make labor go faster. Swaying, rocking, or even dancing can help her body
to relax.

a man and woman dancing.
a man and woman walking.
a woman sitting in a chair.
a woman sitting in a chair, leaning on a man who kneels in front of her.
a woman lying on her side on a bed.
a woman kneeling with her head on pillows on a bench.
a woman sitting, propped up by pillows.
a woman kneeling on the floor with her head on a pile of blankets.
a woman kneeling while breathing out, with her head up and back straight


a pregnant woman lying on her back.
NO!

The mother should NOT lie flat on her back. This squeezes shut the vessels that bring blood to the baby and mother.

It is OK for her to lie on her side with a pad between her legs (see pictures above), or on her back with her upper body propped up — as long as she changes position at least every hour.

Change bedding under the mother when it gets wet or soiled

Most women leak a lot of fluid from the vagina all through labor. This fluid may be show, or it may be broken waters.

When the mother lies down or sits, put clean cloths or pads under her to catch the fluid.

Change cloths and pads when they get very wet or messy. Check the fluid for too much fresh blood or blood clots, or brown, yellow, or green waters.

If the mother has HIV

Giving ART medicines to the mother during labor and birth can prevent the baby from becoming infected with HIV.


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