View source for A Book for Midwives:Care for the mother during labor

{{bctrail|segments=3|chaptitle=Chapter 10: Giving good care during labor and birth}}
{{DISPLAYTITLE:Care for the mother during labor}}
{{SideSupplement|bookabbreviation=abfm|pagealt=is from<br> pages 157 to 163 of|chapterpdf=http://hesperian.org/wp-content/uploads/pdf/en_midw_2021/en_midw_2021_10.pdf|bookurl=A Book for Midwives|booktitle=A Book for Midwives}}
{{chaptertoc|In this chapter:|
<ul class{{=}}"noprint">
<li>[[A Book for Midwives:Chapter 10: Giving good care during labor and birth|Chapter 10: Giving good care during labor and birth]]</li>
  <li>[[A Book for Midwives:Chapter 10: Giving good care during labor and birth#What happens during labor and birth|What happens during labor and birth]]</li>
  <li>[[A Book for Midwives:Care for the mother during labor|Care for the mother during labor]]</li>
  <li>[[A Book for Midwives:Be ready for emergencies|Be ready for emergencies]]</li>
  <li>[[A Book for Midwives:Keep a record of what happens during labor|Keep a record of what happens during labor]]</li>
</ul>}}
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&nbsp;ideas in this section are useful during all the stages of labor and&nbsp;birth. 

The 3 chapters after this one will explain more specific ways to help in each stage of labor and birth.
<div class{{=}}speechbub style="position: relative; width: 325px; height: 220px;  float:right;clear:both;">[[Image:MW_Ch10_Page_158-1.png|right|300px|alt=a pregnant woman speaking with another woman.]]
<div style="position: absolute; width: 110px; top: 15px; left: 29px;">It's too strong! I'm scared!</div>
<div style="position: absolute; width: 85px; top: 25px; left: 217px;">You are doing fine! Labor is supposed to be strong.</div></div>
=== Support the labor ===
When you support the mother’s labor, you help her relax or join with the labor instead of fighting it. Although labor support will not make labor painless, it can make labor easier, shorter, and&nbsp;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. 
{{clr}}
<div  class{{=}}speechbub style="position: relative; width: 325px; height: 190px;  float:left;">[[Image:MW_Ch10_Page_158-2.png|left|300px|alt=a man speaking with a woman.]]
<div style="position: absolute; width: 165px; top: 7px; left: 85px;">I didn't know that there was a way I could help you during the birth.</div>
<div style="position: absolute; width: 95px; top: 85px; left: 200px;">Yes! I will<br> feel so much calmer if you are with me.</div></div>
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.
{{clr}}

=== 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 [[A_Book_for_Midwives:Signs_for_the_midwife_to_check_in_stage_1#safelabor|ways to strengthen labor safely]].<br>
<div  class{{=}}speechbub style{{=}}"position: relative; width: 525px; height: 100px; top:20px;">[[Image:MW_Ch10_Page_158-3.png|center|440px|alt=2 women speaking.]]
<div style{{=}}"position: absolute; width: 115px; top: 22px; left: 50px;">Can we give an injection to hurry the birth?</div>
<div style{{=}}"position: absolute; width: 115px; top: 12px; left: 349px;">
Injections are dangerous. It is not worth the risk.</div>
</div>}}
{{clr}}

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

<div  class{{=}}speechbub style="position: relative; width: 325px; height: 200px; float:right;margin-left:30px;">[[Image:MW_Ch10_Page_159-1.png|right|300px|alt=a woman holding a glass while speaking to a woman who lies on a bed.]]
<div style="position: absolute; width: 120px; top: 20px; left: 40px;">If the contraction is over, I'd like you to take a sip.</div></div>
<div id="drink"></div>
====Help her drink at least at least 1 cup of liquid each&nbsp;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. 
{{clr}}
<table width="58%" style="float:right;">
<tr>
<td>[[Image:MW_Ch10_Page_159-2.png|center|100px]]</td>
<td>[[Image:MW_Ch10_Page_159-3.png|70px]]</td>
<td>[[Image:MW_Ch10_Page_159-4.png|center|100px]]</td></tr>
<tr>
<td valign="top" style="line-height:110%; padding-left:25px;">''Lift the skin on the back of her hand with 2 fingers.  Then let go.''</td>
<td></td>
<td valign="top" style="line-height:110%;">''If the skin does not fall right back to normal, the woman is dehydrated.</td></tr>
</table>
<div id=dehyd></div>
'''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 
<br>
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 [[A_Book_for_Midwives:Home_methods_for_starting_labor#enemas|rectal fluids]] or [[A_Book_for_Midwives:How_to_give_fluid_through_a_vein|IV fluids]]. 

{{clr}}

<div id="rehydration_drink"></div>
=====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 drinkhelps keep the mother’s blood balanced and healthy so she does not get sick or weak.

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.

{{clr}}

<table width{{=}}"100%" frame="box" cellpadding="3" cellspacing="0">
<tr>
<td width="5%" valign="top" rowspan="13" style="padding-top:60px;padding-right:15px;">[[Image:MW_Ch10_Page_160-5.png|left|80px]]</td>
<td colspan="4" style="font-size:large; padding-top:15px;">'''2 ways to make rehydration drink'''</td></tr>
<tr>
<td colspan="4">'''With sugar and salt'''<br>(''Molasses or honey can be used instead of sugar.'')</td></tr>
<tr>
<td colspan="4">In 1 liter of clean '''water''', mix:</td></tr>
<tr>
<td colspan="3">
* half a level teaspoon of '''salt''' </td>
<td width="20%">with 8 level teaspoons of '''sugar'''</td></tr>
<tr>
<td colspan="3" style="padding-left:80px;">[[Image:MW_Ch10_Page_160-1.png|left|70px]]</td>

<td valign="top">[[Image:MW_Ch10_Page_160-2.png|center|240px]]</td></tr>
<tr>
<td colspan="4" style="height:25px;"></td></tr>
<tr>
<td valign="top" colspan="3" style="padding-bottom:30px;padding-right:30px;">''(Before you add the sugar, taste the drink to be sure it is no saltier than tears.)''</td>
<td></td></tr>
<tr>
<td colspan="4" style="padding-top:35px;padding-right:100px;">'''With powdered cereal and salt'''<br>''(Powdered rice is best. Or use finely ground maize, wheat flour, sorghum, or cooked and mashed potatoes.)''</td>
<td></td></tr>
<tr>
<td colspan="3">In 1 liter of clean '''water''', mix:</td></tr>
<tr>
<td colspan="3" valign="top">
* half a level teaspoon of '''salt''' </td>
<td style="padding-top:8px;">with 8 heaping teaspoons (or<br>2 handfuls) of powdered '''cereal'''.</td></tr>
<tr>
<td valign="top" colspan="3" style="padding-left:80px;">[[Image:MW_Ch10_Page_160-3.png|left|70px]]</td>
<td valign="top">[[Image:MW_Ch10_Page_160-4.png|center|230px]]</td></tr>
<tr>
<td>
''(Before you add the cereal, taste the drink<br> to be sure it is no saltier than tears.)''</td>
<td></td></tr>
<tr>
<td colspan="4" style="height:15px;"></td></tr>
<tr>
<td colspan="5" style="padding-left:25px;">Boil for 5 to 7 minutes to form a watery porridge. Cool the drink quickly to give to the mother.</td></tr>
<tr>
<td colspan="5" style="border-bottom:1px solid;padding-left:25px;">'''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.'''</td></tr>
<tr>
<td colspan="6" style="padding-left:30px; padding-bottom:20px;">
*  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. 
<br>
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.<td></tr>
</table>
{{clr}}

<div style="margin-left:30px;margin-top:10px;">'''''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.</div>
{{clr}}
<div id="urinate"></div>

==== Have the woman urinate at least once every 2 hours ====

<div  class{{=}}speechbub style="position: relative; width: 455px; height: 200px;  float:right;top:15px;">[[Image:MW_Ch10_Page_161-1.png|center|400px|alt=a pregnant woman speaking with a woman who is looking at her watch.]]
<div style="position: absolute; width: 75px; top: 23px; left: 44px;">Oh, oh, oh! Ahhh... This one's over.</div>
<div style="position: absolute; width: 95px; top: 13px; left: 317px;">You have not urinated for almost 2 hours. Why don't you try now?</div></div>
If the mother’s bladder is full, her contractions may weaken, which will slow her
labor. 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.

<div style="position: relative; width: 325px; height:150px; text-align: center; font-style: italic; line-height: 110%; float:left;">[[Image:MW_Ch10_Page_161-2.png|left|300px|alt=a pregnant woman on her back; an arrow shows the full bladder in her lower belly. ]]
<div style="position: absolute; width: 115px; top: -5px; left: 80px;">This bladder is too full.</div></div>
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 [[A_Book_for_Midwives:Catheters|insert a catheter]]. If you have not been trained to insert a catheter, get medical help.

{{clr}}

==== 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 [[A_Book_for_Midwives:Helping_the_mother_relax_in_stage_1|ways to help the mother relax]].

<div  class{{=}}speechbub style="position: relative; width: 650px; height: 190px; ">[[Image:MW_Ch10_Page_161-3.png|center|650px|alt=a pregnant woman speaking to another woman, who then sits behind her and speaks.]]
<div style="position: absolute; top: 26px; left: 30px;width:150px;">I have to sit up for the contractions — or they hurt too much.</div>
<div style="position: absolute; top: 107px; left: 25px;width:165px;">I'm so tired! But every time I start to fall asleep my head falls forward and wakes me up!</div>
<div style="position: absolute; top:8px; left: 513px;width:120px;">I will hold your head up so you can sleep between contractions.</div>
<div style="position: absolute; width: 65px; top:115px; left: 514px;">Thank you!</div></div>

{{clr}}
<div id="changeposition"></div>

==== 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 <br>to relax.
<table align=center cellpadding="10" width="100%">
<tr>
<td>[[Image:MW_Ch10_Page_162-1.png|left|100px|alt=a man and woman dancing.]]</td>
<td>[[Image:MW_Ch10_Page_162-2.png|center|110px|alt=a man and woman walking.]]</td>
<td>[[Image:MW_Ch10_Page_162-3.png|center|110px|alt=a woman sitting in a chair.]]</td>
<td>[[Image:MW_Ch10_Page_162-4.png|right|180px|alt=a woman sitting in a chair, leaning on a man who kneels in front of her.]]</td></tr>
<tr>
<td colspan="2">[[Image:MW_Ch10_Page_162-5.png|right|200px|alt=a woman lying on her side on a bed.]]</td>
<td colspan="2" style="padding-left:40px;">[[Image:MW_Ch10_Page_162-6.png|left|200px|alt=a woman kneeling with her head on pillows on a bench.]]</td></tr>
</table>
<table cellpadding="10" width="100%">
<tr>
<td>[[Image:MW_Ch10_Page_162-7.png|left|150px|alt=a woman sitting, propped up by pillows.]]</td>
<td>[[Image:MW_Ch10_Page_162-8.png|center|180px|alt=a woman kneeling on the floor with her head on a pile of blankets.]]</td>
<td>[[Image:MW_Ch10_Page_162-9.png|right|110px|alt=a woman kneeling while breathing out, with her head up and back straight]]</td></tr>
</table>
{{clr}}
<br>
<div style="position: relative; width: 325px; height: 100px; float:right;">[[Image:MW_Ch10_Page_162-10.png|right|300px|alt=a pregnant woman lying on her back.]]
<div style="position: absolute; top: 30px; left: 135px; font-size:larger;">'''''NO!'''''</div></div>
'''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.

{{clr}}
[[Image:MW_Ch10_Page_163-1.png|right|120px]]

==== 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 [[A_Book_for_Midwives:Chapter_9:_Getting_ready_for_labor_and_birth#show|show]],&nbsp;or it may be broken waters. 

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

Change cloths and pads when they get very wet or messy. Check the fluid for too much&nbsp;[[A_Book_for_Midwives:Signs_for_the_midwife_to_check_in_stage_1#bleedinglabor|fresh blood or blood clots]], or [[A_Book_for_Midwives:Signs_for_the_midwife_to_check_in_stage_1#color|brown, yellow, or green waters]]. 
<br>

==== If the mother has HIV ====
Giving ART medicines to the mother throughout pregnancy can [[A_Book_for_Midwives:Medicines_for_HIV_and_AIDS#hivbaby|prevent the baby from becoming infected with&nbsp;HIV]]. Avoid bleeding by not cutting the birth opening or using tools in the delivery.

{{clr}}
<br>

{{Previous and next sections|Chapter 10: Giving good care during labor and birth|Be ready for emergencies}}


[[es:A_Book_for_Midwives:Cuidar_a_la_madre_durante_el_parto]]
[[en:A_Book_for_Midwives:Care_for_the_mother_during_labor]]
[[fr:A_Book_for_Midwives:Soins_administrés_à_la_mère_pendant_le_travail]]
[[ht:A_Book_for_Midwives:Pran_swen_manman_an_pandan_tranche_a]]
{{LastEditDate}}