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Watch for warning signs

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HealthWiki > A Book for Midwives > Chapter 12: Pushing: stage 2 of labor > Watch for warning signs


Contents

Watch the speed of the birth

Watch the speed of each birth. If the birth is taking too long, take the woman to a medical center. This is one of the most important things a midwife can do to prevent serious problems or even death in women.

First babies may take a full 2 hours (and sometimes more than 2 hours) of strong contractions and good pushing to be born. Second and later babies usually take less than 1 hour of pushing. Watch how fast the baby’s head is moving down through the birth canal. As long as the baby continues to move down (even very slowly), and the baby’s heartbeat is normal, and the mother has strength, then the birth is normal and healthy. The mother should continue to push until the head crowns.

But pushing for a long time with no progress can cause serious problems, including fistula, torn womb, or even death of the baby or mother. If you do not see the mother’s genitals bulging after 30 minutes of strong pushing, or if the mild bulging does not increase, the head may not be coming down. If the baby is not moving down at all after 1 hour of pushing, the mother needs help.

Baby is not born after 1 or 2 hours of strong contractions and good pushing

If you do not see signs that the baby's head is coming down, or if the baby seems to be stuck, find out what is causing the slow birth. Some causes of a slow or stuck pushing stage are:

  • the mother is afraid.
  • the mother is exhausted.
  • the mother has a full bladder.
  • the mother needs to change positions.
  • the baby is in a difficult or impossible birth position.
  • the baby does not fit through the mother's pelvis.

See suggestions of ways to help a woman whose labor is slow because she is afraid or exhausted.

Mother has a full bladder

A full bladder can slow labor or even stop it completely. Laboring for many hours with a full bladder can lead to fistula or other problems. Help the mother urinate or, if necessary, put in a catheter.

Squatting can help bring the baby down.
Mother needs to change positions

If one position does not bring the baby down, try other positions. The position that usually works best is squatting. Squatting opens the pelvis, and uses gravity to help the baby move down.

Try giving the mother something to hold on to. For example, she can hold on to a door knob or a rope tied to the ceiling, and pull down as she pushes.

Baby is in a difficult or impossible birth position

See a description of difficult or impossible birth positions.

If the baby is lying facing the mother’s stomach, it may be easier for the mother to push in either the hands-and-knees position or in the squatting position. This may help the baby turn to face the mother’s back as he comes down.

Sometimes the baby’s head is tucked down the way it should be but it is off to one side (asynclitic). It may help if the mother walks, lifting one leg up at a time — as if she were walking up stairs or a steep hill.

If the baby is face first or forehead first, the birth may be difficult or impossible. If you think this may be the problem, get medical help right away. While you are traveling, help the mother stop pushing.

Baby is unable to fit through the mother’s pelvis

If the inside of a mother’s pelvis is very narrow, or a baby’s head is very big, the birth may slow or stop. (The size of the outside of the mother’s hips does not matter.) If the mother keeps pushing for hours with no progress, her womb may tear open, she may get a fistula, or she and the baby may die of exhaustion.

If the baby cannot fit through the mother’s pelvis, the first stage of labor was probably longer than normal too.

If there is no progress — get medical help

If you have tried different methods for bringing the baby down — better pushing, different positions, emptying the bladder, rehydration drink, acupressure, and any other methods you know — and you still see no progress after 1 hour of good pushing, take the mother to a medical center. It is not safe to wait until more warning signs appear.

2 women and a man speaking while the man holds a woman.
We should not
wait any more.
Let's go to the
hospital.
I'll get
the truck.
I'll carry
her over.

If you are far from a medical center, do not wait more than 1 hour — get medical help right away. Thousands of women die every year because they did not get medical help soon enough.

While you are traveling, help the mother stop pushing. Put her in the knee-chest position (or some other position with her hips up) to take some of the pressure off the baby’s head.

WARNING!    Never push on the mother’s belly to hurry the birth. Pushing on the belly can make the placenta separate from the womb, or tear the womb. This can kill the baby or the mother!

Watch for bleeding during pushing

A small amount of blood from the vagina, especially bloody mucus, is normal during stage 2. It is a sign that the baby is moving down. But a gush of fresh blood can be a sign of a detached placenta or a torn womb.

Detached placenta (abruption)
If the mother has signs of detached placenta (a sudden gush of blood from the vagina, very fast or very slow baby’s heartbeat, tense or sore womb, shock) go to a hospital or medical center right away.

a midwife speaking to a woman in labor who is bleeding from the vagina.
Push hard! The baby must come quickly!

If the birth is near and you cannot get to a medical center, have the mother push as long and as hard as she can. Get the baby out fast — you may have only a few minutes. If necessary, cut the mother’s birth opening to make it larger so the baby can come out faster. If the baby takes too long to be born, he and the mother can both die.

Be ready! This baby may need extra help to start breathing, and the mother may bleed heavily after birth). Get help so that someone can care for the baby while you care for the mother.

Torn womb
If the mother has a torn womb, her contractions will stop and she may feel very strong, constant pain. The baby’s heartbeat will get very slow and then stop. If you think the womb may have torn, treat the mother for shock. Get medical help immediately, even if it is far away.


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