Hesperian Health Guides

Labor and birth

Every day 20,000 people visit the HealthWiki for lifesaving health information. A gift of just $5 helps make this possible!

Make a giftMake a gift to support this essential health information people depend on.


HealthWiki > A Health Handbook for Women with Disabilities > Chapter 11: Labor and birth > Labor and birth


Birth starts when the womb begins to contract and open. The time this takes can vary a lot. When it is the mother’s first birth, this usually lasts 10 to 20 hours or more. In later births, it often lasts from 7 to 10 hours. When the cervix is fully open, it usually takes less than 2 hours to push the baby out. Birth ends when the after birth (placenta) comes out.

The length of time it takes for a woman with a disability—any disability—to give birth is no different from the time it takes any other woman, usually from 3 to 24 hours. What may be different is how she can tell that labor has begun, and the position she may need to be in during the delivery.

How to tell you are in labor

WWD Ch11 Page 236-1.png
About 2 weeks before birth, the baby often drops lower in the belly, especially first babies

Labor usually starts when you have been pregnant more than 8 months. The baby will drop lower in your belly, and you may find it easier to breathe.

During the last few weeks of pregnancy, most women feel the womb getting tight a few times a day, or maybe only a few times each week. These tight feelings are practice contractions and are not real labor. They may feel strange and last a few minutes. But they do not usually hurt, and they do not follow a regular pattern.

Even women who are paralyzed and have no feeling in the belly can usually tell when the baby is ready to come out. Although paralyzed women may not have real pain, the belly will feel different enough for them to know that something is changing.

Signs that labor is near

These 3 signs show that labor is starting or will start soon. They may not all happen, and they can happen in any order. If you have any of these signs, tell your birth attendant (health worker, midwife, doctor).

  1. Clear or pink-colored mucus comes out of the vagina. During pregnancy, the opening to the womb (cervix) is plugged with thick mucus. This protects the baby and womb from infection. When the womb starts to open, it releases this plug of mucus and also a little blood.
  2. Clear water comes out of the vagina. This is from the bag of waters that has surrounded and protected the baby in the womb. The bag of waters can break before labor begins, or at any time during labor.
  3. The womb begins to contract and pains in the belly start. During a contraction, the womb will squeeze up and become hard, and then it will relax and become soft again. At first contractions may come 10 or 20 minutes apart or more. When contractions become regular (have about the same amount of time between each one), real labor has begun.


Contractions are usually painful, but if you have no feeling in your belly, you can usually see or feel the changes like this:

a pregnant woman lying down with her hand on her belly.
WWD Ch11 Page 237-2.png
I cannot feel any pain, but I can feel my belly get hard
.....and then soft again.
a man speaking to a pregnant woman lying on a bed; there are crutches beside the bed.
I will go and tell Doña Rosa that your pains have begun.


When any one of these signs occurs, it is time to get ready for the birth. Here is a list of things you can do:

  • Let your midwife know that labor is starting.
  • Make sure the supplies for the birth are ready.
  • Wash yourself, especially your genitals.
  • Continue to eat small meals.
  • Drink plenty of fluids (water or juice).
  • Rest while you can.
  • Apply heat to your lower back, such as a warm cloth or towel. Or ask a friend to massage your back.

Important information about dysreflexia for women with spinal-cord injury

If you have a fairly high spinal-cord injury (usually T6 and above), you can get a sudden, dangerous increase in blood pressure with pounding headaches and severe sweating. You may get these signs when you are in labor.

What to do:

WWD Ch11 Page 238-1.png

See a health worker or midwife regularly so your blood pressure can be checked. This should be done at least once every week for the first 7 months, and then every day for the last few weeks, before your labor starts. This way they will be able to see if your blood pressure starts to get high.

Take care of your bowel program. This is especially important during pregnancy. Drink a lot of water and eat foods that will help you have easy bowel movements. Too much stool in your body can cause dysreflexia.

Make sure your bladder stays empty, because a full bladder can cause dysreflexia. If you use an indwelling (Foley) catheter, make sure it does not become twisted or bent and prevent the urine from coming out.

a woman in a wheelchair at the door to a health clinic.

Look and feel for contractions a few times each day during the last weeks before the baby is due and watch for other signs that labor is starting.

As soon as you have any signs your labor is starting, go to a hospital or maternity clinic right away to give birth. You will need to have anesthesia injected in your spine. This is called an “epidural” and will prevent dysreflexia caused by labor contractions.

How to make labor easier

Make sure you pass urine. Try to pass urine at least once every hour. You will be more comfortable if your bladder is empty. Also, women with a spinal cord injury will be less likely to get dysreflexia if a catheter is left in place all during the labor and delivery so that urine can drain out.

Change your position several times, at least once every hour. Practice ahead of time moving from one position to another so that when labor starts, you can change position more easily between contractions. Ask someone to help if necessary. The more comfortable and relaxed you are, the more relaxed your muscles will be, so it is less likely that they will cramp or spasm. Also, when you change your position often, you will be less likely to develop pressure sores.

Walk around between contractions if you can. Walking helps the womb open and the baby move down.

Breathing during labor

The way you breathe can have a strong effect on how your labor will feel. You can practice different ways of breathing throughout your pregnancy so you will be ready when labor starts. For example:

  • Slow, gentle breathing: Breathe in through your nose to take a long, slow breath. To breathe out, make a kiss with your lips and slowly blow.
WWD Ch11 Page 240-1.png
  • Hee breathing: Take a slow deep breath and then blow out short, quick breaths while you make soft “hee, hee” sounds.
  • Panting: Take quick, shallow breaths.
  • Strong blowing: Blow hard and fast.
a woman breathing out through her mouth.
Hee, hee,
hee, hee…


During labor you can choose whichever breathing methods help you the most.

Birthing positions

These positions can be used during both labor and birth:

If you have little or no leg or arm control, you can sit on a lap.
WWD Ch11 Page 240-3.png
Or you can rest on cushions in a half-sitting position.
WWD Ch11 Page 240-4.png
If you have good arm and hand control, you can use a birthing chair like this. (For another example, see Fatuma’s story.) a U-shaped wooden seat that supports the legs. Or you can use a birthing chair with arm and back support, like this.
the wooden seat with a back and armrests.
With help, a woman with some leg control can squat...
WWD Ch11 Page 241-3.png
...or stand.
WWD Ch11 Page 241-4.png

The person or object that supports you must be strong and balanced. You can also hold onto the back of a chair. The squatting or standing positions can help bring the baby down when the birth is slow, or if the mother is having trouble with pushing.

WWD Ch11 Page 241-5.png
If you have some leg and arm control, you may want to try the hands-and-knees position. This position sometimes also helps prevent and control muscle spasms.


WWD Ch11 Page 241-6.png
If you have little or no leg control, you can lie on your side while someone holds your top leg, with your legs bent...
WWD Ch11 Page 241-7.png
...or straight.

If you are blind or have poor balance, you may feel safer lying on the floor. Most hospital and health centers have special beds for women giving birth. These beds have knee supports and can be useful for women with poor leg control.

Fatuma’s birthing stool

Fatuma Achan lives in Uganda and is paralyzed in both legs from having had polio as a child. When Fatuma became pregnant, like most disabled women, she was told by the doctors at the local clinic she had to give birth by an operation (a Cesarean section, or c-section).

Fatuma on her birthing stool.


Fatuma was determined not to have an operation but to go through normal labor. Other women in her community sometimes gave birth by squatting. Because her legs
a stool in 2 parts, each 18 inches long, 6 inches high, and 6 inches wide.
An easy-to-make wooden birthing stool
were paralyzed, Fatuma knew that she would not be able to hold herself in the squatting position. But she also knew her arms were very strong from pushing her wheelchair all the time. So she built a birthing stool which enabled her to stay in the squatting position. This way her baby could still be born through the vagina.

Even though Fatuma is paralyzed, her womb is still strong and can squeeze itself (contract) to push out a baby. The position of her body on the birthing stool helps the baby drop down gently out of her body through the vagina, just as it does for other women who squat during birth.

For muscle cramps and spasms (sudden stiff muscles) during labor and birth

Women with cerebral palsy, a spinal cord injury, or who are paralyzed from polio can get cramps or tight spastic muscles at any time during labor and delivery. Tight muscles in any part of the body are affected by the position of the head and body. Pulling or pushing directly against the spastic muscles will cause them to tighten more. Here are some suggestions for softening spastic muscles during labor:

WWD Ch11 Page 243-1.png
Throughout labor, do range-of-motion exercises between contractions. If necessary, have someone help. The exercises will keep muscles loose and help prevent cramps and spasms.
WWD Ch11 Page 243-2.png
To help the muscles relax, sit in a bath of clean warm water,
but only before the bag of waters has broken.
WWD Ch11 Page 243-3.png
Cloth soaked in clean, warm water may help.
WWD Ch11 Page 243-4.png
Put something under the head and shoulders to bend them forward. This will help relax stiffness in the whole body.
Do not try to pull a woman’s legs apart at the ankles. This will make her legs pull together more tightly. Instead, after lifting her head and shoulders, bend her legs. To separate her legs, first bring the knees together. This may unlock the legs. If not, hold the legs above the knees and they will open more easily.