Hesperian Health Guides
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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.
- 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 cervix starts to open, it releases this plug of mucus and also a little blood.
- Clear water comes out of the vagina. The bag of waters can break just before labor begins, or at any time during labor.
- Pains (contractions) begin. At first contractions may come 10 or 20 minutes apart or more. Real labor does not begin until contractions become regular (have about the same amount of time between each one).
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 that the supplies for the birth are ready.
- Wash yourself, especially your genitals.
- Continue to eat small meals and drink whenever you are thirsty.
- Rest while you can.
The 3 stages of labor
Every birth has these 3 parts.
Stage 1 begins when contractions start to open the cervix and ends when the cervix is fully open. When it is the mother's first birth, this stage usually lasts 10 to 20 hours or more. In later births, it often lasts from 7 to 10 hours. It can vary a lot.
Stage 2 begins when the cervix is open and ends when the baby is born. This stage is usually easier than Stage 1, and should not take more than about 2 hours.
Stage 3 begins when the baby is born and ends when the placenta comes out.
Stage 1: The cervix opens
To make sure that labor is going well, check:
- How long has the woman been having contractions and how often do they come? At first, they may come every 10 or 20 minutes and last for a minute or less. After some time they will come more quickly — about every 2 to 5 minutes — and each one will last longer, about a minute and a half, until the baby is born. See information about what to do if she has had a contraction every 10 minutes or faster for more than 12 hours and the baby is not ready to be born.
- Have her waters broken? If they have, ask when. See information about what to do if it has been more than a day. Also, see what to do if the waters are green or brown.
- Is the baby in a head-down position? Feel the mother's abdomen. If the baby is sideways or breech, you must take her to a health center or hospital. See how to check the baby's position.
|Walking helps the womb open. It can also make the pain less and help the mother feel calmer.|
You can also help the mother by reassuring her that she is doing well and by encouraging her to:
- stay active.
- eat light foods, not heavy or oily foods.
- drink as much sweet liquid and warm tea as she wants.
- pass urine often.
- take deep, slow breaths during contractions, and to breathe normally between them.
- not push until she feels a strong need to push.
Stage 2: Pushing the baby out
Signs that it is time to push (this means the cervix is fully open):
- The mother feels a strong need to push. It may feel like needing to pass stool.
- During contractions, you can see the mother's bottom bulging and you may see the baby's head at the opening of the vagina. At first, the baby's head moves back inside between contractions.
What to do:
- Stay with the mother all the time and reassure her that she and the baby are doing well.
- Each contraction will come with a very strong urge to push. When the mother feels like pushing, have her take a deep breath and push as if she were passing stool, but with all her strength. Many women find it helpful to moan or groan in a deep voice with the pushes.
- Make sure that everything is going well and is ready for the birth. See information about what to do if the woman has been pushing for more than 2 hours.
Birth of the head
When the baby's head stays at the opening of the vagina, even between contractions, it is time for the head to be born:
- Tell the mother not to push hard, but to give little grunts or little pushes.
- Allow the head to come out slowly, between contractions. This will help to prevent the mother's skin from tearing.
- After the head is born, wipe the baby's mouth and nose with a clean cloth.
Now push hard.
Now do not push hard.
The head usually comes out face down...
...then the baby turns so the shoulders can be born.
Birth of the Shoulders
To help the shoulders come out:
- Gently hold the baby's head and guide it toward the mother's back (away from her abdomen). This lets the front shoulder be born first. Never pull or twist the head.
- The rest of the baby will then come out easily. Be ready! Hold the baby so it does not fall.
Care of the baby at birth
A healthy baby will start breathing, move its arms and legs, and start crying right away. To care for the baby:
- Wipe its mouth and nose with a clean cloth. To help the mucus drain, keep the baby's head lower than its body. If there is a lot of fluid or mucus, remove it with a suction bulb.
- Give the baby to the mother right away. Put a clean cloth around both of them. Do this as soon as possible so the baby stays warm.
- Put the baby to the mother's breast immediately. When the baby sucks, the mother's womb tightens and stops the bleeding. This will also help the placenta come out more quickly.
- Tie and cut the cord only when it turns white and stops pulsing. To prevent tetanus, a serious disease that kills many babies, cut the cord close to the baby's body.
Care of the eyes
|Pull down the lower lid to put a little bit of ointment inside. Putting ointment outside the eye does no good.|
Gonorrhea can cause blindness. Since many women do not know they are infected, put 1% erythromycin or tetracycline eye ointment in each of the baby’s eyes within the first 2 hours after birth.
Stage 3: The placenta comes out
When the baby is wrapped and at the mother's breast, it is time for the placenta to come out.
|Rolling the nipples can help the womb contract and stop bleeding.|
Watch the vagina to see when the cord gets longer. This means the placenta is separating from the womb. Also watch to make sure there is no heavy bleeding. When the cord lengthens, tell the mother to push out the placenta. Do not pull on the cord.
If the placenta does not come out right away and there is no bleeding, it is OK to wait up to 1 hour.
To help the placenta come out:
- Have the mother squat and push. If she cannot push, have her blow into a bottle, sneeze, or cough.
- Ask the mother to pass urine.
- Encourage the baby to nurse, or have someone roll the mother's nipples. This will help make her womb contract.
- If nothing else works, give her an injection of 10 Units of oxytocin in her buttock or thigh. Or give 600 micrograms of misoprostol by mouth.
- If the mother starts to bleed, follow the instructions for too much bleeding.
Check the placenta
When the placenta is out, put it in a bowl and check it to make sure it is all there.
Usually the placenta comes out whole, but sometimes a piece gets left inside. This could cause bleeding or infection later. To see if everything has come out, check the top and bottom of the placenta, and the membranes from the bag of waters.
If the mother is bleeding, or there seems to be a piece of the placenta or membranes missing, follow the instructions for too much bleeding.
|Try to make sure the membranes are all there. You should be able to imagine them fitting together as a sack.||
Waters break but labor does not start
Most women will give birth within 24 hours after their waters break. If labor has not started after 12 hours, the woman and her baby could get a serious infection.
What to do:
- The mother must not put anything in her vagina. She should not have sex. This could cause an infection.
- If she has a fever or there is a bad smell in the vagina, an infection is starting. She needs intravenous (IV) antibiotics. Even if labor starts, the woman and her baby could die. Go to a health center or hospital.
- Try to get labor started. The woman should swallow 2 tablespoons of castor oil, roll her nipples, or have someone suck them for a while every few hours until labor starts. There may also be special local teas that women use to start labor. If labor still does not start after a few more hours, she should go to a health center or hospital.
DANGER! Do not use injections to start labor. They can cause contractions that are so strong that they can kill the woman or the baby.
Baby lying sideways (transverse)
If labor has started and the baby's arm comes out first, it almost always means the baby is sideways. Check the baby's position. A baby lying sideways cannot be born without an operation. Do not try to change the position of the baby once labor has started. This can tear the womb or separate the placenta from the womb wall.
What to do:
- Take the mother to the hospital.
Bleeding before the baby is born
Some light, pink-colored fluid, or mucus and brown blood during labor is normal. But if the mother is bleeding bright red blood, it could mean that the placenta is separating from the womb wall or is covering the opening of the womb. This is very dangerous.
What to do:
- Take the mother to the hospital right away. If possible, start an IV and give her IV fluids.
If the mother has been in strong labor for more than 12 hours, or has been pushing for more than 1 hour with no signs of the baby moving toward birth, there may be a problem.
If after 12 hours of strong labor or 1 hour of pushing there is no progress, take her to a health center or hospital. She may need medicines to help her labor or an operation for the baby to be born.
What to do:
If her contractions do not come every 2 or 3 minutes and lasting for a full minute, she may not be in strong labor. Encourage her to sleep. If she cannot sleep, ask her to roll her nipples and walk between contractions to make labor stronger. Give light foods and fruit juices or tea with sugar to give her energy.
Green or brown waters
Brown or green waters can mean that the baby is in trouble.
What to do:
If it is still early in labor, or if the mother has not started pushing, it is best for this baby to be born in a hospital.
If the mother is in Stage 2 of labor and the baby is going to be born soon, have the mother push as hard as she can and get the baby out quickly. As soon as the baby's head is born, wipe its mouth and nose with a clean cloth or use a suction bulb to suck the mucus out. Keep the baby's head lower than its body to help the mucus come out. If the baby has difficulty breathing, take it to a hospital.
Fever is usually a sign of infection.
What to do:
A woman who is only a little warm may just need to drink more fluids.
Touch the woman's forehead with the back of one of your hands, and touch your own forehead with your other hand. (See how to take temperature with a thermometer if you have one.) If she feels a little warmer than you, she may just need fluids. Give her plenty of water, tea, or juice. Remind her to pass urine every few hours.
If she feels very hot to touch and she has chills, take her to a health center or hospital. She needs antibiotics right away. Give ampicillin, 2 g by mouth every 6 hours, along with 80 mg of gentamicin, IV or IM, every 8 hours, until you can get to a hospital. If you cannot give gentamicin, then give metronidazole with the ampicillin instead, 400 to 500 mg by mouth every 8 hours until you can get to a hospital. If she is allergic to penicillins, give 500 mg of erythromycin every 6 hours instead of ampicillin.
Seizures ("fits") with eclampsia
If the mother starts to have a seizure ("fit"):
- Put something under her head to protect it, and put her on her left side if possible. But do not try to hold her down.
- Keep her cool.
- Send someone to get emergency transportation and take her to the nearest hospital.
See section on pre-eclampsia for how to prevent seizures.
If possible, give one of the following medicines:
- magnesium sulfate, 50% solution. Inject 5 g deeply into each buttock muscle once. Repeat after 4 hours if needed.
- diazepam (see below for how to give).