Hesperian Health Guides

Chapter 10: Giving good care during labor and birth

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

What happens during labor and birth

In this chapter, we give general information about labor and birth, and explain some ways a midwife can support a woman all through the birth of her baby.

Labor is easier to explain in different parts, so in this book, we divide it into 3 stages — opening, pushing, and the birth of the placenta. This chapter has some information about these stages, and we talk more about each of them in separate chapters after this one.

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In the first stage of labor (opening) the cervix opens enough to let the baby out of the womb. For more information about stage 1, see Chapter 11, “Opening.”

During pregnancy the cervix is long and firm, like a big toe. For most of the pregnancy, nothing can get in or out of the cervix, because the tiny opening in it is plugged with mucus.

Near the end of pregnancy, practice contractions begin to shorten and soften the cervix. Even before labor starts, the cervix may open a little and the mucus plug may come out.

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In pregnancy,the cervix is long, firm, and closed. At the end of pregnancy, and in early labor, the cervix gets shorter and softer. In labor, the cervix gets very short and soft, and opens.

Labor contractions push the baby down and pull the cervix open.

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push the
baby down ...
and pull the
cervix open.
  • Contractions push the baby’s head down hard against the cervix. This helps to open the cervix, and moves the baby toward the opening of the vagina.
  • Contractions slowly pull the cervix open. Each time the womb contracts, it pulls a little bit of the cervix up and open. Between contractions, the cervix relaxes. This continues until the cervix is completely open, and the baby can fit through the opening and be born.

A mother’s contractions must get very strong to open the cervix completely. The tiny hole must open to about 10 centimeters (4 inches) across — wide enough for the baby to fit through.

a circle that is 10 centimeters across.
The hole must get this big for the baby to be born!
arrow pointing to a very small hole in the cervix.
The hole in the cervix is this size during pregnancy.

Note: This image may not be exactly 4 inches.
Please measure.


After the cervix is open all the way, contractions move the baby out of the womb and down the vagina. The mother pushes to help move the baby out. This is called stage 2. For more about stage 2, see Chapter 12, “Pushing.”

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Cord is thick, blue, and pulsing —it is still passing blood to the baby. Do not cut.

The birth of the placenta

Just after the baby is born (stage 3) she learns to breathe. The placenta separates from the womb and is pushed out of the vagina. For more about stage 3, see Chapter 13, “The birth of the placenta.”

When the baby is first born, she is still connected to the placenta inside the mother by her cord. The blood from the placenta gives the baby a few minutes to start breathing. Soon the baby can breathe on her own and no longer needs the placenta.

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Cord is thin, white, and not pulsing —it is not sending blood to the baby. OK to cut.

The placenta usually separates from the wall of the mother’s womb in the first few minutes after birth. With a couple of pushes, the placenta will usually come out of the vagina and the baby must breathe on her own.

The first few hours

In the first few hours after the birth of the placenta, the mother starts to recover from the birth, and the baby begins to adjust to the outside world.

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The place where the placenta was attached to the womb starts to tighten and close, and the mother’s bleeding slows down. The mother’s womb will become firm. She might feel strong contractions after the birth. These contractions are healthy, and help to stop the bleeding.

The baby should start to breastfeed. She should urinate, and may pass her first stool.

This page was updated:11 Sep 2019