Hesperian Health Guides

Labor and Birth

A woman comforting a pregnant woman and offering her a glass of water

Every community has traditions of how to care for women in labor. The safest traditions allow nature to take its course while staying alert for signs of danger. Remember:

  • Most births are safe and healthy.
  • Encourage the mother. Hold her hand, talk gently to her, show her how to take slow, deep breaths.
  • Help the mother move, walk, change positions, and make sounds.

If there are signs of problems, do not delay —
get to a hospital right away

 Danger Signs In Pregnancy
  • Too long labor: Labor longer than 12 hours for an experienced mother, or longer than 24 hours (a whole day and night) for a first birth, often leads to injuries in the mother and difficulty for the newborn. Also, if the water breaks, but labor has not started after 12 hours, this can lead to infection.
  • High blood pressure: Blood pressure of 160/110 or higher is an emergency. Get medical help and watch for seizures on the way.
  • Fever: If there is a fever and the mother has a fast pulse, or the baby’s heartbeat is fast, there is probably a womb infection that could harm the mother and baby. Get help and give antibiotics on the way.
  • Sideways baby: This is an impossible birth position and a cesarean birth is needed right away to save the baby. Get medical help.
  • The cord comes out before the baby: This rare occurrence causes the baby’s head to pinch the cord, cutting off the supply of blood to the baby. The baby can only be saved if you can immediately get to a hospital for a cesarean birth. The woman should stay on her hands and knees with her bottom up in the air to keep the pressure off the cord.

Prepare for birth

For a safe birth, prepare these supplies:

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Soap and water to wash hands often, clean the mother, and wash medical tools. New or freshly sterilized razor blades or
sharp scissors for cutting the cord.
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Medicines to stop bleeding: oxytocin, misoprostol. Plenty of disposable gloves to protect the health of the mother, baby, and the midwife. Sterilized or freshly boiled string or ribbon, or cord clamps for tying or clamping the cord.

The family or health worker should also gather:

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Lots of clean cloths or towels to
keep the new baby warm and dry.
A light for seeing the birth
and the baby.
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Water for drinking and
cleaning up.
A bowl for washing up and a
bowl to catch the placenta.

Other useful tools for the health worker or midwife:

  • The mother’s health recordsNWTND pab Page 20-5.png
  • A new or sterilized suction bulb or suction trap for
    sucking mucus out of the baby’s mouth and nose
  • A fetoscope, stethoscope, and blood pressure cuff
  • Sterile needles and suture for sewing any tears

The start of birth

a baby inside the womb with its head at the cervix


Labor pains, or contractions, are the womb tightening and relaxing over and over. These contractions slowly open the bottom of the womb, called the cervix. When the cervix is open all the way, the baby can come out of the womb and then out of the vagina.

Mild, practice contractions start late in pregnancy. They do not last very long and they stop when the mother rests. True labor contractions are strong. They come often, and in a regular pattern, once every few minutes. They do not go away when the mother lies down or rests.

A woman whose bag of waters is breaking

Breaking bag of waters

The bag of waters can break with a big splash or with a slow leak of fluid. The loss of fluid may be the first sign of labor before contractions start. Or there may be a splash during labor. Sometimes a baby is born inside the bag and it does not break at all. These are all normal.

Inside the womb, the bag protects the baby from germs. After the bag breaks, germs can infect the womb and the baby. For that reason, the longer the bag is broken, the more likely infection is to occur. Do not put anything in the vagina after the bag of waters has broken. If the bag breaks and 12 hours – 1 day or 1 night – passes without labor starting, go to a hospital where labor can be started with medicine.

Helping labor start

You might want to help start a labor, or speed a slow labor, in these situations:

  • A too-long pregnancy. A pregnancy longer than 41 weeks can cause health problems for the baby.
  • A broken bag of waters. After water breaks, help start labor to avoid the risk of infection.
  • A labor that is moving very slowly. Help start or strengthen labor so the mother does not become exhausted.

Start with the first method and if it does not work, try the next:

  1. Have her walk, dance, or climb stairs or hills.
  2. Massage her nipples as if milking the breasts. Or have a baby nurse. This should bring some contractions.
  3. Mix about ¼ cup castor oil with some juice and have the mother drink it. This usually causes painful diarrhea and cramps, but it may also start contractions.
A  pregnant woman drinking a mixture of castor oil and fruit juice
¼ cup castor oil
fruit juice
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There may be plant medicines that are used in your community to start labor. Some of these may be safe, others are not. Before using them, ask yourself: have these plants started labor for other women? Have women or babies ever had health problems after taking these plant medicines? Have these medicines been used for a long time or did people only start using them recently? See Medicines, Tests, and Treatments (in development) for more ideas about how to know if a plant medicine is safe.

  • Do not try to start labor if the baby is sideways in the womb.
  • Do not waste time trying to start labor if you are far from medical help. Instead, use your time to go to the hospital.
  • Never give oxytocin, misoprostol, or other medicines to start labor at home. These medicines are so strong they can kill.

Helping a woman in labor

Mostly you can help a woman give birth by giving loving encouragement. Avoid putting your fingers inside the vagina to check the cervix. This is not necessary in a normal labor and can cause infection. Do not push on the belly or use cloths to pull the baby down. None of this helps get the baby out faster.

For most of labor, watching quietly is better than interfering.

A pregnant woman walking"
Walk around or change positions every hour or so.

During the opening stage of labor, the health worker should simply encourage the mother. Remind her to:

  • breathe slowly, blow, or make sounds to relieve the pain during contractions.
  • sip liquids often, and eat small amounts of food.
  • urinate every few hours. A full bladder slows birth.

Check the health signs of the mother and baby

If you know how, check the mother’s blood pressure, pulse, and temperature, and the baby’s position and heart rate, as soon as labor starts. Continue checking regularly during labor. These signs
can tell you if the mother is getting an infection or pre-eclampsia, or if the baby is in trouble.

A health worker checking a pregnant woman's blood pressure

To look for pre-eclampsia: Check the blood pressure. Blood pressure of 160/110 or above is severe pre-eclampsia and may lead to seizures. Get help.

To look for infection: Check the mother’s temperature. It often rises in labor, but a temperature of 38° C (100.4° F) or higher is usually an infection. While any infection (such as malaria or urinary tract infections) can happen in labor, be especially mindful of infection inside the womb. Other signs of womb infection are:

  • The baby’s heartbeat is more than 180 beats in a minute.
  • The mother’s pulse is more than 100 beats in a minute.
  • The mother’s vagina smells bad.
  • The mother’s belly is sore or tender to the touch.

Treat womb infection with ampicillin and gentamicin right away and continue to give it after the birth. If signs of infection are severe, also give metronidazole. See more information on these medicines. And get help.

To check the baby’s well-being: A baby’s heartbeat that stays less than 120, or ever goes below 100, is a sign that the baby is not getting enough oxygen and is in danger. The baby might die, but there is nothing to do except deliver the baby.

Length of labor

Each woman’s labor is different and that is normal. A healthy labor can be very fast or can last many hours. However, some babies get stuck and will not be born without medication or surgery. Think about how long it will take for you to get to a hospital. If you are far away and labor has gone on for hours, start toward help sooner.


Once the mother feels a strong urge to push, she can do so safely. Mostly, mothers know how to push their babies out without help. Do not yell at the mother or boss her.

A woman in labor squatting with another woman holding her up under the arms
A woman in labor on hands and knees
A woman in labor propped up on pillows"
Squatting, hands-and-knees, and propped up on pillows are all good pushing positions. If one position does not bring the baby out, try another.

Pushing usually feels good to the mother compared to the earlier labor pains. If the labor has been long, the mother may doze off between contractions and then wake up to push.
If pushing takes a long time:

  • encourage the mother to change positions.
  • ask the mother to urinate. A full bladder slows labor.
  • ask her to rest between contractions, and then take a deep breath and push as hard as she can during contractions.

After 2 hours of strong pushing, get medical help. Surgery may be needed to bring out the baby.

If the baby is breech: You may be able to feel the baby is breech (butt or legs first) by feeling the mother’s belly. If you see a lot of fresh, dark meconeum (baby feces) coming from the vagina during labor, the baby is likely breech. See information on how to deliver breech babies.

This page was updated:02 Jan 2018