Hesperian Health Guides
Giving Birth
Contents
- 1 Signs that labor is near
- 2 The 3 stages of labor
- 3 Danger Signs During Labor
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 may break just before labor begins.
- Pains (contractions) begin. At first, contractions are usually far apart (10 to 20 minutes or more) and not evenly spaced. As labor continues, they get closer together and have about the same amount of time from one to the next.
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 outer 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. How long it lasts varies a lot, especially for early labor when contractions come less often. Stage 1 can last from more than 20 hours (during a first birth) to less than 10 hours (in later births).
Stage 2 begins when the cervix is open and ends when the baby is born. This stage is usually easier than Stage 1, and usually takes 2 to 3 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 ago did the contractions begin 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. If strong contractions come every 10 minutes or faster for more than 12 hours and the baby is not ready to be born, see “Too-long labor”.
- Have the waters broken? If they have, ask when. If it has been more than a day, see “Waters break and labor does not start in a few hours”. If the waters are green or brown, see “Green or brown waters” .
- Is the baby in a head-down position? Feel the abdomen. If the baby is sideways or breech, you must go to a health center or hospital.
You can also help by reassuring the person in labor that they are doing well. Encourage them to:
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Walking helps the womb open. It can also make the pain less and help someone in labor feel calmer. |
- stay active.
- eat light foods, not heavy or oily foods.
- drink as much sweet liquid and warm tea as they want.
- pass urine often.
- take deep, slow breaths during contractions, and breathe normally between them.
- not push until they feel a strong need to push.
| During labor, help someone choose the positions they are most comfortable in. For many years, doctors and some midwives asked people in labor to lie on their backs, but this is often a difficult position for going through labor and giving birth. Encourage someone in labor to try different positions. Most find it easier to push the baby out when they are kneeling, squatting or sitting propped up. | |||
kneeling |
squatting |
sitting propped up |
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Stage 2: Pushing the baby out
Signs that it is time to push (this means the cervix is fully open):
- The person feels a strong need to push. It may feel like needing to pass stool.
- During contractions, you can see their vulva 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 them all the time and be reassuring—say how well they and the baby are doing.
- Each contraction will come with a very strong urge to push. When they feel like pushing, have them take a deep breath and push as if they were passing stool, but with all their strength. Many people in labor 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. If someone has been pushing for more than 2 or 3 hours, see “Too-long labor”.
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 person pushing 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 skin around the vagina 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 laboring person’s back (away from their 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 parent right away. Put a clean cloth around both of them so the baby stays warm.
- Put the baby’s mouth to the parent’s nipple immediately. When the baby sucks, the womb tightens and stops the bleeding. This will also help the placenta come out more quickly.
To cut the cord:
| 1. When the cord turns white and stops pulsing, put 2 clean ties around it, using square knots. Put one tie about 2 finger widths from the baby and put the other one about 2 more finger widths farther from the baby. | |||
| The first loop of a square knot... |  |
...and the second loop of a square knot. |  |
| 2. Cut the cord between these 2 ties with a new razor blade. If you must use a different tool to cut the cord, be sure it has been sterilized. |  |
Tie the cord in 2 places before cutting. The chance of a baby getting tetanus is greater when the cord is cut far from its body. | |
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IMPORTANT! To avoid tetanus and other infections, the cord and anything that touches it must be very clean. Never put dirt or animal dung on the cord stump.
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Care of the eyes
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Pull down the lower lid to put a little bit of ointment inside. Putting ointment outside the eye does no good. |
To prevent blindness, put medicine in each of the baby’s eyes within 2 hours of birth. Use 0.5% erythromycin ointment, 1% tetracycline ointment, or 2.5% povidone-iodine solution. If you cannot get one of these, use 1% silver nitrate solution, although it does not work as well and may irritate the baby’s eyes. It is better than not using anything.
Stage 3: The placenta comes out
When the baby is wrapped and at the breast, the placenta should come out soon.
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| 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 person in labor to push out the placenta. Do not pull on the cord. To help the placenta come out:
- Have the person squat and push. If they cannot push, have them blow into a bottle, sneeze, or cough.
- Ask them to pass urine.
- Encourage the baby to nurse or have someone roll the person’s nipples. This will help make the womb contract.
- If the placenta does not come out right away and there is no bleeding, it is OK to wait up to 1 hour.
- If nothing else works, inject 10 Units of oxytocin in the buttock or thigh.
- See what to do if there is heavy bleeding.
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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 there is heavy bleeding, or there seems to be a piece of the placenta or membranes missing, follow the instructions for what to do for too much bleeding.
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Try to make sure the membranes are all there. You should be able to imagine them fitting together as a sack. |
 piece
missing |
Waters break but labor does not start
In most births, the baby is born within 24 hours of the waters breaking. If labor has not started after 12 hours, the pregnant person and baby could get a serious infection
What to do:
- Do not put anything in the vagina. Do not have sex. This could cause an infection.
- If there is fever or there is a bad smell from the vagina, an infection is starting. The person needs intravenous (IV) antibiotics. Even if labor starts, the pregnant person and baby could die. Go to a health center or hospital.
- Try to get labor started. The pregnant person should swallow 2 tablespoons of castor oil and roll their nipples, or have someone suck them for a while every few hours until labor starts. There may also be special local teas that you can use to start labor. If labor still does not start after a few more hours, 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 pregnant person 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 medical help. 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.
TRANSPORT!
What to do:
- Go 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 there is bright red bleeding, it could mean that the placenta is separating from the womb wall or is covering the opening of the womb. This is very dangerous.
TRANSPORT!
What to do:
- Go to the hospital right away. If possible, give IV fluids on the way.
Too-long labor
If someone has been in strong labor for more than 12 hours, or has been pushing for more than 2 hours with no signs of the baby moving toward birth, there may be a problem.
Take the person to a health center or hospital. They may need medicines to help the labor or an operation for the baby to be born.
What to do:
In strong labor, contractions should come every 2 or 3 minutes and last for a full minute. If this is not happening, encourage the person to sleep. If they cannot sleep, ask them to roll their nipples and walk between contractions to make labor stronger. Give light foods and fruit juices or tea with sugar for energy.
Green or brown waters
Brown or green waters can mean that the baby has passed stool in the womb. The stool can get inside the baby’s mouth and nose, and make breathing hard or cause infection after they are born.
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What to do:
If it is still early in labor and pushing has not started, it is best for this baby to be born in a hospital.
If the labor is in Stage 2 and the baby is going to be born soon, have the person in labor push as hard as they 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
Fever, a temperature over 38°C (100.4°F), is usually a sign of infection. To check for fever, use a thermometer or touch the person’s forehead with the back of one of your hands, and touch your own forehead with your other hand.
If the person feels only a little warmer than you, they may just need fluids. Give plenty of water, tea, or juice. Remind them to pass urine every few hours.
What to do:
Someone with chills who is very hot to touch needs medical help right away. Take them to a health center or hospital. If you have it, inject 2 g ampicillin in the muscle one time. After 6 hours, inject 1 g and repeat every 6 hours. Also inject 80 mg gentamicin in the muscle every 12 hours, and give 500 mg metronidazole by mouth every 8 hours. Stop giving these medicines 24 hours after the birth if the person has no fever.
Seizures (convulsions) with eclampsia
If someone in labor has a seizure:
TRANSPORT!
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- Put something under their head to protect it, and put them on their left side if possible. But do not try to hold them down.
- Keep them cool.
- Send someone to get emergency transportation and take the person to the nearest hospital.
- If possible, give a medicine for seizures.
Because someone having seizures cannot swallow pills, medicine must be injected or given in the rectum (the butt). See the box below.
For more information about these medicines, see the “Medicines Pages.”
Magnesium sulfate works best and is safest during pregnancy. If you do not have magnesium sulfate, give diazepam in the rectum (it does not work as well when injected).
How to give magnesium sulfate Give 10 g magnesium sulfate 50% solution by injecting 5 g deeply into each buttock. Then inject 5 g magnesium sulfate 50% solution every 4 hours, alternating buttocks. Continue for 24 hours after the birth or after the last seizure (whichever is later).
How to give diazepam
Diazepam comes as a liquid or as pills you can crush to give in the rectum. Use a syringe to give medicine in the rectum, but except for drawing liquid into the syringe, YOU MUST REMOVE THE NEEDLE.
The dose is 10 mg after the first convulsion. Then wait 15 minutes. If convulsions do not stop, you can give 10 mg more, but do not give more after that.
For liquid diazepam: First load the syringe and then TAKE OFF THE NEEDLE. Put the barrel of the syringe gently into the rectum and empty it inside. Hold the syringe in place for at least 5 minutes—it will keep the medicine from leaking out. If some fluid comes out, it is OK to give 5 mg more.
For diazepam pills. Crush 10 mg of pills into fine powder and mix with clean, cool water. The powder will not dissolve completely. Draw the mixture into a syringe WITHOUT A NEEDLE and put it into the rectum using the instructions above for liquid diazepam.