Giving birth

Maternal Healthcare

Signs that labour is near

These three signs show that labour is starting or will start soon. They may not all happen, and they can happen in any order.

  • Clear or pink-coloured 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 surrounding the baby can break just before labour begins, or at any time during labour. 
  • Pains (contractions) begin. At first contractions may come 10 or 20 minutes apart or more. Real labour 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:  
    • Let the midwife know that labour is starting. 
    • Make sure that the supplies for the birth are ready.

The mother should:

  • wash herself, especially her genitals 
  • continue to eat small meals and drink whenever she is thirsty 
  • rest while she can.

Stage 1: The cervix opens

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 seven to 10 hours. It can vary a lot.


The cervix opens. Illustration by Annabel Milne © Dorling Kindersley

Illustrations by Annabel Milne © Dorling Kindersley

Stage 2: Pushing the baby out

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 two hours.

Pushing the baby out. Illustration by Annabel Milne © Dorling Kindersley

Illustrations © Dorling Kindersley



Assisted delivery 

Sometimes the mother needs help to get the baby out. The baby or the mother may be too tired to push, or the baby may be in distress. In a health centre or hospital, a doctor or midwife can use forceps or a vacuum extractor (sometimes called a ventouse) to pull the baby out gently. This should not damage the baby. The baby’s head can appear misshapen for a few days after the birth, but this is not a cause for concern.


Assisted delivery. Illustration by Annabel Milne © Dorling Kindersley

Illustrations © Dorling Kindersley
 


Stage 3: The placenta (afterbirth) comes out

This is the easiest part of labour for the woman, but it still needs to be carefully managed. Putting the baby to the breast immediately stimulates the womb to contract and push the placenta out. When the placenta comes out it should be looked at carefully to check that it is complete. If it is not complete, seek help from a health worker. After the baby is born there can be serious bleeding, even if the labour has gone well up to this point. This is why it is important to have planned ahead for the labour – so you can be sure of a trained person being present at this stage.

Danger signs in labour  

  • Waters break but labour does not start 
  • Baby lying sideways 
  • Bleeding before the baby is born 
  • Too long labour (contractions at least 10 minutes apart for 24 hours or more) 
  • Green or brown waters 
  • Fever 
  • Fits or convulsions

If you see any of these signs, get medical help immediately

Cesarean section  

When the baby cannot be born through the vagina, an operation called a caesarean section is necessary. The mother will be given drugs to make her sleep without pain (anaesthetic) or she will have an injection in her back so that she does not feel pain below the waist. The doctor makes a cut in her belly and carefully takes the baby out. After the cut is sewn up, the mother stays in hospital for some days to recover. It is then advised that future babies are born in a hospital. A woman can give birth normally after having one caesarean section for a previous birth, but there is a small risk of the womb tearing, which can lead to the deaths of both mother and child. In a hospital, midwives and doctors can prevent this happening.

Information taken from Where Women Have No Doctor, with kind permission of the publishers, Hesperian, 1919 Addison Street Suite 304, Berkeley, CA 94704, www.hesperian.org 


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