26-2Normal Labour( Delivery / Childbirth)When the baby is fully mature, it gets ready to leavethe womb and be born into the world. The womb(uterus) then starts squeezing (contracting) to throwout the baby. This is called labour. Labour is di-vided into 3 stages:First Stage: From the Second Stage: From end Third Stage : From the timemoment labour pain of I stage until the baby is the baby is born until the pla-starts until the head born. centa and membranes arereaches the birth ca- thrown out.nal. Preparations for Childbirth at Home clean room with clean clean bed hands The 5 Cleans of Delivery clean blade clean tie (thread) clean cord for tying cord
26-3To increase the chances of mother and child remaining safe, WE MUST KNOW: I. When NOT to plan a delivery in the villageDO NOT try to conduct delivery in the village if : The woman had a caesarean operation earlier. The woman had more than one still born child. The woman has a known heart disease or has very severe anaemia (she is very, very pale and breathless). The woman is very short in height, has a limp and it is her first delivery. She bleeds before labour. Could be Difficult births. She is having twins. Better to send to hospital. The baby in the womb is felt to be lying horizontal. II. When to Refer during deliveryDo not wait any longer in childbirth if: Labour has already started and the face, the Refer to hospitalhand or the cord is seen. In such cases, RUSH to ahospital. First stage (beginning of labour until the headreaches birth canal) takes more than 24 hours. Second stage (child is born) does not progressand the pains start decreasing instead of increasing. Third stage (throwing out placenta & bag) lastsmore than 30 minutes or the woman bleeds over twocupfuls of blood. The woman shows signs of shock – her pulsebecomes too fast and she sweats; her pulse feels weakand her B.P falls below 90 /60 mm Hg. Put her headdown and feet up; give her lots of fluid with lots ofsugar. Refer to a doctor immediately. Labour goes on and does not progress; The baby’s heart rate falls below 120 or 160 per refer to a hospital minute.
26-4 Stages of LabourStage I: The labour starts: The uterus starts squeezing (called contractions). Startingoff with a backache, the squeezing increases in duration. There is agap of time between each squeeze but this gap of time shortens andthe squeezing comes more often. Towards the end, a contractioncomes every five minutes. The tube of the cervix expands and a plug (made up of mucus)that had blocked the cervix all this time, mixes with some blood andcomes out. The bag in the womb surrounding the baby may tear early or late in the first stage oflabour. The water around the baby comes out and labour will quickly progress from there. The mouth of the cervix becomes bigger to allow the baby out. This stage lasts longer for women in labour for the first time. Others do not take as long. Help the woman in I Stage She should be told about how delivery happens and what all to expect much before she gets labour. She should be told that the first stage may last up to 10-20 hours and she should learn to relax. Allow her to roam freely between her pains. Ask for some thick string to be boiled (two pieces of 4 inches long). Also ask for a new shaving blade or a piece of bamboo to be freshly cut and boiled. Let her drink fluid with lots of sugar, like tea or hot milk. Keep listening to the baby’s heart sound. If less than 120 per minute, send to the hospi- tal immediately. Wash her belly, buttocks (bums), legs and pelvic area with soap and warm water. DO NOT MASSAGE OR PUSH. DO NOT ASK MOTHER TO BEAR DOWN. This stage should not last more than 24 hours. If it prolongs, send to a hospital.
26-5Stage II: The baby comes out If the bagis yet to tear when Know the natural process by which the baby comes out.the mouth of cer- You may help it but DO NOT go against the process.vix has openedfully, then labour 1.could get delayed. Mouth of 2.The bag can be Head lowers; womb opens;ruptured with a puts pressure head turns topair of clean boiled on the cervix. mother’sforceps also. midline. As the ba-by’s head ispushed out of thevulva, the stretch-ing is most pain- 4. Head comes 3. Headful and causes the out fully, startswoman to cry out shoulders comingloud. Usually, in comes to out; bendsthe next push, the mother’s backwards.body is thrown midline.out with lots offluid. Helping the woman in II Stage The woman should be close to the bed prepared for the delivery. Clean and sun-dried (or ironed sheets) must be spread. Make sure that there are lots of “soaking clothes” to soak all the fluids and blood of childbirth. The woman must be either in a “sitting” or “propped up” position so that she can push more easily. Encourage the woman to relax between the squeezing of the womb but she should push hard during the painful squeezing of the womb. Keep watching the birth opening. When the head reaches the birth opening (vulva) and stretches it, the anus (shit hole) begins to open. Soon after, the head is seen at the vulva at each squeezing pain. Once the heads stops going back after each squeezing pain, then it means that the delivery is about to happen.Delivering the head Once the head is “crowned” (it is surrounded on all sides by a stretched vulva) ask her not to pushhard. She should instead take small, fast breaths. Or else her opening may tear. Carefully deliver the head by pressing forward the head with the hand portion . This will give the baby and the mother less trouble and will lessen chances of the birth opening being torn. DO NOT PULL or PUSH. Only the mother should do that. As soon as the head is born, feel for a loop of cord around the neck. If so, slip it over the neck. If you cannot slip it over , bring it out, tie it at two places (at least oneinch apart) and cut it in between. If this is not done, the child may not be able to breathe. Keep giving the mother hot tea or milk with lot of sugar in between contractions if there is a delay. The second stage stage may take up to 4 hours.
26-6 After baby is born As soon as the baby comes out fully, hold it with head downwards. This will drain any mucus in its mouth. Gently insert a finger in its mouth to remove anything from it. Usually a child breathes and cries very fast after it is born. If not, hold the baby by its feet and turn it upside down with the head towards the floor. And gently tap it between its shoulders or on its feet. Cutting the cord Wait for the cord to stop beating and to turn white. With a finger and thumb squeeze the cord to- wards the child. Tie the cord about ½ to 1 inch away from the child’s naval. Tie another cord one inch away from this. Cut in between the two strings with a new blade or a thin bamboo strip. Clean the baby, wrap it warm and put it to the mother’s breast.Stage III : The placenta How to help the woman in Stage IIIcomes out Let this stage proceed naturally unless there is a de-After a few minutes of rest, the lay for more than half and hour or there is too much bleed- ing.womb will harden and pushout the placenta along with If the placenta is delayed andsome blood (usually 20 to 30 does not get thrown out, try the fol-spoons). The entire bag (mem- lowing method:branes) also comes out. All • While the mother is lyingthis should be thrown out by down, hold the cord with the rightthe womb within half an hour hand (BUT DO NOT PULL). With theor severe bleeding can happen. left hand at lower end of the abdo- men, push the womb (uterus) gen- tly upwards. Then push gently in downward direction till the placenta is pushed out of the vulva. If you know • Once this is done, lift the womb out of the pel- how to give an vis with the left hand. injection, 0.5 mg of ME- Once the placenta comes out, THYL-ER- check it carefully. If any part is GOMETRINE missing, a gap will be seen. This (METHERGIN) can be serious as it can cause se- can be given vere bleeding. Be ready to refer im- to the mother in her mus- mediately. cle. If given just after the baby’s shoulder is born, The bag (membranes) should it helps the mother avoid form a complete bag except for a single hole through which severe bleeding in the the baby passed. If any part is missing, it is likely to come third stage of labour. out a few days later. But till then the woman may keep bleeding.
26-7 Know the Answers Labour & ChildbirthPlease Fill in the Blanks: 1. The first stage of labour begins with _______ and lasts until the _______. The second stage finishes with _____________ and the third stage of labour ends with the ________________. 2. The 5 things to be kept clean for a safe delivery at home are ____________, __________________, ___________________, __________________ and ____________________. 3. The bag of water in the womb breaks open in the __________ stage of labour. This will ______________ the speed of labour. 4. The mother should be referred to a hospital if the baby’s heart rate in the womb falls below ____ per minute. 5. If _________ or ____________ are left behind in the womb, it may lead to severe _______ after the delivery.Please mark if “right” or “wrong”: 1. The cord must be cut half to one foot away from the naval of the baby. 2. If the third stage of labour is getting delayed, you must carefully pull the cord out with the right hand. 3. A mother must be referred for delivery in a hospital if the baby is felt to be lying horizontally in the womb. 4. A woman must not be given anything to eat or drink once labour has started. 5. The mother must be encouraged to relax her abdomen when she gets labour pains.