5.2.3  Watch for warning signs

Important! Do not apply fundal pressure to help push the baby out. Fundal pressure can cause the placenta to detach or the uterus to rupture.

Watch the speed of each birth. If the birth is taking too long, take the woman to a hospital. This is one of the most important things you can do to prevent serious problems or even death of women in labour.

First babies may take a full 2 hours of strong contractions and good pushing to be born. Second and later babies usually take less than 1 hour of pushing. Watch how fast the baby’s head is moving down through the birth canal. As long as the baby continues to move down (even very slowly), and the baby’s heartbeat is normal, and the mother has strength, then the birth is normal and healthy. The mother should continue to push until the head crowns.

But pushing for a long time with no progress can cause serious problems, including fistula, uterine rupture (you will learn about this in Study Session 10 of this Module), or even death of the baby or mother. If you do not see the mother’s genitals bulging after 30 minutes of strong pushing, or if the mild bulging does not increase, the head may not be coming down. If the baby is not moving down at all after 1 hour of pushing, the mother needs help.

Therefore, refer immediately if the woman stayed (couldn’t deliver) in the second stage for more than:

  • 1 hour with no good progress (multigravida woman)
  • 2 hours with no good progress (primigravida).

Important! Good progress in the second stage is characterised by a marked change in level of station of the baby’s head. If you have a woman in the second stage with little or no fetal descent, or you see any signs that the baby is developing caput or excessive moulding of its skull, refer the woman to hospital or a health centre immediately.

5.2.2  Support the mother’s pushing

5.3  Conducting delivery of the baby