Chapter 11: Opening – stage 1 of labor
When to get medical help
Get help quickly if labor has not started in 8 to 12 hours,
or if it starts but stays weak and any of the following are true:
• The baby is early (less than 8 months).
• There are signs of infection.
• The woman is at risk of having a sexually transmitted infection
(see Chapter 18) or she recently had a bladder or vaginal infection.
• The mother has put something in her vagina since her waters broke.
You might want to go to a medical center or hospital even if there are no
warning signs. At a medical center, medicines can be given to safely start the labor.
Think about the time it takes to get to the medical center. For example, if the
medical center is 4 hours away and labor has not started 8 hours after the water
broke, you should start on your way to the medical center. If the medical center
is more than a day away, give the mother antibiotics to prevent infection (see
page 179) and start on your way there right away.
If you decide to stay at home
Give the mother antibiotics to prevent infection and watch her closely for signs of
infection. If you have a
hour we will
thermometer, take her
temperature every 4 hours.
If any signs of infection
develop, get medical help.
See page 179 for more on
infection in labor and
how to treat it.
W atch for the cord coming down in front of the baby
Rarely, when the bag of waters breaks,
the cord comes down the vagina in front
of the baby’s head. The cord is more
likely to slip past the baby’s head if:
• there is a lot of water.
• the baby is small or less than
• the baby is in a difficult position.
• the baby was high in the pelvis
when the water broke.
down the vagina
before the baby
A Book for Midwives (2010)