Chapter 11: Opening – stage 1 of labor
WARNING! Do not tell the mother to
push before her cervix is completely
dilated! Forcing a mother to push in stage 1
— before the cervix is open — can make it
rip or swell, and then it cannot open. This is
very dangerous. Even if the mother avoids
injuring the cervix, all the extra pushing will
not bring the baby faster, it will only make
the mother very tired, and make the birth
Pushing too soon can also damage the
mother’s muscles and cause her to have
less control of her bladder and bowels after
Pushing before the
cervix is open is like
trying to put on a shirt
that is too small.
When to do a vaginal exam
The only way to be sure that the cervix is opening is to do a vaginal (internal)
exam. But because vaginal exams increase the risk of infection, and you need
training and gloves to do them, you should not do these exams unless there is a
good reason. After you have been trained, you can use the instructions on
page 339 to help you to do a vaginal exam, but only if you have a good reason.
Good reasons to do a vaginal exam are:
• a long, hard labor with no signs of progress. A vaginal exam can tell you if
the cervix is opening.
• a prolapsed cord. In a vaginal exam, you can push the baby’s head away from
the cord (see page 176).
• any medical emergency. A vaginal exam can tell you if there is time to get
medical help before the birth.
Never do a vaginal exam if there is heavy or unusual bleeding from the vagina
(see page 112).
Labor is too long
Wa r nin g sig ns Labor is too long when strong contractions last more than
12 hours for women who have given birth before, or 24 hours for women giving
birth for the first time.
Sometimes a long labor is fine, and there is no danger as long as the mother
rests between contractions, drinks liquids, and urinates regularly. But a long labor
can cause serious problems, including fistula (a hole in the vagina that can leak
urine — see page 273), torn womb, or the mother or baby dying. When a mother
is having a long labor, watch her closely for warning signs. Are the pains getting
further apart? Does she have any signs of infection? Is she getting exhausted? Is the
baby’s heartbeat normal?
A Book for Midwives (2010)