Watch for warning signs
First babies may take a full 2 hours (and sometimes more than 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 (see page 273), torn womb, 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.
Baby is not born after 1 or 2 hours of strong contractions
and good pushing
If you do not see signs that the baby’s head is coming down, or if the baby seems
to be stuck, find out what is causing the slow birth. Some causes of a slow or stuck
pushing stage are:
• the mother is afraid.
• the mother is exhausted.
• the mother has a full bladder.
• the mother needs to change positions.
• the baby is in a difficult or
impossible birth position.
• the baby does not fit through
the mother’s pelvis.
Page 191 suggests ways to help a woman whose labor is slow because she is
afraid or exhausted.
Mother has a full bladder
A full bladder can slow labor or even stop it completely. Laboring for many hours
with a full bladder can lead to fistula or other problems. Help the
mother urinate or, if necessary, put in a catheter (see page 352).
Mother needs to change positions
If one position does not bring the baby down, try other
positions. The position that usually works best is squatting.
Squatting opens the pelvis, and uses gravity to help the baby
Try giving the mother something to hold on to. For
example, she can hold on to a door knob or a rope tied to
the ceiling, and pull down as she pushes.
Squatting can help
bring the baby down.
A Book for Midwives (2010)