A well-prepared delivery room prevents delays during emergencies and reduces the risk of postpartum infection. Midwives must ensure the environment is warm, well-lit, and draft-free to protect both the mother and the incoming newborn from hypothermia. Every instrument tray must be checked before labour advances to the second stage.
When a pregnant woman arrives at the health facility complaining of uterine contractions, the midwife performs a prompt yet thorough evaluation. This initial contact confirms whether true labour has begun and rules out immediate obstetric emergencies like cord prolapse or severe pre-eclampsia.
The assessment begins with a review of the antenatal card to check her baseline haemoglobin, blood group, and scan results. Next, the midwife checks vital signs: blood pressure, pulse, temperature, and respiration. Abdominal palpation determines the foetal lie, presentation, position, and descent. Finally, an abdominal or sterile vaginal examination assesses cervical dilation, effacement, membrane status, and the presence of any blood-stained show.
The partograph is a graphical record of the progress of labour and maternal-foetal condition, designed to spot prolonged labour and foetal distress early. Midwives plot cervical dilation against time, using alert and action lines to guide timely interventions or referrals.
Labour pain is intense and unique to every woman. Midwives offer continuous reassurance, explaining every procedure before touching the patient, which drastically lowers anxiety and reduces perceived pain. Fear and tension cause the body to release catecholamines, which can slow down uterine contractions.
Non-pharmacological pain relief methods include back rubs, sacral counter-pressure, warm showers, controlled breathing exercises, and encouraging a mobile posture. When these are insufficient, pharmacological options such as pethidine, tramadol, or regional blocks may be administered if prescribed and indicated.
The second stage begins with full cervical dilation and ends with the birth of the baby. The midwife supports maternal pushing efforts while safeguarding the perineum to prevent severe lacerations. As the baby's head crowns—meaning the widest diameter of the head distends the vulva—controlled delivery is paramount.
The midwife applies gentle downward pressure on the baby's head to allow the occiput to slip beneath the pubic symphysis, followed by upward guidance to deliver the chin. Throughout crowning, instructing the mother to pant rather than push forcefully prevents rapid expulsion and reduces perineal tearing.
Once the head is delivered, it restitutes to align with the shoulders. The midwife checks the neck gently for a nuchal cord; if present and loose, it is slipped over the head, or clamped and cut if tightly wrapped. Downward traction delivers the anterior shoulder, followed by upward traction to release the posterior shoulder.
The rest of the baby's body follows quickly. The newborn is placed immediately on the mother's abdomen or chest. The midwife dries the baby thoroughly with a clean, warm towel while simultaneously assessing breathing, colour, and tone. Drying removes amniotic fluid and provides tactile stimulation to cry.
Active management of the third stage of labour prevents postpartum haemorrhage, which remains a leading cause of maternal mortality. AMTSL involves three essential steps executed immediately after the baby is born:
Post-delivery inspection is mandatory to confirm complete expulsion of all products of conception and to check for maternal birth canal trauma. Retained placental fragments or membranes can cause delayed postpartum haemorrhage and severe uterine infection.
The placenta is laid flat to examine both the maternal surface for missing cotyledons and the fetal surface for completeness of membranes and aberrant vessels. Following placental check, the midwife inspects the vulva, vagina, and perineum under good light, identifying any lacerations or episiotomy sites requiring repair.
The first two hours following the birth of the placenta constitute the fourth stage of labour, during which the mother remains at highest risk for sudden postpartum haemorrhage. Midwives monitor blood pressure, pulse, uterine contraction, and lochial flow every fifteen minutes for the first hour, and every thirty minutes for the second hour.
Simultaneously, immediate skin-to-skin contact is encouraged. Placing the naked baby prone on the mother's chest promotes thermal regulation, stabilizes newborn breathing and blood glucose, and encourages early initiation of breastfeeding through the baby's self-attachment reflexes.