There are 3 common signs of labour:

1. When the woman experiences contraction pains at regular intervals and with increasing frequency. This is the most common.
2. When she notices a mucus discharge that is blood-stained.
3. When the "water bag" burst. This occurs first in about 7% of women.

When the woman has one of these 3 signs, she should go to the hospital immediately.

Normal labour has 3 stages.

First Stage:
This begins with the start of contraction till the cervix (neck of the womb) is fully dilated. For 1st time mother, this usually takes about 12 hours but it can be longer. For 2nd and 3rd time mother, it usually takes about 8 hours. For some, it could be shorter.

Second Stage:
This is birth itself, where the baby is pushed through the birth canal by the muscular contractions of the womb and the mother's efforts, into the waiting hands of the doctor. The umbilical cord is then cut.

Third Stage:
This is the delivery of the placenta, which occurs with further uterine contractions. The placenta is delivered by the doctor. If there is any perineal tear of episiotomy, this will now be repaired.

Assisted Vaginal Delivery for Forceps / Vacuum Cup
The indications for assisted vaginal delivery by instruments include:

1. Fetal Compromise
2. Maternal Distress
3. Failure to progress in second stage of labour
4. After coming head of breech

The failure to progress in 2nd stage of labour may be a manifestation of:

1. Poor maternal effort
2. Poor contractions
3. Tight fit
4. Reduced maternal urge to push due to epidural analgesia
5. Malposition (for example, baby is facing upwards instead of looking downwards)

Our newly refurbished delivery suite A midwife doing a CTG on patient in labour	Special Births by Caesarean Section Up to 80 to 90% of women would experience vaginal births. The remaining 10 to 20% would experience Caesarean births when an operation is conducted to remove the baby from the womb. Caesarean section is undertaken if vaginal delivery entails increased risk to mother or baby. Below are some of the reasons for Caesarean deliveries: 1) Maternal indications: Severe heart disease Preeclampsia / Eclampsia (Hypertensive Disorder in pregnancy) Congenital pelvic abnormality 2) Fetal indications: Fetal compromise Malpresentations (breech, transverse lie at term) Big baby Placental praevia and abruption
Trained midwife assisting mother in labour while husband is encouraged to give moral support