Childbirth

Childbirth (labour and delivery) is the process by which a baby is born. Most deliveries in India now happen in institutions — hospitals, medical colleges, primary health centres — which has substantially reduced maternal and newborn deaths. A safe delivery with a skilled birth attendant is every woman's right.

Stages of labour

• First stage — regular contractions gradually open the cervix fully. The longest stage, especially in a first delivery.
• Second stage — pushing the baby out.
• Third stage — delivery of the placenta.

Signs labour has started

• Regular contractions getting stronger, longer and closer together.
• Show — a blood-streaked mucus discharge.
• Water breaking — a gush or slow leak of clear fluid.

When to go to hospital — dial 112 or go if

• Contractions every 5 minutes for an hour (first pregnancy) or every 10 minutes (second or later).
• Water breaks — go in, even without contractions.
• Any vaginal bleeding beyond a normal "show."
• Severe headache, blurred vision, swelling, fits, severe abdominal pain — pre-eclampsia/eclampsia — emergency.
• Reduced baby movements.
• Cord prolapse (feeling something come through the vagina) — emergency; lie down, call 112.

Pain relief in labour

• Support, breathing, position changes, warm showers, walking, massage — all helpful.
• Nitrous oxide ("laughing gas") where available.
• Epidural anaesthesia — highly effective; available in most urban hospitals; ask about it in advance.
• Pain relief is your choice — ask for what helps you.

Caesarean section

Caesarean is lifesaving when truly needed — fetal distress, abnormal presentation, obstructed labour, severe pre-eclampsia, placenta covering the cervix. The Indian C-section rate has risen in the private sector, and not every caesarean is necessary. If C-section is suggested and it's not an emergency, ask why, whether a trial of labour is reasonable, and consider a second opinion.

Birth preparedness

• Know where you will deliver.
• Arrange transport in advance — 102 (government ambulance in many states) or 112.
• Keep documents, money, antenatal card, labour bag ready from week 36.
• Have a trusted person who can accompany you.
• Discuss pain relief, birth plan, feeding and family planning with the Health Expert during antenatal visits.
• Many state governments provide free delivery and newborn care under Janani Suraksha Yojana-type schemes — ask ASHA.