24-Hour Labour, Delivery & Immediate Maternal-Newborn Care

The Labour Room at AS Medical Complex provides assessment, monitoring, childbirth support, and immediate post-delivery care for pregnant women who present in labour or with pregnancy-related concerns requiring hospital evaluation.

Labour and childbirth are natural physiological processes, but complications can sometimes develop rapidly. Safe maternity care therefore requires careful observation of both the mother and baby, timely recognition of abnormal findings, access to appropriate treatment, and rapid escalation when a normal labour pathway becomes complicated.

WHO recommends a woman-centred approach to intrapartum care, combining clinical safety with dignity, communication, informed decision-making, emotional support, and appropriate monitoring throughout childbirth.

The Labour Room works as part of a broader maternity-care pathway that may involve:

• Obstetrics & Gynecology

• Anesthesia

• Pediatrics / Newborn Care

• Laboratory

• Radiology and Ultrasound

• Blood Bank where required

• Operating Theatre

• Emergency Services

• Inpatient maternity care

• Other specialist departments

depending on the mother’s and baby’s condition.

Our Labour Room Services

Depending on clinical need, pregnancy risk, gestational age, specialist availability, and hospital facilities, Labour Room services at AS Medical Complex may include:

• 24-hour labour assessment

• Assessment of contractions

• Assessment after rupture of membranes / water breaking

• Assessment of vaginal bleeding during late pregnancy

• Assessment of reduced fetal movement

• Maternal vital-sign monitoring

• Fetal heart-rate assessment

• Cervical assessment where clinically indicated

• Monitoring of labour progression

• Support during normal labour

• Vaginal delivery

• Pain-relief options according to clinical circumstances

• Intravenous fluids where indicated

• Labour induction where medically indicated

• Cervical ripening where required

• Augmentation of labour where clinically appropriate

• Monitoring after induction or augmentation

• Assisted vaginal birth where indicated and appropriate expertise is available

• Recognition and initial management of obstetric emergencies

• Escalation for Caesarean Section when required

• Management of selected postpartum complications

• Immediate maternal observation after delivery

• Immediate newborn assessment

• Support for early mother-baby contact where clinically appropriate

• Breastfeeding initiation support where appropriate

• Referral or transfer for higher-level maternal or neonatal care when required

The exact services available should reflect the confirmed obstetric, anesthesia, neonatal, surgical, blood-transfusion, and monitoring capabilities of AS Medical Complex.

When Labour Begins

Labour occurs when regular uterine contractions lead to progressive changes in the cervix and ultimately childbirth.

Women experience labour differently.

Possible signs that labour is beginning include:

• Regular painful contractions

• Contractions becoming stronger

• Contractions becoming closer together

• Increasing pelvic pressure

• Lower back discomfort

• Passage of mucus or a blood-stained “show”

• Rupture of membranes / water breaking

ACOG notes that true labour contractions generally become regular, stronger, and closer together and tend to continue despite rest or changes in position.

Not every contraction means active labour has started.

Some pregnant women experience irregular Braxton Hicks contractions, particularly toward the end of pregnancy.

If there is uncertainty, clinical assessment can determine whether true labour has begun.

When Your Water Breaks

The amniotic sac surrounding the baby can rupture before or during labour.

The woman may notice:

• A sudden gush of fluid

• Continuous leaking

• A smaller persistent watery discharge

ACOG advises contacting the obstetric care team if the membranes rupture, even if regular contractions have not yet begun.

Important information can include:

• Time the fluid started

• Approximate amount

• Colour

• Odour

• Whether contractions are present

• Fetal movement

• Gestational age

Patients should not assume every vaginal fluid loss is normal pregnancy discharge.

Hospital assessment may be required.

Labour Room Admission & Initial Assessment

When a pregnant woman presents to the Labour Room, the clinical team may assess:

• Gestational age

• Contraction pattern

• Fetal movement

• Whether membranes have ruptured

• Vaginal bleeding

• Previous pregnancies and births

• Previous Caesarean Section

• Current pregnancy complications

• Medical conditions

• Medication

• Allergies

• Antenatal records

• Maternal vital signs

• Fetal heart rate

Depending on the presentation, additional assessment may include:

• Abdominal examination

• Cervical examination

• Ultrasound

• Laboratory tests

• Urine testing

• Other investigations

The purpose is to determine:

• Whether labour has begun

• Stage of labour

• Maternal condition

• Fetal condition

• Whether the pregnancy is low or higher risk

• Whether Labour Room admission is required

Not every woman presenting with contractions requires immediate admission if active labour has not started and both mother and baby are clinically well.

Monitoring During Labour

Monitoring during labour helps the maternity team evaluate whether labour is progressing safely and whether the mother and baby remain clinically stable.

Depending on individual risk, monitoring may include:

Maternal Monitoring

• Blood pressure

• Pulse

• Temperature

• Breathing

• Pain

• Contraction pattern

• Fluid balance where required

• Vaginal bleeding

• Other clinical observations

Fetal Monitoring

The baby’s heart rate may be assessed using:

• Intermittent fetal-heart monitoring

• Electronic fetal monitoring in selected pregnancies

depending on:

• Pregnancy risk

• Stage of labour

• Medications

• Induction or augmentation

• Maternal condition

• Fetal concerns

• Other clinical factors

WHO's Labour Care Guide is specifically designed to support structured monitoring of both maternal and fetal wellbeing and labour progression while promoting evidence-based, respectful care.

Progress of Labour

Labour is a dynamic process and does not progress at exactly the same rate in every woman.

The clinical team assesses the overall picture rather than relying on one measurement alone.

Assessment can include:

• Strength and frequency of contractions

• Cervical dilation

• Cervical effacement

• Descent of the baby

• Fetal position

• Fetal heart rate

• Maternal wellbeing

WHO's modern intrapartum guidance emphasizes that labour progression varies between individuals and that unnecessary intervention should be avoided when mother and baby are well.

If labour is progressing more slowly than expected, the Obstetrics team may reassess:

• Contractions

• Fetal position

• Fetal size

• Maternal pelvis

• Membrane status

• Maternal condition

• Fetal wellbeing

before deciding on further management.

Stages of Labour

Labour is generally considered in stages.

First Stage

The first stage begins with labour contractions producing cervical change and continues until the cervix becomes fully dilated.

During this stage, care may involve:

• Maternal monitoring

• Fetal-heart assessment

• Monitoring contractions

• Monitoring cervical progress

• Hydration

• Bladder care

• Comfort measures

• Pain-relief options

• Emotional support

Second Stage

The second stage extends from full cervical dilation until the baby is born.

During this stage:

• Contractions continue.

• The baby descends through the birth canal.

• The mother may develop an urge to push.

• Maternal and fetal monitoring continues.

The maternity team provides guidance according to the mother’s condition, position of the baby, fetal wellbeing, and progress.

Third Stage

The third stage occurs after birth of the baby and involves delivery of the placenta.

Care during this period focuses particularly on:

• Placental delivery

• Uterine contraction

• Blood-loss assessment

• Maternal vital signs

• Prevention and early recognition of postpartum haemorrhage

Severe bleeding after childbirth remains one of the most important preventable causes of maternal illness and death globally, making careful observation after delivery essential.

Supportive & Respectful Labour Care

Childbirth care should address both clinical safety and the woman’s experience.

WHO recommends respectful maternity care that protects:

• Dignity

• Privacy

• Confidentiality

• Informed choice

• Effective communication

• Emotional support

throughout labour and childbirth.

Where hospital policy and clinical circumstances allow, support may include:

• Clear explanations

• Discussion of procedures

• Appropriate mobility

• Comfortable positioning

• Hydration according to clinical circumstances

• Relaxation and breathing techniques

• Support from an approved birth companion

• Pain-relief options

Clinical decisions should be explained whenever circumstances permit.

Pain Relief During Labour

Pain during labour varies considerably.

Some women prefer minimal medication, while others require pharmacological pain relief.

Pain-management options depend on:

• Stage of labour

• Maternal condition

• Fetal condition

• Clinical circumstances

• Patient preference

• Anesthesia availability

Possible approaches may include:

• Breathing techniques

• Position changes

• Relaxation

• Supportive care

• Injectable medication where appropriate

• Regional analgesia such as epidural where available and clinically appropriate

No single pain-relief method is best for every woman.

The benefits, limitations, and potential risks of medical analgesia should be discussed with the patient whenever possible.

Labour Induction

Induction of labour means using medical methods to start labour before it begins naturally.

Induction should have a clinical indication or be undertaken according to an appropriate obstetric plan.

Possible reasons may include selected cases of:

• Pregnancy continuing beyond the recommended gestational period

• Rupture of membranes without labour

• Maternal hypertension

• Preeclampsia

• Diabetes

• Certain fetal concerns

• Other pregnancy complications

ACOG explains that induction may involve cervical ripening and medication to stimulate uterine contractions, depending on cervical readiness and the clinical situation.

Induction is not simply a medicine given once.

It can require:

• Cervical assessment

• Cervical ripening

• Medication

• Fetal monitoring

• Contraction monitoring

• Reassessment over time

The process may take considerable time, particularly when the cervix is not yet favourable.

Augmentation of Labour

Augmentation is different from induction.

Induction starts labour when it has not begun naturally.

Augmentation aims to strengthen or improve labour that has already started but is not progressing adequately.

Possible interventions may include:

• Amniotomy in selected patients

• Oxytocin where clinically indicated

• Other obstetric management

Such treatment requires careful monitoring because overly frequent or prolonged uterine contractions can affect both mother and baby.

Normal Vaginal Delivery

When labour progresses normally and there are no significant maternal or fetal complications, birth may occur vaginally.

During delivery, the maternity team focuses on:

• Maternal wellbeing

• Fetal wellbeing

• Controlled delivery

• Recognition of complications

• Blood-loss monitoring

• Immediate newborn assessment

Not every vaginal delivery follows exactly the same course.

Care should respond to the condition of the mother and baby rather than forcing childbirth into one rigid timetable.

Assisted Vaginal Delivery

In selected situations, an Obstetrician may consider an assisted vaginal birth using an appropriate instrument.

This may be considered when:

• The second stage is prolonged

• Maternal pushing needs to be shortened for medical reasons

• There are selected fetal concerns

• Other suitable clinical circumstances exist

An assisted vaginal birth requires assessment of:

• Cervical dilation

• Fetal position

• Fetal descent

• Maternal pelvis

• Fetal wellbeing

• Other safety factors

It should only be performed by appropriately trained clinicians and where the required support is available.

Caesarean Section During Labour

A woman who planned a vaginal birth may sometimes require a Caesarean Section if continuing labour is no longer considered the safest option.

Possible indications can include:

• Significant fetal distress

• Failure of labour to progress

• Certain abnormal fetal positions

• Placental complications

• Cord-related emergencies

• Significant maternal complications

• Other obstetric emergencies

The decision is based on the clinical situation rather than simply how long a patient has been in the Labour Room.

Emergency Caesarean delivery requires coordination between:

• Obstetrics

• Anesthesia

• Operating Theatre

• Nursing

• Newborn/Pediatric team

• Laboratory and Blood Bank where required

Previous Caesarean Section

Women who have previously undergone Caesarean delivery require individualized delivery planning.

The appropriate route of birth depends on factors such as:

• Reason for previous Caesarean

• Type of previous uterine incision

• Number of previous Caesareans

• Current pregnancy

• Placental location

• Fetal condition

• Maternal condition

• Availability of emergency operative support

Previous Caesarean Section does not automatically determine the same management for every future pregnancy.

The delivery plan should be discussed antenatally with the Obstetrician.

Preterm Labour

Preterm labour occurs when labour begins before 37 completed weeks of pregnancy.

Possible symptoms include:

• Regular contractions

• Pelvic pressure

• Lower back discomfort

• Abdominal cramps

• Change in vaginal discharge

• Watery discharge

• Bloody or mucus-containing discharge

ACOG lists contractions, pelvic pressure, low backache, abdominal cramps, and changes in vaginal discharge among possible warning signs of preterm labour.

Possible preterm labour requires prompt obstetric assessment.

Management depends on:

• Gestational age

• Cervical changes

• Membrane status

• Maternal condition

• Fetal condition

• Infection

• Available neonatal support

Reduced Fetal Movement

A pregnant woman who notices a significant reduction or change in her baby's usual movement pattern should contact her maternity-care provider or attend for assessment according to the advice given during antenatal care.

Assessment may include:

• Clinical history

• Fetal-heart assessment

• Maternal assessment

• Ultrasound where clinically indicated

• Additional fetal monitoring

Reduced movement should not simply be ignored while waiting for the next routine antenatal appointment.

Vaginal Bleeding During Pregnancy

Vaginal bleeding in late pregnancy should be medically assessed.

Possible causes range from relatively minor conditions to serious obstetric complications.

Depending on the situation, assessment may consider:

• Amount and colour of bleeding

• Pain

• Contractions

• Placental location

• Fetal wellbeing

• Maternal vital signs

• Previous pregnancy history

Heavy bleeding, fainting, severe pain, or maternal deterioration requires emergency assessment.

Preeclampsia & High Blood Pressure

Preeclampsia is a pregnancy-related condition involving high blood pressure and signs of organ dysfunction.

Warning symptoms can include:

• Severe persistent headache

• Visual disturbance

• Upper abdominal pain

• Significant swelling in some patients

• Breathing difficulty

• Other concerning symptoms

ACOG notes that preeclampsia can involve abnormal kidney or liver function, low platelets, severe headache, visual changes, upper abdominal pain, or fluid in the lungs.

Severe preeclampsia can become dangerous for both mother and baby and may require urgent delivery.

Seizure During Pregnancy

A seizure during pregnancy, particularly when associated with severe hypertension or preeclampsia, may represent eclampsia.

This is an obstetric emergency.

Immediate priorities may include:

• Maternal stabilization

• Airway and breathing support

• Blood-pressure management

• Appropriate medication

• Fetal assessment

• Obstetric delivery planning

A pregnant woman with a seizure requires immediate emergency care.

Fetal Heart-Rate Concerns

Changes in the fetal heart rate may sometimes indicate that the baby requires closer assessment or intervention.

The clinical team considers:

• Baseline fetal heart rate

• Variability

• Accelerations

• Decelerations

• Contractions

• Maternal condition

• Stage of labour

• Medication

• Other clinical factors

One isolated fetal-heart observation should not necessarily be interpreted without context.

Persistent concerning findings may require expedited delivery.

Meconium-Stained Amniotic Fluid

Sometimes amniotic fluid becomes stained with meconium.

Management depends on:

• Gestational age

• Thickness of meconium

• Fetal heart pattern

• Labour progress

• Newborn condition after birth

Meconium does not automatically mean that the baby is in severe distress, but it can require increased observation and appropriate newborn preparedness.

Umbilical Cord Prolapse

Umbilical cord prolapse occurs when the cord moves down through the cervix ahead of or alongside the presenting part of the baby.

The cord can become compressed, reducing blood flow to the baby.

This is an obstetric emergency and may require rapid intervention and urgent delivery.

Patients should immediately alert maternity staff if they feel or see a cord-like structure after the membranes rupture.

Shoulder Dystocia

Shoulder dystocia occurs when, after delivery of the baby's head, the shoulders cannot easily pass through the birth canal.

It is an unpredictable obstetric emergency requiring specific manoeuvres by trained maternity professionals.

Immediate coordinated action is needed to complete delivery while reducing risks to mother and baby.

Postpartum Haemorrhage

Postpartum haemorrhage – PPH is severe bleeding after childbirth.

WHO identifies PPH as a leading cause of maternal mortality worldwide and emphasizes prevention, early recognition, and prompt treatment.

PPH can occur after:

• Vaginal birth

• Caesarean birth

and can sometimes occur unexpectedly even when pregnancy and labour were uncomplicated.

Possible causes include:

• Poor uterine contraction

• Retained placental tissue

• Birth-canal trauma

• Blood-clotting problems

• Other obstetric conditions

Prevention & Management of Bleeding After Birth

Immediately after delivery, the clinical team carefully assesses:

• Uterine contraction

• Placental delivery

• Blood loss

• Maternal pulse

• Blood pressure

• Overall clinical condition

WHO's current postpartum-haemorrhage guidance emphasizes proactive prevention, objective recognition of excessive blood loss where feasible, and rapid bundled treatment when PPH develops.

Treatment depends on the cause and severity and may include:

• Uterotonic medicines

• IV fluids

• Medication to control bleeding

• Examination for retained tissue or trauma

• Blood products where indicated

• Procedures or surgery in severe cases

Retained Placenta

The placenta normally separates after birth.

If it does not deliver appropriately, intervention may be required because retained placental tissue can increase the risk of:

• Bleeding

• Infection

• Other complications

Management depends on:

• Time since birth

• Bleeding

• Maternal condition

• Placental status

and may require medication or manual/surgical management.

Birth Tears & Episiotomy

Vaginal birth can sometimes result in tears involving tissues around the vagina and perineum.

Minor tears may require little or no treatment.

Larger tears may require repair.

An episiotomy is a surgical incision made in the perineum in selected clinical circumstances.

It should not be regarded as a routine requirement for every vaginal birth.

WHO recommends avoiding routine or liberal use of episiotomy during spontaneous vaginal birth.

Immediate Care After Delivery

After childbirth, the mother remains under observation because important complications can occur during the immediate postpartum period.

Monitoring may include:

• Blood pressure

• Pulse

• Bleeding

• Uterine contraction

• Pain

• General condition

• Urination

• Perineal or surgical assessment where appropriate

The maternity team also watches for:

• Postpartum haemorrhage

• Hypertension

• Infection

• Retained placenta

• Other complications

Immediate Newborn Care

After birth, the newborn is assessed to determine whether normal transition after delivery is occurring.

Assessment may include:

• Breathing

• Heart rate

• Colour

• Muscle tone

• General response

• Temperature

Most healthy newborns transition normally.

Some babies may require additional:

• Warming

• Airway support

• Breathing support

• Oxygen according to clinical need

• Pediatric/Newborn assessment

• Higher-level neonatal care

depending on their condition and available facilities.

Mother-Baby Contact After Birth

When both mother and baby are clinically stable, early contact between them may support:

• Bonding

• Temperature regulation

• Breastfeeding initiation

WHO promotes respectful maternity and newborn care that supports appropriate early contact and feeding while ensuring clinical safety.

Medical needs take priority if either the mother or newborn requires urgent treatment.

Breastfeeding After Delivery

Where mother and baby are stable, breastfeeding support may begin soon after birth.

Early support can involve:

• Positioning

• Attachment

• Recognition of feeding cues

• Practical assistance

Some mothers or babies may require additional support because of:

• Caesarean delivery

• Prematurity

• Maternal illness

• Newborn illness

• Feeding difficulties

Preparing for Labour Room Admission

As the expected delivery period approaches, patients may benefit from keeping important items ready.

Where available, bring:

• Antenatal record

• Ultrasound reports

• Laboratory reports

• Blood-group information

• Medication list

• Allergy information

• Previous operation records

• Details of previous Caesarean Section

• Identification

• Necessary personal items

However, urgent maternity care should never be delayed because documents or belongings are unavailable.

Medicines & Medical Conditions

Tell the Labour Room team about relevant conditions such as:

• High blood pressure

• Diabetes

• Heart disease

• Asthma

• Epilepsy

• Kidney disease

• Thyroid disease

• Blood-clotting disorders

• Previous obstetric complications

Also provide information about:

• Current medicines

• Blood thinners

• Insulin

• Medication allergies

• Previous anesthesia problems

This information can affect labour and delivery management.

Birth Plan

Some women prepare a birth plan outlining preferences regarding:

• Labour support

• Pain relief

• Mobility

• Delivery preferences

• Immediate newborn contact

• Feeding

A birth plan can support communication between the patient and maternity team.

However, childbirth can be unpredictable.

The plan may need to change if a complication develops or the safety of the mother or baby requires another approach.

When Should You Come to the Labour Room?

Contact your maternity team or attend for assessment according to your obstetric instructions when:

• Regular contractions develop

• Contractions become increasingly strong and frequent

• Your water breaks

• You experience vaginal bleeding

• Fetal movement becomes significantly reduced

• You develop significant abdominal pain

• Your doctor has instructed you to attend for induction

• You develop symptoms of a pregnancy complication

• You are uncertain whether labour has begun and have been advised to seek assessment

ACOG advises contacting the obstetric care provider when the membranes rupture and seeking guidance when labour symptoms develop.

When Is Immediate Emergency Assessment Required?

Seek immediate maternity or Emergency assessment for:

• Heavy vaginal bleeding

• Severe abdominal pain

• Collapse or fainting

• Severe breathing difficulty

• Seizure during pregnancy

• Severe persistent headache with visual changes

• Sudden severe deterioration

• Suspected umbilical cord prolapse

• Severe trauma during pregnancy

• Significant reduction in fetal movement

• Labour symptoms substantially before 37 weeks

• Other symptoms your Obstetrician has identified as high risk

Preterm labour symptoms and acute pregnancy complications require prompt evaluation because some complications can progress rapidly.

Multidisciplinary Maternity Care

Safe labour and childbirth can require close coordination between multiple services.

Depending on the mother and baby, care may involve:

• Obstetrics & Gynecology

• Labour Room nursing and midwifery staff

• Anesthesia

• Pediatrics / Newborn Care

• Emergency Services

• Operating Theatre

• Laboratory

• Blood Bank

• Radiology

• Ultrasound

• General Medicine

• Cardiology

• Other specialists

A patient may begin labour as a low-risk maternity case and later require additional specialist care if complications arise.

For this reason, Labour Room care should remain connected with the wider hospital system.

Follow-Up After Delivery

After initial post-delivery observation, the mother and newborn may proceed to appropriate inpatient maternity care according to their condition.

Before eventual discharge, care may include:

• Maternal examination

• Bleeding assessment

• Blood-pressure assessment

• Pain management

• Wound or perineal assessment

• Breastfeeding support

• Newborn assessment

• Medication instructions

• Follow-up planning

• Warning-sign education

Women should understand which symptoms require urgent medical review after leaving the hospital.

Warning Signs After Childbirth

Urgent medical assessment may be required after delivery if a woman develops:

• Heavy vaginal bleeding

• Fainting

• Severe weakness

• Severe headache

• Visual changes

• Difficulty breathing

• Chest pain

• High fever

• Severe abdominal or pelvic pain

• Worsening wound redness or discharge

• Seizure

• Other significant deterioration

WHO emphasizes that dangerous maternal complications can occur not only during pregnancy and childbirth but also during the postnatal period.