What happens when you arrive at a health facility to give birth
At the maternity entrance a midwife will ask for your antenatal card, check your blood pressure and temperature, feel your abdomen, listen for the baby's heartbeat and examine you to see how far labour has come. If labour is established you are admitted to the labour ward and checked at intervals until the baby is born; if it is early you may be asked to walk about and stay close by. If the facility cannot manage your labour safely, you are referred to a larger unit, and that call is normally made early rather than at the last moment.
- Go to the maternity entrance and say you are in labour. Do not join the general outpatient queue.
- Your antenatal card is the one thing you must not leave behind. It tells the midwife everything about this pregnancy.
- Most health centre IIIs conduct normal deliveries but cannot perform an operation, so a referral is a normal event, not a disaster.
- The first hour after birth is when the midwife watches you most closely for bleeding, and when the baby should first feed.
- Do not leave without the baby's child health card, your own card filled in, and a date for the first postnatal check.
General information, not medical advice. If you are worried about a mother or a child, go to your nearest health facility or speak to your village health team.
What to do in the first ten minutes after you arrive
Find the maternity entrance rather than the main outpatient door. Maternity is usually a separate block, and a woman in labour is not asked to sit through the general queue. If it is night and the gate is closed, knock at the maternity block itself. Someone sleeps on duty there even when the rest of the unit is dark.
Say plainly that you are in labour and hand over your antenatal card straight away. The card is the fastest way for a midwife who has never met you to know your blood pressure through the pregnancy, your blood test results, and anything that was flagged as needing watching.
Send whoever brought you to park the boda properly, carry in your packed bag and then stay. You will want a person outside the ward who can fetch water, buy a missing item and phone home. Many units will not let that person into the labour room, but they will need them nearby.
What the midwife checks before she admits you
The first examination is quick and it has a purpose. She takes your blood pressure and temperature, feels your abdomen to find how the baby is lying, listens to the heartbeat, and does an internal examination to see how far the cervix has opened. She will ask when the pains started, how far apart they are, whether water has broken, and whether the baby is still moving.
From that she decides one of three things: you are in established labour and are admitted, you are in early labour and should stay close and walk about, or something needs more than this facility can give and you should be referred now while there is still time.
If she says it is early, do not go home. A mother from a far parish who goes home at four in the morning often comes back too late, or does not come back at all. Ask whether there is a waiting shelter, a bench, or a relative's home in the trading centre where you can wait within walking distance.
Who is in the room with you
Usually a midwife, sometimes with a student midwife or a nursing assistant helping. In a busy unit that same midwife may be looking after two or three women at once, moving between beds. She is not ignoring you when she leaves the room.
Many labour wards do not let husbands in, mostly because the room is open and other women are in it. Some will allow one female attendant, your mother or a sister, to stay and help. Ask at an antenatal visit rather than arguing about it during a contraction.
If you would like a particular person with you, say so early and calmly at admission. If the answer is no, agree with that person where they will wait, and what you want them to do if you are moved.
What happens through the hours of labour
You will be checked at intervals: the baby's heartbeat, your blood pressure, the strength and spacing of the pains, and from time to time another internal examination to see how labour is progressing. Between checks you may be encouraged to walk, change position, empty your bladder and drink.
There is no fixed length. A first baby usually takes longer than a fourth. What the midwife is watching for is whether things are moving forward, and she will act if they stop.
Speak up if something changes: heavy bleeding, a severe headache, blurred vision, a sudden strong pain that stays between contractions, or the baby going quiet. You are not being a nuisance. Those are the moments the ward exists for.
What happens in the first hour after the baby is born
The baby is dried, kept warm and normally laid skin to skin on your chest. The cord is clamped or tied and cut. The placenta is delivered shortly after, and the midwife will press on your abdomen to check the womb is contracting, which is how heavy bleeding is prevented.
You should be helped to put the baby to the breast within the first hour. The first thick yellow milk is exactly what the baby needs, and early suckling also helps your womb tighten. Ask for help with the latch there and then rather than waiting until you get home.
The baby is weighed and looked over, and both of you are watched for the next few hours. This is the reason not to rush home the same afternoon, however much you want your own bed.
What happens if you are referred to another facility
A referral usually means the facility you are in does not have what your labour now needs, most often an operating theatre or a blood supply. A health centre III conducts normal deliveries. An operation needs a higher level unit, and getting you there early is better practice than keeping you and hoping.
Ask three things before you move. What is the problem, in words you can repeat to the next midwife. Can they write the referral note and give it to you. Can they phone ahead so the receiving unit knows you are coming.
Transport is the part that fails. An ambulance may be out, or without fuel, or two hours away. Have a plan already: a boda rider you know by name, a neighbour with a vehicle, and money set aside that is not spent on anything else. This is the single thing most worth arranging before labour starts.
What to do if the unit is full or there is no midwife on duty
It happens, particularly at night and at the end of the month. Ask directly what time a midwife will be available and whether they can call her. If nobody can say, ask to be referred to the next facility instead of waiting in a corridor.
Do not go home to wait, and do not accept a delivery in the compound outside the ward as the plan. Ask the person who brought you to start finding transport onward while you are still asking questions inside.
Afterwards, tell your village health team member what happened. Staffing at these facilities changes often, and she is the person who follows up the mothers in her parish. What you tell her is how the next mother avoids the same night.
When can you go home, and what should you leave with
You will be kept for a period of observation after an uncomplicated delivery, and longer if you had an operation or heavy bleeding. Ask what the plan is rather than assuming, and do not discharge yourself early because the ward is crowded or you are worried about a bill.
Before you leave, make sure you have the baby's child health card, your own card written up with what happened, and a clear date and place for the first postnatal check. Ask which danger signs should bring you straight back, and write the facility's number in your phone.
This guide describes what generally happens, not what will happen at your facility or your school. Costs, timetables and rules differ between districts and they change. Check anything that matters with your health worker, the head teacher, or your district office. If something here is wrong or out of date, tell us and we will correct it.
Questions people ask
- Can my husband be in the room with me?
- In many Ugandan labour wards, no, because the room is shared with other women. Some units allow one female attendant instead. Ask that specific facility at an antenatal visit, so nobody is negotiating it during labour.
- What if labour starts at night and there is no transport?
- This is the most common reason mothers deliver at home when they did not intend to. Agree with a named boda rider in advance, keep his number in more than one phone in the house, and keep the fare set aside separately. Tell your village health team member your plan so somebody else knows it too.
- Will I be sent away if I arrive too early?
- You should not be sent home if you live far. You may be asked to walk about, wait outside the ward or use a waiting shelter until labour is established. Say clearly how far you have come, because that changes the advice you are given.
- What if I arrive without a mama kit?
- Go anyway. Arriving without a kit is a much smaller problem than delivering at home without a midwife. Facilities vary in what they can supply on the day, so ask in advance at antenatal what they will provide and what you must bring.
- Is it a bad sign if the midwife says I must be referred?
- Not usually. It most often means the facility does not have a theatre or blood, so you are being sent where those exist. It is a sign that somebody looked properly. Ask for the referral note in writing and ask them to phone ahead.