Complete Guide to Labor, Birth, and Immediate Postpartum Care with Dr. Upadhyaya

Posted on May 5, 2025 by sydney collins

At The American Canadian School of Medicine (ACSOM), we’re dedicated to advancing global health education by sharing expert perspectives from leaders in the field. As part of our commitment to excellence in maternal and newborn care, we’re proud to feature insights from Dr. Deepa Upadhyaya, PhD, RM, CNM.

 

Dr. Deepa Upadhyaya, PhD, RM, CNM is a respected educator, researcher, and midwife with a global perspective on maternal and newborn health. As Associate Professor and Academic Director of the Bachelor of Midwifery program at Mount Royal University, she brings decades of experience in perinatal care and healthcare education across Canada, the U.S., Europe, and Africa. Her work focuses on midwifery preceptorship, perinatal care in low-resource settings, and fostering cultural humility in healthcare. Dr. Upadhyaya is also an active voice in national healthcare organizations, dedicated to improving outcomes for mothers and babies worldwide.

Understanding the Stages and Phases of Labor: A Complete Guide

Labor is the process that leads to childbirth. Let’s break down each stage in simple terms.

First Stage of Labor

This stage begins when labor starts. It has two main phases:

Latent Phase (Early Labor)

• Mild contractions begin
• Cervix starts to open slowly
• You can usually stay home during this time
• For first-time moms, this phase may last longer

Active Phase

• Contractions get stronger and more regular
• Cervix opens faster
• Usually starts at 6 cm for first-time moms
• Around 4 cm for moms who have given birth before
• Time to be at the hospital

Second Stage of Labor

This is the pushing phase:

• Baby moves down the birth canal
• Mom pushes with contractions
• Baby’s head crowns (becomes visible)
• Baby’s shoulders and body follow

How the Baby Moves During Birth

1. Head enters the pelvis
2. Chin tucks to chest
3. Head turns to fit through
4. Head comes out under pubic bone
5. Shoulders turn and deliver
6. Rest of baby follows

Third and Fourth Stages

Third Stage

• Delivery of the placenta
• Happens shortly after baby arrives

Fourth Stage

• First few hours after birth
• Close watching of mom and baby
• Important healing time begins

How We Track Progress

Healthcare providers check these things:

• Cervix opening (measured in centimeters)
• How thin the cervix gets
• Where the baby sits in the birth canal
• Strength of contractions
• Mom and baby’s health

The Bishop Score

This helps measure how ready the body is for labor by checking:

• Cervix opening
• Cervix position
• How soft the cervix is
• Baby’s position
• How thin the cervix is

Fetal Monitoring During Labor: Methods and Best Practices

Types of Monitoring

Intermittent Auscultation

• Uses tools like Doppler or fetoscope to check baby’s heart
• Common in Canada, less used in United States
• More natural approach to monitoring
• Helps avoid unnecessary interventions

Electronic Fetal Monitoring (EFM)

• Continuous tracking of baby’s heart rate
• More common in United States
• Works as a screening tool
• May sometimes show false concerns

When to Check Baby’s Heart Rate

Early Labor (Latent Phase)

• Check every 60 minutes if in hospital
• Not needed if laboring at home
• Home monitors not recommended

Active Labor

• Check every 15-30 minutes
• Listen for at least 60 seconds each time
• Normal heart rate is 110-160 beats per minute

Pushing Stage

• Check every 5 minutes
• Listen after each contraction
• More frequent monitoring needed

What We Look For

Normal Signs

• Heart rate between 110-160
• Heart rate goes up when baby moves
• Regular pattern
• Good variability

Warning Signs

• Decreasing heart rate
• Unusual patterns
• Changes during contractions

Special Cases for EFM

You might need continuous monitoring if you have:

• Green-colored fluid
• Unusual heart rate patterns
• High blood pressure
• Diabetes
• Oxytocin for labor induction

Monitoring Tools

Doppler Device

• Most common tool
• Easy to use
• Gives clear sound of heartbeat

Traditional Tools

• Pinard stethoscope
• Fetoscope
• Often used in places with fewer resources

Important Notes

• Avoid buying home monitors
• Pay attention to baby’s normal movement patterns
• Tell your care team if you notice changes
• Trust your healthcare providers to choose the right type of monitoring

Labor Dystocia and Interventions: A Comprehensive Overview

When labor slows down or stops, doctors call it labor dystocia. Let’s learn what causes it and how to help.

What is Labor Dystocia?

In Canada, doctors diagnose labor dystocia when:

• The cervix opens less than 0.5 cm per hour
• This slow progress continues for 4 hours
• This happens during active labor

The Five P’s of Labor

Healthcare providers look at five key factors when checking for labor problems:

1. Power

• How strong the contractions are
• How often they come
• Whether they’re doing their job

2. Passage

• The shape of mom’s pelvis
• How well the birth canal can let baby through

3. Passenger (The Baby)

• How big the baby is
• The size of baby’s head
• Babies of moms with gestational diabetes might be bigger

4. Position

• How the baby’s head is lined up
• Whether the head is tilted to one side
• How well the baby’s head is tucked

5. Psyche

• Mom’s emotional state
• Level of fear
• How well she’s coping

Managing Labor Dystocia

When labor slows down, doctors can try several things:

Common Treatments

• Give oxytocin through an IV to make contractions stronger
• Break the water bag (called amniotomy)
• Watch baby’s heart rate closely
• Help with delivery tools if needed
• Do a C-section if other methods don’t work

Good News About Labor Dystocia

The most common cause is weak contractions. This is actually helpful because:

• We can fix weak contractions
• We can give medicine to make them stronger
• Other causes might be harder to fix

Remember: Fear can slow down labor. Staying calm and getting good support helps labor move along better.

Managing Birth Complications: Breech Delivery and Shoulder Dystocia

Sometimes babies come in unusual positions during birth. Let’s learn about two special cases and how doctors handle them.

Breech Birth

A breech birth happens when the baby comes feet or bottom first. While most breech babies are born by C-section, it’s important to know how to deliver them vaginally when needed.

Key Steps in Breech Delivery

1. Hands-off Approach
   • Let the mother push naturally
   • Avoid pulling on the baby
   • Wait for legs to come out on their own
2. If Legs Need Help
   • Gently flex the baby’s knees
   • Guide legs down one at a time
3. Delivering the Arms
   • Wait to see the baby’s shoulder blades
   • Turn baby to help arms come out
   • Use special moves to free the arms
4. Head Delivery
   • Keep baby’s chin tucked to chest
   • Support baby’s body
   • Help head come out in a J-shaped motion

Important Tips

• Don’t rush – let birth happen naturally
• Keep baby warm
• Watch the umbilical cord
• You have about 4-5 minutes to deliver the head after the body

Different Positions Can Help

• Some mothers deliver breech babies standing up
• Hands and knees position can work well
• Each position has its benefits

Family-Centered C-Sections

If a C-section is needed, many hospitals now offer family-friendly options:

• Clear drapes so parents can watch
• Special ways to pass baby to parents
• Making the experience more like natural birth

When to Get Extra Help

Call for backup when:

• Labor isn’t moving along
• Baby shows signs of stress
• Cord comes out before baby
• Mom needs emergency C-section

Tips for Healthcare Teams

• Keep training up to date
• Know when to call for help
• Stay calm and work together
• Keep parents informed

Remember: Each birth is different. Having a skilled team ready for any situation helps keep mom and baby safe.

Postpartum Hemorrhage Prevention and Management Guide

Postpartum hemorrhage (PPH) is heavy bleeding after giving birth. Let’s learn how to spot it and handle it safely.

What is Postpartum Hemorrhage?

We check for PPH when:

• Blood loss is more than 500 mL after a vaginal birth
• Blood loss is more than 1000 mL after a C-section
• Mom shows signs her body is struggling with blood loss

The Four T’s: Why Bleeding Happens

1. Tone

• Most common cause
• Happens when the uterus won’t tighten up
• Linked to low iron levels
• The uterus needs to squeeze tight after the placenta comes out

2. Tissue

• Parts of the placenta stay inside
• The uterus can’t close properly
• Needs medical help to fix

3. Trauma

• Tears or cuts from birth
• Can happen in the birth canal
• May need stitches

4. Thrombin

• Blood doesn’t clot well
• Can make bleeding hard to stop
• Needs special treatment

How We Stop the Bleeding

Quick steps to help:

• Rub the uterus (fundal massage)
• Give medicine to make the uterus squeeze
• Start IV fluids
• Keep mom warm
• Watch mom’s blood pressure

Taking Care of the New Baby

Right after birth, we:

• Keep baby warm
• Dry baby off
• Give gentle stimulation
• Put baby in a good position
• Only suction if needed

Important Note About Suctioning

• We used to suction every baby
• Now we know most babies (85%) do fine without it
• We avoid extra suctioning to prevent harm

When Baby Needs Help Breathing

If a baby:

• Isn’t breathing (apneic)
• Has a heart rate below 100
• We give positive pressure ventilation right away

Remember

• Watch closely for bleeding after birth
• Act quickly if mom loses too much blood
• Keep both mom and baby warm
• Most babies breathe well on their own
• Know when to call for help

Always tell your healthcare team if you notice heavy bleeding or feel unwell after giving birth.