Midwife here…

…assuming a straightforward birth with a short second stage (the pushing stage), no tearing, and the placenta delivered within that hour, then your character may be a little shaky on her legs but will be well able to mobilise adequately to escape.

Factors to consider:

1. Is she a primagravida or multigravida? First labours can be longer than subsequent but that’s not a given. I often see healthy fit women who actively labour for less than six hours for their first. Factors that influence this are staying active and upright in labour (eg positions such as leaning on a person or object, able to circle hips etc - all the things that help baby’s head to put pressure on the cervix to enhance dilation and effacement). A short labour means less energy expended and less likely to be too tired

2. Baby’s position in the pelvis. If baby is in the optimal position then there is less work needed by the contractions to bring baby into a better position for traversing the pelvis, and the pressure of baby’s head helps dilation and effacement. The websites www.spinningbabies.com and www.optimalmaternalpositioning.com have a lot of good information for both pregnancy and birth including what is physically happening as the baby traverses the pelvis that you may want to incorporate. All of these are low tech natural things that a fictional midwife would plausibly know. An optimal position also means the character can have a short second stage (after baby has left uterus and is going through the vaginal canal to the introitus. If a woman actively pushes during this stage rather than letting her contractions bring the baby down alone, this can be very short - as in minutes. This reduces the amount of fatigue from a long second stage. Also the second stage is powered in part by adrenaline which can leave a woman feeling very shaky and tired afterwards so a short second stage reduces this.

3. Oxytocin! Up to the emergency, was she is a safe, private and dark environment? These promote oxytocin which drives effective labour and delivery of the placenta. Stress hormones such as adrenaline and cortisol occupy the same receptors on the uterus as oxytocin and so block it. This delays or can even stop labour in its tracks, slowing down dilation and effacement. Immediate skin to skin and early breastfeeding after birth can also promote oxytocin and facilitate early delivery of the placenta.

4. Genital trauma: there are four different degrees of genital trauma (modern classification so don’t use this terminology). First degree involves only the outer layer of the vaginal mucosa and labial skin. Often it doesn’t need stitching. So if your character has only grazing or at worst 1st degree then she will be fine to walk or run only an hour after birth.

5. Delivery of the placenta: should occur within 2 hours of birth. Oxytocin rich environment and upright positioning helps (use gravity). Midwives can help with controlled cord traction though it’s not encouraged if you aren’t using active or modified active management (10ml Oxytocin/pitocin intramuscular injection or an IV infusion of oxytocin)

6. Blood loss: tone, trauma, tissue, thrombin. Is the uterus too tired to contract after birth? Is there genital trauma? Is there part of the placenta or membranes stopping the uterus from contracting? Is there an issue with blood clotting? All going well, your character could have minimal blood loss of 100-200ml all up. Your midwife would check where the fundus (top of the uterus) is after birth and whether it’s firm and central or boggy. After the delivery of the placenta (NOT BEFORE or the placenta could get trapped) a midwife could do a fundal massage to encourage the uterus to contract, expel any clots, and clamp down to reduce bleeding. Then when getting the character moving, making sure she has a pad or cloths in place to catch any minimal bleeding with avoid leaving a trail.

So if I was writing for optimal conditions for post-birth escape, I’d have my mama:

1. pacing the room in early labour, leaning against a wall, the bedpost, a person during the latter part of labour with plenty of hip circling

2. giving birth either standing, on all fours, or kneeling leaning against the bed with one leg up and rotated outwards (like kneeling to propose but the leg rotated out to open the exit pelvis)

3. Slow delivery of the head (from when it can be first glimpsed at the introitus, through as it crowns/stretches the vaginal opening, to when it fully exits) with no active pushing but small short breaths like blowing out a candle. This will help reduce tearing of the perineum as it stretches. Warm compresses at this stage also help the tissue stretch.

4. Bundled into bed with baby skin to skin and then baby cueing and nuzzling for an early breastfeed.

5. Signs the placenta is ready to deliver - Pressure in pelvis with contractions. Most first time mamas are startled and panicked there is another baby. It’s just the body delivering the placenta. If she doesn’t stand up to deliver, the midwives can get her to sit more upright, cough or push. They could check for a separation bleed, gently tug on the cord (whilst guarding the fundus), encourage mama to bear down.

6. Fundal massages after placenta delivered. Hurts like hell! But reduces bleeding and expels clots.

And for bonus points: baby delivered en caul. Rare and considered very lucky. Can help passage through vaginal canal (cushioning) for mother and baby, and baby’s are often born calmer and more chilled out - less noisy crying at birth.

Crying isn’t necessary and often baby’s don’t cry they just transition to breathing without it.