Delivering a baby is hard work. Aptly named labor, the process before childbirth can be physically and emotionally taxing — and even painful. While no two patients experience labor and delivery the same way, new mothers who give birth at the hospital often share overlapping experiences..
Learning about your hospital’s typical labor and delivery protocol, and establishing some expectations for the sensations you will feel on your big day may help you prepare.
When You Arrive at the Hospital
If your birth plan is to give birth at the hospital, you will likely go through a series of standard check-ins and interactions with medical staff offered for people delivering babies. Exact protocols may vary based on your health, your baby’s health, planned or unplanned changes to your delivery needs or your doctor’s advice. Protocols also vary based on if you are having a vaginal birth or C-section.
In general, however, when you arrive at the hospital to give birth, you will need to go to the labor and delivery area and check in at a front desk, providing your name and date of birth to an available staff member. They’ll likely give you a wristband and may give you some paperwork to fill out. From there, depending on the type of birth you have, you’ll go through different steps before having your baby.
[READ: Checklist for Choosing a Maternity Hospital.]
C-section
If you are having a C-section birth at the hospital, you can expect to go through steps like:
— Early arrival to the hospital. If you are having a planned C-section, you will be assigned a time and date to arrive at the hospital. That’s typically about two hours before your procedure will officially start. Scheduled c-sections may occur before your body initiates labor naturally, so some mothers who undergo this procedure may not feel contractions or labor pains connected to giving birth. C-sections are not always scheduled, however, and some are unplanned, which can be harder to plan for. If you experience an unplanned or emergency C-section, your provider will alert you to changes when they are necessary.
— Getting prepped. Like many surgeries, C-sections require some preparation. This includes getting you set up with anesthesia, hooking you up to an IV for fluids and medication, hooking you up to a catheter and clipping your pubic hair (if necessary). Medical staff will assist you through these steps.
— Enduring the procedure. A C-section procedure can last about 30 minutes. During a C-section procedure, you will be awake but should not feel pain.
— Saying a quick hello to your baby. After your baby is delivered, you will get to see your child quickly before it is taken to another room for more medical care and you are stitched up.
— Recovering at the hospital. You and your baby will stay overnight in a recovery room after giving birth through C-section. If all goes well, you may stay for two nights following the birth. If there are complications or either of you needs extra medical support, you may stay longer. In some cases, you may go home but your baby will stay in the hospital.
[READ: What to Expect After a C-Section]
Vaginal birth
If you are having a vaginal birth at the hospital, you can expect to go through steps like:
— Going to a triage room. The triage room is a room where staff will preliminarily assess you before deciding to admit you into the hospital. In the triage room, staff will hook you up to a monitor to check on your baby’s heart rate and measure your contractions. Nurses will also take your vital signs and conduct other measurements to assess what stage of labor you are in. Depending on what stage of labor you are in, they may admit you to the hospital or ask you to go home.
— Going to the delivery room. The delivery room is where you will deliver your baby if you are having a vaginal birth. If your birth plans change and you need to have a C-section, you may deliver your baby in an operating room. In the delivery room, you will change into a hospital gown and get ready to push your baby out of your body. You will also be assigned a nurse who will assist you, and you will make decisions about how you want to manage pain. This can include opting for pain management modalities like an epidural or IV pain medication, which you should be able to request at any time during your delivery. If all goes as planned (which doesn’t always happen, but don’t worry — your doctors and nurses should be prepared for the unexpected), you will eventually deliver your baby.
— Holding your baby. After you give birth, and so long as there aren’t complications, your doctor or nurse will place the baby on your breast for skin-on-skin contact with your newborn.
— Post-delivery care. Post-delivery care can include stitches for your vagina, if tearing occurred, and/or taking your baby to the neonatal intensive care unit, if the baby needs extra care and monitoring. You’ll also deliver the placenta after you deliver your baby.
— Heading to the postpartum room. You’ll likely stay in your delivery room for an hour or two after giving birth. After that, however, and so long as nurses attest that your vital signs are in a safe range, you will be wheeled into a postpartum room with your baby, if they are not in the NICU.
[READ: Natural Ways to Induce Labor: What Experts Recommend]
What is labor induction?
Induced labor, or labor induction is a medical procedure used to jolt your body into labor if your doctor deems it time for you to give birth but you have not started contractions. If you arrive at the hospital for induced labor, you will arrive at a predetermined time set by your medical provider. You’ll check in at the front desk and receive some vital signs monitoring before being given medication to jump-start your contractions.
Dr. Kylie Fuller, an OB-GYN at Pomona Valley Hospital Medical Center in Pomona Valley, California, says that labor inductions are sometimes viewed in a bad light, but that they can be essential interventions for safe pregnancies, depending on a mother’s health circumstances. For instance, some conditions like diabetes increase the risk of having a stillbirth, making it a health risk to have the baby inside the body for too long. They can also be helpful in cases where the baby is “stubborn” and has not been incentivizing contractions in the body, Fuller says.
“The goal of inductions and the timing of inductions is always to keep the baby and the mother as safe as possible,” Fuller says.
[SEE: What to Pack in Your Hospital Bag When You’re Expecting.]
Understanding the Stages of Labor
Labor, or a so-called “normal” labor, consists of three stages. Of note, not all pregnant people experience a three-stage labor, and scenarios like emergency C-sections or scheduled C-sections may alter this progression. If you do not go through all three stages of labor, you are not necessarily having an “abnormal” pregnancy, and you can still deliver a healthy baby.
The three stages of labor include:
1. Early labor. This is when contractions begin.
2. Active labor. This is when your body is actively trying to have your baby. During active labor, you can expect to have regular contractions and your cervix to eventually dilate to 10 centimeters.
3. Delivery of the placenta. After you have pushed the baby out of your body, you will deliver the placenta.
Comparing stages of labor
| Stage | Cervical Dilation | Contractions | Key Event/Focus |
| Early labor | 4 to 6 cm | Painful; increase in duration and intensity; interval decreases | Managing pain at home; 5-1-1 rule for first-time mothers. |
| Active labor | Up to 10 cm | Most regular and rapid; strong | Admission to hospital; ability to receive pain medication; pushing. |
| Delivery of placenta | NA | A few more contractions | Placenta detaches and exits; potential for chills/bleeding. |
[READ: What to Know About Vaginal Birth After Cesarean (VBAC).]
Stage 1: early labor
In early labor, your cervix will dilate to between 4 to 6 centimeters — 6 if it is your first pregnancy, and closer to 4 if it is your second or third time giving birth.
Dr. G. Thomas Ruiz, a board-certified OB-GYN and lead OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, California, explains that this is because the transition from early to active labor tends to occur sooner for mothers who have already given birth.
“The first baby, the pelvis hasn’t been tested yet,” Ruiz says. “The second time, it’s like the body remembers. The stage is set from the previous pregnancy, so the second one moves a lot quicker.”
He adds that hospitals will admit you sooner too.
A quick hospital admission may be a perk for some expecting mothers, as the sensations that accompany early labor, like contractions, are considered very painful. Painful contractions begin in early labor and then increase in duration and intensity throughout this stage. At the same time, the interval between contractions decreases, so that they occur closer together over time.
To cope with the pain of contractions, Ruiz says it is important for patients to utilize skills like deep breathing. Because hospitals won’t admit you — or offer you more significant pain reduction remedies — until you are in active labor, he emphasizes the importance of establishing mechanisms of managing pain on your own, or with a support system.
For first-time mothers, when painful contractions have been occuring at five minute intervals for an hour and lasting a full minute each time, you can be admitted to the hospital, Ruiz says. He advises first-time mothers to remember this via the acronym “511” to memory, and to head to the hospital at this time. For people who have already given birth before, he advises heading to the hospital sooner.
Stage 2: active labor
“In active labor, your cervix will dilate to about ten centimeters. During this stage, you will experience the most regular uterine contractions and the most rapid cervical change,” Ruiz says. For first-time mothers, this can look like one to two centimeters of cervical change every two hours. For patients who’ve already had babies, change can occur twice as fast.
Typically, during active labor you will feel the need to “push,” or make motions to move the baby through and out of your body. You will also be able to be admitted to the hospital to receive support from doctors and nurses, as well as pain management medications and modalities, as your body prepares to deliver your baby. Active labor can last several hours until your baby is born.
Stage 3: delivery of the placenta
After you deliver your baby, you will likely experience a few more contractions, which will help detach your placenta from your uterus so that it too can exit your body. You may experience some bleeding, chills or the need to push again — but this can vary from patient to patient.
Pain Management During Labor
Giving birth hurts. The way you experience pain sensations, however, can vary based personal tolerance and pain management practice, as well as what types of medication or non-medication support you want to utilize during labor. The type of pain you feel can also vary based on what stage of labor you are in. Contractions, which start in the early stage of labor and continue through the active stage, are often described as the most painful part of labor.
“As any woman who’s been through labor will tell you, a uterine contraction is the most painful thing that you can go through,” Ruiz says.
Actually pushing the baby out of your body, such as when the baby’s head makes contact with the opening of your vagina, can be painful in a different way, he adds.
To mitigate pain during labor, hospitals offer various forms of pain management support.
For pain related to contractions, these can include:
— IV pain medications, which include opioids
— Nitrous oxide, which is a short-acting anesthetic inhalant
— Epidurals
Pain management options
| Method | Type | Function/Action | Impact on Baby |
| Epidural | Local anesthetic (catheter) | Provides complete pain relief from contractions (lower body) | None (considered low risk). |
| IV pain meds | Opioids | Systemic pain reduction | Can cross the placenta, may make the baby sleepy |
| Nitrous oxide | Short-acting anesthetic | Short-term pain relief (inhalant) | Can cross the placenta, may make the baby sleepy |
| Anesthetic agents | Nerve block (peroneal/saddle) | Numb the vaginal exit (for pushing pain) | NA (local effect |
What is an epidural?
An epidural is a local anesthetic commonly used during labor and delivery. There are different ways of administering an epidural, but during labor and delivery, an epidural is most often facilitated via a catheter in your back. To place an epidural, your provider will inject a large needle just outside the epidural space on your back, which is an area that contains the spinal cord, and then thread a catheter into place. Once the catheter is situated, the provider will remove the needle and inject the anesthetic through the catheter. The catheter will stay in place throughout your labor and block pain sensations in your lower body, connected to your contractions.
“By applying a local anesthetic continuously, you’ll get basically complete pain relief from the uterine contractions — without stopping the uterine contractions,” Ruiz says.
There are some downsides to epidurals, he adds, such as that the anesthetic may make a patient less aware of a uterine contraction when it is occurring and less apt to push in conjunction with the sensation. They can also leave patients with sore backs following their delivery, due to the size and force of the needle. However, there are several benefits to epidurals as well, he adds, including significant pain relief and insignificant risks.
“The beautiful thing about epidurals,” Ruiz adds, “is that they don’t affect the baby,” so they are considered low risk.
Pain remedies like nitrous oxide can cross the placenta and thus have an impact on the baby. Generally, the impact will be to make the baby sleepy — and not cause harm, Ruiz says. Still, mothers who worry about medications crossing the placenta should be aware of this impact.
It is important to note that epidurals do not block the pain of pushing a baby out of the vagina, which must be managed through different modalities.
How to manage pain while pushing
For pain related to pushing the baby out of the vagina, providers may offer alternative forms of relief.
These can include:
— Anesthetic agents. Medications like the peroneal nerve block or the saddle block can numb the vaginal exit.
— Mineral oil. These can be applied at the opening of the vagina to create a sleek exit opening.
— Perineal massage. This can help stretch the opening of the vagina.
— Patience and time. To allow the baby to ease out slowly without tearing your vagina.
The doctor you work with and the methods they use during delivery can also impact the level of pain you feel while pushing the baby out of your body. Ruiz discourages patients from working with doctors who have a high rate of episiotomies during delivery. An episiotomy is a surgical operation where the provider cuts a part of the perineum to expedite the delivery of the baby. It is not currently the standard of care — unless you need an emergency delivery — and can increase the patient’s pain. To reduce the likelihood of an unnecessary episiotomy, Dr. Ruiz advises choosing a provider or facility with an episiotomy rate of less than 5%.
Natural pain reduction remedies in labor and delivery
Not all patients want to use pain medications during labor and delivery, and many opt for a non-medicated birth. People who opt for non-medicated births can manage pain through natural remedies.
Various natural remedies exist, including:
— Relaxation techniques
— Use of heat or hot water
— Water births
— Gentle massage
— Hypnosis
Some patients work with a doula or birth coach who assists them in natural pain management modalities on their due date, too.
Dr. Ruiz encourages patients to take birthing classes leading up to their delivery date, so that they can practice natural techniques to manage contractions. Birthing classes are helpful for patients who do not want to rely on anesthesia during birth, as well as patients who do. Even if you would like to receive anesthesia during labor, it is important to remember that you will not be admitted into the hospital to receive those supports until you are in active labor — meaning you may need to manage early labor contractions largely on your own.
Post Delivery
After giving birth, the joy of seeing your newborn baby might take your pain away. Post celebration, however, it is important to remember the work your body just went through — and to recognize that you need time to heal.
Some key post-birth moments include:
— First meal. You can eat a few hours (or longer if you have a c-section) after you give birth to your baby. It’s the perfect time for a celebratory meal of the foods you craved during pregnancy but couldn’t eat.
— Lactation support. If you’ll be breastfeeding your newborn, a lactation nurse will help with things like latching and positioning your baby.
— Going to the bathroom. Nurses and hospital staff will guide you through this process to help with pain and any extra precautions for your birthing scenario.
— Walking. Nurses and other staff will help you get up and walking to promote healing, support digestion and prevent blood clots.
[READ: A Patient’s Guide to Postpartum Depression]
Checking baby’s health
After giving birth, the medical staff will need to assess your baby’s health status. Even if there are no complications in your pregnancy, there are some basic tasks they’ll need to check off. These can include checking your baby’s measurements, assessing common conditions like jaundice and offering bathing or feeding support.
Medical staff will also give your baby a test called the apgar score. Apgar is an acronym for appearance, pulse, grimace, activity and respiration.
In this test, nurses will evaluate:
— How your baby looks, including their skin tone
— Your baby’s pulse
— Your baby’s reflexes and response to stimuli
— Your baby’s muscular activity
— Your baby’s breathing
In addition, your baby’s heel will be pricked for a blood sample by a medical professional to do tests for things like hypothyroidism, sickle cell disease and other diseases. They will also undergo a newborn hearing screening test, and likely receive eye drops and a vitamin K shot to help protect your baby from infections.
Discharge From Hospital
The day you get to take your baby home and officially welcome them into the family is an exciting day. Before you leave the hospital, a doctor will evaluate you and your baby’s health, including vital signs and any health conditions or concerns. Once you are approved for discharge, you’ll need to have an infant car seat installed and ready in your vehicle to get your baby home safely from the hospital.
Healing involves being gentle with yourself when walking and going to the bathroom, leaning on loved ones for support and nourishing your body to help with the healing process and the nutrients it needs for lactating if you’re planning to nurse your newborn. In the days and weeks following your delivery, treat your body and mind with kindness too to promote recovery and wellbeing.
“The general rule to prevent additional trauma and to prevent infection is to allow a full six weeks of healing with nothing in the vagina, says Fuller. This applies to first-time mothers with non-complicated vaginal births, and includes avoiding baths, pools and hot tubs.
If you have delivered via a C-section, you will also need to be mindful of pain near your incision site.
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Delivery and Labor: What to Expect at the Hospital originally appeared on usnews.com
