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.
[READ: Early Labor Signs and Symptoms]
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 likely be awake. It’s normal to feel sensations like touch, movement and pressure, but not pain. If you do feel pain, let the team know so they can stop and address this.
— Saying a quick hello to your baby. After your baby is born, you’ll often get a peek before they are brought to the team in the room to do a quick assessment. After that, they can be brought to you for skin-to-skin or for your partner to hold while the surgery is completed. They typically only leave the operating room if there are medical concerns or complications.
— Recovering at the hospital. You and your baby may briefly go to a recovery room after the birth, or you may go back to the room you were in prior to your delivery. You’ll then likely be moved to the postpartum unit for the remainder of your stay. If all goes well, you may stay for one to 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 if you are in labor. Depending on what they find, they may admit you to the hospital or ask you to go home. Keep in mind you may be seen by a midwife or doctor while in triage, or it may just be the nurse who is communicating with them if they are not in the hospital.
— Going to the labor room. The labor 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 will be moved to an operating room. In the labor room, you will change into a hospital gown. 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.
— 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 chest for skin-to-skin contact with your newborn.
— Post-delivery care. Post-delivery care can include stitches for your vagina, if tearing occurred, monitoring for bleeding and more frequent vital signs checks in the immediate period. Your baby should remain in the room with you at all times, unless they need additional care that may occur in the neonatal intensive care unit. You’ll also deliver the placenta after you deliver your baby.
— Heading to the postpartum room. You’ll likely stay in your labor room for an hour or two after giving birth. After that you will be wheeled into a postpartum room with your baby.
[READ: Natural Ways to Induce Labor: What Experts Recommend]
What is labor induction?
Induced labor, or labor induction is a medical procedure used to put your body into labor if your doctor or midwife deem 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 medications or tools, like a foley catheter insertion into the cervix, are used to start induction.
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 you go well past your due date.
“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 3 Stages of Labor
Labor consists of three stages:
1. Early labor. This is the early, slower phase when regular contractions begin that cause your cervix to soften, open and/or shorten.
2. Active labor. This is the period of more regular cervical change.. 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 birthed your baby, you will deliver the placenta.
Comparing stages of labor
| Stage | Cervical Dilation | Contractions | Key Event/Focus |
| Early labor | 0 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 | 6 to 10 cm | Most regular and rapid; strong | Admission to hospital; pushing. |
| Delivery of placenta | NA | A few more contractions, usually within 30 minutes of having your baby is considered normal. | Placenta detaches and exits. |
[READ: What to Know About Vaginal Birth After Cesarean (VBAC).]
Stage 1: early labor
In early labor, your cervix will dilate up to 6 centimeters, as 6 centimeters is in general considered the definition of active labor.
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 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.
When you’re having regular contractions that are changing your cervix, or even if they aren’t and you’re needing help to cope, you can be admitted to the hospital. In the latter scenario, they may give you pain medicine to help you rest. If the contractions stop or you feel more comfortable and your cervix is unchanged, you can then go home and come back for another assessment to see if this time it is true active labor
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. However, it’s important to note these are only estimates, and it can be entirely normal for active labor to take longer than this.
Once in active labor, you will 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, shakes or the need to push again — but this can vary from patient to patient and whether or not you had an epidural.
[SEE: Understanding Maternity Hospital Packages and Costs]
Pain Management During Labor
Giving birth hurts for most people. The way you experience pain sensations, however, can vary based on 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
— Non-pharmacologic methods, such as soaking tubs
Pain management options
| Method | Type | Function/Action | Impact on Baby |
| Epidural | Local anesthetic delivered via catheter placed in your back | Provides the best pain relief from contractions (lower body) but may not relieve all pain or sensations | If mom’s blood pressure drops after placement, it can also lower the baby’s heart rate. This can often be treated, but, if not, may require an urgent C-section |
| IV pain meds | Opioids | Systemic pain reduction | Crosses the placenta, may make the baby sleepy, so it’s often not given right before birth. |
| Nitrous oxide | Short-acting anesthetic | Short-term pain relief (inhalant) | Crosses the placenta, but is so short-acting that it can be used even at the end of labor. |
| Anesthetic agents | Nerve block (pudendal) | Numb the vagina (for pushing pain) | NA (local effect) |
| Non-pharmacologic methods, such as soaking tubs or deep breathing | Varies | Calms and reduces pain perception | NA |
What is an epidural?
An epidural is a local anesthetic commonly used during labor and delivery. An epidural works via a catheter in your back. To place an epidural, your provider will first numb the area with a very small needle to inject numbing medicine. They will then inject a longer needle into the epidural space on your back, which is the 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 start the flow of 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. However, there are several benefits to epidurals as well, he adds, including significant pain relief and insignificant risks.
It is important to note that epidurals may not block all the pain of when a baby is crowning, so it can be normal to feel some pain, burning or intense pressure at this moment. Thankfully, it’s often brief!
If needed, a local injection called a pudendal block can be done to help with pain not adequately covered by an epidural or in someone who did not have an epidural but now wants pain relief. This is an injection down through the vagina via a needle to numb the pudendal nerves, which can block some of that pain sensation.
How to prevent tearing while pushing
For pain related to pushing the baby out of the vagina, providers may offer alternative forms of relief.
These can include:
— Mineral oil. These can be applied at the opening of the vagina to help reduce friction as the baby births.
— Perineal massage. Done before labor or in between pushes, this can help soften the vaginal muscles and may help reduce their tearing.
— A controlled birth. Providers will often recommend to stop pushing so your baby’s head can deliver in a controlled way to prevent tearing.
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 or midwives 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’s not currently the standard of care — unless you need an emergency delivery — and can increase the patient’s pain as well as postpartum bleeding. To reduce the likelihood of an unnecessary episiotomy, Dr. Ruiz advises choosing a provider or facility with an episiotomy rate of less than 5%.
Non-pharmacologic 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 non-pharmacologic remedies.
Various drug-free options exist, including:
— Relaxation techniques
— Use of heat or hot water
— Water births
— Gentle massage
— Hypnosis
— TENS units
Some patients work with a doula or birth coach who assist them in natural pain management modalities during their labor and birth.
Dr. Ruiz encourages patients to take birthing classes leading up to their delivery date, so that they can practice these 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.
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 right 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. Keep in mind that if you’ve had a C-section, you may want to start small with liquids or less-exciting foods.
— Lactation support. If you’ll be breastfeeding your newborn, your nurse will help with things like latching and positioning your baby. If you need extra help, a lactation consultant can provide additional support.
— 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 vital signs and measurements, assessing common conditions like jaundice and offering feeding support.
Medical staff will also assign your baby an apgar score at one and five minutes after your baby’s birth. Apgar is an acronym for appearance, pulse, grimace, activity and respiration. This is a way to communicate how well they are transitioning after being just born, and if any additional support may be required.
In this score, 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
After their birth, it is also recommended that your baby receive erythromycin eye ointment, a vitamin K injection and their first hepatitis B vaccine. If you have questions about this, don’t hesitate to ask your nurse.
In addition, prior to your baby’s discharge, your baby’s heel will be pricked for something called a newborn screen. This is a blood sample to screen for issues like hypothyroidism, sickle cell disease and other diseases. Prior to discharge, they will also undergo a newborn hearing screening test.
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. It’s important to know, however, that data does not support these practices but they do tend to be recommended. If you have concerns about that, you can ask your midwife or doctor.
If you have delivered via a C-section, you will also need to be mindful of pain near your incision site. Your health care team will provide instructions on changing any wound dressing covering the stitches. The C-section recovery process varies by individual.
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Labor and Delivery: What to Expect at the Hospital originally appeared on usnews.com
