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Overview

About 98% of all births in the United States are in hospitals. Even if you plan for a birth center or home birth, knowing about your backup option is smart. Birth is not an all or nothing decision where you are either having a baby in a hospital with tons of interventions or having a baby at home with no interventions and incense burning in the background. There is an infinite number of options available to you to prepare for and craft the birth you want. The key to getting the birth experience you want is education. Whether you plan a cesarean section or have a natural labor, you could do either in a hospital setting. This episode will help you get more familiar with what you expect in a hospital birth from the moment you arrive, through your labor and birth, until you are discharged and headed home with your new baby.

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Know Where to Go

You need to know where to go. Hospitals are large facilities. Knowing ahead of time how to get there, where to park, and where to go is essential. Get your birth partner involved in this step so they can navigate and you can focus on your labor. Hospitals should offer a physical or virtual tour of the labor and delivery floor or unit. A tour is also a great time to ask about parking and where to go if you end up in labor after hours. After hours you will need to go through a different entrance before going to labor and delivery. The bottom line is, know where to go.

Know the Hospital Policies that Will Affect Your Birth

It is essential to know what your doctor or midwife’s policies are and what the hospital’s policies are in relation to your birth plans. Hospitals are major organizations that have policies and procedures in place to protect both patients and hospital staff. These policies will have an impact on your labor, birth, and stay. If there are any interventions you would like to opt in to, or if there are any that you would like to avoid, talk to your care provider about the hospital’s policy beforehand so you can plan accordingly.

Pre Fill Out Paperwork

Ask if you can preregister or complete any paperwork ahead of time and get that done before you are in labor. Ensure the hospital has everything you can fill out ahead of time and a copy of your insurance card or coverage on file. When your big day comes, you do not want to be filling out paperwork in between contractions, so plan ahead.

Take Advantage of Hospital Staff

You are surrounded by experts in a hospital. You will have many nurses, doctors, midwives, pediatricians, and specialists available. Depending on how long you’re at the hospital before giving birth, you may interact with many different people. Most hospitals have their staff working eight- or 12-hour shifts, so if you’re there for 36 hours, you may be seen by at least three nurses and three or more doctors. At the birth and immediately following the arrival of your little one, you will see even more faces. Take advantage of having so many pros around you. Ask any question you have and encourage your partner to do the same. Remember you will be home shortly without all those experts to consult, so take advantage of them being there now, during your hospital stay.

Find Out When Your Primary Doctor or Midwife Will Be Present

When you are surrounded by nurses and doctors, it may surprise you not to see your primary care provider. It is a good idea to talk to your doctor or midwife before you go into labor to find out if they will be there for your labor and birth, when in the process they will show up, and how long they will stay. In some cases, you won’t see your care provider until you are ready to push, but you want to know what their policy is beforehand so you are not disappointed when you expect them to be there, and they aren’t. It is also possible that you have your prenatal care at a practice with several doctors or midwives, and the person who will be present for your birth is the person who happens to be on call when you go into labor. Generally, you will have several nurses taking excellent care of you during most of your labor, and they will alert your doctor or midwife when they need to be there. Talk to your care provider beforehand so you know when you can expect to see them. For more in-depth information on the doctor or midwife on call, see this episode.

Being Prepared for an Emergency

A perk of a hospital is that it is equipped for any type of emergency. You could be planning on having your baby in a hospital setting if you have a high-risk pregnancy or if your care provider is expecting any complications. Keep in mind that most births do not involve an emergency, but if this is something you are concerned about, you can rest assured that the hospital and staff are well equipped to handle anything. Of course, a cesarean is a surgery that would need to take place in a hospital. Other episodes dive more in-depth into cesarean birth and a gentle cesarean.

Know When to Go In

You should know when your doctor or midwife wants you at the hospital in labor. For example, they may tell you to come in when your contractions are 5-1-1. This means contractions are five minutes apart, lasting for one minute, for an hour. Make sure you know when your doctor or midwife would like to be there. If you aren’t sure whether you should go in or not, call your care provider, they can probably tell how your labor is progressing from talking to you on the phone.

If you have a scheduled induction, you know exactly when you should be at the hospital. As of 2014, just over 23% of labors in the U.S. were induced. This intervention is common, but ultimately it is up to you to decide if it is the right thing for you and your baby. If you are considering an induction, check out this article on that topic.

What Happens When You Arrive

Once you get to the hospital, the staff will evaluate you and determine whether you are actually in labor and should be admitted or whether it is a false alarm and you should be sent home. The routine procedures and the timeline will vary slightly from place to place, but overall this should give you a good overview of the process and what you can expect.

Triage

Your first stop will likely be a triage room. A nurse will check your vital signs by taking your pulse, blood pressure, and temperature. They will ask you some questions about when your due date is, when your contractions started and how far apart they are, whether your water has broken, and if you’ve had any vaginal bleeding. Those are the questions to start. Be prepared to answer a lot of questions as your care provider or a nurse is evaluating you. You will probably be asked the same questions by multiple people.

Fetal Monitoring

Next, they will hook you up to a fetal monitor to check your baby’s heart rate and measure your contractions. It is standard policy to get hooked up to this monitor when you arrive. If you are low risk and everything is going well, you have many options for fetal monitoring. For more detail on electronic fetal monitoring and how your choices impact your labor, see this episode.

Vaginal Exams

After the fetal monitor, your care provider may suggest a vaginal exam. The purpose of a vaginal exam is for your care provider to measure your cervix for dilation and effacement. There are pros and cons to vaginal exams, and you can read the evidence on those in this article.

They can also verify whether your membranes have ruptured, meaning your water broke. If it is suspected that your water did break, a nurse may take a swab from your vagina to test it and confirm whether it is amniotic fluid. Often the time of your water breaking sets a 24-hour clock for your care provider.

Abdominal Exam

Following a vaginal exam, you will have an abdominal exam. During this procedure, your nurse or care provider will feel and palpitate around your belly to determine whether your baby is head down. If they are having a tough time figuring out how your little one is situated, they may do a quick ultrasound to confirm your baby’s position. In general, a breech baby is born via cesarean.

False Alarms

The data the hospital staff is gathering also includes going through your chart, lab results, and medical history. They are gathering as much data as possible to determine whether you are, in fact, in full labor or whether it is a false alarm, and you should head home. If you do get sent home, don’t stress about it. Many moms show up early to the hospital, and there is no harm in doing that. I am a big believer in trusting your gut, so if you think you need to go to the hospital, go. Doctors, nurses, and midwives deal all the time with moms coming in who are too early, so don’t worry about it. Think about it as a practice run.

Also, keep in mind that if it is clear that you will have your baby relatively soon, staff will not force you to sit through triage and questions. Whether you go straight to labor and delivery or you spend some time getting admitted, once they admit you to labor and delivery, you can rest assured that you will be holding your baby soon.

Transfer to a Delivery Room

Once admitted, you will transfer to a delivery room. This is the space you will be in until you are holding your baby. If you want to do anything to modify your birth environment, now is the time to do that. You will get to put on a hospital gown. Most hospitals will let you bring in your own if you want to buy one.

You will be assigned a labor and delivery nurse who will be your main point person for just about everything. They should let you know where everything is in the room and how to get a hold of them if you need anything. Don’t be shy about asking questions or asking for anything that would make you more comfortable. This could be ice, a wet washcloth, a birthing ball. If you want something, it never hurts to ask.

Staff may ask you if you have a birth plan. If they don’t ask and you do have one let them know. Even if you do not have a written plan, be sure to speak up if there is anything particularly important to you. For example, if you know you want an epidural as soon as possible, let them know. Or, if you are planning a natural birth and want to avoid medication, make sure they know that upfront. If you haven’t written a birth plan yet and want to see an example, I would be happy to send you a copy of mine as a sample of how it could be structured or worded. Click here to get a copy of my birth plan via email.

IV Fluids

At many hospitals, it is routine to start IV fluids once the hospital admits you. Typically an IV is required if you need antibiotics because you tested positive for Group B strep, if you can’t keep fluids down and are dehydrated, if you opt for an epidural, Pitocin, or if you have any health problems or complications. If you are low risk and everything is progressing fine, you may be able to ask to hold off on the IV or ask for a saline lock (sometimes called a “hep-lock”) instead. A hep-lock is an IV catheter put in on the top of your hand, without tubes delivering fluids or medication. With a hep-lock in, your care provider has easy access to deliver medications or fluids in the event you need or want them later.

Epidural

If you are going to ask for an epidural, you should know that it can take a while, perhaps 30-45 minutes, to get an anesthesiologist to your room, for them to administer the epidural, and for it to take effect. As a quick overview, once the epidural is in place, you will receive continuous electronic fetal monitoring, you will most likely get an IV to provide fluids to keep you hydrated, and you will have a catheter. If you are not familiar with a catheter, it is a small tube that will allow your bladder to empty.

Your Doctor or Midwife 

Up until this point, you may not have even seen your doctor or midwife yet. If they are available, they may come by to check on you, or it could be later on about the time you are reaching the second stage, or the pushing stage, of labor, or near the time of birth. For most of your labor, it will be you and your partner or support person. At the time of this article, hospitals are limiting the number of people allowed due to COVID-19. Hopefully, we will see additional support people and doulas being embraced again in hospitals soon.

The Second Stage of Labor

Your labor could be short or long. There is no way to predict this, especially with first-time moms. The first stage is when your cervix is dilating and effacing and tends to be the longest stage. You will know when you are reaching the second stage of labor because your contractions will get more intense and be closer together, and you will get the urge to push. I wish there were a better way to describe it than just the urge to push, but you will know when you get to that point. When you hit this point, if you do not have a nurse or your care provider in the room, now is an excellent time to ask for them. Before you start pushing, they may recommend a quick exam to make sure you are fully dilated to ten centimeters. The best part about the pushing stage is this is when your baby is born.

Assisted Delivery

In a hospital setting, your care provider would have access to forceps or a vacuum extractor for an assisted birth if they deem it necessary. Assisted delivery, also called an instrumental delivery, is becoming rarer. In the United States, forceps are used much less than vacuums. Overall, assisted deliveries account for about 3% of all vaginal births. You may want to address assisted delivery in your birth plan.

Birth

When you are about to deliver, you will find that there are suddenly more people in your hospital room. In general, there will be at least three nurses, and your OBGYN or your midwife. Once your little one is born, there will probably also be a pediatrician or a family physician there to check in on your little one while your care provider is checking on you.

Skin to Skin Contact

In most cases, your care provider will put your baby directly on your chest right after birth. If there are any issues, of course, they will address those. Their number one job is to make sure you and your baby are healthy. The good news is that you are in a hospital, and if anything isn’t perfect, they have the staff and the resources to treat it.

There is a lot of evidence to support placing newborns skin to skin with their mothers immediately after birth. Skin to skin contact helps your baby transition from fetal to newborn life with greater respiratory, temperature, and glucose stability and significantly less crying, indicating decreased stress. Mothers who hold their newborns skin to skin after birth have increased maternal behaviors, show more confidence in caring for their babies and breastfeed for longer durations. Skin-to-skin contact is critical.

Hospital Identification

One mandatory hospital procedure will be done before either you or your baby leave the delivery room and likely within a few minutes after birth. You, your partner, and your new baby will get matching labels that have your names and some identifying details on them. You should verify everything is correct on them before they go on each of your wrists like a bracelet. Sometimes it will go on your baby’s ankle. As an added precaution, the hospital may also attach a small security device to your baby’s ankle—some hospitals even footprint newborns.

Newborn Procedures

Some procedures are routine that your little one will go through shortly after birth. You can request to postpone many of them or ask that they are performed with your baby on your chest. Talk to your doctor or midwife about your options. It is really up to you to make informed decisions, and even if something is routine, you have options. For a deep dive into the evidence on these procedures, see the episodes on Erythromycin and Vitamin K and Vaccines 0-24 Months.

Your Hospital Stay

Generally, you and your baby will stay in the delivery room for around two hours after birth, and then they will bring you a wheelchair and take you to another room where you will be for the remainder of your stay. How long you stay at the hospital depends on several factors, including the hospital’s policy and how you and your baby are doing. Most parents spend 24-48 hours in the hospital. The duration of each stay is on a case by case basis. Make sure you discuss the length of your stay with your care provider well before you go into labor to know what the hospital’s policy is and what you can expect.

Once you have your baby if you feel ready to go home or maybe not quite prepared to leave, speak up and find out your options. You will likely spend at least one night in the hospital, and your partner should be able to spend the night with you. Some rooms will be equipped with a chair that turns into a bed for your partner. You can always ask your care provider what the accommodations are at the hospital, and you can bring a pillow or anything else that would help your partner be more comfortable.

You will probably be exhausted after your baby is born, and you will probably be sore, and this is normal. If you had an epidural, you might not be able to walk. Your job is to cuddle your baby and rest. If you have any questions about how you feel or anything going on with your body, do not hesitate to ask.

Asking for Help

You are surrounded by experts in the hospital, especially after your baby arrives. You can get assistance with breastfeeding or swaddling. If you have questions about how to change a diaper or whether your baby’s sleeping is normal, ask them. Please take advantage of the staff while you have access to them. Chances are the hospital has a lactation consultant on site. Have them come by for a short visit, even if breastfeeding is going well. Getting off on the right foot with breastfeeding can make a huge difference for both you and your baby.

Requesting Privacy

On the other hand, you may find that you just need a little quiet and some time without staff continually going in and out of your room to check on you or your baby. Ask your nurse or care provider if you can get a few hours without being disturbed; perhaps you can put a do not disturb sign on your door. The hospital staff will understand that you need to rest, and it is not outlandish to ask for a break from people coming in and out of your room at all hours to check on you or your baby.

Getting Discharged from the Hospital 

When you are ready to go home, you will need to go through the discharge process. Before being discharged, you and your baby will be examined to ensure you are both in good health. Hospital staff will be covering a lot of information, and it would be helpful to have your partner here for that chat to help you remember everything. Your care provider should go over procedures on how to take care of yourself as you are healing and how to take care of your little one’s umbilical cord. They will go over what you can expect for the next few days and any warning signs you should keep an eye out for. You will need to sign paperwork before you go, and you may also make a follow-up appointment with your pediatrician before leaving the hospital. The discharge process can take a while, so if you know you want to go home soon, let your nurse or care provider know well ahead of time.

 

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