The ABCs of hospital delivery
By Christa Melnyk Hines
The hospital delivery process begins long before labor pains begin. Here's what to expect.
Admissions. At around 32 weeks gestation, schedule a preadmission appointment to complete most of your paperwork before labor, like the birth certificate and other forms.
"At that time, we do all of the preadmit work like consents you'll sign when you come to have the baby," says preadmission coordinator Clara Davis, RN.
Birth plan. Do you want an epidural or prefer natural childbirth? A birth plan communicates your desires for your labor and delivery experience. If you have a plan, bring it with you to the preadmission appointment and delivery.
Circumcision. At hospitals, circumcisions are usually performed within 48 hours of delivery. Talk to your doctor about the procedure's benefits and risks. Your preadmission coordinator will have the paperwork you need to complete when you're ready.
Delivering physician. Many doctors check in on their patients first thing in the morning and midday. "We page the delivering physician as soon as we think it's time. If a baby is having heart rate issues, we can always page them to come evaluate," says labor and delivery nurse Jenna O'Connor, RN.
Epidural. An epidural is a pain-relieving local anesthetic administered by an anesthesiologist that numbs pain in the lower half of the body.
"Allow 45 minutes from the time you ask for your epidural to getting it," O'Connor says. "We like to give IV fluids prior to that at a faster rate to help prevent blood pressure from dropping from the anesthesia."
Fetal heart monitor. Healthcare practitioners will either periodically monitor your baby's heartbeat during labor, or you will be hooked up to an electronic fetal heart monitor, especially if you are on medication to be induced.
Get ready. Pack your bag between 32 and 35 weeks of pregnancy. Bring toiletries and comfortable clothes, including warm socks and slip-on shoes. You'll also need a take-home outfit for your baby and a car seat.
Hepatitis B. The American Academy of Pediatrics recommends all healthy newborns receive their first dose of hepatitis B vaccine within 24 hours of delivery. Hepatitis B is a potentially fatal viral infection that attacks the liver.
Induction. Prior to an induction, your provider will examine your cervix and decide whether you should go into the hospital the day of the scheduled induction or the night before. If you go in the night before, you might receive a medication or a balloon catheter that thins or softens the cervix. When your cervix is ready, you'll be given a medication called Pitocin to induce contractions.
Jacuzzi® tubs. Many hospitals offer laboring moms full-size whirlpool bath tubs for pain relief early in the delivery process. Check with your doctor to see if this an option for you.
Vitamin K. All babies are born vitamin K deficient. Upon birth, your baby will receive a vitamin K shot, which is essential to aid the body in forming clots to prevent severe and potentially life threatening bleeding.
Lactation consultant. Breastfeeding specialists visit new moms in the hospital to address any initial questions or concerns around breastfeeding.
Marking the moment. During preadmission, you'll have the opportunity to decide if you want your newborn photographed. "But, you're not obligated to buy anything," Davis says.
NICU. Premature infants, multiples and sick or low birth-weight babies are usually transferred to a neonatal intensive care unit, which provides specialized care.
Overnight stays. The typical hospital stay for a vaginal delivery is 24 to 48 hours, while a C-section is between three and four days.
Pediatrician. The hospital will notify your baby's physician when you're admitted. He or she will provide a physical examination of your infant within 24 hours postpartum.
Questions. Throughout your pregnancy journey, you'll likely have many questions come up about what to expect when you get to the hospital to deliver your baby, like where to park, which entrance to go in (especially if you go into labor after hours), and what you should pack. Your physician, nurses, doula and/or midwife, your hospital's preadmission coordinator and your instructors at hospital labor and delivery classes are all excellent sources of information.
Risks? Because hospitals are prepared for complications that can arise during labor and delivery, they are among the safest places to deliver babies, especially for women considered high risk. High-risk pregnancies include women who are expecting multiples, are under the age of 17 or over the age of 35, or have a health condition like diabetes, high blood pressure or depression.
Surgery. A Cesarean section requires an incision through the abdomen and uterus. You'll receive an epidural and will likely be awake for the procedure. Upon arrival for a planned C-section, you'll be hooked up to a monitor and an IV, receive a physical assessment and bloodwork.
Tours reduce uncertainty. Scheduling a firsthand look of a hospital's birthing center early in your pregnancy can familiarize you and your partner ahead of time with the hospital layout, parking and available classes and amenities. Some expectant parents tour as early as six to 12 weeks gestation.
"By meeting them early, we can help them feel as comfortable as possible throughout the entire process," says labor and delivery nurse Danae Young, RN, a hospital maternity navigator, who offers birthing center tours and guides expectant parents through preadmission paperwork.
Visitors. Decide who you want in the delivery room. "This can be doctor-directed a little bit. For example, if the patient is having trouble with their blood pressure, we're not going to want them to have a lot of visitors in their room at that time," Davis says.
When your baby arrives, your loved ones can access the locked unit during visiting hours by providing your first and last name.
Of course with COVID-19, visiting privileges may be restricted. Check with your hospital for updated protocols.
Wireless monitoring. Some hospitals wirelessly monitor the baby's heart rate and a laboring mom's contractions. The wireless monitor allows patients the freedom to move around, use the restroom, take a shower or sit on a birth ball.
X or Y? Still unsure if your newborn is a Xenia or a Yasmin? Try settling on a name before you check out of the hospital. Otherwise you'll get a call from the State Department of Health for not completing your birth certificate paperwork--and it can cost you extra.
Zen. Giving birth is rarely considered a "zen-like" experience, but many hospitals prioritize comfortable accommodations for expectant parents, like private suites, in-room music options, rocker-recliners, and "quiet time for moms" to allow for family bonding.