What to Expect During Childbirth
Date: July 1, 2010
Having your first child is daunting. What do you take the hospital? Should you use a midwife or doula? What can you expect? How can you prepare for labor?
These questions go through every expectant parent's mind. And though moms-to-be all get advice from mothers, sisters, friends and complete strangers, we thought it might be helpful to get the low-down from the pros. We asked a labor and delivery nurse, a mother/baby nurse, and a certified nurse midwife for their advice. Here's what you should know before your bundle of joy arrives.
Rest — you're going to need it
Everyone agrees that you're going to be tired. "The thing parents don't know at all is that after delivery they'll be up every two hours, even in the hospital, because of breastfeeding.
The maximum you'll be able to sleep is three hours at a time," says HoYu Pan, a labor and delivery nurse at Duke Birthing Center in Durham.
Erin Birkmeyer, a mother/baby nurse at Presbyterian Hospital in Charlotte, agrees. "Rest while you can in the hospital. New parents will have tons of visitors, but when you have so many, you never have time to rest, and [then] you're exhausted and going home. You're going to need a lot of help when you get home. If you have friends and family who can help out or cook a meal, take it!"
Enter the professionals
No one is prepared for the number of medical personnel you'll see while you're at the hospital, during birth and after. Doctors. Nurses. Anesthesiologists. "There are people coming in and out of the room," Birkmeyer says. "Parents don't realize how many people are involved in the care of both mom and baby."
After the delivery, and depending on the hospital, there may be one nurse for mom and one for the baby, making sure everyone is recovering and healthy. They'll check on you regularly for the first few hours.
Not sure you want to give birth in a hospital? Consider a midwife, either for a home birth or birth at a birthing center. "Midwives are the experts in low-risk deliveries," says Deb O'Connell, a certified nurse midwife and owner of Carrboro Midwifery. "We've been delivering babies for centuries. Know your options. Most American first-time parents aren't aware of what is out there: hospitals, birth centers, home births ... determine which is the most comfortable for you."
Birth takes time
"There are so many TV shows and reality shows about giving birth right now, and it's generally not as fast as it is on TV," says Dana Morris, a labor and delivery nurse at Forsyth Medical Center in Winston-Salem. "They're not prepared for the pushing process to take as long as it does. It can take two hours [of pushing] for a first baby."
Pan agrees, and goes one step further. "Parents probably don't know that even an induction can be a two-day process. If the cervix isn't ready, mature, it's going to take two days."
Share your written birth plan with the nurses. "If you come in with specific ideas of what you do or don't want during labor, whether it's specific music, a very quiet environment, if you don't want to be asked if you want pain medicine, we'll read your plan and try to follow it as best as we can," Morris says.
But having a plan doesn't mean you have to stick to it. Every birth is different, and pain levels — and tolerances — vary. It's OK to decide in the middle of labor that you need to make a change to that labor plan.
"Just because a mom's decided something initially doesn't mean she can't change her mind," Morris says. "If you can sit still long enough for [the] anesthesia [department] to do their work, you can get an epidural."
However, Pan cautions that getting an epidural too early can lead to a longer labor. "People don't realize that an early epidural will affect fetus rotation and can extend labor and pushing time. The ideal time would be in the middle of the active stage of labor, around five or six centimeters [dilated]. Walking around will help the baby rotate to the proper position and will shorten the second stage of labor."
Once you have an epidural, you're not able to leave the bed, so you can't help the baby rotate, which can lead to complications that could lead to a C-section.
Even in the hospital, you can have a midwife or doula with you if you want a natural birth but feel the need for the security of a hospital setting in case something goes wrong. "We've had midwives handling birth at UNC for 10 years as a division, serving as faculty members, teaching residents. In the Triangle, midwives have had a presence for over 20 years," Pan says.
Regardless of whether you're planning a natural birth, O'Connell stresses the need to interview your health-care provider. "Don't be afraid to ask questions. How long have you been practicing? What is your rate of C-sections? Do you support natural childbirth? What's your epidural rate, and how experienced are your anesthesiologists at giving them?" If you're going to use a midwife, find out if she is board-certified. Is she a certified nurse midwife or a certified professional midwife? Are doulas allowed in your hospital?
Also find out the visitation policy at a facility before you're in labor. Many hospitals limit the number of people in the labor and delivery room. Be sure you know the maximum count including the dad or coach. And if there are people you don't want to be there, let the nursing staff know.
Take childbirth-preparation classes. Morris suggests taking them at 30-32 weeks because they meet for several weeks and give parents the opportunity to ask questions of labor and delivery nurses, as well as take questions back to their doctor if necessary.
"They give lots of information to prepare parents and help them make sound decisions," Pan says. Depending on the location, the classes may also offer a tour of the hospital facilities so new parents can see where they'll be admitted and where they'll stay. "Some hospitals have virtual tours so parents can learn about the admission process so it will be easier for them when they arrive," Pan says.
O'Connell is also a fan of parenting classes. "A lot of women don't have a clue as to how [parenthood] might change them, and younger people aren't aware of how a baby is going to totally change their lives. A parenting class is worth the money."
What to bring
So, what do you take with you? According to Morris, people love their own pillows. Either the hospital pillows aren't fluffy enough or there aren't enough of them. People consistently remember the video camera or the regular camera, but rarely remember both. And if you want the first-day handprints and footprints in the baby book, you need to remember to bring the book with you. Most hospitals have a first-day photograph service, so make sure you bring the first-photo outfit.
Take care of yourself
Take care of your health — before and after the baby. "It usually takes two weeks for a mom to get back to normal, but it takes six weeks for a complete recovery," Birkmeyer says. So after about two weeks, you'll start feeling pretty good again, but your body is still recovering from labor for another month after that.
"A lot of clients are not aware of how important the first trimester, even pre-pregnancy, is," O'Connell says. Entering a pregnancy at a healthy weight can make a difference when it comes to hypertension and gestational diabetes. And prenatal vitamins are a must to help keep mom and baby healthy.
If you're breastfeeding, you'll also have a lactation specialist. Usually you won't meet the lactation specialist until you're in the mother/baby section of a hospital, but check with your labor and delivery nurse as well. At Forsyth Medical Center, labor and delivery nurses are also trained to help mothers with the initial feeding.
"The lactation consultant is available for your entire stay, and visits once a day," Birkmeyer says. "Sometimes at first it's kind of difficult. By the time you go home, we'll make sure you're comfortable with it and confident that you're doing it right."
Just remember, you've never done this, and neither has your baby. Relax and enjoy this time and don't be afraid to ask questions. Nurses, doulas and fellow moms will always be around to share their advice.
Kim Justen, a freelance writer, lives in Advance, N.C., and is the mother of two.
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