Preparing for Baby
Pregnancy and Birth Basics

Birth 101

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Birth 101

It’s time for delivery - now what?

25 MINUTE READ

Published October 2024

AUTHOR

Elisabeth Mulligan
Registered Nurse, MSN, RN

Whether you go into labor spontaneously, are scheduled for an induction, or scheduled for a cesarean section (c-section), questions will swirl as your due date approaches. This guide will teach you how to recognize labor, what happens when you go to the hospital, and your options during the course of your labor and delivery. Many times, childbirth is the first time a woman has been admitted to the hospital in their lives, so we want you to feel prepared and empowered to have a positive birth experience!

Birthing basics

In the United States, 98.4% of women give birth in hospitals, 0.99% give birth at home, and 0.52% give birth in a birthing center¹. Even so, within the hospital setting, there are wide variations regarding approach to childbirth and available resources. This guide includes information on the “typical” hospital setting, but be sure to always speak with your midwife or OB/GYN to understand your unique hospital resources.

Breaking it down further

Am I in labor?

Every woman has their own unique story about how their labor started - and yours will be too! There are some signs that labor may be near, such as a loss of your mucus plug, lightening (sharp, shooting pains in the crotch area), or feeling less short of breath because the baby has dropped further into your pelvis, relieving some of the pressure in your diaphragm² . However, these signs are not guarantees that labor will begin within a certain timeframe.

True signs you are in labor include contractions (i.e., the tightening of the uterus) that:

  • True contractions (the tightening of the uterus) occur at regular intervals. True labor contractions have a pattern, and as time goes on, they get closer together²

  • True labor contractions continue even when you rest or move around.

  • True labor contraction pain usually starts in the back and moves to the front.

If you experience any of these true labor symptoms, if your water breaks, or if you are unsure, call your provider. They will give you instructions on next steps. Most providers follow the 5-1-1 rule³ to determine if you are in labor and should go to the hospital.

The 5-1-1- rule means:

  • Contractions occur every 5 minutes or fewer.

  • Contractions last at least 1 minute.

  • This pattern has been going on consistently for at least 1 hour.

Arriving at the hospital

When you arrive at the hospital, you will check-in and be escorted to a triage room for evaluation. A nurse will place monitors on your belly to listen to your baby’s heartbeat and measure any contractions you may or may not be having. If you think your water has broken, the nurse may perform a “Fern Test”⁴, in which she will swab your vagina and send the sample to the lab to see if there is presence of amniotic fluid, indicating your water has broken!

The triage nurse may also do a cervical assessment⁵. Three things are measured during the assessment:

  1. Dilation - how open your cervix is, in centimeters 

  2. Effacement - how thin your cervix is, in percentage (0% not thin at all, 100% fully thinned)

  3. Station - the position of the baby in relation to the ischial spines of the pelvis, ranging from -3 (highest position) to +3 (lowest position)⁵

Based on the above criteria and any other unique factors, your provider will decide to admit you or to send you home. If you are sent home, do not despair! Use the time to rest, shower and eat. Once you get admitted to the hospital, it is “go-time”! 

It’s called labor for a reason!

When you are admitted to the hospital, you will be transferred to the labor & delivery room. This room will have a number of items unique to the labor & delivery setting, including:

  • a bathroom with a shower,

  • a large warmer for the baby, which includes a scale, oxygen, and suction for after delivery,

  • a monitor similar to that in the triage room, that tracks your baby’s heartbeat and your contractions,

  • an IV pole,

  • a place for your support person to rest/sleep, and 

  • labor support items such as a peanut ball, a birthing ball, and a mirror.

The first few hours in the labor & delivery room will be busy, as there are a number of administrative items and safety measures to complete ASAP. Most of these things will be completed by your nurse. Here are some things to expect:

  • You will complete any admission paperwork/sign consent forms.

  • You will have the monitors placed on your belly again, to measure your baby’s heart rate and your contractions. In some cases, these are connected to a monitor with cords and in other cases they are cordless and communicate wirelessly to the monitor.

  • Your nurse will start an IV and draw blood. The IV is a safety measure that allows quick access in case of an emergency. Most patients will automatically be given IV hydration fluids. The IV is also used to administer antibiotics (e.g, if you are strep B positive), as well as pitocin⁶ (the synthetic form of oxytocin) if your labor needs to be augmented. 

  • You will be visited by members of different teams, including a provider from your OB/GYN office, a member of the anesthesia team, and depending on your hospital, perhaps a resident, a midwife, or a medical student.

  • You will discuss the plan of action for your labor with your provider and your nurse. This is your opportunity to discuss your preferences and ask any lingering questions. Your conversation should include things like:

    • How often you and your baby will be monitored

    • If they foresee a need for pitocin 

    • How you feel about having your water broken if it isn’t already

    • Your pain management plan

    • The need for antibiotics if you tested positive for group B strep at your 36 week appointment

    • Eating and drinking during labor 

    • Movement during labor

    • Delivery preferences like pushing positions, who cuts the cord, and placing your baby skin to skin

Phases and stages of labor⁷

If your cervix was not checked by a nurse in triage, you will be checked by a nurse or provider once you are admitted to the labor & delivery room. Knowing what stage of labor you are in can help you manage your expectations of your labor and birthing experience. Patients routinely ask “how long do you think this will take?” and the answer is: no one can predict how long your labor will last! Labor can last from hours to days. For first-time moms, labor is typically longer and pushing can take a few hours. Be patient - your body knows what to do!

  • Dilation

    • 0 to 6 cm

    Contraction pattern

    • Every 5-20 minutes

    • Lasting 30-60 seconds

    What You Can Do with Your Provider’s Permission

    • Rest & relax

    • Eat (if allowed)

    • Stay hydrated

    • Walk or change positions

  • Dilation

    • 6 to 8 cm

    Contraction pattern

    • Every 3-5 minutes 

    • Lasting 45-60 seconds

    What You Can Do with Your Provider’s Permission

    • Consider your pain management techniques

    • Chew ice chips

    • Breathe 

    • Use a birthing ball or peanut ball

  • Dilation

    • 8 to 10 cm

    Contraction pattern

    • Every 2-3 minute

    • Lasting 60-90 seconds

    What You Can Do with Your Provider’s Permission

    • Breathe

      Notice any urge to push and talk to your nurse or provider

  • Dilation

    • 10 cm to birth

    Contraction pattern

    • Every 3-5 minutes

      Lasting 45-90 seconds

    What You Can Do with Your Provider’s Permission

    • Your nurse will teach you how to push during your contractions

    • Try pushing in different positions

  • Typically the placenta is delivered shortly after birth. You may be asked to push gently - listen to your provider’s instructions.

Your birthing experience

Pain management

Deciding how you want to manage your pain during labor is a personal choice. Each person experiences pain differently, and if you have never been in labor before, it is hard to anticipate what labor and childbirth will be like for you. Both pharmacological and non-pharmacological pain management techniques have their own risks and benefits, so educate yourself and know your options before your labor begins. Also keep in mind, it is OK to change your mind regarding what your pain management plan is during your labor!

If you are hoping to experience labor and birth without pain medication, talk to your provider about your plan at your prenatal appointments. Some hospitals may be able to align staffing so that you have one-on-one attention from your nurse, but many hospitals do not have that flexibility. In that case, you may want to consider having another support person, such as a doula, with you. A doula can provide continuous support during labor, which has been shown to improve outcomes for women and their infants including decreasing the use of pain medication.  Some nonpharmacological pain management techniques include massage, counter-pressure, aromatherapy, patterned breathing, hydrotherapy, and focus and distraction.

Neuraxial anesthesia, most commonly an epidural, provides the most effective pharmacological pain relief in labor and is used in nearly three-fourths of labors in the United States⁹. Opting to use pharmacological pain management does not make your birth any “less natural” - it simply is a helpful tool for the birthing process. No matter what your plan is and how you do it, at the end of the day you gave birth to your baby and that is something to celebrate.

Below is a table of pharmacological pain relief options typically used in labor. As with all medication, each choice (even opting for no medication) comes with a set of risks and benefits. It is your choice to weigh these benefits and potential side effects when deciding what is right for you and your family. Speak to your nurse and provider about the options available to you at your delivering hospital.

  • When

    • Anytime 1 hour before delivery  

    Possible side effects

    • Itching, vomiting, nausea, drowsiness  

    Benefits

    • Reduce awareness of pain; calming effect 

    Possible risks

    • Can affect baby’s breathing and heart rate for a short time

  • When

    • During contractions 

    Possible side effects

    • Dizziness, nausea 

    Benefits

    • Lessens anxiety and increases a feeling of wellbeing 

    Possible risks

    • N/A 

  • When

    • Just before delivery or after delivery for repairing a perineal tear

    Possible side effects

    • Chance of an allergic reaction 

    Benefits

    • Numbness in the vaginal/pelvic area, complete directed pain relief 

    Possible risks

    • N/A 

  • When

    • Labor and often C-sections, longer lasting pain relief 

    Possible side effects

    • Itching, sometimes nausea and vomiting  

    Benefits

    • Numbness in lower half of body while remaining awake, do not generally lose complete feeling 

    Possible risks

    • Potential risk that your baby will experience a change in heart rate, breathing problems, drowsiness, reduced muscle tone, and reduced breastfeeding. These effects are short term. 

  • When

    • C-section, quick pain relief 

    Possible side effects

    • Itching, sometimes nausea, vomiting 

    Benefits

    • Complete loss of feeling in lower half of body 

    Possible risks

    • Potential risk that your baby will experience a change in heart rate, breathing problems, drowsiness, reduced muscle tone, and reduced breastfeeding. These effects are short term. 

  • When

    • Combined quick and long-lasting action, during labor and/or delivery 

    Possible side effects

    • Itching, sometimes nausea, vomiting 

    Benefits

    • Complete loss of feeling in lower half of body 

    Possible risks

    • Increases risk that your baby will experience a change in heart rate, breathing problems, drowsiness, reduced muscle tone, and reduced breastfeeding. These effects are short term. 

  • When

    • Emergency situations 

    Possible side effects

    • Itching, sometimes nausea, vomiting 

    Benefits

    • Puts patient to sleep, complete lack of awareness of pain 

    Possible risks

    • Can affect baby’s heart rate and breathing (minor, rarely severe side effects)

Pushing positions

Changing positions while pushing can be an effective way to stay comfortable in labor as well as help shorten pushing time¹⁰. Keep in mind that if you have an epidural, your hospital or provider will have policies that will not allow you to stand or be out of your hospital bed. However, there are still plenty of pushing options to try even if you do have an epidural! Keep in mind most hospitals will require constant monitoring of the baby at this stage of labor, so you will have to work with your nurse and provider to ensure that they can safely monitor the baby while you are choosing your pushing positions!

Pushing Positions with an Epidural for Pain Management¹¹

  • On your side

  • On your hands and knees in bed

  • Using a squat bar

  • Closed knees

  • In a semi-recumbent position 

Your baby’s arrival!

Pushing Positions without an Epidural for Pain Management¹⁰

  • Any of the above positions are options, plus

  • Use of a birthing ball

  • A birthing stool or chair

  • Standing

  • Leaning

  • Semi-sitting

  • Squatting

  • Kneeling

While most women give birth either flat on their backs or in a semi-sitting position, research shows that alternative upright or side-lying positions can aid in the descent of the baby into the pelvis and lead to a shorter second stage of labor¹¹. Partner with your nurse and provider on your expectations for pushing and delivery.

Depending on your unique circumstances, there will be a team of healthcare professionals in your delivery room waiting for that final push and for the arrival of your baby! As soon as you deliver your baby, your provider will quickly assess whether it is safe to allow your baby to go immediately to you for skin-to-skin or if there is an indication to take the baby to the warmer for further evaluation. Such circumstances could include if there was a complication during the delivery (see “pivoting” section below), if the NICU team is present at delivery for a preterm baby, chorioamnionitis, or non-reassuring heart tones, if there is presence of meconium during delivery, or a variety of other reasons. If your baby needs further evaluation, try to remain calm. Most likely, your support person can go over to the warmer and watch the team working on your baby and dictate to you what is going on. Remember, everyone in your delivery room has two goals - the safety of you and the safety of your baby.

Approximately 9 in 10 women who give birth vaginally experience perineal trauma or tearing¹². After delivery of the placenta, your provider will assess your perineum and do any repairs at the bedside. Episiotomy, creating a controlled incision in the perineum to help facilitate childbirth, was once a widely used technique until 2006 when the American College of Obstetricians and Gynecologists (ACOG) made a recommendation against the use¹³. Now, providers use different techniques such as perineal massage, warm or cool compresses, and pushing management to reduce the perineal trauma.

Pivoting

When things don’t go as planned

It is almost a guarantee that despite all of your preparation and planning, your birth experience will not go 100% according to plan. DO NOT DESPAIR! Our goal is to prepare you to pivot when things don’t go as planned. A woman’s sense of empowerment and control is most predictive of maternal satisfaction with childbirth¹⁴. Educate yourself on the below scenarios so that if they should arise, you feel empowered and in control of your birthing experience. 

  • Hospitals are prepared with tools to help your labor move along when necessary. If your labor is not progressing as it should, your labor can be augmented using pitocin. Pitocin is commonly given to help regulate your contraction pattern and create stronger contractions, thus shortening your labor time. A peanut ball is a fantastic tool that is used in active labor to aid in opening the pelvis. Speak with your delivery team about the tools they have to help your labor move along safely.

  • Chorioamnionitis is an infection that can occur before labor, during labor, or after delivery¹⁵. Most commonly, chorioamnionitis is associated with prolonged rupture of membranes, prolonged labor, tobacco use, meconium-stained fluid, multiple vaginal exams post rupture of membranes, and in women with known bacterial or viral infections. However, it can occur at term and in women without prior infections. If you spike a fever of 100.4 degrees F or higher, you will be treated with antibiotics and your baby will be assessed post-delivery.

  • It is normal for your baby’s heart rate to fluctuate during labor, in fact we want to see it accelerate or decelerate at certain points in relation to your contractions! Sometimes, the heart rate will dip and stay low for longer than normal. In these cases, your nurse will intervene with some tricks to help get the baby to respond, such as changing your positions or giving you some extra fluids. If the baby’s heart rate does not respond appropriately, your nurse may call for extra help. Extra nurses, doctors, anesthesia and residents may rush into your room. The sense of urgency can be overwhelming - try to stay calm and listen to directions. Everyone is doing their best to keep you and your baby safe.

  • Sometimes babies are very close to being born but need a little extra help with their final entry into the world. In these cases, your provider may recommend an instrument-assisted delivery. This is when your provider uses either forceps or a vacuum in conjunction with your pushing to help deliver the baby. Between 5% and 20% of newborns are delivered by instrumental delivery in developed countries¹⁶. Instrumental delivery is the most significant risk factor for severe perineal lacerations. However, it can help you avoid a c-section, if properly executed.

  • A baby’s first bowel movement, called meconium, can happen in utero. While this is not always an emergency, it is something that needs to be monitored as part of your delivery. This happens most commonly in post-term babies (babies born after 40 weeks gestation)¹⁸. When a provider sees meconium stained fluid during pushing, your baby will be assessed immediately post-delivery for Meconium Aspiration Syndrome (MAS)¹⁹. MAS is when some of the meconium-contaminated amniotic fluid gets into the baby’s lungs during delivery, causing respiratory distress.

  • While it is normal to lose blood during your delivery, when a woman loses too much blood, it is considered a postpartum hemorrhage. Your provider and nurse will monitor your blood loss during delivery and in the immediate hours postpartum. Your nurse will conduct fundal massages frequently in which she will press and massage your belly to measure how your uterus is contracting back to its original size²⁰. During these assessments, you will expel blood and clots. Your nurse will assess your bleeding to ensure that your blood loss is within the normal range for your type of delivery (vaginal vs. c-section). When you move to the postpartum room, your postpartum nurse will perform fundal assessments as well, but more infrequently. A general rule of thumb is if you pass any clots larger than a golf ball and/or saturating one pad per hour with blood, you should notify your nurse. About 3% of deliveries that occur in hospitals are complicated by postpartum hemorrhage²¹.

Special Circumstances

VBAC, C-section, Induction

Vaginal birth after cesarean (VBAC) or trial of labor after cesarean (TOLAC)

If you are attempting a VBAC, you have most likely already discussed the risks and likelihood of a successful vaginal delivery with your provider. They can use a VBAC calculator²² to provide information during your shared-decision-making discussion. There are certain factors that may predict a successful VBAC, such as the type of incision used for your c-section, maternal risk-factors, and the reason for your c-section, e.g., failure to dilate would not be a good indicator for a VBAC, while fetal intolerance of labor would be. If you opt to try for a VBAC, you can expect to be monitored closely to ensure the safety of you and your baby.

C-Section

Indications for a planned c-section include your baby is breech (not in a head down position), concerns about the location of your placenta or your own medical conditions. 

If you are preparing for a scheduled c-section, you will arrive at the hospital at the time communicated to you by the hospital team. After checking in and completing the administrative paperwork, you will be ushered to a pre-operative (“pre-op”) space where you will change into a hospital gown, a nurse will monitor you and your baby, and start an IV. 

You will then be escorted to the operating room (OR) for your surgery. Be prepared, the OR can be cold! Your team in the OR will include:

  • Labor & delivery nurses

  • OR nurses

  • OR techs

  • Anesthesia staff

  • Your provider/surgeon

This team will talk you through all of the prep needed for your surgery, including:

  • Placing spinal anesthesia. This is similar to an epidural, but will completely numb the lower half of your body.

  • Scrubbing your belly with a sterile solution.

  • Placing sequential compression devices (SCDs) on your calves. These are stockings that wrap around your legs and periodically inflate and deflate to keep the blood flowing in your legs while you are laying down.

  • Inserting a foley catheter through your urethra into your bladder. This will allow your urine to drain until you gain function of your bladder again after surgery.

  • Once the OR team has you prepped and is ready to begin surgery, they will bring your support person into the OR.

Most routine c-sections last only 30-60 minutes from start to finish, with the majority of the time being spent on the back end, after your baby is born! This is exciting because once your support person comes into the OR, you will get to meet your baby very soon!

Certain medications are given during a c-section that can make you nauseous or shaky. This is normal! Communicate with your anesthesiologist as to how you are feeling and they will do everything they can to keep  you comfortable. Most often if you feel well enough and your baby is doing well, your nurse will bring your baby to you and hold it on your chest for some skin-to-skin. If you do not feel well enough for this, you can do cheek-to-cheek skin-to-skin, and your support person can hold the baby while you recover. 

Once your c-section is complete, the team will clean you up, transfer you to a different bed, place your baby on your chest and roll you out of the OR back to your pre-op room, where you will recover for a few hours. 

An emergency c-section is unplanned and decided upon during labor or pushing because either the health of the baby or the mother is at risk. Despite the name, the majority of c-sections that are unplanned are not true emergencies. You will hopefully and likely have time to discuss the decision with your provider and prepare with your nurse and support person. If you have an epidural, the anesthesia team will dose it so that your entire lower half is numb enough for surgery. Keep in mind, if you do not have an epidural and there is a true emergency in which the baby needs to be delivered imminently, you will have to be put under general anesthesia.

Induction

You may opt to be induced for either personal or medical reasons. There are several ways that labor can be induced, and it will vary depending on your delivery hospital and your personal circumstances. Your provider may place a cervical ripening balloon in your cervix at their office or at the hospital, you may be given medication to soften and thin your cervix, or some combination of both²³. As with every decision made during labor, induction has its own risks and benefits. Talk to your provider about their guidance for induction and the process that they follow at their hospital.

Overall goals

Feel safe, be safe, have a safe delivery

Above all, trust your team. Your delivery team is there to support you during labor and delivery of your baby. Their goal is to keep you and your baby safe, and will work with you to make smart decisions. At the same time, you can create a supportive environment for yourself by bringing items from home that bring you joy, such as music, aromatherapy, and string lights or flameless candles. Remember, having a baby is a marathon, not a sprint. Prepare yourself mentally and physically for your labor and delivery, but also follow the guidance of the healthcare professionals as the plan shifts. Consider using the following “Birth Wish List” to communicate your preferences with your delivery team.

About the author

Elisabeth Mulligan

Registered Nurse, MSN

Elisabeth started her nursing career in labor and delivery at one of the busiest birthing hospitals in the U.S., assisting with hundreds of deliveries from routine to complex. Now specializing in women's reproductive health across the lifespan . . .

Read More

Resources our Experts Love

  • ACOG: Labor & Delivery ↗

  • Parent Data: Experiencing Labor and Delivery - Insights and tips froman L&D nurse ↗

  • Lamaze International - Giving Birth with Confidence ↗

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When to get
expert support

  • If anything feels “off” to you during the course of your labor. Laboring may be a new experience for you, and many times what you are feeling is normal for labor. However, it is important to keep a clear line of communication with your healthcare team so that they know if something is going awry.

  • If you notice any of the following warning signs, call your nurse immediately:

    • Severe vaginal bleeding 

    • Severe headache with blurred vision

    • Severe abdominal pain

    • Fast or difficulty in breathing

    • Fever

    • Extreme swelling of the fingers, face, or legs

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