What to Expect: Hospital Birth

by Steven Hockstein, MD and Adrienne Moore, MD

Childbirth -- depending on who you ask, is either the most wonderful or the most excruciating experience of a woman's life. Or both. If you're facing childbirth for the first time, you probably have lots of questions and concerns. What happens exactly during labor? How long does it take, and what are the possible complications?

Below, two OBGYNs will fill you in on some big questions about the big day.

At what time of a gestation, or the length of time of a pregnancy, does the average woman give birth?
STEVEN HOCKSTEIN, MD: A woman's due date is 40 weeks after her last menstrual period - 280 days. And that is about the time most women deliver, plus or minus a couple of weeks.

So you have a window there of about a couple of weeks. Dr. Moore, what are the signs and stages of labor?
ADRIANNE MOORE, MD: Well, the signs of labor are rhythmic contractions, generally about five minutes apart, and lasting for a full minute.

And there are how many different stages to labor?
ADRIANNE MOORE, MD: There are three stages of labor. In the first, and longest stage of labor, the cervix dilates and become effaced through a series of contractions. In the second stage of labor, which is probably the hardest and most physically challenging, a woman is pushing after the cervix is completely open. The third stage of labor is simply the delivery of the placenta.

Can you talk a little bit about the beginning of contractions and how the cervix or the neck of the vagina begins to open to allow the baby to pass through?
STEVEN HOCKSTEIN, MD: Throughout the latter part of pregnancy a woman has contractions. They come, they go. They are generally mild, and they're not regular in their pattern. During this time, the cervix will change. It becomes softer, and it dilates, or opens, a centimeter or two. The woman will go into labor eventually around her due date, at which point the regular, painful, stronger contractions will dilate her cervix. The cervix shortens at the same time as it dilates. And the physician or nurse check the progress of that dilation during labor, and measure it in centimeters. And they also check how thick it is.

And what about the breaking of the water that may or may not happen around this time?
STEVEN HOCKSTEIN, MD: The bag of water is a membrane that surrounds the fetus inside the uterus, and it contains the amniotic fluid. During labor - sometimes prior to the onset of labor, this bag may break on its own, or a patient's physician may break it. When that happens, prostaglandins are released, and contractions become stronger and more regular, and the progress of labor generally picks up.

What are prostaglandins?
STEVEN HOCKSTEIN, MD: Prostaglandins are chemical mediators for contractions throughout the body. But they are involved in mediating uterine contractions.

They move the labor along?

How does a woman know when to go to a hospital? And once she arrives there, how is she going to be treated? What can she expect?
STEVEN HOCKSTEIN, MD: She and her physician will have discussed beforehand how soon she needs to go to the hospital. And when she does go to labor and delivery, she'll be greeted by the nursing staff. And generally she'll be hooked up to a fetal monitor, which measures the fetal heart rate and also can measure the contractions. She'll be given an IV usually, and some blood will be drawn. Then she's moved to a labor room where she'll be for the rest of her labor.

How long can she anticipate - on average -- that her labor might take?
ADRIANNE MOORE, MD: Anywhere from 12 to 24 hours.