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?
STEVEN HOCKSTEIN, MD: Yes, they do.

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.

During that period, if a woman is uncomfortable, there are lots of different pain medications. One that we may have heard of before is an epidural. Can you explain what an epidural is?
STEVEN HOCKSTEIN, MD: Epidural anesthesia is medicine that is injected through a small plastic catheter into the small of a woman's back. It's very similar to an IV. The medicine is injected around the spinal cord. This gives the woman excellent pain relief from the belly button down. And it can be titrated, meaning that the dosage can be adjusted. If she's uncomfortable, some more medication can be injected. Throughout the course of the labor, if it wears off some more medicine can be given. And many women choose this while they're in labor and find it really excellent.

Many of us have heard of Apgar scores. Can you say something about that?
ADRIANNE MOORE, MD: The Apgar score is a traditional means of scoring the well-being of the infant at the time of birth. It has no implications for how well the baby will do thereafter.

After a normal labor and delivery, how long does a pregnant woman stay in the hospital? STEVEN HOCKSTEIN, MD: For a vaginal delivery, people typically stay in the hospital for two days. So if a woman delivers on Monday, Tuesday is considered Day 1. Wednesday -- she will go home. For Caesarian section, women typically stay in the hospital four days if their recovery is uncomplicated.

What happens, Dr. Moore, with a mother and her baby within those two days in the hospital?
ADRIANNE MOORE, MD: In many hospitals, the mother and the baby are allowed to stay in the same room, and the mother learns to care for the baby, especially if she's a new mother, and learns to bathe the baby and breastfeed. It's enormously helpful to a new mother to be afforded this adjustment time.

Dr. Steven Hockstein is currently Assistant Professor of Obstetrics and Gynecology at New York Presbyterian Hospital . Weill Cornell Medical College in New York City. Dr. Hockstein received his medical degree from the University of Maryland School of Medicine and completed his residency in Obstetrics and Gynecology at the Prentice Women.s Hospital . Northwestern Memorial Hospital in Chicago, Illinois. He is board certified in Obstetrics and Gynecology.

Copyright © Steven Hockstein. Permission to republish granted to Pregnancy.org, LLC.