What to expect in the delivery room

Your bag is packed for the hospital. You’ve prepared a special place for your infant and stocked up on tiny diapers. And you’re eagerly waiting for the day your baby will be born.

Now you’re just left to wonder (and wonder and wonder) exactly how it’s all going to go, especially if it’s your first delivery. It can be great to have an outline of your wishes for labor and delivery. But having a birth plan doesn’t mean everything will happen the way you expect, so you also need to be prepared for changes.

It’s important to remember that every woman’s labor is different. And you can’t really predict what will happen. However, there are childbirth patterns that hold true for most women.

We asked providers who deliver babies every day to break down some of the basics.

Before the hospital

Feeling contractions doesn’t necessarily mean you’re in labor. In fact, it’s normal to feel mild contractions on and off in the weeks before your due date. Those contractions are called false labor or Braxton-Hicks contractions.

How do you know when you’re nearing true labor? Be sure to time your contractions whenever you feel them. Write down how much time passes between the start of one contraction and the start of the next.

The general rule: For your first baby, you’re in true labor if the contractions are 5 minutes apart and have been going on for 2 hours. If you’ve given birth before, look for contractions 5 minutes apart that have been going on for one hour. That’s information your provider will need.

You should call your doctor if you think you’re in labor, or if you’re not sure. They’ll advise you on your next steps. Labor typically lasts between 12 and 18 hours for women having their first baby, according to the American College of Obstetricians and Gynecologists (ACOG). For women who have given birth before, labor usually last between 8 and 10 hours.

You may be ready to go to the hospital if your contractions last a minute or longer, come every five minutes (or more frequently), and have been going on for an hour, says ob-gyn Courtney Martin, D.O. If they are further apart, you may be in early labor. “If you’re having them every 10 minutes or they’re only 30 seconds long, it’s probably okay to still be at home,” says Dr. Martin.

You should also call your doctor right away if your water breaks. That could feel like a sudden gush of fluid or a steady trickle.

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Arriving at the hospital

The process varies based on where you go to deliver your baby. At most hospitals, you will probably need to check in at the information desk first. From there, you’ll be directed to the labor and delivery department.

Once you arrive, you’ll be taken to a triage area. That’s where you’ll be assessed before being admitted, says labor and delivery nurse Shula Kohengadol, R.N. Your partner, a family member, or another support person can be with you.

A nurse will:

• Take your vital signs
• Use an external fetal monitor to check your baby’s heart rate and your contractions
• Do a vaginal exam to see how dilated your cervix is

What happens next depends on how far along your labor is. You may be moved to the labor and delivery room, where you’ll be monitored by a nurse. “Sometimes we’ll have women walk around our unit for a few hours and then check them again to see if their labor has progressed,” says Kohengadol.

If your water has broken, your contractions come frequently (at least every two or three minutes), and you’re already 4 to 5 centimeters dilated when you arrive at the hospital, you’re close to the active labor stage. The team will likely admit you for delivery right away.

Going through active labor

Active labor begins when the cervix has dilated to 6 centimeters, according to the March of Dimes. It lasts four to eight hours, on average. Expect the contractions to get stronger and more frequent as it progresses, says Cheryl Bellamy, D.N.P., a perinatal clinical nurse specialist.

This is the time to lean on your labor partner and health care team for support. To relieve discomfort, use the breathing and relaxation techniques you learned in your childbirth classes or ask your health care team for suggestions.

Getting pain relief

You may choose to get pain relief if the contractions get too intense. An epidural block is the most common type of pain relief used for childbirth, according to ACOG. When you get an epidural, medicine is injected into your spine to relieve pain in the lower half of your body. Many hospitals suggest waiting until you are at least 3 to 4 centimeters dilated to avoid slowing the labor process, Bellamy says.

Note that you will need to sit or lie still while the epidural is injected. It typically takes the anesthesia team about 15 minutes to place an epidural, says Bellamy. You should expect another 20 minutes before the medication takes full effect. You may shiver after an epidural. That is common, according to the National Library of Medicine.

Opioids are another type of pain relief. They can be given as a shot or through an intravenous (IV) line. Opioids can relax you and reduce your awareness of pain. Another option: Local anesthesia, which is given as an injection that can block pain in the vaginal area. These are called local and pudendal blocks. The injection is typically given just before the baby is born, according to ACOG.

Remember, if your birth plan doesn’t go exactly the way you planned, that’s okay. “Don’t be too hard on yourself, and just take it one step at a time,” says Kohengadol.

For example, sometimes it’s necessary to have an unplanned C-section for the health of the mother or baby. That can happen if the baby’s heart rate drops, the mother is not dilating, or her water has been broken for a long time, among other reasons, says Kohengadol. In a C-section, you will be given anesthesia first. Then your baby is delivered through surgical incisions in your abdomen and uterus, explains the Cleveland Clinic.

Time to push

Transitioning from active labor to the pushing or second stage of labor can be especially intense and painful. The contractions now come closer together and can last for 60 to 90 seconds. Expect to feel pressure in your lower back and rectum.

“At this time, you may or may not feel a strong urge to push,” Bellamy says. Having an epidural for pain relief may affect your urge to push. Tell your health care team if you feel the need to push. But don’t do so until they give you the okay. Pushing too soon could make your cervix swell and tire you out.

The pushing stage is shorter than the first stage of labor. For first-time moms, it can last anywhere from 20 minutes to two hours. After that last big push, your baby emerges from the birth canal.

What happens after your baby is born

Once your baby has arrived, it’s time to cut the umbilical cord. Your ob-gyn can take care of that. Or your partner or support person may want to do it. You will be encouraged to hold your baby directly against your bare skin immediately after delivery. This is called “skin-to-skin" contact. The labor and delivery nurses can dry, wipe off and check your baby’s vitals at the same time.

Following that there is a third stage of labor — delivering the placenta. The process of delivering the placenta typically begins right after delivery. It may take 15 to 30 minutes to complete. You’ll experience more contractions. “But these are closer together and not as painful as earlier,” Bellamy says.

This is also the time that your provider will stitch up your episiotomy, if you had one. An episiotomy is a surgical cut that widens the opening of the vagina during childbirth. Not all women need one. But it may be done to help your provider deliver your baby.

After that, it’s time to focus on your new baby. Skin-to-skin contact helps encourage a new baby to start breastfeeding, according to ACOG. It also helps your baby adjust to life outside the womb. Snuggle up together and enjoy getting to know the newest member of your family.

Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association.