8 Questions For A Labor & Delivery Nurse: What Every Woman Needs To Know
The unknowns about labor and delivery can cause lots of stress for expectant mamas and we get so many questions from our community about what to expect during childbirth. Whilst it’s important to remember the experience will be unique for every woman and every baby, we want to answer as many of those questions as we can. So we sat down with Labor & Delivery Nurse Lauren Marino to ask her the top 8 questions women want to know about Labor and Delivery. Let’s dive right in…
1. How is home birth different from a hospital birth? Is one safer than the other?
Lauren says: In the US, home births account for roughly 1% of all births each year, in the UK, it’s around 2%. Deciding between the two really depends if you have any risk factors that indicate that you or your baby may need extensive medical care during or after delivery.
In terms of safety, home births are associated with lower rates of maternal labor intervention. They can also be very intimate and personal for the whole family, promoting unaltered and unmedicated labors often using water and other midwifery techniques.
However, research shows that women who have home births are twice as likely to experience perinatal death; to put that into perspective, with hospital births in the US, perinatal death occurs in 1.8 births per 1000, with planned home births that number increases to 3.9 per 1000. The risk of neonatal seizures and impaired neurological function also triples, but it’s important to note that these events still occur in less than 1.3 per 1000 births. Another risk of having a home birth is that there is still a chance (up to 37%) that the mother, the baby, or both will need to be transferred to a hospital either before or after delivery due to complications (such as excessive bleeding or severe laceration, infection, shoulder dystocia, or labor has stopped progressing).
The decision to give birth at home versus a hospital should be thoughtfully planned as far in advance before birth as possible.
2. Should women bring a birth plan with them to the hospital?
Lauren says: Coming to the hospital prepared is always a good idea! A birth plan is a checklist that you fill out indicating your wishes in terms of your environment during labor, which non-pharmacological pain coping mechanisms you’d like to try (check out question number 3 for more on this!), and guidelines for medications or interventions you do or do not want to be offered to you.
Birth plans should be constructed with knowledge about the interventions you’re planning out as well as considerations for your unique condition in pregnancy/delivery. So it’s a good idea to do some research into what you would like on your birth plan ahead of time and then discuss it at a prenatal appointment with your provider. If you do not want to bring a written out birth plan with you to the hospital, it is still a good idea to take a basic childbirth class to understand what to expect.
Finally, remember to advocate for yourself so you can have the positive birth experience that you desire!
3. What are some non-pharmacological pain management techniques women can use during labor?
Lauren says: Some natural techniques that commonly work for laboring women include:
Taking a bath or shower with warm (not hot) water
Sitting on a birthing ball
Using breathing techniques
Dimming the lights and listening to relaxing music
Using your birth support person to provide counterpressure where you feel pain
Squeezing a fine-tooth comb in your hand during contractions
There are many options and things to try, so it’s a good idea to have practiced or researched methods that may work for you prior to actual labor!
4. If a woman is being induced, what should they expect?
Lauren says: When induction day arrives, you will most likely be instructed to call the labor and delivery unit to confirm that they have enough nursing staff available to safely start your induction on time. Once you arrive at the hospital, the healthcare team will do a number of admission tasks such as checking your cervical dilation, placing an IV, drawing your blood for baseline values, and monitoring your baby’s heart rate. You’ll be given medication or have a cervical balloon placed to start the induction depending on your health history and cervical exam.
Some women get told to go to sleep after being induced…Why is that?!
Lauren says: That’s right! Inductions can take many hours — it’s sometimes up to 2 or 3 days before your baby is born! So it’s best to get as much sleep as you can before your contractions get painful and you’re actually in labor. Once you are feeling pain, it’s a good idea to walk around your room or the halls, utilize birthing balls, or take a bath or shower (if your hospital allows). From there you will have the choice to take pain medication, get an epidural, or continue to labor unmedicated.
5. What are the pros and cons of epidurals? Are there any side effects?
Lauren says: One of the pros of epidurals is getting contraction pain relief, which allows women to rest before they have to push. It will also help cover your pain after the baby is born when your provider is repairing any lacerations that occur. Some women who are too tense in labor actually dilate more after getting an epidural due to their muscles relaxing! Additionally, if you are in need of an urgent cesarean section, you’d be able to stay awake for birth during the surgery instead of needing to be put under general anesthesia.
Depending on the person you ask, the cons can include not being able to consume solid food after the placement (until after you deliver the baby), being unable to walk/move around outside of the hospital bed, and having a slight chance at a longer pushing phase of labor.
One completely harmless side effect that is seen daily is involuntary body shakes due to the anesthetic medication. Another is the potential that your epidural may not cover your pain perfectly due to where the catheter sits in the spinal column; luckily these can sometimes be troubleshot and fixed. Some women also experience a drop in blood pressure after the first epidural dose is initiated, but this can be resolved with IV fluids and medication. Other more rare side effects will be discussed with you prior to placement.
6. Once a woman is in labor, how long until the baby arrives?
Lauren says: Ah, the million dollar question! Every woman and every pregnancy is different, there are no two alike. Early labor, called the latent phase, is what generally takes the longest. This is defined as cervical dilation between 0-6 centimeters. On average, a first-time mother’s latent labor phase takes 20 hours, while a woman’s subsequent delivery latent phase averages 14 hours.
Active labor, referring to 6-10 centimeters dilation, generally progresses faster at an average of 1-1.5 centimeters per hour. Once a woman’s cervix is fully dilated and the baby is low enough to begin pushing, that phase can also vary in length depending on factors affecting the labor; including powers (contraction strength), passenger (size and position of baby), and passage (the mother’s pelvis and anatomy).
7. Is there any way to avoid tearing during delivery?
Lauren says: There are many factors that play a role in if a woman’s perineum will tear or not. Surprisingly, up to 80% of women will experience some degree of laceration if they have a vaginal delivery. Increased fetal birth weight & operative vaginal delivery (vacuum or forceps) are the two most common influences.
To avoid tearing, you could try perineal massage leading up to delivery and your provider may utilize perineal support while you are pushing. There are some pushing positions that may also help avoid tearing including side-lying, kneeling, and squatting. Remember that despite these actions, it is highly common for a woman to tear during birth but the recovery is generally more favorable over episiotomies*, which are not widely used at most hospitals anymore.
*An episiotomy is when a doctor or midwife makes a cut in the area between the vagina and the anus during childbirth to make the opening of the vagina a bit wider, allowing baby to come through it more easily.
8. What should be expected during a hospital stay after baby is born?
Lauren says: After birth, you and your baby will be monitored closely by the healthcare team to ensure you are both healthy and recovering from delivery. This includes frequent checks of your vital signs, laceration or cesarean incision, vaginal bleeding, and assisting you to walk to the bathroom for the first time after delivery.
For baby, the hospital team will measure vital signs, along with initial assessments and measurements, to ensure that baby is transitioning well from in utero. There will also be a number of standard tests to be completed for baby prior to discharge, including hearing screenings, jaundice checks, daily weights, oxygen saturation testing, and sometimes blood draws for blood sugar monitoring or the newborn screen. Nurses or lactation consultants will also be available to assist you in learning how to latch the baby if you plan on breastfeeding, or help you learn how to bottle feed properly.
Something else you want to know about Labor & Delivery? Ask away in the comments!
This post was written in collaboration with Lauren Marino
Lauren has a Bachelor of Science in Nursing degree and is currently working in California as a Labor & Delivery nurse. She has also worked as a Registered Nurse in Fertility Case Management and Postpartum. She is an active member of AWHONN, a non-profit organization directed at helping promote the health of women and newborns. In her career, Lauren has strived to find the gaps in patient care and help connect patients with the knowledge they need to feel more prepared for pregnancy, childbirth & the immediate postpartum period. Lauren is also a mother to Sophia, who is now 10 months old.
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