Things Labor & Delivery Nurses Wish You Knew!
I have to admit, I’m a lucky duck when it comes to easily accessible knowledge of everything baby. Some of my best friends are nurses, specifically working in Labor and Delivery (L&D), the Neonatal Intensive Care Unit (NICU), and Postpartum departments of well known hospitals in the Central Valley of California. If I have a question, I simply shoot a text to one of these ladies and they are constantly helping me clarify things that I am confused about, or even things that may be contradictory to what I’ve heard/read/learned in my crunchy birthing class/etc.
When I found out I was pregnant, one of the most terrifying parts to me was labor, delivery, the chances of the worst happening, and postpartum. I mean, pretty much every mom with a bad birth story comes out of the woodwork ready to scare the hell right out of you when you announce your joyful news. From the day it becomes ‘Facebook Official’, moms (with the best of intentions) reach out to give you advice. I know, I feel like I’ve heard it all! But what isn’t so apparent, is the actual medical advice that I sought from my educated friends with tons of experience at the bedside of real moms, day in and day out.
This blog post, along with two others, will complete a three part “What Your L&D/NICU/& Postpartum Nurse(s) Wish You Knew” series! Why should I be the only one with access to this critical, first-time-mom, good to know info?! Tag your momma friends, and lets educate some ladies before they even hit their first contraction!
Please note, names with an asterisk (*) have been changed in this dialogue to protect identities. The following statements are in no way endorsed by your specific doctor or follow your specific health needs. Always consult your doctor or healthcare professional prior to starting, stopping, or continuing any advice outlined in the following post. Take what you can, and be sure to ask questions to your healthcare provider.
Part 1: Labor & Delivery.
*Courtney has been working as a labor and delivery nurse for three and a half years. She is a registered nurse, and has a knack for helping expectant mommas work through pain to meet the little guy or gal that will change their lives forever. This is her list of items she wants you to know!
First things first, you need to know the process.
This post will be very little help to you if you don’t understand the process from body and mental changes, to medical terminology. Let’s start with an explanation of labor in general! Click the links on any of the medical words in these first sets of bullet points that you may not understand to better assist you. There is NOTHING to be embarrassed about, you don’t know what you don’t know!
Your cervix (an opening located at the end of your vagina/birth canal, typically closed until labor begins) will dilate, or open, eventually all the way to 10 centimeters (think the diameter of a wiffle ball), at which point, your baby can begin the descent into the birthing canal (your vajayjay).
The process of dilation can be long and unpredictable. Prepare for a long, uncomfortable process. Birthing classes are a good idea, whether through your hospital, Lamaze, Bradley, or other coping methods and measures to assist you with a calm, educated labor and delivery.
The process of dilation involves contractions that are strong enough, and frequent enough to make cervical change. This does NOT mean if you’ve had contractions for a day straight that you are ready to deliver a baby.
1-4 centimeters of dilation is considered “early labor” and may be painful, but is still not considered “active” until at and after 4 cm. People can experience many different lengths of “early labor” and confuse this with “active labor” often.
Early Labor + Normal “Active” Labor = Dilation to 10 centimeters, then you can push and deliver the baby! YAY!
Now, how your body changes throughout labor.
The next portion will explain the physical and mental checkpoints you may pass through from early labor discomfort, all the way to delivery!
During “early” labor, pain can be manageable, but is consistently increasing. You can become irritated and uncomfortable. To aid in relaxation, take hot baths, ask your partner for a massage, anything to make yourself comfortable for the duration of this stage. Ideally, you will manage your pain levels at home during this part of labor.
When pain becomes intolerable, and you are unable to walk or talk through contractions, this is a good rule of thumb to head to the hospital.
If your water breaks at any time, you should get to the hospital.
Once you are assessed at the hospital, if they deem that you are in fact dilated to 4+ centimeters, you will be admitted and begin “active” labor.
Body changes during the “active” labor stage can include: nausea, vomiting, hot flashes, sweating, need to urinate more often, and increased pain and pressure as contractions intensify.
At this point, you will be offered pain relief methods such as: IV pain medication or epidural.
Should you elect to go without medical pain relief, you will want to utilize natural pain relief methods such as: visualizations, prayer or meditation, music, diffusing essential oils, massage, counter pressure, changing positions, etc.
Next is the “transition” phase of labor, which will last from 7-10 centimeters. Once you are fully dilated to 10 centimeters, you are considered “complete”.
Body changes during “transition” can include: shaking (sometimes uncontrollably), feeling like “I can’t/don’t want to do this anymore” (this is an important time to have a support person to assist with the feeling of hopelessness, also a sign that you’re crossing a mental checkpoint into the “transition” phase), feeling intense vaginal pressure (like you may need to poop, or something is “down there”), or feeling like you need to push.
You can sit in transition phase depending on baby’s status, some doctors may allow you to “labor down” meaning you allow the contractions to do the work, while you tolerate the pressure of the contraction to bring the baby down without you having to actively push.
This is only typical in patients who receive an epidural, as those delivering naturally will feel an intense natural urge to push each time they have a contraction.
For a first time mom, pushing can go on from 10 minutes to 2+ hours, with or without an epidural. Be prepared for the workout of your life. At this time, your nurse will coach you through effective pushing techniques and will prompt you when you have contractions if you are unable to feel them. As your uterus contracts, it is squeezing baby down and out, so each time you also push with a contraction, it is essentially doubling the force to deliver baby.
“Complete” + Pushing = Baby!!! Good job!
Other things to know
Now that you understand the logistics of labor and what will happen to your body, we can provide you a bit more information about items you may not be aware of!
After birth, you will continue to experience cramping, this time more similar to actual period cramps as your uterus goes back down to normal size, these cramps can last for 2-3 days after child birth and can also be brought on when you breastfeed. This is completely normal and nature’s way of making sure you don’t bleed to death.
The full time it takes for your uterus to reach its original size, pre-pregnancy can be weeks. This is also associated with bleeding similar to a normal period. This will start with heavy days, then lighter days, panty liner days, discharge, and then all bleeding will cease.
You should do research and prepare yourself before you go into the hospital to know what your hospital offers as far as equipment available for labor (birthing balls, peanut balls, birthing bar, etc.)
You will have many decisions to make during the labor process that you should consider prior to feeling your first contraction. You should make your wishes regarding medical interventions known to your doctor and all nursing staff caring for you including, but not limited to:
Breaking your water
Use of pitocin
Medical pain relief (IV pain medication or epidural)
Who you want in your room during labor and delivery
Delayed cord clamping
Cord blood banking
Skin to skin (additional or less time than the hospitals normal policy)
Newborn medications for baby
Hospital’s policy on rooming in, meaning parents keep the baby with them at all times, versus sending baby to other rooms or nursery for tests, rest, etc.
Tough decisions that may need to be made in emergency type situations (think of the worst and best possible outcomes and give hypothetical decisions to spouse or support person)
Have a mental birth plan but do not bring your 3 page, single spaced, typed plan to the nurses. The nurses will make fun of you.
Setting high expectations on your birthing experience will set you up for disappointment or feeling inadequate if things must change. This drastic change of plans can make you feel like ‘less of a woman’ or regretful that your birthing experience did not go according to your highly detailed plan. While it’s important to know your decisions, rights, wants, and needs and to have a basic outline of what your desires, it is equally as important to allow the medical side, crunchy (holistic) side, and practical side to come together to have a safe and happy birth experience. Things change at a moment’s notice, it’s important to have an open mind. The main goal of your experience is to have a safe delivery for mom and baby, whatever it takes to achieve that is what all parties are trying to accomplish.
Know that your nurse genuinely cares about you and your baby. These are real people, working long hours at all times of the day and night to accommodate your requests, help you feel more comfortable, and to safely guide you through labor and delivery.
If you are grateful for your nurse’s services, get her or him a prepackaged snackiepoo. They will be grateful.
If you had a good experience, thank the staff, or do something nice. They work 12 hour shifts, day and night, birthdays, anniversaries, holidays, and more to support you and your family during these amazing moments.
“We do genuinely love our jobs and what we do. Each birth is special. It’s pretty cool what I do.”
And there you have it! Nothing too scary about medical knowledge, not that this will be exactly how your particular birthing experience plays out. At the end of the day, you have to remember, everyone is on the same team, with the same end goal. It is important to know what is going on with your body, and to listen to the advice of your doctor and nursing staff, or midwife if you are delivering outside of a hospital. Get ready for the ride of your life, and remember that the pain and work are only temporary.
See you soon with Part 2: If Your Baby Ends Up In The NICU