After hours (and sometimes days) of labor, you’re finally 10 centimeters dilated! Giving birth is extremely overwhelming, and I’m hear to walk you through it from my eyes! If this is your first baby, you may need to push for a little while before we meet your lovely bundle of joy. An average amount of time a first-time mom pushes is right around the 2 hour mark.
I know, that sounds like forever. The reality is, your body has never had something as big as a baby pass through your vagina before, and it just takes some time for baby to squeeze through your pelvis. This is an average though, and some patients only push ONCE (and then I deliver your baby instead of the doctor/midwife!!)
No worries though, your labor nurse will be there with you for every push! Usually, I tend to push with a patient until the top of baby’s head comes underneath your pubic bone, and stays there. AKA, you’re crowning.
Once you’ve pushed baby down far enough to where I feel like it’s appropriate to call your doctor or midwife, A WHOLE LOTTA STUFF GOES ON.
I begin by calling your doctor/midwife and a few extra nurses to your room. Generally, if there are no complications we are aware of at the time, I would call my charge nurse and a newborn specialist to take care of baby once you deliver. Usually a scrub tech (nurse aide) will come to your room as well if available.
My charge nurse is there to help with any extra computer charting, offer an extra set of hands for those last few pushes, and for moral support. She is also there to assist in case an emergency arises.
The newborn specialist is present to do just that, take care of baby! She is usually designated to assign Apgars, dry and stimulate baby, suction baby, and get baby skin-to-skin if able. Although, I am fully able to assume this role if there is no baby nurse available at the time. All L&D nurses are trained in neonatal resuscitation immediately after birth, so no worries there!
During the next hour, the newborn specialist will be performing a head to toe assessment of baby, getting frequent vital signs, and doing baby’s measurements. She will also give baby a vitamin K shot, and an antibiotic eye ointment. Both of these are optional, and can be done at a later time if you wish.
IMMEDIATELY AFTER YOU DELIVER
Nowadays, most hospitals will do delayed cord clamping for at least one minute, unless baby comes out and needs immediate intervention. This has come into standard practice, which is great! After the cord has been clamped, your partner (or whomever you choose) can cut the umbilical cord, and you can begin immediate skin to skin with baby.
At this point, you still have half of an umbilical cord hanging out of you, and an entire placenta still inside that needs to come out. Generally, the placenta detaches on its own, and you will deliver it in the next 5-10 minutes after baby. Sometimes taking up to 30 minutes. The placenta doesn’t hurt nearly as terribly as baby coming out, but it’s still not awesome. It’s basically like giving birth to a huge mound of Jell-O.
After the placenta is delivered, your doctor/midwife will be performing fundal pressure. This is done to assess how your bleeding is, and if your uterus is firm and acting the way it should after delivery:
When you are pregnant, the capacity of your uterus expands to over 500 times larger than it was pre-pregnancy! After it expels baby and placenta, it’s still pretty stretched out.
Given that it’s a huge muscle, its primary job after delivery is to contract and shrink down to its pre-pregnant size. This is a process, (it takes about 6 weeks to shrink completely), but it begins immediately after birth.
It’s important for it to be doing its job, because if it’s not shrinking down effectively, you can have a whoooole lot of extra bleeding and it can actually be super dangerous. In fact, this is the #1 way woman used to die in childbirth. Luckily we’ve made a lot of advancements since then, and birth mortality is at an all time low in the world.
OKAY, LET’S TALK ABOUT THE BLEEDING SOME MORE
So, now that your placenta is out, I’m going to be doing a few things to make sure we don’t have all that scary bleeding!
You’re going to have SOME bleeding (in fact you’re probably going to think it’s a lot), but my PRIMARY job right now is to make sure it stays under control.
One thing I do is give you PITOCIN (Oxytocin) through your IV. This is the same Pitocin you had during labor if you were induced, I just give you a heck of a lot more. Pitocin helps to make sure your uterus is doing its job of contracting down. Although don’t worry these uterine “contractions” don’t hurt the same way that they did during labor!
The other thing I do is give you a massage!! A FUNDAL massage. Even though they contain the word FUN, there is nothing fun about them. Fundal massage consists of me pressing HARD on your stomach, to make sure your uterus is in the right area and that it’s nice and firm.
Unfortunately, I need to do these massages every 15 minutes for the next 2 hours while you are still in L&D. Once you transfer to postpartum, your nurse will perform them much less frequently.
Once your doctor/midwife feels your bleeding is controlled right after delivery, he/she will leave and we will get you cleaned up. This is the time when you can eat, recover a bit, and let your family in to see you and baby. This is also the time when you will breastfeed baby for the first time, if that’s your preferred feeding method.
You will stay with me for approximately 2 hours before heading to a postpartum room. Some hospitals keep you in the same room for your entire stay. Either way, after 2 hours, we will bother you a lot less!
Learn more about postpartum here, and 7 strange symptoms to watch for.
I hope I’ve given you a glimpse into what’s to come! There is SO much info you process when you come to have your baby, and I know it can be very daunting and outright confusing at times.
Just know that as your labor nurse, I always have your best interests at heart. I am your advocate, and I’ll always be on your side. With that said, here’s to a happy and healthy delivery!
HEY HEY! I see you are probably in the middle of packing your hospital bag…before you read anything else, CHECK THIS OUT! Hillary from Pulling Curls is a fellow labor and delivery nurse, and she created a fantastic ONLINE PRENATAL COURSE. That’s right, she goes over EVERYTHING, and you don’t have to even have to leave your couch! You get all the benefits of a traditional in-class style course, but you get to enjoy it from the comfort of your own home. There’s even a Beginning Prenatal Class you can try FREE first if you’re not prepared to buy anything right now. Pretty brilliant if you ask me! 🙂
Founder, Labor Teen