When you haven’t had a baby before—or even if you have—you might have questions about what actually happens when it’s time for the baby to be born and you leave for the hospital. While what we discuss here won’t be the case everywhere, there are some general things you can expect when you’re planning a hospital birth.
When to go in
First, you might head to the hospital when you’re already in labor, or you might have a scheduled induction, where you and your care provider have planned together for you to come in to the hospital to get the labor process started. If you’re heading to the hospital in labor, call the labor and delivery unit and your care provider and let them know that you’re coming. That way, they know to expect you and can hopefully have a room ready for you. This call also gives your provider a heads’ up that you’re on your way in and may be staying at the hospital to have your baby.
If you’d like to avoid pain medication and a longer hospital stay, the advice is usually to labor at home for as long as possible before you go into the hospital. Laboring at home has advantages. You’re comfortable in your own clothes and space. You can eat your own food and do what you want—watch TV, play your own music, work on projects, nest and get baby’s space ready, and move in whatever way you’d like. Your partner might be able to keep sleeping while you labor, which is much harder for them to do in a cramped hospital room. On the other hand, if you’re group B Strep positive and your water breaks or your contractions are four to five minutes apart (or closer), your care provider will usually want you to come in so that you can begin receiving antibiotics that will help prevent complications in you and baby that can arise from group B Strep.
Induction or scheduled cesarean
If you’re scheduled for an induction or planned surgical birth, which usually happens for a medical reason, you’ll start your labor or be prepped for surgery at the hospital. As discussed above, coming in for an induction or surgical birth is usually scheduled, so the nurses and providers in labor and delivery know to expect you. They also will likely have a plan about how to proceed with your induction or surgery, which will depend on provider practices and policies at the hospital. If you’re going in for a scheduled C-section, you’ll likely be given instructions not to eat after a certain time the night before to minimize the risk of aspiration when receiving anesthesia.
And induction-wise, if you’re trying for a vaginal birth after cesarean section (VBAC), the safest way to induce your labor is with dilation (sometimes called a cervical ripening balloon or a foley catheter) followed by administration of synthetic oxytocin or Pitocin, a medicine that encourages your uterus to contract. If you haven’t experienced a previous surgical birth, you might also be offered a cervical ripening agent, types of medicines that are taken orally or placed directly in the vagina at the cervix to encourage the cervix to soften and thin.
Regardless of whether you’re being induced or coming into the hospital already in labor, your nurse will likely start an IV in your arm or hand. At many hospitals, your IV might be attached to fluids that flow slowly into your bloodstream and help you stay hydrated. At other hospitals, you might just have your IV started and then what’s called saline-locked, where a small bit of tubing is attached to the IV catheter (a slim, flexible plastic tube that stays in your vein) and then it’s just clamped off. That way the medical providers have quick access to your IV if needed, but you’re not stuck to the IV pole. Another thing that many hospitals do is monitor you and your fetus either intermittently or continuously. The nurses may also collect some blood to run labs and ask you a ton of questions about your pregnancy, health, and labor.
Labor is going
Once your labor gets started and your uterus is contracting in a regular pattern, you’ll labor in the hospital. You’ll likely have access to pain medications if you want them, either opioids given through your IV or epidural anesthesia. Whether you have access to other types of labor support—nonpharmacologic pain relief like laboring in the shower or bath, food, doulas, respectful communication—depends on your hospital. Writing out and sharing your birth preferences with your care provider and hiring a doula are two ways to advocate for yourself and the experience you want for your birth.
As birth approaches
Throughout your labor, you’ll be offered opportunities to check your cervix and interventions that may change your labor, like rupturing your membranes (also known as breaking your water). Everything you’re offered at the hospital is optional—you don’t have to consent to anything. If you need more of an explanation, you can ask for it from your nurse or provider. How your care team handles the second stage of labor (you pushing your baby out) depends upon their standards of practice, your preferences, and whether your pregnancy and labor have been complicated by any extenuating circumstances (high blood pressure or gestational diabetes, for instance).
When baby has arrived, what to expect at the hospital depends on your preferences and how you and baby are doing. If everything looks fine and the care team doesn’t have concerns about baby’s transition from the womb, they will likely keep baby with you and examine baby while he or she hangs out on your chest or belly. If they follow evidence-based practice, they will delay cutting baby’s umbilical cord. After an hour or two of you spending some time with baby, the care team will likely take baby to a warmer in the room to weigh, measure, and assess baby. They’ll also probably monitor your blood pressure and bleeding following birth, and if needed, give you medications or fundal massage to help your uterus contract and stop bleeding. Once you’ve recovered for a few hours, you’ll likely be moved to a postpartum room where you and your family can stay for 24-72 hours to adjust to your new family member before going home.