What to expect during L&D???

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I am almost 32 weeks pregnant and starting to become more and more anxious over labor and delivery. I graduated nursing school 4 years ago and don't remember much from my maternity rotation (zero interest in L&D or having a baby...then an 'oops' happened). I'm just wondering what a typical experience would be in terms of amount of lady partsl exams to expect, interventions to expect, what your "ideal patient" is like, what interventions can be declined, etc. I am older (turned 35 in April, due Sept 1st), but otherwise have been considered low risk (no htn, no diabetes, no placenta previa, weight gain has been perfect, baby measurements have been perfect, fundal measurements have been exact, etc.).

The only thing I am absolutely positive about is an epidural. The one thing I do remember from nursing school is the lady partsl delivery I watched of a first time Mom who went totally natural, no pain medications at all, and she moved around that bed like a dying animal. It was horrifying. That cemented the idea of an epidural.

Any input would be greatly appreciated!

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Specializes in LDRP.

A lot of it will vary based on provider/facility. You will likely be admitted through OB triage either because your water broke or you have been having contractions and your cervix has dilated enough that they think you are in labor. If you come in in early labor, you may be sent home and told to come back when contractions get more intense/regular, or you may stay in triage for a couple hours getting re checked to see if you are making change.

If you have a scheduled induction you will show up at a date and time agreed upon with your doctor and put right in a room. There are different kinds of inductions (cervical ripening, mechanical, pitocin, AROM). Inductions usually take a long time, especially in first time moms, so if you are being induced, be prepared to be there for a while (not unusual to have the baby a day or two after the induction starts).

lady partsl exams will vary. Where I work if someone is on pitocin they get checked every two hours, but if they are resting comfortably their check might be deferred another 2 hours. If they aren't on pit there are no hard and fast rules but many times we stick to the every 2 hours, or when mom is feeling changes/we see changes in the fetal heart rate. You can refuse a check if you don't want one at that time. They are kind of uncomfortable (more so for some people than others), but once you have an epidural they are relatively painless.

You can decline most interventions. Your provider will go over the risks and benefits of each before doing them. Generally any intervention we do is for the benefit of you and/or the baby. Some things may be non-negotiable like fetal monitoring if you are hooked up to certain meds/have certain risks, IV fluids if you have an epidural, a catheter (either straight cath or foley) if you have an epidural, etc.

There is no real ideal patient, every birth is different. As long as you are kind and respectful to your nurses/doctors, we don't care that much. We can handle a little yelling and swearing during labor (just don't take it out on us--take it out on your partner if you must, haha.)

Your provider will be able to answer a lot of your questions. Also ask about doing a tour of the L&D unit. They will explain a lot of their procedures and you will have an idea of what will go on at that particular facility. Good luck!

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I would recommend a prenatal/birthing class.

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Specializes in MS, OB.

To add to what everyone has said--- try to make your main goal: healthy mom and baby. In my experience, the more rigid the patient is about their "ideal" labor and delivery, the more disappointed you will be.

As for going natural vs epidural-- it is possible to have a non-medicated birth if you want to. I had 3 of them and did not die. I'm not saying that you should avoid an epidural, but keep an open mind. You might surprise yourself. Everyone's labor course is different. If you come in in active labor you might just roll along and deliver fairly quickly. Inductions tend to lead to epidural because it drags out and no one want to be uncomfortable in the hospital for hours and hours. Try to labor at home as long as possible. Walk, take a shower..the longer you stay out of bed, the better. Others may disagree, but I find that the women that move during labor go faster. As I said, our ultimate goal is always to have a healthy happy mom and baby. How you get there is your personal choice. Good luck and congrats!

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Specializes in OB.

I highly encourage any first time parent to take a comprehensive childbirth ed course to get prepared for labor and birth. Knowledge is power! If you don't know what you don't know, childbirth ed can help you become familiar with the process of labor as well as how to cope (with or without an epidural). You should take a tour of the hospital, as well as ask specific questions of your actual OB provider about how they practice (childbirth class will give you a good foundation of knowledge to know what to ask).

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An epidural is a pain intervention. While most women do end up getting one, it is entirely individual as to when you get it. At my facility as long as you can sit still for it you can get it whenever- even at 10 cm. Though at that point it is usually better just to push through the pain since it can take 15 mins to get the epidural in and another 20 to 30 for it to be effective. Move as much as possible. I love the epidural as I hate to see my patients suffering but honestly movement is the best method to move labor along and that can't be done as effectively with epidural.

Good luck. Baby comes as baby comes. Educate yourself but don't go in with clear cut expectations because every birth is different. C sections happen for many reasons (baby in distress, failure to vertically progress, failure for fetal descent) healthy baby is the best goal. And ask your nurse whenever you have a question. That is why she is there.

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Specializes in Reproductive & Public Health.

Agree with everyone above. You don't need special care in early labor and it tends to progress faster when you are at home, where you can eat and drink and rest and go outside. It can be hard to figure out when you are actually in a solid labor pattern, and being in and out of triage a few times is really normal. If you are uncomfortable and sleep deprived at home, tell us and we can help you feel better while we wait for you to go into labor.

In terms of interventions- you are the boss. Talk about it ahead of time, ask questions and make sure you understand why certain things might be done and what your options are. If you want an epidural, you will need to be comfortable having an IV, continuous monitoring, and maybe needing a catheter, for example. Labor is too unpredictable for a concrete "birth plan," but we will go out of our way to meet your needs as much as possible. You might not be in a position to advocate for yourself when you are in the thick of it, so it helps to communicate your preferences to your team and to whoever is supporting you through the process.

Epidurals are pretty amazing. They are certainly not without risk but the safety profile is favorable. None of the grogginess of IV narcotics, and you retain a lot of mobility even though you are stuck in bed. There is nothing inherently commendable about unmedicated labor, and there are definitive medical benefits to adequate pain relief when you have a less-than-straitforward delivery. For most women though, it's just personal preference.

No matter what your pain management plans are, you will still have pain and discomfort because that's just how it is. So it is important to learn strategies to ride it out. A good childbirth ed class is very helpful. And for some women a doula is a lifesaver.

I genuinely enjoyed my unmedicated births, but if I had another baby I would use nitrous, 100% for sure. Nitrous is *the best* for labor.

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Specializes in Critical Care.
To add to what everyone has said--- try to make your main goal: healthy mom and baby. In my experience, the more rigid the patient is about their "ideal" labor and delivery, the more disappointed you will be.

As for going natural vs epidural-- it is possible to have a non-medicated birth if you want to. I had 3 of them and did not die. I'm not saying that you should avoid an epidural, but keep an open mind. You might surprise yourself. Everyone's labor course is different. If you come in in active labor you might just roll along and deliver fairly quickly. Inductions tend to lead to epidural because it drags out and no one want to be uncomfortable in the hospital for hours and hours. Try to labor at home as long as possible. Walk, take a shower..the longer you stay out of bed, the better. Others may disagree, but I find that the women that move during labor go faster. As I said, our ultimate goal is always to have a healthy happy mom and baby. How you get there is your personal choice. Good luck and congrats!

You sound like my mom (who had 11 babies, all of them natural). Her number one piece of advice to me when I was 18 and pregnant was to stay out of bed, on my feet, and away from the hospital until there was a real reason to go. I might have taken that advice a bit TOO much to heart as my kiddo was delivered 15 minutes after I arrived at the hospital (and very nearly made it out BEFORE I got there). But! I did enjoy a very fast labor and easy delivery and was up and about quickly afterwards as well :)

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I just wanted to say thank you to everyone who responded...the info really helped! I also want to say I have a whole new respect for L&D nurses and what you have to deal with...I can only imagine some of the patients you have that refuse to sway from their birth plan no matter what. I would have to think pregnant women (and their families) have to be the most fickle group of patients out there.

I had in my head I wanted to labor at home, didn't want AROM, didn't want to have a lot of lady partsl exams, and didn't want to be tied to a bed with monitoring. Well, all that was tossed out the window in a hot second! My blood pressure went up when I was 37 weeks, I kept an eye on it at work. At 37w 6d, I was at work and it sky rocketed. I called my provider and was told to head upstairs for an assessment (I work where I was delivering). I fully expected to be sent home on bed rest, but, nope...they started to induce me. I was totally unprepared. After 48 hours, 1 round of Cervidil, 2 rounds of Cytotec, 1 round of pitocin, AROM, 10 lady partsl exams, continuous monitoring, 90 minutes of pushing, and 1 truly amazing epidural, my little guy finally arrived!

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Specializes in OB.
I just wanted to say thank you to everyone who responded...the info really helped! I also want to say I have a whole new respect for L&D nurses and what you have to deal with...I can only imagine some of the patients you have that refuse to sway from their birth plan no matter what. I would have to think pregnant women (and their families) have to be the most fickle group of patients out there.

I had in my head I wanted to labor at home, didn't want AROM, didn't want to have a lot of lady partsl exams, and didn't want to be tied to a bed with monitoring. Well, all that was tossed out the window in a hot second! My blood pressure went up when I was 37 weeks, I kept an eye on it at work. At 37w 6d, I was at work and it sky rocketed. I called my provider and was told to head upstairs for an assessment (I work where I was delivering). I fully expected to be sent home on bed rest, but, nope...they started to induce me. I was totally unprepared. After 48 hours, 1 round of Cervidil, 2 rounds of Cytotec, 1 round of pitocin, AROM, 10 lady partsl exams, continuous monitoring, 90 minutes of pushing, and 1 truly amazing epidural, my little guy finally arrived!

Congrats! Hope you are all well.

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