What Will Giving Birth Be Like?

Where Will I Have My Baby and Who Will Assist Me During the Birth?

Choosing where you will have your baby is an important decision. Hospitals and birthing centers have different rules about how you have your baby and how to take care of the baby after it is born. Talk with your health care provider about where you would like to have your baby. Make a plan for how you would like your labor and delivery to go. See page 33 of the booklet, "Your Guide to a Healthy Birth," for a sample plan.

Some low-risk women even choose to give birth at home with a midwife. If you choose to give birth at home attended by a midwife, be sure that he or she is licensed in New York State. Also, be sure that your midwife has an agreement with an obstetrician and a birthing hospital in case you or your baby have complications during labor and you need to be admitted to a hospital.

When you talk with your health care provider to choose a hospital or birthing center, ask these questions:

  • What hospital or birthing center would be best for me and my baby?
  • If my baby or I have complications, can the hospital or birthig center care for me? Will I need to be transferred to another hospital? Can my baby and I be transferred together so I can stay with my baby?
  • If either of us has a problem and we are transferred to another hospital, who will be my health care provider there?

Be sure to check out the hospital or birthing center where you will deliver. New York State Hospital Profile contains information on hospitals in New York State.

Visit the hospital or birthing center you've chosen and ask questions. It's important to know ahead of time if the hospital or birthing center and staff will support what you included in your birth plan.

Hospitals and birthing centers should also give you written material that explains labor procedures. You should also receive hospital and birthing center statistics. These are in a "Maternity Information Leaflet." You may also receive information about other services, such as birthing and breastfeeding classes.

Many hospitals and birthing centers offer tours of their maternity floors and give you a chance to ask questions.

You might want to know:

  • Can my support person stay with me the whole time during labor and after I have the baby?
  • Can I walk during labor or use a shower or hot tub for relaxation?
  • What can I drink or eat when I am thirsty or hungry?
  • What will I be allowed to do to comfort myself or relieve pain?
  • Will I need a fetal (baby) monitor to keep track of the baby's heart while I am in labor?

Remember to take your birth plan to the hospital or birthing center. This will help you remember the questions you want to ask.

It is important for you to deliver in a place that can give you and your baby the best care. You may need to deliver at a hospital with experts who can help during and after labor and delivery. This is true if you have a medical problem such as a heart condition, or if your baby develops problems.

It is also important to see if the hospital or birthing center you chose accepts your insurance. Find out early so you can make a different choice, if needed.

You're Ready to Have Your Baby!

You are getting closer to having your baby so be sure you are ready!

  • Having someone with you during labor is important. Whether it is your baby's father, a relative, or a friend, having support will help you get through labor.
  • Be sure you know how to reach your health care provider at any time, day or night. Ask him or her when you should call about possible labor.
  • Plan your ride to the hospital or birthing center get child care for any other children, if needed.
  • Be sure to practice your route to the hospital or birthing center to be sure you can get there in a hurry. Remember, traffic will differ depending on the time of day. Be sure you know where to park and check in.
  • Pack a "labor bag." This way, the supplies to support you through labor will be in one place. Include items that will make you and your support person more comfortable during labor. Things you might want to bring include: your favorite pillow; snacks for your support person; and a CD player with your favorite music. Also pack anything else you might want while you are in the hospital.

Knowing When It's Time

Sometimes, especially for a first baby, it is hard to tell if you are really in labor. Don't be embarrassed if you go to the hospital or birthing center in false labor and end up being sent home. Babies usually come when they are ready and shouldn't be rushed!

Signs of labor may include:

  • Contractions that become uncomfortable, painful and more and more frequent.
  • Lower back pain or menstrual-like cramps that don't go away.
  • Your water breaks. It may be a small trickle or a large gush.
  • You have a brownish mucous discharge. This is probably the mucous plug which plugs your cervix. This could mean your cervix is dilating (starting to open) or becoming thinner. Labor may start soon after you see this discharge -- or several days after it appears.

Follow the directions of your health care provider about when to call and what to do.

Many women worry about the pain of labor. Don't worry. Labor is hard work but the payoff is your baby! During labor, your uterus tightens and relaxes. This causes your cervix to open. The cervix is the opening to your uterus. When your cervix is fully open, then you can push with the contractions to help your baby through the birth canal (vagina). Labor takes a different amount of time for everyone. Remember, each contraction brings you closer to holding your baby!

How Do I Manage My Pain in Labor?

Having a baby can be painful but it is so worthwhile. Everyone is different. It is important that you understand your options so you can have the best childbirth experience and a healthy baby to hug.

Before you go into labor, be sure to talk to your health care provider about managing your pain. Be sure to ask how different methods might affect you, your baby and your labor.

Natural pain relief – There are many things that a woman can do to ease labor pains. Some ways to ease labor:

  • Using breathing and relaxation techniques
  • Have a quiet, comfortable environment to promote relaxation
  • Change positions and move around as you desire
  • Take showers or warm baths
  • Use cold packs or heat on your lower back
  • Use a labor ball or chair
  • Listen to favorite music
  • Have a support person
  • Have massage or counterpressure on your lower back

If you plan on using natural methods during labor, talk to the hospital or birthing center staff beforehand so they can fully support your choices. Give your birth plan to the hospital staff when you arrive. A sample birth plan form can be found on page 33 of "Your Guide to a Healthy Birth."

Medicinal pain relief - There are also many different choices of medicine for pain relief. Be sure you fully understand how they work and how they may affect your delivery so you can make the right choice. There are two kinds of pain-relieving drugs in labor:

  1. Analgesics - These soothe pain without a total loss of feeling or the use of your muscles.
  2. Anesthesia
    • General anesthesia - This may cause you to lose consciousness.
    • Regional anesthesia - This will remove all feeling from parts of your body. For example, an epidural will block pain to the lower part of your body.

The following are options for pain relief in labor.

  • Intramuscular or Intravenous (IV) analgesic - Medicine can be given to you through a shot into one of your muscles. Or, you may have a needle inserted into one of your veins to deliver medicine. This is called having an IV. These medicines help ease the pain but they usually do not totally take it away. Side effects or some disadvantages of this type of pain relief:
    • You may feel drowsy and sleepy;
    • You may feel sick to your stomach, dizzy and you may throw up; and
    • These medicines also pass into the baby's bloodstream and cause the baby to feel sleepy as well.
  • Epidural anesthesia - A doctor injects medicine into the lower part of your back into the epidural space. An epidural blocks labor pain by numbing nerves to the lower part of your body. Side effects or disadvantages of epidurals:
    • It may lower your blood pressure temporarily and make you feel sick to your stomach or dizzy;
    • It may cause you to shake or you may become itchy;
    • Some women may get a headache; and
    • It may affect the natural urge to push/bear down when it comes time to have your baby since it affects your ability to feel.
  • Spinal anesthesia – The medicine is injected into your spinal fluid. The medicine numbs your lower body and gives immediate pain relief. This is often used for a C-section.

It is important to talk to your health care provider before you go into labor. You need to completely understand your options and make the choice that is best for you and your baby.

Make Sure Your Baby Is Ready!

Near the end of your pregnancy you may be uncomfortable or anxious to see your baby. Some women now choose to have labor induced or to have a C-section. Although it may be appealing to be better able to schedule your delivery or to relieve your discomfort at the end of your pregnancy, don't rush things.

Your health care provider may recommend an induction. This may happen because there are medical risks such as high blood pressure or problems with the baby. If this occurs, you need to fully understand why. Ask questions.

Unless your health care provider tells you that your health or your baby's health is at risk and you need an induction, be patient, don't rush things. Let nature and your body take its course.

Below is some important information about the induction of labor.

What Is Induction of Labor?

Most women will go into labor on their own after about 40 weeks of pregnancy and as they get close to their due date. Sometimes women have their labor induced because of a medical problem for them or their baby.

It is important to have all the information you can before you decide whether to be induced. Some questions to ask include:

  • Is there a problem with my health or my baby's health that makes it important for me to have an induction?
  • Why do I need this induction?
  • What happens if I wait to have the baby?
  • How will my labor be induced?
  • What are my chances of having a C-section if my labor is induced?

Labor may be induced if:

  • Your pregnancy is postterm (more than 42 weeks);
  • You have high blood pressure caused by your pregnancy;
  • You have health problems such as diabetes that may be worsened by your pregnancy or may harm the baby;
  • You have an infection in your uterus (chorioamnionitis);
  • Your placenta has started to separate from the uterus (abruptio placenta); or
  • Your water has broken and labor hasn't started.

There may be reasons why your health care provider believes induction is right for you. It is important that you fully understand the reasons. You should know how the induction will be done and the risks as well as the benefits.

Induction of labor may include:

  • Stripping the membranes –Your health care provider may choose to strip your membranes to help bring on labor. To do this, your health care provider will perform a vaginal exam and sweeping his or her finger over the membranes that connect the amniotic sac to the wall of the uterus. This may cause spotting and cramping. It may or may not result in labor.
  • Rupturing the amniotic sac (breaking your water) – Your health care provider may break your water to try to induce labor. It is important to note that this may not bring on labor. But, once your water is broken, you may need to receive medicine if labor does not begin.
  • Ripening the cervix - Your health care provider may put medicine into your vagina to induce labor or get your cervix more ready for delivery. These drugs may cause the muscles of your uterus to contract.
  • Giving medicine to start labor – Although it is not well understood, it is thought that the body releases oxytocin which brings on labor. Oxytocin is given through an IV and increased to the point where you will experience regular contractions.

Possible Side Effects and Risk of Induction

It is important to know that induction may have side effects and risks. Your health care provider should explain these fully so you can make the best decision for you and your baby.

  • You will most likely need to be on an external fetal heart monitor the whole time during your induction. Be sure to ask the staff if the hospital or birthing center has telemetry monitoring so you can move around. If not, you may be restricted to bed. This will limits your chances to use natural ways to comfort yourself. It also may increase your use of pain relievers.
  • Medicine such as oxytocins can result in labor coming on very quickly. It can also make your contractions stronger than if you went into labor naturally. This can lower your baby's heart rate. The oxytocin will be adjusted to help maintain your labor and your baby's heart rate at a safe level.
  • If you have an induction, you and your baby are at a higher risk for infection than women who do not have inductions.
  • If your induction does not work, you may go home or you may have a C-section.
  • Rupture of the uterus is a rare but possible complication.

A baby's lungs and brain matures late in the pregnancy. Sometimes it is hard to know exactly when the baby was conceived and when the baby is due (full term at 40 weeks). Having an elective induction may also result in having your baby before 39 weeks. An elective induction is one that is done for convenience or without a medical reason. This may lead to health problems for your baby.

New York State lists the rates of inductions at all hospitals in New York State.

Remember, the health of you and your baby is the most important thing when you choose to have a baby. You can get very uncomfortable and tired near the end of your pregnancy but don't rush it!

It you need to be induced for your health or your baby's health or you need a C-section for medical reasons, then it is important to do so. If not, be patient. Your body and your baby will let you know when it is time!

What about C-Sections?

Most healthy women can have their babies vaginally. The rate of women having C-sections has increased tremendously over the past 20 years. New York State is no different. For information on rates in various hospitals:

When would my health care provider recommend a C-section?

There are times when having a C-section is very important for the health of you and your baby. These are:

  • When you are carrying more than one baby;
  • You have health problems (HIV, herpes infection, heart disease, very high blood pressure);
  • You have problems with the shape of your pelvis or the baby is very large and will not fit through;
  • There are problems with the placenta such as a previa (the placenta is covering the cervix);
  • There are problems with the umbilical cord;
  • The baby is not in a good position – also called "breech;" or
  • The baby is showing signs of distress (low heart rate, etc).

When a woman chooses to have a C-section before labor, with or without a medical reason, it is called an elective C-section. An elective C-section may seem more convenient so you can schedule when your baby will be born. It may also seem easier than labor. But, a C-section is major surgery. It may put your health or your baby's health at risk. A C-section may also affect how you will be able to deliver your next baby.

It is important for you to fully understand what a C-section is and to have enough information to make a good decision about the best way to deliver.

What Questions Should I Ask Before I Have a C-Section?

  • What will happen if I do not want a C-section?
  • What are all of my options?
  • Can I stay awake during my C-section and have a support person with me?
  • Will I need a C-section in the future if I get pregnant again?

Do not hesitate to ask your health care provider all of your questions. You need to completely understand what will happen and why.

What Is a C-Section?

A C-section is when your health care provider makes a cut in your abdomen and uterus and removes the baby. Your baby will be delivered through this cut rather than coming through your vagina.

A C-section is major surgery. like all surgeries, there may be risks to you and your baby.

What Are the Risks to Me and My Baby?

The risks to the mother are generally thought to be greater from C-section than from vaginal delivery. They include:

  • More likely to develop blood clots such as a pulmonary embolism (blood clot in the lung);
  • Injuries to the bladder, ureter or bowel;
  • Longer period of hospitalization;
  • Increased chance of infection, such as a wound infection;
  • A greater likelihood of having a hysterectomy (removal of the uterus) in the early period following birth;
  • More intense and longer lasting pain after the birth;
  • Greater chance of rehospitalization for complications due to the surgery; and
  • Because a mother delivering by C-section will have less contact with her infant at first, she may have a harder time bonding with her baby. She may also be at greater risk for perinatal depression than a woman who has a vaginal delivery.

C-sections also have a significant impact on a woman's future pregnancies. If you have a C-section, you will have a:

  • Greater risk of ectopic pregnancies (the baby develops outside the womb);
  • Greater chance of infertility (inability to get pregnant);
  • Greater risk of placental abnormalities, including placenta accreta (having your placenta implanted into the lining of your uterus) or placenta previa (the placenta covering your cervix);
  • Greater chance of uterine rupture in a future pregnancy or labor;
  • Increased risk for placental abruption (the placenta separates, pulls away from the womb before your baby is born); and
  • Increased chances of life-threatening conditions with future pregnancies.

Elective C-section. This is a C-section which is done without a medical reason or before labor starts. These are discouraged before 39 weeks of gestation unless there is evidence of fetal lung maturity. This is also true of inductions of labor before 39 weeks gestation. Compared with births at 39 weeks, births at 37 and 38 weeks are associated with increased rates of problems. These include:

  • Fetal death;
  • Increased rates of respiratory issues and the need for mechanical ventilation;
  • Newborn sepsis (severe infection);
  • Hypoglycemia (low blood sugar);
  • Less likelihood of being breastfed than if the infant is born vaginally; and
  • Increased likelihood for the child to develop asthma both in childhood and adulthood.

What Are My Chances of Having a Vaginal Birth after Having a C-Section?

Some studies show that having a vaginal birth after a previous C-section (VBAC) can be dangerous due to the scar on your uterus. There is a risk of your uterus rupturing. Other studies show that under certain circumstances women who have already had a C-section can safely deliver a baby vaginally. It is important to talk to your health care provider about your options for a vaginal delivery or a repeat C-section. It is important that you talk with your health care provider and understand your options. This will help you and your health care provider make a decision that is right for you and your baby.