How can I prepare for my arrival at the hospital when I go into labor?
Well before your due date, you and your partner should prepare a bag with the items you'll need and map out the most direct route to the hospital or birth center. Find out where to park, keeping in mind that you'll be leaving your car for at least 24 hours, and find out where you should enter if you arrive after hours.
Most hospitals offer scheduled tours of the obstetrical floor. It's a good idea to take advantage of one of them if you can. The more familiar you are with your surroundings, the less intimidating labor will seem.
You'll also want to become familiar with the signs of labor beforehand. At some point before your due date, your caregiver should give you a specific set of instructions for when she'll want to hear from you and at what point she'll advise you to head for the hospital. (If you haven't nailed this information down yet, do so at your next prenatal visit.)
What do I do when I get to the hospital?
That depends on your individual situation and hospital policy, and often the time of day as well. In some cases, you'll come through the main hospital entrance and the staff at the front desk will send you directly to the maternity ward.
Sometimes (and commonly, if it's after hours), you'll enter through the emergency room and be transported to the maternity ward from there. If you aren't yet sure what to do, be sure to find out at your next prenatal visit.
Head for the nurses' station when you arrive at the maternity ward. The staff there will help you deal with any necessary paperwork. The rest can wait until after your baby's born.
At some hospitals, you can register ahead of time, so most of the paperwork will already be done when you arrive in labor. Check it out when you go for your tour, or ask your caregiver about preregistration.
A nurse may lead you directly to a birthing room and pair you with a labor and delivery nurse. If it's not clear that you're in active labor, or you need to be admitted for other reasons, she'll most likely bring you to an exam room first. Your caregiver will evaluate you there to see whether you're ready to be admitted.
What happens next?
Protocols differ, but to determine whether you're truly in labor and how you and your baby are doing, your caregivers will:
- Ask you for a urine sample and have you change your clothes. Your nurse will have you pee into a cup and use a dipstick to test your urine and then give you a gown to change into. (If you'd rather, most hospitals — and all birth centers — will allow you to wear your own gown and robe.)
- Check your vital signs and more. A nurse will take your pulse, blood pressure, and temperature. She'll note your breathing rate and ask about your due date. She'll ask when your contractions started and how far apart they are, whether your water's broken, and if you've had any vaginal bleeding.
She'll also want to know if your baby's been moving, if you've recently had anything to eat or drink, and how you're coping with the pain. Your caregiver will ask you the same questions — and possibly some others — so don't be surprised if you have to tell your story twice.
Both the nurse and your caregiver — or a doctor or midwife on staff at the hospital — will read through your prenatal record, check your previous lab results, and take your history. They'll want to know about any previous pregnancies and births, health problems or allergies, medications you're taking, complications you've had during this pregnancy, and whether you tested positive for Group B strep. (Be sure to ask your caregiver about your GBS status during a prenatal appointment in case a copy of your chart isn't there when you arrive at the hospital or was sent before your test results were available.)
- Monitor the frequency and duration of your contractions and your baby's heart rate. Your practitioner will listen to your baby's heartbeat, either with an electronic fetal monitor or with a handheld Doppler like the one used during your prenatal visits. She'll also periodically put her hands on your belly to feel your contractions.
- Perform an abdominal and vaginal exam. Your caregiver will feel your belly to assess your baby's position and estimate his size. Then, if she suspects you might have ruptured your membranes, she'll do a speculum exam to see whether you're leaking amniotic fluid.
She'll also want to do a pelvic exam to check your cervix for dilation (opening) and effacement (thinning) and to feel how low your baby is. She may wait to do this, however, if your amniotic sac is leaking and you aren't having regular contractions yet and she plans to wait awhile before inducing labor.
If your caregiver isn't certain after the abdominal and vaginal exam that your baby's coming headfirst, she'll use a portable ultrasound machine to confirm his position.
At this point, if it looks like you're not in labor or are still in early labor — and everything is okay with you and your baby — you'll probably be sent home until your labor is further along. (In some cases, you may be asked to stay for an hour or two so you can be re-examined to see whether there's been any change since the initial evaluation.) Otherwise, you'll be admitted.
What happens once I'm admitted?
In addition to the steps above, the nurse or your midwife or doctor may:
- Ask whether you have a birth plan. If you're not asked, and you do have one, be sure to bring it up! Even if you don't have a written birth plan, share your needs and preferences with those in attendance, including the labor nurse and the doctor or midwife.
For example, be sure to let the staff know if you hope to labor without medication or if you have your heart set on an epidural — or if you're not invested in one route or the other.
- Draw some blood. She'll send a sample to the lab so your blood can be typed (in case you need a transfusion) and checked for anemia, signs of infection, and possibly other things.
- Possibly start an IV. At many hospitals, it's routine to start an IV when a woman in labor is admitted. You'll definitely need one to get antibiotics if you test positive for Group B strep, for hydration if you can't keep fluids down, if you want a spinal or an epidural, if you need oxytocin (Pitocin), or if you have any health problems or pregnancy complications.
But if your pregnancy has been normal thus far and no labor complications are expected, you can — with your practitioner's approval — hold off on the IV. That way, you'll be freer to move about as the urge strikes you, without having to contend with tubing and an IV pole.
Another option is to ask to have a heparin or saline lock attached to your IV catheter (the part that's inserted into the vein). This small device keeps the blood in the catheter from clotting, and it has a portal so your caregivers can plug tubing in at any time. You can get fluids or medications whenever you need them, but you won't have to be tethered to an IV pole in the meantime.
Your nurse or caregiver should also orient you, showing you where everything is in your room and on the unit (for example, where your partner can get ice for you) and explaining what she's doing and why each step of the way. Don't be shy about requesting anything you might need, like a rocking chair, a cool washcloth, or another blanket, and feel free to ask questions as things come up over the course of your labor and the rest of your hospital stay.