What happens on the day you deliver your baby?

There’s a wealth of information out there about the physical process of giving birth. But many women go into labour still unfamiliar with the scene – and process – that awaits when they finally reach the maternity ward, where 97.5% of the UK’s babies are born. ‘You’ll meet, on average, 18 to 25 people during the course of your stay – from cleaners to consultants,’ says Mervi Jokinen of the Royal College of Midwives. And just as every birth is different, so is every maternity unit. Most units offer advance tours, which can help a great deal with familiarisation. 

However, having deeper understanding of what happens when you arrive at hospital – perhaps in pain, often in the middle of the night – will help you feel more in control of your birth. After all, knowledge is power where childbirth is concerned. Here, we’ve put together some been-there, done-that information to make D-day a smoother, less surprising experience

What happens on arrival

First stop is the hospital admissions desk, from where you’ll be directed to the maternity unit reception. A midwife there will take you to an admission room ‘triage’ (an area of the labour ward) where your condition will be assessed. ‘Ideally, hospitals try to give you the same midwife all the way through the birth,’ says Mervi. ‘However, being able to do so depends on so many factors – from the duration of your labour to the length of a midwife’s shift (an average of between seven and a half hours and 12 hours, depending on the hospital).

Your initial assessment

You will be asked if you’ve had a show (a plug of mucus in your knickers, often tinged with blood and a sign labour has begun), whether your waters have broken and if so what colour they were, whether contractions have started and how frequent they are. The midwife will want to know how many weeks pregnant you are and whether you’ve had any problems. She’ll also need to see your maternity notes.
Next, she will check your blood pressure, temperature, pulse and urine. An external examination of your stomach will reveal your baby’s position. Your midwife may to do an internal – or vaginal – examination, the only way to find out how many centimetres dilated you are.

Everything the midwife does is written down in your notes and the midwife will start a partogram (record of your labour) so if she goes off duty, the next midwife will be able to assess your progress quickly. At some stage she’ll go through your birth plan. If you don’t have a plan already the midwife will ask if you have any special preferences for labour.

After your assessment, you will be probably allowed to slip out of your clothes into whatever you want to wear for the birth or a hospital gown. ‘This is a good time to have something to eat and drink,’ says midwife Adele Hamilton. ‘Your body is working hard so you need to keep your strength up.’ She suggests something light, such as a yoghurt or a biscuit and a cup of tea.

 If you’re in early labour you may go home and wait or if labour is progressing or you don’t want to go home you will probably be sent to the antenatal ward or a special waiting area. Only once labour is deemed to be ‘established’ (from 3cm dilated) will you be taken to a delivery room where you’ll stay until your baby is born.

If you need intervention

Throughout your labour, the midwife will regularly check your pulse, temperature, blood pressure, urine, cervix and the baby’s position and heartrate. If everything is going according to plan you’ll be left to progress, but many deliveries include some form of medical intervention…

Induction

You may have your labour artificially started you have signs of pre-eclampsia (high blood pressure and levels of protein in urine) or you’re 10 days overdue. Labour is triggered with a drip containing syntocinon (an artificial form of the labour hormone, oxytocin). The drugs can create stronger and faster contractions than those in a ‘normal’ labour, so you may require pain relief. The baby will be monitored with a CTG (cardiotocography) machine if you’re induced, which measures your baby’s heart rate.

Augmentation

If you are in established labour and your cervix is not dilating at the rate of at least half a centimetre an hour or your contractions have slowed or stopped, your midwife may call a doctor to discuss speeding things up (augmentation). If your waters haven’t already been broken, they will be now. If this doesn’t work, you could be given a syntocinon drip and have your baby’s heartbeat monitored with the CTG machine).

Pain relief

Options for pain relief include Entonox (gas and air), pethidine (an opium derivative, which is injected into the muscle) or an epidural (a local anaesthetic in your spine – this takes about 15 to 20 minutes to organise). ‘If you wanted hydrotherapy (a water birth), be prepared for the possibility that the pool may not be available when you need it,’ warns doula Lucy Symons.

Forceps and ventouse

If your labour has not progressed adequately, you’re too exhausted to continue, or your baby is in distress (indicated by its heart rate), your midwife may decide on an assisted delivery. A doctor will feel to check the position of your baby and its progression along the birth canal before deciding which instrument – forceps or ventouse – is safest to use. A ventouse is a vacuum device with a suction cup that is attached to your baby’s head, gripping him and helping guide him out as you push.

Forceps are surgical ‘tongs’ that cup the baby’s head and allow him to be turned or pulled out quickly, avoiding a caesarean. There are different types depending on what’s required. Unlike with ventouse delivery, forceps often require an episiotomy (cut to the skin behind the vagina), as they tend to be used if the baby is further up the birth canal. Both procedures will leave slight marks on your baby, but these will disappear within a few weeks.

What if I need a c-section?

Elective caesarean

This is the name for any c-section planned in advance. You’ll be offered a surgical delivery if labour is assessed to be unsafe for the baby or the mother – for example if the baby is positioned feet- or bottom-down in the womb (breech). You’ll come into hospital the evening before to fast, though procedures vary from hospital to hospital. Before surgery, the top few centimetres of your pubic hair will be shaved off (often the site for the incision) and you’ll be given medicine to neutralise the acid in your stomach.

An anaesthetist will give you a regional anaesthetic to numb the lower part of your body (such as an epidural) and you’ll have a catheter inserted and be put on a drip containing drugs that reduce the risk of low blood pressure. The operation is normally staffed by about 10 people (surgeon, anaesthetist, midwife, paediatrician, assistants, nurses and students) and takes 30 to 45 minutes. You’ll be moved to a recovery room after your baby has been delivered and kept under close observation until the anaesthetic has warn off and before being moved on to the maternity ward.

Emergency c-section

This happens when the baby needs to be delivered with speed (within 30 minutes). Because of the urgent nature of the operation there may not be time to complete the same procedure as for an elective caesarean but an epidural will be topped up or administered and you may be given drugs to reduce nausea or vomiting.

After the birth

However he arrived, your baby will be given a brisk rub down, cleaned and you will both be given identification bands with your names (or just surname for the baby if you haven’t chosen a name). The midwife then weighs, measures and checks your baby then will give him to hold (ahhhh!) while she checks if you need stitches. She will then offer you an injection of Syntometrine to speed up delivery of the placenta, or leave it to come on its own. While she waits for this to pass, she’ll fill out the birth record. You will be advised to allow your baby to have an injection of vitamin K, which improves blood clotting.

After a vaginal birth you will stay in the delivery suite for one to two hours, be sent for a shower, then you will be taken to the postnatal ward. If you’ve had a c-section you’ll be stitched up, then they’ll move you to a recovery room until you get some feeling back, then if everything is well you’ll be moved on to the ward. Ward midwives will show you how to start breastfeeding and care for your baby, although the aftercare is less attentive in busier hospitals.

Home time is a matter for negotiation – policy varies, although some hospitals allow it within six hours. The usual time of a first stay, though, is around 48 hours. If you’ve had a caesarean you usually stay in for three to four days. Before you’re discharged you and your baby will be checked over. Your baby will have his reflexes and hearing tested and you’ll be given advice for caring for any wounds or stitching.
When all the forms are filled in and the boxes ticked, you’ll be granted full and total responsibility of a small person. Now that’s when the fun really starts...
 


Who’s who on the maternity ward

Midwife Specialist medic in all aspects of maternity care from delivering babies to post-natal care. She will have completed a degree in midwifery leading to registration with the Nursing & Midwifery Council. As well as delivering your baby, she will also manage the paperwork required for your hospital stay.

Auxillary nurses
Assistant who will help you care for your baby.

Breast-feeding Coordinators/assistant
Will help you establish breastfeeding.

Obstetrician
A doctor who specialises in pregnancy. Obstetricians perform caesareans. Some also combine obstetrics with a speciality in gynaecology and although they do ‘rounds’ you’ll only see one if you have complications.

Paediatrician
A specialist in children’s health and medicine. The paediatrician will check your baby over before you are discharged. You’ll also see one in the sad event of your baby having problems.

Consultant
The term for a senior specialist doctor. It’s unlikely you’ll see a consultant unless you have complications or require a caesarean.

Anaesthetist
Specialist in administering anaesthetics, such as epidurals.
 

Guide to the delivery suite
‘Although this is a functional room in a hospital, many delivery suites are designed to look like a bedroom to help women feel at ease,’ says doula Lucy Symons. ‘You will probably find a bed, a chair and some art on the walls. But most of the furniture can be converted to medical equipment in the blink of an eye.’ Normally there is gas and air and an oxygen cylinder in the room. You can bring or ask to borrow a birthing (or Swiss) ball to rest on or use during labour, a mattress for the floor, or a bean bag. Many suites also have a TV and, if you’re lucky, an en suite bathroom. If you want the room to be rearranged, you can request this. 

Bassinet
A cot specially designed for newborn babies. In hospital they tend to be clear plastic with a cupboard underneath and wheels. Bedding is provided.

Scales
To weigh your baby immediately after birth.

Birth ball
Many suites are now equipped with birth (or Swiss) balls, which you can sit on or lean over to help you feel more comfortable.

Delivery bed
Beds in delivery suites are adjustable to help you sit up or lie down.

Gas portal
Most gases such as Entonox (gas and air pain relief) and oxygen are fed through special portals in the wall, rather than in canisters. The only sign of this being in the room may be the interchangeable mouthpiece.