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Behind-the-Scenes Advice You Need to Know From a Labor Nurse

As a 29-year Labor and Delivery RN, I share advice to help women live their best life through child-bearing years and beyond.

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Labor, Birth Education, and Preparation Is Vital for a Positive Birthing Experience

Your labor, postpartum, nursery, and lactation nurses will be the most important people in your circle during the first days of your newborn's life. There are a million things we want you to know ahead of time, so I'm sharing 17 to get you on your way to a great birth experience!

I can't stress the importance of prenatal education. Prenatal education should include a labor and birth class and a tour of the hospital where you plan to deliver so you're familiar with that specific environment. Nurses are more than happy to educate you and answer questions, but knowing the bare-bones basics beforehand, helps ensure a positive and memorable birthing experience.

Before I was a labor nurse, I read every book I could find at my local library on pregnancy and childbirth with my first pregnancy. I attended Lamaze and Infant Care classes at the hospital, where I planned to deliver. My thirst for knowledge and what to expect was insatiable. I couldn't imagine going through labor and birth, clueless and unprepared. I can't tell you how many women fail to prepare themselves...at all.

If you're skipping the classes and consulting the "University of Google," please add the words "evidence-based" or "peer-reviewed" to your search to ensure you're reading the most accurate and reliable data available. There are many books on labor and birth, but this is one I recommend reading: Natural Labor and Birth: An Evidence-Based Guide to the Natural Birth Plan. It was published in 2018 by a board-certified obstetrician and included alternate outcomes every pregnant woman should know and be prepared for.

17 Things Nurses Wish Every Pregnant Woman Knew Before Coming to the Hospital

1. We Have Your Back

Your labor nurse is watching you and your baby's labor responses and is highly skilled in this field. She knows how much blood is too much, how far your vital signs can be stressed when it's really time for pain medication, and when the baby's about to be born. Your nurse recognizes concerning changes with your baby's heartbeat and your vital signs and will promptly notify your doctor while simultaneously performing interventions to correct them. Nurses are your doctor's lifeline between the two of you because rarely are they present in the hospital during your labor.

We'll fluff your pillows, change your amniotic-soaked under-pads, and bring you toaster-warmed blankets when you're shivering (not because you're cold, but because your body's responding to the stress of labor). We'll bring endless ice chips and popsicles, empty your bladder after your epidural, and put you into laboring positions that'll make you think we've lost our minds.

We'll do all these things without batting an eye. But, we want you to do your part. What's that, you ask? Please educate yourself and don't rely on what your mother told you about her experiences or how awful your friend's birthing stories are. Your labor is unique; every one of them will differ.

It’s possible to have a slew of doctors, nurses, and support staff rush in and gather at your bedside to discuss what's best for your labor and delivery when we see something concerning. Try not to panic and allow the doctors and staff to inform you of decisions or suggestions with an open mind. We're working together as a team to do what's best for you and your baby.

2. Labor Is Most Definitely Going to Hurt

Please don't ask if labor's going to hurt. It's called "labor," not "fun and games." Your contractions will feel like 60-90 seconds of your worst period cramps and the tightest corset you could cinch on your body. The peak feels like your pelvic organs are falling out of your vagina. If your baby's facing funky, you may feel a gnawing lower back pain that doesn't ease up until the baby shifts positions--or you get an epidural. Of course, it's not like this the entire time; it builds as you progress. When you can't walk or talk through your contractions, it's about to get real. This isn't to scare you, but you need to be mentally prepared to practice breathing and relaxation techniques and not be caught off guard.

New father helping weigh the baby

New father helping weigh the baby

3. Birth Plans are Nice to Have, but Plans Almost Always Deviate

That may sound cryptic or that we don't respect the specifics handed to us on a piece of paper because we do, but our mission is to get your baby out safely. So while birth plans aren't the issue, a closed mindset often comes with them. Let me explain what I mean by this.

There's a tendency for some people and groups to vilify nurses and doctors as "unnecessary interventionists." We want to honor your wishes; however, we also know if you have a super rigid birth plan, there's a chance if you see the blinding lights of the operating room, you'll not be the least bit prepared.

If you feel strongly about making a birth plan, my advice is to do so and call it "my birth wishes or my birth preferences list." I'm brutally honest when I say most births don't go according to "plan." We don't want you arriving at your labor with delusions of grandeur that make you put up a fight when we need to take fast action to save your baby--or you. It's happened more times than I can count, and during a labor crisis, seconds count.

We want you to take control of your birthing experience. It's fantastic to be motivated, educated, and informed, but prepare for the unexpected with an open mind too. I don't recommend adding things on your lists like "internal monitors only if medically necessary." We'd never circumcise or vaccinate your baby without your written consent, so we also won't use internal monitors without first explaining the rationale and getting your blessing. If we feel it's needed, we'll make sure you understand why and we shouldn't waste time arguing about it. Time is of the essence when it comes to labor complications.

Some good ideas for your "birth wishes" (notice I didn't say "plan") that nurses love to see are--which are also good reminders for us too:

  • keeping the lights dimmed whenever they're not needed
  • limiting the visitors to your room
  • not asking your partner to cut the umbilical cord (it's generally expected he or she will, so if you don't want that, please let us know)
  • refusing a blood transfusion if urgently needed (we need to know this)
  • planning to bank your cord blood for the future (telling us after your delivery's too late)
  • wishing to not be offered pain medication, unless you request it
  • planning to keep your placenta for encapsulating, making soup or planting a tree
  • any cultural considerations we may not be familiar with

If you're up-to-date on the latest and greatest from having attended a birthing class, you'll know we practice delayed cord clamping, put your baby on your chest at delivery (if uncomplicated), and do everything possible to avoid your baby being separated from you--unless your baby is having distress. We want you to trust that we never want to delay bonding with your newborn.

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4. Please Don't Ask How Long This Is Going to Take

While we make many predictions, we really have no idea; no one does. First-time labors can take up to 24 hours and sometimes longer, and so can third labors. The length of your labor is directly proportional to the size and position of your baby, the readiness of your cervix, the shape of your pelvis, the strength of your contractions, and if your labor is spontaneous or induced. A baby that's malpositioned or a uterus with a dysfunctional contraction pattern can cause a hang-up and take hours to correct. Please be patient and know we'll do everything we can to get your baby delivered in a safe and timely manner on the baby's terms as long as it's safe.

5. You're Probably Getting an I.V.

For your safety, we'd really like for you to have an IV, even if it's just a port. Women can and do bleed excessively following birth (and sometimes beforehand if a problem arises, such as placental abruption). Time is crucial in a crisis, and these complications can cause your veins to collapse and make inserting one very difficult. I love giving IVs, but I hate getting them, so I fully appreciate the apprehension and fear they bring. Rest assured, the pain is temporary, and your arm will be mobile and pain-free. An IV isn't the end of the world, and it can help save your life.

6. "I'll See How Bad it Gets" Isn't the Best Answer When Asked About Your Plans for an Epidural

Please research your pain control options ahead of time, and don't be disillusioned because you think you have a high pain tolerance. There's nothing like labor pain, and nothing prepares you for it unless you've already experienced it.

If you feel strongly you want natural, unmedicated labor; my favorite kind of labor, take my advice and prepare for how you'll handle the pain. Your options include guided meditation, self-hypnosis, massage, music, aromatherapy, IV medication, or a combination of these methods. The more prepared and focused you are on what you want, the more successful you'll be when the pain gets real. If you change your mind and decide to chuck it all, that's fine with us, and we'll support you and have the epidural gods in your room in a flash. Just remember, the point where it gets unbearable is the point at which you're nearing the finish line.

7. An Epidural Doesn't Slow Down Your Labor

A common misconception and rumor are once you receive an epidural, labor slows down or stops—quite the contrary. An epidural can help your labor by allowing you to release the tension you're holding during contractions, therefore relaxing the pelvis. This makes it easier for the baby to descend and gives you a much-needed rest, particularly if your labor is prolonged by inadequate contractions or a baby that's large or in an unfavorable position. While most women can handle natural labor, the choice to receive an epidural is a personal one. An epidural can also be quite beneficial when maternal exhaustion sets in.

8. Pitocin Doesn't Make Contractions More Painful

Another misconception touted by women who've been induced with Pitocin or had it during a stalled labor is that "labor was terrible because they gave me Pitocin." The truth is, "a contraction is a contraction", whether spontaneous or induced, the pain of a contraction is hell on wheels. Pitocin can make contractions faster and harder, with less time than spontaneous contractions that more naturally adapt your body for delivery, which can wax and wane for hours and even days.

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9. Be Prepared to Move Around

While you may want to spend your labor relaxing in bed on your back, that's not helpful. Your nurse will have you sitting, bouncing, squatting, standing, leaning, bending, twisting, and contorted six ways to Sunday. We know what works to make your baby move into an aligned position for exit. Here's a very comprehensive article depicting the many positions you may find yourself in during your labor.

10. We Don't Want to Perform Unnecessary Interventions

Every intervention means more work for us and more bother to you—more monitoring, more equipment, and more documentation. We don't want that for either of us. We also don't want you to have a C-section because that's riskier for you and more work for us too. When your doctor thinks you've labored enough and it's time for operative delivery, we're usually asking for one more hour for you to do it on your own. We've probably told a little white lie about what you're really dilated so that you can have more time—we're passionate about that. Again, we always have your back!

Fetal Scalp Electrode for directly measuring fetal heart-rate tracing in real-tine

Fetal Scalp Electrode for directly measuring fetal heart-rate tracing in real-tine

11. We May Need to Attach a Fetal Monitor to Your Baby's Scalp

You've probably heard horror stories from other mothers on this topic. Rest assured, the fetal scalp electrode isn't a torture device. The tiny spiral electrode is the equivalent of getting a small splinter in your finger and is relatively painless, despite how it looks (I've applied one to my own finger to confirm this). We don't routinely apply one, but sometimes they're necessary to give us a better picture of your baby's fetal heart rate pattern and changes.

12. We Don't Care If You Poop

Poop happens during birth, and we expect it. In fact, we want you to poop. The fact is, if you're pooping, you're pushing properly and with the right muscles to get the job done, especially if you have an epidural and can't feel what you are doing down south. It would be best if you didn't do an enema before you come to the hospital on the flip side. We want poop when the time comes, not diarrhea!

13. We Want to Know If You're Upset About Something

When we leave the room, complaining to your family isn't going to solve anything, nor is posting about it on social media or waiting for the hospital survey to arrive weeks after you're home. Ask us anything, without hesitation, at the time you're concerned or upset. We have charge nurses and management ready and willing to address your issues if your nurse can't.

Please remember you're in a hospital, not a hotel. While we try our hardest to allow you to rest, a hospital is a busy, bustling, and noisy environment. Nurses can be loud—we don't mean to be, but we're human. Babies are crying, and we'll be in and out of your room a thousand times because we only have a short time to teach and care for you before you go home. Plus, we're caring for two of you, so that makes for even more trips to your room 24 hours, round the clock.

14. We Love Being the Bad Guys

We won't think twice about it. We don't like your 16 visitors going in and out and constant calls from the front desk asking who we can allow in or how many you already have in the room. Visitors can distract from the care we're trying to provide and the focus you need on yourself. While this may sound harsh, it's the truth. If your mother-in-law is making you homicidal, she's likely making your nurse feel the same. Just say the word, and we'll happily do the dirty work and give them the boot--I mean, kindly ask them to proceed to the waiting area or suggest they get a cup of coffee. We're pros at this game!

A baby being born via C-Section delivery

A baby being born via C-Section delivery

15. You May Need a C-Section

There are a plethora of reasons why you may end up needing a C-section. We realize that's not your desire, and we'll guide you through this. Some of the reasons you may not have a vaginal delivery include:

1. The baby isn’t positioned properly, and our attempts at fetal rotation have failed.

2. Your labor pattern is inadequate, or the baby doesn’t fit through the pelvis due to malposition or large size.

3. The baby’s heart rate may indicate he or she is not handling labor well, necessitating an immediate need for operative delivery.

4. Your placenta may have issues as in prematurely separating (abruption) or isn't providing insufficient perfusion to the baby.

5. You have multiple babies who aren't in a favorable position for a vaginal birth.

6. You had a C-section prior, and your uterine scare puts you at an increased risk of uterine rupture, a life-threatening condition.

16. You Won't Have Milk Right Away

When you first put your baby to breast, please don't ask for a bottle because the baby is crying or isn't latching on and you think they're "not getting any milk". You're right, the baby isn't getting milk because it takes up to 72 hours for milk to develop. What your baby IS getting, are microdroplets of liquid gold called "colostrum". This is one of those times when "a dab will do" is true. Those nearly invisible droplets are loaded with the antibodies and nutrients your baby needs for the first several hours to a few days of life. This is why it's very important for you to nurse your baby every 2-3 hours round the clock during that crucial first few days. The only time we'll suggest supplementing with a bottle, is if your baby's blood glucose levels are at a concerning level or the baby is jaundiced.

You will still look pregnant for a few weeks after your delivery.

You will still look pregnant for a few weeks after your delivery.

17. You Won't Be Wearing Your Regular Clothes Home From the Hospital

Even I made this mistake! You're beyond sick of your oversized clothing and can't wait to don your skinny jeans again. But trust me, you'll not want anything tight or form-fitting against your lady bits or C-section incision; not to mention, you'll not be skinny that fast. It takes a good six weeks to return to your pre-pregnant weight and even longer if you're breastfeeding, as your body stores a little additional fat for milk production. The only thing you'll want tight as a bug in a rug is your bra because when that milk does come in, it comes with a vengeance, and it hurts. Keeping the girls tight and free from bouncing is very important, so be sure you have a good supply of comfy, supportive nursing bras you can also sleep in and some comfy sweatpants.

I hope these tips help set your mind at ease and prepare you for your big day. I speak candidly and from experience and maybe even from a bit of frustration. As women, we carry the weight of everything...kids, jobs, sports, school, keeping the house, helping friends and family, the list goes on. But preparing for your labor and birth, whether your first or your fifth child, should be a priority. Keeping up with current recommendations and educating yourself on recent practices will most assuredly help you have the best labor and birth experiences possible. If you have any questions or suggestions, please leave me a comment or ask in the Q&A section. I'm always happy to help.

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2019 Debra Roberts

Comments

Thuy on June 03, 2019:

Wow all great to know for if I have a child someday. I have no idea what to expect and I would also be reading up on what birthing is like when the time comes.

By Joanna K on June 03, 2019:

This is excellent support for women giving birth. I agree with Tracy, labour and delivery nurses do all the hard work. It's good to read that we women can take control of the whole process. It helps to know that there are options and alternatives.

Elizabeth on June 03, 2019:

This is so accurate and super relatable. I learned many lessons in round one that for round 2 I packed a dress as a going home outfit for the ultimate comfortable ride home :)

Tracy C on June 02, 2019:

This is so timely! Today is my daughter's due date, and I'm going to share this with her.

Labor and delivery nurses are the best--they do all the work! The doctor usually just comes in to catch the baby lol.

Snehal on June 02, 2019:

Thanks for coming up with this post! My cousin sis is due in september. I am sharing this insightful article with her. :)

Live Learn Better on June 01, 2019:

I can remember all these vividly during our pre-delivery appointment. Great advice straight from the ones who know best.

Rachele Hollingsworth on June 01, 2019:

As an English teacher, I LOVE your advice to add “evidence-based” or “peer-reviewed” to Google searches...one of my biggest lessons to students is to evaluate the legitimacy of their sources! I must say, I’ve had two babies in two different hospitals and I absolutely adored every one of our labor and delivery nurses!! I think they are a special breed of people, to assist in bringing new life into the world every day!

Trish Veltman on June 01, 2019:

Essential information for expectant mothers. you explain it all so clearly - I especially like you being so honest about the pain. Far better to have a realistic idea of what to expect.

Lyosha on June 01, 2019:

It sounds super useful. I am not pregnant yet ( as far as I know) but I work on this so your post is a lot of use to me, it makes me feel more calm for the future

Diane DeNicola on May 31, 2019:

I say all the time how important nurses are in the whole scheme of the health system. They are the backbone of the hospital and that is true even more for labor and delivery. In my case, as I'm sure in most the doctor comes in right at the time of delivery. My first daughter had some issues because she was turned around a bit and the nurses were so nice in talking me through everything and comforting me before, during and post delivery. And then helping me learn to breastfeed.

Erica (The Prepping Wife) on May 31, 2019:

I don't have kids, nor do I want them. After reading this, I shuddered at the idea a little bit more. Lol. But I also think it is important to read this post for expecting mothers. Many times we all go to the hospital with preconceived notions, especially if having to wait in a waiting room at the ER. People post about that on social media all the time! But in reality, the nurses and doctors are there to help, but there is always a demand for more and more, or a true emergency happens. I wish more people understood these kinds of things when going to the hospital.

Liz Westwood from UK on May 21, 2019:

Having had 4 children and recently grandchildren, I have read your article with interest. I laughed at your comments about a birth plan. I have lost count of the number of times people I know have gone off plan. A good outcome for mother and baby has to be of paramount importance. At such times plans go out the window.

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