15 Things Your Labour and Delivery Nurse Wants You to Know

​1. Your doctors and nurses want you to have a birth plan.

You should have a sheet of paper with a general outline of how you want your birthing experience to go. It should include things like your expectations for pain management, who you want in the delivery room, and if you want the nurses to save your placenta. Write down those things as you think about them throughout your pregnancy: Do you want your baby immunized? Circumcised? Do you want dad to cut the umbilical cord? Except…

2. Your delivery will probably not go according to plan.

It's frustrating, I know! That doesn't mean you've failed. It's perfectly OK to say, "I actually do need something for the pain." I had a patient several years ago who came with a 10-page birth plan. She wanted to have a natural birth, with no medication, lying on a specific pile of pillows, and she wanted her husband to cut the umbilical cord. It turned out that when her water broke, her husband slipped in the fluid, he hit his head, and became unconscious. He was rushed to the ER for his head injury just as the baby was born, so he missed the entire birth and did not get to cut the baby's cord. Sometimes, things just don't go according to plan, but you don't have time to be fussy about it.

3. When your water breaks, it's not like in the movies.

Some women experience a huge gush, but for others, it's a very small leak. You might think, "Did my water just break or did I just pee myself?" Either way, it doesn't stop after it initially breaks. You'll continue as if you're slowly peeing yourself for the duration of labor. As the baby pushes down, the amniotic fluid surrounding your baby continues to leak out until your baby is born, at which point there is usually a big stream behind the baby.

4. Birth will probably take way longer than you expect.

For first-time moms, 12 to 18 hours is pretty standard. It could take longer. It doesn't mean you're in active labor the whole time, but the actual pushing part is no cakewalk either. When I first had my child, before I was a nurse, I got to the pushing part and was like, "Oh great, it's finally over!" and then spent the next three hours pushing. The good news is that after your first baby, your labour time usually gets cut in half. The path has already been paved, so to speak, so they just slide out after the first one.

5. Make sure your partner knows where to find the hospital's ice machine.

Once you get into active labor, some hospitals won't let you to eat or drink anything — all you get are ice chips. I always tell dads-to-be or whoever else is in the delivery room to find the ice machine and make sure mom's cup is never empty.

6. You are going to bleed all over yourself and you'll probably poop.

Birth is very messy. When your cervix expands, there will be some bleeding (your blood, not the baby's). If it's mixed with the amniotic fluid, it can really look like a lot of blood. As you're pushing, you'll see more blood and you'll probably also poop, since everything is right down there, pressing on your rectum. It's nothing to be embarrassed about. Most of the time, when I'm pushing with the mom, I'll just clean it up and she won't even know.

7. It's normal for your baby's heart rate to dip.

Nowadays, most patients have a fetal monitor on their abdomen to assess the baby. You can see your contractions coming and keep an eye on the baby's heart rate. During a contraction, the baby is being squeezed, which stops blood flow to the uterus temporarily. The baby has a reserve, but once in a while, the reserves get depleted and you'll see a dip in the heart rate. Some moms really freak out about that, but it's perfectly normal.

8. There's no point in being modest.

As we get closer to the baby being born, more and more people come into the room: There's the doctor, the nurse that was taking care of you, the nurse who's going to take care of the baby, a unit assistant, and so on. Some people are kind of shy about it, given that their whole body is on display, but at the time of birth, you can't afford to be modest. The only thing that matters — besides the mom's health — is that baby coming out.

9. Your newborn will look more like an alien than a Gerber baby.

The bones of the cranium are not fused in utero, so the two bones on the top can get squished together when the baby comes out of the birth canal. It can look like "cone head." Usually, within 24 hours, that's completely gone, and it looks nice and round. Most babies are also born a little pale with blue hands and feet, because their oxygen is low. They'll gain normal color within a few hours. Babies that are born prematurely sometimes come out with this protective substance called vernix, which helps protect their skin in utero. It looks like a waxy, white cream, and it covers their whole body. Plus, you'll see some of the blood from birth all over your baby. If you're a little surprised by how your baby looks, that's perfectly normal.

10. Breastfeeding isn't always intuitive.

We have some babies who latch on right away, and other babies who need a little bit of extra help. It's not quite as natural as you'd expect. I always tell moms, "You're learning how to breastfeed, but so is your baby!" It's new for both of you. All nurses are all trained to help moms with lactation, plus most hospitals have lactation specialists who can come coach through breastfeeding.

11. Your milk won't "come in" until a few days after birth.

The first milk you produce, right after delivery, is called "colostrum." It's high-quality, low-quantity stuff with all of the immunities needed to protect your newborn baby. Sometimes moms get anxious about not producing enough milk right away, but your baby had plenty of nutrients in the womb, so he doesn't need much right after birth. About two or three days later — usually, you've left the hospital by then — you'll likely experience engorgement in your breasts. That's when you'll start to produce higher quantities of milk.

12. You'll still look pregnant right after you deliver.

Don't bring your skinny jeans with you the hospital, because when you leave, you're going to look pretty much the same as you did when you got there. Your stomach is kind of like an empty shell after delivery: Sure, the baby is gone, but your uterus is still up in your abdomen and your blood volume is still higher than it was pre-pregnancy. It takes at least six weeks for your body to get back into its pre-pregnancy state. During that time, your uterus reduces in size and descends back into the pelvis; you lose weight and your abdominals regain muscle tone; and your blood volume, which increases by 40 or 50 percent during pregnancy to support the baby, returns to normal.

13. Sweating profusely is normal after giving birth.

Your body creates a lot of extracellular fluid and blood plasma during pregnancy, so after you give birth, your kidneys are working hard to get rid of it by sweating. In that first week after birth, you'll wake up drenched in your own sweat. I remember thinking, Do I have a disease? because every time I got up to feed the baby, I'd have to change my nightgown — it was that soaked.

14. You and your baby will both go home in diapers.

During those first two or three days in the hospital, your postpartum bleeding and discharge is going to be really heavy. Your nurses will give you some fairly large peripads to sop up all the bleeding. Your uterus is trying to get back to shape, so it's compressing all sorts of open blood vessels. By the time you go home, it'll be a lot lighter and you might be able to wear regular-size pads. It's normal to pass small blood clots, but if you see blood clots larger than a golf ball or if you're soaking through a pad on an hourly basis for more than two hours, then you should call a doctor. Some moms continue to have discharge for three weeks postpartum; other moms, for as long as six weeks. Tampons aren't an option, since your vaginal area is pretty sensitive after birth, so you'll have to wear pads until the discharge stops.

15. Once you're home, don't be afraid to ask for help.

Giving birth is incredible, exhausting, hard work. Your body has just transformed itself for nine months; now, over the course of six weeks, it's going to transform back to a non-pregnant state. You have to try to rest in order for that to happen — even though that seems impossible with a new baby in the house. We tell new moms to sleep when your baby sleeps, avoid vigorous exercise, and get help from your partner or family members so you don't have to do anything but focus on your recovery and your new baby. If you overexert yourself — even if it's just putting the dishes in the dishwasher — you might notice heavier vaginal bleeding, and that's your body telling you, "You're doing too much. Sit down and rest."

Suze Ketchem, MSN, RNC-OB, CNS, has been an OB nurse for over 30 years in various roles and settings. She currently serves as the president of the Association of Women's Health, Obstetric, and Neonatal Nurses.