Labour and Delivery, as I Learned It

Before the birth I built myself a map of labour and delivery, from classes and from reading. This is that map. How my own delivery actually went is a story of its own, which I will share later.

The map of labour

Labour has real structure to it, even though it doesn't feel that way from the inside. This is the map I built for myself from classes and reading before the birth, stage by stage.

Early and active labour

Labour builds from early contractions, irregular at first, into active labour, where contractions become more regular and intense. The hospital rule of thumb for when to go in: 5-1-1, contractions five minutes apart, lasting one minute, for a full hour. (See Pre-Labour Signs for how I timed this.) My husband's job list through this stretch was deliberately simple: keep me hydrated, remind me to breathe.

Transition

The shortest phase, and the most intense. I'd been warned ahead of time: this is the point where conversation isn't really wanted, if your partner needs to ask you something during transition, yes/no questions only.

Second stage, pushing

Crowning is the moment the baby's head becomes visible at the vaginal opening. After the baby is born, nutrient-rich blood keeps flowing from the placenta for about a minute. The cord is clamped in two places and cut only once it turns white, which means the blood flow has finished. No nerves are involved, so there's no pain to baby or mom in this step. This is delayed cord clamping.

Third stage, the placenta

5–20 minutes after the baby is delivered, the placenta follows. After that, involution begins, the uterus's return to its pre-pregnancy state, which takes about six weeks.

The positions and tools I had ready

Labour positions get a lot of internet coverage that assumes a level of mobility an epidural, monitoring, or your own body might not allow for. These notes are from what I remembered about my delivery.

The position I'd prepared around

Sitting upright made the most sense for me, in a chair, on a couch, or propped up in the hospital bed. That was the one I'd planned to lean on.

The tools I asked about

A peanut ball (a peanut-shaped exercise ball placed between the knees, often used to help open the pelvis while lying on your side) and a regular birth ball might already be available at the hospital, even if nobody offers them upfront, ask. The birth ball is also useful earlier, in the lead-up to labour, for opening the hips and pelvis and for pelvic exercises generally.

The epidural

The epidural decision comes up fast once labour is underway, so it is worth understanding before you are in it. The middle of labour is no place for research.

Timing

An epidural can technically be given at any time during labour. In practice it's usually suggested once contractions are 4–5 minutes apart. That's because it can affect how strong and how long contractions run, and providers weigh that against how labour is progressing.

Why so many people choose it

From what I was told and read, very little of the medication reaches the baby. That is a big part of why so many people choose it without much hesitation.

What happens after

Once it's in, you stay in bed. It numbs you from roughly the chest down, so mobility is no longer an option for that stretch of labour. Worth planning around mentally: whatever positions or movement you wanted to try, that window closes once the epidural is placed.

The first hour after birth

The first hour after birth has its own choreography. I read up on it beforehand, and it turned what would have been a blur of activity into things I could recognize in the room. This is the sequence, as I learned it.

APGAR, the first check

Right after birth, the team scores the baby on five things: Activity, Pulse, Grimace, Appearance, Respiration. Any score above 7 means the baby is doing great. You may not even notice it happening.

Delayed cord clamping

Nutrient-rich blood keeps flowing from the placenta to the baby for about a minute after birth. The team waits until the cord turns white, meaning the blood has finished flowing, then clamps it in two places and cuts between. No nerves are involved, so there's no pain for baby or you. The placenta follows 5–20 minutes later.

The newborn checklist

• Eye ointment or drops, protective, routine
• Vitamin K shot, newborns are born low on it; it's needed for blood clotting
• Hepatitis B vaccine, offered at birth in some cases
• PKU test, a heel-prick screening for rare metabolic conditions
• Hearing screen and oxygen saturation test, quick and painless

Two things that surprised me

The white coating on the baby, vernix, is a natural barrier against bacteria, which is why bathing is delayed rather than immediate. And your own recovery has a name and a timeline too: involution, the uterus returning to its pre-pregnancy state, takes about six weeks.

Why C-section babies get talked about

You may have heard this one. A baby born vaginally picks up specific microbes from the birth canal on the way out, and those microbes help colonize the baby's gut. Babies delivered by C-section miss that particular exposure. It is a real and interesting piece of biology, and that is all it is.

There are also studies showing that later in life, it does not really matter much whether a baby was born by C-section or vaginally. So please do not treat a C-section as an abnormal delivery and a vaginal birth as the normal one. There are only two ways to get a baby out. And a lot of the time, when the baby is stressed or there are other complications, a C-section is the better way, sometimes the only way, to get the baby out safely.

So let's not compare which one is better. I ended up with a C-section, and I ended up with the guilt too. It took me a while to get over it, and to understand that a C-section is normal, and very often required and necessary. I want you to know this before, not after. If you end up with one, you deserve to enjoy that phase with your baby instead of sinking into guilt or grief over how the baby arrived. Recovery is already hard enough on its own.

And before you even get into pregnancy, try not to fix your mind on how the delivery will go. A lot of it is simply not in your hands. Walk in with that clarity, and no decision made in that room will feel like you let anyone down.