Labor And Delivery, An Osbstetrician’s Experience

The primary care giver during labor is the nurse. She/he will make sure your partner is comfortable during labor. She/he will carry out the doctor’s orders as well as help guide you through labor. The labor and delivery nurses can make or break the birth experience.

A caring helpful nurse will make sure both of you are comfortable, answer loads of questions and be a conduit to the doctor. Needless to say some nurses don’t provide the same level of concern. If you sense the nurse isn’t really in tune to your needs, ask to speak to the shift supervisor about changing nurses. 

While in labor, your partner will have vaginal exams performed to see how her labor is progressing. We measure the dilation of the cervix from 0-10 centimeters. Dilation between 0-5 centimeters is considered latent phase. It can last up to twenty hours (now you know why there is no hurry to get to the hospital the first time around). The last five centimeters go much quicker (1-2 centimeters dilation per hour is a good rule for the first baby. Subsequent labors will go at a faster rate.) This is known as the active phase of labor. 

If your partner has an epidural already, you won’t see a difference in the intensity of the labor contractions. For those utilizing narcotics or natural childbirth, the contractions seem to come faster and stronger. Speaking with the nurse or health provider will help give you an idea when they anticipate the delivery and help your partner gauge her ability to tolerate the discomfort of labor. 

 A new type of discomfort enters the picture as the baby starts to move down the birth canal. Rectal pressure occurs when the baby is pressing on the surrounding organs and tissue. Your partner will complain of an intense desire to defecate. It generally is a good sign that delivery is getting closer. Those with an epidural may note pelvic pressure or a mild sense of rectal pressure. 

A vaginal exam will confirm that your partner is 10 centimeters, in the second stage of labor, and ready to push the baby out. Once again there is a tremendous variation on the length of time until delivery. First time moms can expect to push for 1-2 hours. With subsequent deliveries the pushing phase will be much quicker. 

Pushing relieves the intense pressure of the second stage. Often times you and the nurse will be working with your partner to help her push the baby out. You might be supporting one of her legs or helping her keep track of how long to push. You might want to hide in the corner. That is up to you and your partner. However, your involvement will definitely help motivate your partner and keep her focused. 

Women with an epidural still need the same support and encouragement. The major difference is the diminished amount of pain she is experiencing in comparison to women having a natural birth. 

During all stages of labor the baby’s heart rate and contraction pattern is being recorded. It serves as a good measure of the baby’s ability to tolerate the stress of labor. Changes in the heart pattern are expected from time to time, especially when the baby descends into the birth canal. If there is concern about the baby’s health, the doctor will be involved in planning ways to help the baby.  

Finally the baby’s head will be visible at the opening of the vagina. This is known as crowning. Once again, it may take a while before the baby arrives.   

Many physicians choose to enlarge the space for delivering the baby. They will cut an episiotomy. It is cut right before the birth of the baby. Contrary to popular myths, it isn’t done to hasten the birth so they can go play golf. It is performed to avoid tearing of the tissue. The epidural or a local anesthetic is sufficient to manage the discomfort from the incision. 

The baby will make its entrance soon. This is a good time to review your plans for delivery. Are you going to be next to your partner, looking over the doctor’s shoulder, or standing in the corner? This is your experience, not ours! You do what is right for you! The vast majority of men witness the birth of their baby. Nearly 100% are happy they did. 

When the baby comes out, it is placed on the mom’s stomach or given to a nurse. The umbilical cord is cut (by you/your partner/or doctor). Take a few quick pictures and enjoy the moment. The baby will be wrapped in a blanket while the doctor finishes their work. 

This is a good time to ask the nurse to take a family photo. The baby will go to the nursery for a short visit with you in attendance while the doctor finishes up their work.  

Congratulations. Now the hard work begins.

– Dr. Craig Bissinger

Parsippany, New Jersey

Dr. Bissinger, a highly respected, board-certified obstetrician and gynecologist, is author of Pickles and Ice Cream: A Father’s Guide to Pregnancy.