Shanon Cook: Hi, I'm Shanon Cook, mom of one with another one on the way. Now, when you first arrive at the hospital and you're in labor, you might not necessarily be in the mood to check out your surroundings and ask questions. So today we're here at St. Luke's-Roosevelt Hospital in New York City to take a tour of the labor and delivery ward, and joining me is Ashley Leffew, which is a French name. And she's a labor and delivery nurse here at St. Luke's. Thanks for joining us.
Well, let's imagine that true labor has arrived. Will you show us a delivery room?
Ashley Leffew: Sure.
Ashley: So basically when you first come into the room, we have you change into a hospital gown. Some people bring in their own gowns, but if you are going to bring your own gown in, we prefer it to unbutton so that you can have access to the IVs and things if you had to go back for a c-section. And then this is the belly band that goes on, and this is what keeps the monitors on. Okay? So we would have you go change into your gown, give us a urine sample, and then come back, and then I would get you on the monitor. We would monitor your contractions and the baby's heart rate with these two monitors.
So the heart rate, the fetal heart rate, will come on this side of the strip. And the contractions will be on the bottom. On the screen, it's an LCD screen, and it will show the blood pressure, the heart rate of the mom, and the baby's heart rate.
Shanon: Now, what if I'm saying, "I want an epidural!" I'm not necessarily going to get one straight away, am I?
Ashley: Not necessarily. So there's a few things we have to do before you get an epidural. We first and foremost have to get baby on the monitor, see what baby's doing. And then we would get an IV started. So, we'd get the baby on the monitor, do vitals, and then get your IV started.
So we usually try to do the IV someplace on your lower arm. On either side, wherever we can get a good vein. And then these are the pumps that the fluids go in. So this can tell us exactly how much fluid the baby, the mom is getting, so we can keep up with ins and outs. And then we draw your blood at the same time, so that hopefully you only have to get one stick and then we send your labs off. And then when we get your labs back, then you would be a candidate for an epidural.
Shanon: Okay. Let's just say I've been hooked up and I have an epidural. What happens now? What kind of monitoring do you do?
Ashley: Okay, so immediately after the epidural, we're going to closely monitor your blood pressures, because that is one of the side effects of an epidural, is that your blood pressure can decrease. So we keep the baby on a continuous monitoring and we are going to monitor your blood pressures at least every two to five minutes for the first 20 to 30 minutes of your epidural to make sure that your vital signs are stable. The blood pressure hooks up to here, so this is what'll be connected, and it registers up on the screen.
And then you also have a button that you can push if you need extra medicine. So you'll continuously get medication through the epidural to keep you comfortable, but if you start to have pain throughout your labor, then you can push that button. It'll give you a little extra.
Shanon: If you don't have an epidural, is the monitoring of mom and baby any different?
Ashley: Sometimes yes, sometimes no. It really depends on what the baby's heart rate is doing. So if the baby looks great and there's good variability and reassuring fetal heart rate strip, then sometimes the doctors will say we can do intermittent monitoring, which is going to allow Mom a little more freedom so she could walk in the hallways and then come back every 30 minutes to 45 minutes and get back on the monitor.
Shanon: Now, when it comes time to actually push the baby out, you may find that the atmosphere in this room changes dramatically. Here to talk a little bit about why is Dr. Jacques Moritz. He's head of the ob-gyn ward here at St. Hello. He's also my doctor.
With my first pregnancy, when I – when it came time to push, it kind of got exciting in there. What's going on?
Dr. Jacques Moritz: Well, before it's time to push, there isn't really much to do. And it should be pretty much hands-off. They check the heartbeat, that's done with the machine behind you, and everything's pretty chill until it comes time to push.
Shanon: Generally, how long is a woman pushing for?
Moritz: Right, so it depends on if it's her first baby or second baby. Let's go first baby, two to three hours it can be. And second baby, all bets are off. They are incredibly fast.
Shanon: Now, after a woman has delivered her baby, the baby's come out, she doesn't necessarily get to hold it right away.
Moritz: We try, we try. If everything goes well, the way we try to deliver is the baby should come this way and should go right on top of you. Mother, skin to skin, right? Usually we have the father cut the cord, or at least we ask him. Half the time they do, half the time they don't. And then the baby stays with you. And then we get to work. We start looking, okay, are there tears, how bad are the tears, how are we going to repair the tears? And more important, the placenta. Everyone forgets about the placenta, but it's a real critical part of delivery.
Shanon: So after Mom's had a chance to snuggle with baby, baby comes here. What is this?
Moritz: So two things. So, this is the warmer, that warms up the baby. The first thing is, if a vacuum or a forceps were used, the baby comes here right away. And there's a pediatrician waiting for it. A lot of times the reasons that we use those instruments is the heart rate was down or we need to deliver the baby quick and sometimes the baby needs what's called resuscitation. So there's oxygen, there's drugs here. The pediatrician can what we call work on the baby. And bring the baby from being in a water state to being in an air state. And sometimes it takes the babies a little bit of time.
If the delivery goes fine, the mother has finished bonding with the baby, the baby will come here, it receives the bands, the fingerprints, and two important things, the vitamin K shot, which everybody gets, it's the first baby's shot. It gets a shot of vitamin K to make the blood thicker so that the baby won't bleed in the brain or anything. And it also gets some cream in the eyes in case there's gonorrhea or chlamydia.
Shanon: Thank you, Dr. Moritz, for sharing all your knowledge. Just keep in mind that your hospital might have a slightly different procedure when it comes to labor and delivery, so maybe you'd like to check with them to see if you can do a tour of the hospital ahead of time. For BabyCenter, I'm Shanon Cook.