Hospital Labor & Delivery Methods

by UPMC Magee-Womens Hospital

As you prepare to give birth, it helps to consider how you want to deliver and what you want the experience to be. This is an exciting time, but it can also be overwhelming and a bit scary. Having a birth plan and being prepared for all possibilities helps you through the final months. Learn about the birthing methods you may encounter at the hospital, and work with your health care provider to develop a birth plan that works for you.

Evaluating Birthing Methods in a Hospital Setting
Your health care provider can guide you through the medical aspects of your birthing plan to meet your and your baby’s health needs. We will support your birth plan as much as possible, but your health care provider may deviate from the plan to keep you and your baby healthy. Because things can change throughout your pregnancy or during delivery, it helps to understand possible birthing and labor methods:

Vaginal birth
Everyone’s experience is different, but most often your doctor will aim for you to deliver your baby vaginally. You can choose to have pain medication or opt for no medications during your delivery.

How to prepare for a vaginal delivery
One way to prepare is to create a birth plan. This includes your preferences for which people you want present, music playing, pain medications, and other elements you feel are essential to your experience. Just remember that your birthing team’s goal is to ensure a safe, healthy delivery, and sometimes things don’t go as planned.

Take classes to learn labor and relaxation techniques and what to expect from childbirth. You may also want to tour the birthing center in advance to see what you can expect at the hospital.

Vaginal birth risk factors and complications
Vaginal birth delivery is safe in most cases. Complications are rare, but there is a risk of infection, heavy bleeding, or hemorrhage with childbirth. You may also experience vaginal tearing, especially if this is your first child.

Sometimes the vaginal delivery may not go exactly as you planned. In a medical emergency, you may need to deliver by cesarean section. In other cases, the baby may have some difficulty coming out. If you’re fully dilated and pushing, but the baby is not coming out, or the baby is facing the wrong direction, you may need assistance with the birth. Forceps and vacuum extraction are performed by an obstetrician to help guide your baby out of the birth canal.

Forceps: The health care provider applies forceps to the baby’s head, while you continue to push as normal.

Vacuum extraction: The doctor applies a soft cup with a vacuum pump to your baby’s head. You continue pushing, while the doctor guides your baby out.

These methods do pose additional risks, but serious injuries with the use of these methods are rare. Your health care provider will only suggest one of these methods if all other options have been exhausted. You can also choose a C-section.

What to Expect During a Vaginal Birth
As labor begins, your cervix will open (dilate) and thin (efface), preparing your body to deliver the baby. Contractions become stronger and closer together as your labor progresses.

Once in the hospital, you can begin your breathing and relaxation techniques or other methods you’ve practiced before childbirth. You may receive an epidural or other pain-control measures. Speak to your provider about these options.

When your cervix is fully dilated (10 cm), you may begin pushing with coaching from your nurse or midwife. Once your baby is born, you’ll then push a little more to deliver the placenta. The care team will clean your baby and stitch any vaginal tears.

You will be able to have immediate skin-to-skin contact and may start breastfeeding.

Vaginal birth recovery
Most moms spend 24 to 48 hours in the hospital for a vaginal birth recovery. While in the hospital, you will receive fluids if needed and can have pain medication if desired as well. You may want ice packs applied to the perineum to ease pain and swelling.

You’ll be sore in the vaginal area for days or even a couple weeks after your vaginal birth delivery. Once you go home, take it easy at first. The first bowel movement after delivery may be painful. You may find a sitz bath helpful for soreness. For a normal vaginal delivery, it can take four to six weeks to feel like yourself again and return to work. You may bleed for a few days to a couple weeks as well. Stick with light lifting and minimal chores at first.

Your health care provider or nurse will offer information on caring for yourself at home and when to call if you have problems.

Natural (drug-free) Birth
Also called drug-free birth, this is a vaginal delivery in a hospital without an epidural or other pain-control medications. Many women want to avoid medications throughout the birthing experience and elect natural methods to control pain. Your care team will still monitor you and your baby throughout the experience but will limit interventions only to those necessary for your and your baby’s health.

How to prepare for natural delivery
You will prepare much like you would for a vaginal delivery. Childbirth classes and classes on breathing and labor techniques are helpful. One advantage of not receiving the epidural is that you’ll be able to move around more freely and try different labor positions. Get familiar with these positions well before going into labor.

If you want to have a doula or birthing coach, choose them early and begin establishing that relationship. Be sure your birthing team knows what your wishes are for delivery and are familiar with your support people. You can complete a birth plan to note your decisions and communicate with your health care provider or midwife and nurses. Remember that the plan is a guide and may change based on medical circumstances during labor and delivery.

Natural birth risk factors and complications
Vaginal birth, with or without pain medications, is safe for most women. Giving birth at UPMC gives you access to the latest medical technology and experts who can respond quickly if something goes wrong.

Your risks with a natural birth are the same as with a vaginal delivery:

• Vaginal tears
• Infection
• Hemorrhage
• Weakened pelvic muscles

Sometimes things don’t go as planned and you may need an emergency cesarean section or an assisted delivery with forceps or vacuum extraction. Your care team will be monitoring you and your baby closely throughout the process and will act quickly to care for you and your baby.

What to Expect During Natural Birth
Your natural birth delivery will follow much the same course as a vaginal delivery with medication. Your cervix will open (dilate) and thin (efface) as you undergo the stages of labor. The contractions will steadily get stronger and closer together.

Labor, especially with a first child, can last for hours, and the pain can be exhausting. That’s where your support team and relaxation techniques come in. Another potential advantage to forgoing pain medication is that those medications can sometimes slow labor. By avoiding them, you may be able to push through the last stage of labor faster.

Recovery After Natural Birth
Immediately after giving birth you will be encouraged to hold your baby for skin-to-skin contact. You can also begin breastfeeding right away if you choose. UPMC has lactation consultants available to help you get started with breastfeeding.

After a vaginal delivery, most women stay in the hospital for 24 to 48 hours. Your vaginal area will be sore, and it may hurt to urinate or have a bowel movement at first. A sitz bath may help ease soreness. You may also experience bleeding for a few days to a few weeks after giving birth. Take it easy for four to six weeks when you get home. Stick with light chores and avoid heavy lifting.

Your health care provider will give you instructions to care for yourself and your baby when you first get home.

Labor Induction
In some cases, your health care provider may want to induce labor, or stimulate contractions, to encourage the birth of your baby. The goal is to induce labor for a vaginal birth.

Why do doctors induce labor?
If you’re approaching two weeks past your due date, your doctor will likely talk about inducing you. Your doctor may also suggest induction for health reasons that require your baby to be delivered sooner to avoid complications. These include:

• Preeclampsia or other high blood pressure problems
• Your water breaks but labor doesn’t begin
• Infection
• Your baby’s growth is restricted
• Your placenta separates from the uterine wall
• Gestational diabetes
• Other medical conditions

Some women may also elect to be induced. If you live far away from the birthing center or have a history of delivering quickly, your doctor may agree to induce you. However, you must be at least 39 weeks along to reduce any risks to your baby.

How labor is induced
Depending on your circumstances, there are a few ways your doctor can induce labor:

Break your water: Also called rupture of membranes, this is when your health care provider uses a small hook to create a hole in the membrane that holds your amniotic fluid. This is done if you’re already dilated and your baby’s head has dropped. The goal is for contractions to start within a few hours

Ripen the cervix: Your cervix needs to soften and thin out before it begins to open. Medications called prostaglandins are placed next your cervix to encourage this process

IV medications: Your health care provider may give you oxytocin to start or strengthen contractions. You will receive the medication through an IV, and your care team will monitor your baby’s heart rate closely

Labor induction risk factors and complications

Failed induction: Although induction works for the majority of women, sometimes it doesn’t stimulate labor. If your cervix hasn’t ripened, your chances of induction failing are higher. If induction doesn’t work, you may need to have a C-section.

Lower fetal heart rate: Oxytocin may cause stronger contractions, which can affect your baby’s heart rate. This is why the medical team constantly monitors your baby’s heart rate throughout labor and can respond quickly if needed.

Other risks are the same as those for a vaginal delivery, but your chances of experiencing these complications are slightly higher with induction. You may have a higher risk of infection the longer your membranes are ruptured. Excess bleeding after delivery is another possible complication.

How to prepare for labor induction
You can still follow your birth plan in many ways with music, mood, relaxation techniques, and support people. Just know that things may not always go as planned. Contractions, when you’re induced, can be stronger and more painful than without induction. Talk to your health care provider about this if you’re considering delivering without pain medication.

What to expect during labor induction
Induction is a little bit of “wait and see.” Your health care provider may try one technique to stimulate contractions and then try another. Once labor begins, you will move through the stages of labor as in any delivery. Your contractions will get stronger and closer together. This process can be faster and more intense when you’re induced.

Your care team will closely monitor you and your baby to determine whether a C-section or any other interventions are necessary to care for both you and your baby.

Vaginal birth after C-section (VBAC)
Having had a C-section in the past doesn’t mean you must have one for each subsequent birth. Many women can safely have a vaginal birth after cesarean. It’s important to ask your health care provider if vaginal birth after cesarean is an option for you and to discuss the risks and benefits.

When you go into labor, you and your doctor will prepare for a vaginal birth. You will start with a trial of labor after cesarean section (TOLAC). If all goes well, you can continue through the vaginal birth. However, if you or your baby face any risks, your doctor may decide if a C-section is the safest method of delivering your baby.

Is VBAC right for you?
Certain factors affect whether you are likely to have a successful vaginal birth. Delivering vaginally will allow you to avoid further scarring on your uterus, and you will have less pain and a shorter recovery time than with a C-section.

Not everyone is a candidate for VBAC, so you’ll need to work closely with your health care provider throughout your pregnancy to ensure your circumstances make this a safe option. Many women have the option of a vaginal birth, even if you’re pregnant with twins. Here’s what you should discuss with your doctor:

Your preferences: As long as there isn’t a medical reason requiring a C-section, you have the option of trying vaginal delivery.

Reason for your prior C-section: Often, a C-section becomes necessary because of complications during delivery. Each birth is different, so you may have different circumstances this time and may be better-positioned for a successful vaginal delivery.

Delivery history: Discuss any successful vaginal deliveries you’ve had in the past.

How many C-sections you’ve had: The biggest risk is that the C-section scar could tear open. This risk increases with each C-section.

How many pregnancies you plan to have: Each C-section increases the risk of problems in future deliveries. Having a vaginal birth this time may benefit you for future pregnancies.

Your birthing center: VBAC does carry risks, so you want to make sure you’re delivering in a center that has experience with this type of delivery and that can perform an emergency C-section if needed.

VBAC risks and complications
To be as prepared as possible, discuss any potential VBAC risks with your doctor:

Rupture of C-section scar: This is the biggest risk and poses a danger to you and your baby. The chances of the scar tearing are low; however, if you’ve had multiple prior C-sections, this risk increases.

Emergency C-section: There’s no guarantee that you will be able to deliver vaginally; problems could arise during delivery. These problems may require your doctor to perform a C-section.

Infection: Needing a C-section after a trial of labor increases your risk of infection compared with a vaginal birth or planned C-section, although the overall risk is still low.

You may have a lower chance of having a successful vaginal birth if you:

• Are older than 35
• Are obese
• Had a previous C-section because of difficult labor
• Have a baby estimated to weigh more than 9 pounds
• Had your last pregnancy less than 18 months ago

How to prepare for Vaginal Birth After C-Section
Prepare as you would for a vaginal birth by attending childbirth classes and learning techniques for laboring and relaxation. Communicate throughout your pregnancy with your health care provider to ensure that it is still healthy for you to deliver vaginally. You may want to complete our birth plan guide to help share your expectations with your health care providers and nurses. Because you never know what may happen, it helps to be mentally and emotionally prepared for the possibility of a C-section.

What to expect during VBAC

Trial of labor after cesarean (TOLAC): This follows like normal labor, where you can move around. Your care team will monitor you closely to ensure you and your baby are safe. Your chances of a successful vaginal delivery are higher if your labor begins on its own.

IV preparation: You will receive an IV in your arm to deliver medications and fluids as needed.

Medications for strengthening labor: If your labor begins to slow, your doctor may administer oxytocin to boost contractions.

Pain medicine: If you choose to have an epidural or other pain-control options, your care team will offer it to you.

Delivery: If all goes well, you will have a successful vaginal delivery.

You can have skin-to-skin contact with your baby right away and begin breastfeeding if you choose.

VBAC Recovery
Your recovery is similar to a normal vaginal birth. Most moms stay in the hospital 24 to 48 hours. While in the hospital, your care team will look after you and your baby. Your vaginal area will be sore at first, and you may use ice packs to ease the pain and swelling.

For the first few days or even weeks, you will have some bleeding or spotting. It may take four to six weeks before you start feeling normal again and are able to return to work. Take it easy during this time. Avoid heavy lifting and rest as much as you need to. Your health care provider will give you specific instructions for caring for yourself at home.

Cesarean section (C-Section)
A cesarean section is a surgical delivery of your baby. The doctor makes an incision in the abdomen and uterus to remove the baby. It’s a fairly common procedure, with about one in five babies delivered by C-section.

Why you might need a C-section
A C-section is only performed when medically necessary for the safety of you and your baby. It is not an elective procedure. The C-section may be planned because of known conditions or it may happen because of a complication during a vaginal delivery. Some reasons you may have a scheduled C-section include:

Medical conditions: These include gestational diabetes, high blood pressure (preeclampsia), or infections like herpes.

Multiples: If the situation warrants, you may need a C-section to deliver twins.

Large baby: There’s concern the baby may not be safely delivered vaginally because of its size.

Position of placenta: The placenta may block the cervix (placenta previa).

Previous cesarean delivery: Many women are able to deliver vaginally after a past C-section, but it’s not always safest. Your doctor will talk to you about whether vaginal birth after cesarean (VBAC) is an option for you.

Problems with the fetus: Anomalies or other issues were discovered during prenatal testing.

The baby’s position: If the baby is breech (feet first) or sideways, it is much harder to deliver vaginally.

You may need an emergency C-section in a situation when you were planning to have a vaginal birth. This may be because:

• The baby needs prompt delivery
• Complications during VBAC
• Failure of labor to progress, which can happen during labor induction
• Complications during labor, such as placental abruption, when the placenta detaches from the uterine wall too early
• How to prepare for a C-section

Even though you won’t be laboring and pushing in the traditional sense, you are still giving birth and it’s normal to feel nervous. Complete a birth plan using our guide to notify the care team of your preferences for support people, the environment of the room, and whether you want to breastfeed or formula feed. Practice some relaxation techniques, pick music to listen to in the operating room, and take steps to mentally prepare for the delivery.

Throughout your pregnancy, aim to maintain a reasonable weight gain and stay as physically active as you can. This will help you during the recovery phase.

C-Section risks and complications
A C-section is a surgical procedure, so it does carry some risks, but serious complications are rare. Some risks include:

• Infection
• Bleeding
• Injury to surrounding organs or bladder and bowels
• Negative reactions to medications
• C-section scar

You may have one of three different types of incisions, but scars today are much smaller and more easily hidden than in the past.

Low transverse incision: This is the most common type. It is a horizontal incision made across the lower part of your uterus, typically below the bikini line. Incisions in this area usually bleed less and form stronger scars, which increases your chances of having a vaginal birth in the future.

Classical incision: This is how all C-sections used to be performed, with a long vertical incision high up on the uterus. These are used rarely and only in emergency situations that require this type of incision.

Low vertical incision: This type of incision is similar to the classical, but lower on the uterus. It is used when the baby is in an awkward position.

What to expect during a C-section
On the day of your delivery, you will be prepared for surgery and attached to equipment to monitor you and your baby’s health. You’ll meet with the anesthesiologist who will explain the pain-control methods used. You are awake during the procedure, but you won’t feel pain. You may feel some pressure or pulling.

The doctor will make the incision, gently deliver the baby from your uterus, and give the baby to the nurse. He or she will cut the umbilical cord and remove the placenta. After delivery, the doctor will close the incision in the uterus with stitches that dissolve and use stitches or staples to close the incision on your abdomen.

You can hold and begin nursing your baby immediately.

C-section recovery
After the surgery, you may receive pain medication to keep you comfortable. If you’re breastfeeding, lactation consultants can help you find the right position. It may be difficult to sit up at first, and you want to be sure the baby isn’t putting pressure on your incision during feedings.

You may spend two to four days in the hospital after delivery. While in the hospital, you’ll be encouraged to walk soon after the anesthesia wears off.

For the first few days, you may have soreness at the incision and be constipated or gassy. Avoid lifting anything heavy and limit activities that put pressure on your incision.

It may take you six to eight weeks to fully heal and return to work and normal activities. Your health care provider will give you specific instructions about activity and caring for your scar.

Article provided by UPMC Magee-Womens Hospital. No matter what happens, our experts are here for you and your baby. Each year, nearly 9,000 babies are born at Magee. You’ll find comfort and compassion in our Birthing Center combined with expertise and the latest medical technology. Whether you want minimal medical interventions or are facing a high-risk pregnancy, our caring staff will support you (and your support people) throughout every step. To make an appointment for prenatal care at UPMC Magee, call toll-free 1-866-MyMagee (696-2433).