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Part 3: Delivering

[00:00:00] All righty, team. It's Friday. I'm not on call, but I just have a lot of stuff to get done. So we're gonna motor through this video. So we talked about, part one was what happens if you go into labor? How do you know you're in labor when you get to the hospital? What might happen? What might happen if you have a C-section? 

What might transpire during labor part two was right when the baby comes out, what happens in that flurry of activity? Let's talk about part three, which is literally the baby has come out, so I'm gonna break it up to vaginal versus C-section. So the baby came out, baby's lying on your chest. Baby is either vigorous, crying, you know, doing all the things that confirmed to us. 

Everything's great and you're paying attention to your baby. The nurse is helping you and helping the doctor because now the doctor wants to make sure that the placenta comes out. The placenta. The minute your uterus realizes the baby is out, it starts to ideally contract to get the place. I say ideally because sometimes that uterus is stubborn and that placenta is stubborn and it doesn't wanna come out. 

I'm not gonna discuss the whole notion of what happens when you have [00:01:00] a retained placenta, cuz that. For another video, but when the B the placenta comes out, we want your uterus to then contract and stop bleeding. Cuz as you can imagine that placenta's been attached. So you'll be getting, most likely, if you're in America iv, what we call Pitocin, which is the synthetic oxytocin. 

Even if you didn't get it during labor, you would get it typically right after the baby comes out to make your uterus contract. And if your. Doesn't do what we need it to do and stop bleeding and really contract well. Then your doctor's gonna be massaging your uterus, making sure all the parts of the placenta came out, giving you different medications. 

That is all, while again, you're smuggling with your baby. And your baby is ideally kind of doing a combination of. Crying sometimes when we stimulate to show us that the baby's okay and snuggling against your chest, and that is again, helpful for the baby's microbiome, for the baby's glucose regulation and temperature regulation. 

And it helps your hormones try to figure out what to do if you decide you want a nurse. What if you can't do skin to skin again? It's okay. I didn't do skin to skin [00:02:00] again with any of my three babies. Is it great? Of course, there's so many nice benefits. There's a lot of things in life that are ideal that we don't get to do, and that doesn't mean the dent end result is not just as good. 

So if you can do it, it's great. And if you can't do it, it's okay, because there's other ways that you're still gonna bond with your baby. So again, let's assume the baby has come out vigorous crying. Great if the baby came out, not vigorous, not crying, not kind of showing us all of the things that we want. 

Um, evaluate that the baby is had gotten enough oxygen and is moving its muscles and everything, then your nurses and your doctors might have to do a couple things to kind of vigorously, um, stimulate the baby and ask the nurse, the neonatologist or the pediatrician to even come into the room. And that can be nerve-wracking, like right when the baby comes out, if the baby's not crying. 

Then we sometimes clamp and cut the cord quickly instead of letting dad do it. And at that point we sometimes then whisk the baby over to the little warmer where the nurse, the doctor, or a neonatologist or a pediatrician or a pediatric pa or [00:03:00] a pediatric nurse practitioner, will come and do an assessment, suction the baby, assess the baby's heart rate, assess the baby's oxygen, and during that time, it's like mom and dad. 

Mom and her partner, the doctor, everyone's. waiting because we like to hear that little heart, that little cry, and sometimes it takes a minute or two. And yes, that is nerve-wracking for everybody. It does not mean that the baby suffered through some tragic loss of oxygen during delivery. It often just means the baby came out. 

Stunned, like, holy cow, I'm coming out of this opening. So again, just to be prepared. In a perfect world in the movies, the baby comes out screaming and crying. We love that. When the baby doesn't come out screaming and crying, most of the time it is okay, and the baby will scream and cry a minute or two later. 

And then frankly, all night long, right? So now let's say you've had a C-section. All that same thing happens except for the fact that right when the baby comes out, as we talked about, the cord gets clamped and cut, the baby goes immediately to the pediatrician at the warmer. And that's because when babies come out from a belly instead of the vagina, they don't get the fluid [00:04:00] squeezed out of them, and they can sometimes have a little bit. 

Fast breathing. They have to be suctioned. And so the pediatricians do that in the room. Dad or your birth partner can't cut the cord cuz they're not sterile. But we leave the cord long enough that they could always do it later, like we talked about. So then once the pediatrician has assessed the baby, it can be one to five minutes. 

They'll kind of wrap the baby up and bring the baby over to you where you're lying down with a drape up to here while the doctor is finishing sewing. . Many patients ask if they can do skin to skin in the operating room and in our hospital the nurses really try to accommodate. But you can probably guess we need to have more than one nurse, cuz I need the nurses to pay, pay attention to when I need them to hand me things and get things for me to keep you safe while I'm operating. 

But for them to be able to attend to you and the baby and hold the baby near you to make sure it's safe, that the baby doesn't fall off your chest since you only have this much room, is sometimes challenging. So if there are enough nurses, then we always try to accommodate. And if there aren't, like I say, Whoever's with you in the operating room, your husband, your wife, your mother, your birth partner, they can also be the one [00:05:00] holding the baby, which is typically what happens. 

They can unsnap your gown, snuggle the baby next to your chin. Next to your shoulder. So even if it's not full on skin diskin contact, it really is. , I would say is good. And I say that again as the girl who was in the operating room who when my babies came out, I was like, um, I bought a little something in my IV so I can kind of take a nap right now. 

I did not do any of the skin to skin. I didn't even do shoulder to skin. I just was happy to be like, the babies are out. Can I please get something to sleep? So you'll see how you feel and talk about it with your doctor and talk about it with your anesthesiologist and the nurses. So again, let's say you do get to do skin to skin or not. 

Either way, the person who's with you will be holding the baby right next to you. Your doctor will finish your C-section, and then you and your doctor and whoever's in the room. In our hospital, and I suspect this is true in most hospitals nowadays, they hand the baby to you when you're on the stretcher and you get wheeled into the recovery room. 

Different hospitals are different. At our hospital, you actually recover in the same room you started, which happens to be a labor room. Other hospitals will have a separate admission versus recovery room. But [00:06:00] again, typically as long as the baby's okay, they try to keep that baby with you. So now we're back to vaginal or C-section. 

You're holding your baby, you finished your delivery. The nurses are doing their thing. They have to keep making sure that you're safe because after the delivery you still might have bleeding or blood pressure issues. Is that terrible and scary? No, because we're watching out for it. So while I can't say everything's done, nothing we need to pay attention to, I can say the best majority of patients are fine and those that aren't are being watched so that we can catch those things that we worry about. 

Like your blood pressure going up like your. . So during your stay, especially that first 24 hours, you'll be watched more carefully. It's sometimes annoying cuz in the middle of the night those nurses have to come in and check you and again, by the second night, you tend to have less surveillance because we know that you're farther from the delivery and safer. 

So they will also be pushing on your uterus. The top of your uterus is your fundus. They're gonna come in and periodically feel where your fundus is and push on it to make sure that it's contracted. If your fundus tends to get higher, higher. [00:07:00] That can be a sign that it's filling up with blood, or that could be a sign that your bladder is full if you no longer have a catheter in your bladder. 

If you've had a vaginal delivery, chances are you're going to the maternity ward without a tube in your bladder, which is called a catheter or a Foley. Sometimes you can't feel anything even after one or two hours with your epidural, and then the nurses might leave in the catheter because you won't be able to pee without the sensation. 

If you've had a C-section, you typically go to mater. With your catheter and different hospitals have different protocols, but pretty much the standard is to leave it in for 12 to 24 hours, and that can change based on your vital signs and how much urine you're making and how the surgery went. But that's kind of the standard. 

I myself, after my vaginal delivery, actually had it in for 48 hours because I was really swollen. From the pushing. That's not typical, but it can happen. So again, there are variations, but the standard is that if it's a C-section, 12 to 24 hours, if it's a vaginal delivery, you won't go upstairs with it. We won't go to the maternity ward with the Foley. 

So then during that 24 hours, again, the nurses are watching for your blood pressure. They're making sure that you're not dizzy and that you're peeing [00:08:00] okay, and that you're bleeding is appropriate. Appropriate bleeding is different for everybody. Some people have barely little pad. Other patients need the diaper. 

I kind of feel like up to a heavy period is considered okay, and everyone has a. System with what they think is a heavy period, but the nurses will be watching you and the doctors will be seeing you each day to make sure you're okay If you've had a vaginal delivery. Most states allow you to stay for two nights. 

That means two nights after the delivery. So if you're there for four nights for an induction, which is rare, don't worry, you still only stay two nights after the delivery, and that includes like you delivered that baby at 11:59 PM. that is your first night. It's annoying. So usually we tell patients like, hold out for 1201 so that you can have almost like an extra night if you've had a C-section. 

It's kind of state dependent. Connecticut allows for four nights after the C-section. Other states allow for three. Uh, now during covid, a lot of my patients have asked to go home after three, occasionally after two. And depending on them, their vital signs, their support staff at home, we would let them. 

But we just give them certain precaution. , [00:09:00] how do you care for down there? The hospital's gonna give you a baggie and it's gonna have that mesh underwear that y'all thought was so gross. And then once you've had a baby, you're like hoarding the mesh underwear. So you'll have mesh underwear, you'll get a squirty bottle, what we call a peri bottle. 

The peri bottle is meant to kind of soothe and clean, so you feel like you have to pee. It's nice to put some warm water in there and just. Squeegee down there. Cause it helps stimulate it and make it less nerve-wracking. When you pee, you don't need to do really anything else. You just gently wash either just with water or mild soap like dove and water. 

Gentle, clearly no rubbing, pad it dry and that's it. In the ideal world, if you can actually lay in bed, maybe on a towel without a pad and just let everything kind of air itself out, that would be great. But in the real world, if you don't have the time to do that, because now you're home taking care of a baby, you're gonna be wearing a. 

Sometimes it's those big diaper pads. Sometimes you d you demote to just the super or a maxi. If you've had a C-section, your incision will either have sutures that get dissolved or staples or some [00:10:00] doctors still use non-absorbable sutures that they pull out, and that just has to do with doctor preference and what experience they've had with how things heal. 

I tend to really like staples, but we're moving a little bit more towards absorbable sutures. I could do a whole story about that. I had staples. They healed. Great. So I think it just depends on the doctor, but I am doing more of the absorbable sutures because some of the data suggests it and people tend to like it and they don't need to have them removed. 

So you'll talk about that with your doctor. I really think they're actually all equivalent just based on your doctor's preference. So I would defer to them as opposed to like what you think or what you've heard, to be honest. Um, and I tell patients to put heat on their incision. There's some data that the first 24 hours you can use ice on your incision after surgery to decrease swelling and then switch to. 

So again, ask your doctor if they have a preference. I tend to like heat because heat helps the area heal by opening up the blood supply into any area. Just think like when you've had a bug bite where it looks all pink and kind of infected. You wanna use heat to make sure that the, the blood supply opens up to give the blood, [00:11:00] good blood cells in there so you don't wanna decrease swelling. 

If you've had a bug bite with infection, you might not realize. You wanna decrease swelling if you think you sprained an ankle. But if you think there's any sign of infection, which is what we're concerned about in an incision from a C-section, is decreasing infection, then you wanna actually heat it again, the first 24 hours with swelling. 

The data can show that maybe ice is okay. I am not commenting on that right now. Okay, for your vagina, Again, we're not worried about infection. Your vagina's amazing. You have so much blood supply in your vagina that even when it tears all kinds of ways till Sunday, I know that sounds terrible, but it does sometimes, and we repair it. 

It heals like the likelihood of an infection in your app. Episiotomy or tear is. , teeny. So I tell patients ice for the first 24 hours of your vagina, because that really does decrease swelling cuz Lord, it can get swollen in your labia and your rectum and everywhere. And then to soothe it if you want, you can use heat, but most patients don't need to. 

When you go home, it's very common to have more bleeding because you're kind of running around, as I joke, you're [00:12:00] no longer in your little cocoon. The more you're active. Sometimes your UUs relaxes and then pushes out even a clot. Ask your doctor what they feel comfortable with. I feel comfortable with if you gush out a clot, but it's not gushing liquidy blood. 

If it's one clot, I'm not that worried. If it's repetitive, call us and then we talk about it. The other thing that can happen is that you might get much more swollen, especially when it's your first baby, and especially if you've been in labor for a long time and gotten a lot of fluids and things like that in your iv because. 

You're mobilizing the fluid to help pee it out. What that means is your body retains fluid. You'd have fluid during D during the pregnancy in your body. It retains it. It doesn't retain it in the blood vessels. It seats out of the blood vessels and into the tissue, meaning your hands, your feet, your ankles. 

That's why you get swollen because the blood supply is no longer holding all the fluid. It's seeped into the tissue. You want your body to mobilize that fluid back into the blood vessel. Filter it through your kidneys and pee it out. That's why you'll notice sometimes a couple days after the delivery, you're peeing a ton. 

And if it's nice and clear, that's a sign that you are diuresing, meaning getting rid of [00:13:00] the fluid. And we love that. And the best way to do that is just drink a ton of water. So the more you drink, the more you're gonna be able to mobilize that. But that means that sometimes you go home and you get more puffy and swollen for that first week or two. 

The other thing that sometimes happens is a really terrible headache when you're home, and that's often related to the drop in estrogen if you're nursing or just from the hormones from having the baby. But you have to differentiate between that. Versus things like a headache from the spinal anesthesia, if you had a C-section or an epidural can sometimes cause the spinal, the, the headache because you have what's called a wet tap. 

Um, or you can have a headache from preeclampsia. So you do wanna differentiate. And the best way I think is if you have a terrible headache, Have some, none. The NSAIDs, like ibuprofen, maybe caffeine. And if the headache goes away in in the next hour, you're okay. But if that headache persists, call your doctor. 

It's sometimes postpartum pre-eclampsia. So again, this video is not meant to be like, oh my God, all these things could happen. It's meant to say. A lot of things can happen, but most people are okay. [00:14:00] And again, even when things happen, if we keep our wits about us and you communicate with your doctor and you know the things to be worried about, and if you don't know and you're worried, I know it's frustrating cuz we get a lot of phone calls, but we'd always rather you just reach out. 

Okay, so that is at the third part system. Now, I really realize every time I do this that there's so much more to talk about. We could talk about spinal headaches, we could talk about, I haven't even talked about levels of terrace from your vaginal delivery, like for second, third, fourth degree terrace. So much more to discuss. 

Any of you who like it, you can always come and join us at Tribe called V because that's where we're gonna be having even more education at some point. Um, but that is it. I'm gonna go see some patients. Bye.