By the time my due date arrived, I was more than ready to give birth: I’d distributed laminated copies of my birth plan to my midwife and the hospital, and had kept a duffle bag with nursing pajamas, spare contact lenses and nipple cream sitting by the front door of my apartment for weeks.
But when my midwife accidentally broke my water during my last prenatal checkup, my birth plan was thrown into chaos. Less than an hour later, with pain radiating through my lower back, I was being wheeled through the hospital. As the waves of pain crested, I felt for brief moments like I was outside my body, looking down at myself. There I was: swollen, struggling and surrounded by strangers in scrubs.
Apparently the one thing I hadn’t done to prepare for labor was learn about the people whose job it was to get me through it. If raising a child takes a village, giving birth to one takes at least a densely populated cul-de-sac. During my stay at the hospital, at least 30 healthcare professionals played a direct role in my care. Here’s the rundown I never got of all the pros who might show up to help you push, breathe and swaddle.
Labor and delivery
I assumed my midwife would be actively involved in my labor, start to finish, but it was actually a rotating cast of nurses who got me through the 18-hour slog to my emergency C-section. When you’re trying to deliver a baby and it feels impossible, your nurses are the people who will convince you that you can do it. The head nurse didn’t so much as bat an eye when I threw up on her (multiple times), and the nurses under her supervision were similarly compassionate and professional.
“The attending physician is in charge of your hospital admission, but you have the most face-to-face time with the nurses taking care of you during labor and after delivery,” said Megan Cheney, medical director at the Banner University Women’s Clinic. “Your nurse will help you navigate through the process of being in the hospital, having labor pains and taking care of your baby once he or she is born.”
Residents and medical students
There are 5,500 registered hospitals in the U.S., according to the American Hospital Association. More than 1,000 of them are teaching hospitals, where medical students and residents get their on-the-job training. “If you deliver in a teaching institution,” Cheney said, “you should expect to have a resident and possibly a medical student.”
Both a med student and an ob-gyn resident were present at different times during my labor and delivery. An attending anesthesiologist, meaning the doctor who administers epidurals and other pain management medication, also showed up with a resident in tow.
“Residents are doctors in training and are actively involved in patient care,” explained Adeeti Gupta, an ob-gyn and founder of the Walk-In Gyn Care Clinic in New York City. “They have also passed their licensing exams, so they are technically doctors and allowed to prescribe medication and take care of patients.”
Medical students, on the other hand, don’t make any decisions about diagnosis or treatment. They’re there primarily to observe and sometimes to perform basic tasks, such as drawing blood and taking vital signs, as instructed by their supervisors.
Most academic hospitals have built-in or implied consent policies for residents and medical students to be involved in patient care. “If a patient explicitly refuses care from either type of trainee,” Gupta said, “they have that right.” But a hospital might in turn reserve the right to decline nonemergency care.
A resident who walks into the delivery room should state their name and that they are a resident. If you want to know where someone staffed on your case falls in the medical pecking order, just ask for the attending physician.
Birth attendants: Obstetricians and midwives
I planned to give birth in a hospital under the guidance of a midwife, whom I chose as my primary pregnancy provider, or “birth attendant.” About 13 percent of American women are making the same choice, per a 2018 study. And, according to the American College of Certified Nurse Midwives, midwife-attended births are on the rise overall.
Midwives are skilled reproductive primary care providers. As long as labor complications don’t arise and patients give birth vaginally, they’re licensed to perform hospital deliveries on their own. While midwifery might be associated with home birth, the vast majority of midwife-attended births take place in hospitals, and more than half of all midwives are employed by hospitals, medical centers or physician practices. Doulas, on the other hand, do not serve a clinical role. Instead, they provide the mother with emotional and moral support during pregnancy and labor. While they are trained to assist medical providers in a birth, they are not licensed to carry it out themselves.
“Midwives can do a normal uncomplicated vaginal delivery without supervision,” Gupta said. “Some trained midwives can even do complicated deliveries (using forceps, etc.), as well. However, most midwives will call in the obstetrician physician at that point. If the delivery process reaches the point where a patient needs surgical intervention or some other complicating high-risk factor is affecting the pregnancy, an ob-gyn is needed.”
My midwife-only birth plan didn’t pan out for two reasons. My midwife didn’t arrive at the hospital in time to run my labor and delivery. And because I was still in labor at the 18th hour, I had to have an emergency cesarean section, which only a doctor can perform. It’s fairly common for women who use midwives for prenatal care to end up getting delivered by doctors. In a 2018 analysis of deliveries at the Ohio State University Wexner Medical Center, more than 21 percent of women transferred from midwives to obstetricians for delivery.
In most cases, Gupta says, midwives and doulas show up when labor begins, whereas obstetricians tend only to be present from start to finish in high-risk situations. Sometimes the obstetrician will join the fun just as a patient is ramping up to push the baby out (a period called transition), which starts once the cervix is dilated 10 cm. Delivery nurses send obstetricians or other appointed birth attendants progress reports the whole time, so they know when they’re needed. But don’t count on “your” physician showing up; if they work in a practice, you’ll probably get whichever OB happens to be on call.
Nurses are also responsible for updating the attending physician, the on-call obstetrician in charge of monitoring every laboring women on the floor. Some larger hospitals, Gupta says, have two attendings on call per wing: one to perform C-sections and tend to other emergencies, and a second to supervise triage, and labor and delivery.
Attendings are basically there to tend to patients who need them and oversee the whole labor and delivery operation. If your designated birth attendant is an obstetrician or midwife who works outside the hospital where you’re delivering, you might not see an attending at all.
Anesthesiologists frequently play a role in delivery. They administer epidurals to at least 60 percent of women who give birth vaginally, according to the Centers for Disease Control and Prevention. And in C-sections, the delivery method for nearly 1 in 3 babies born in the U.S., they might employ a few different methods to numb the body for surgery, including a spinal block, epidural and general anesthesia.
I received two epidurals before the attending obstetrician decided to do a C-section. Needless to say, I kept the anesthesiologist busy. Between contractions, she asked me about my pre-pregnancy weight and current weight, and any history of allergies or substance abuse. These questions were not small talk. “The anesthesiologist will explain the possible risks and benefits, complications and expected outcomes of the pain-relief procedure.” Gupta said. “They want to make sure that the patient does not have a contraindication to an epidural, such as a bleeding disorder.”
Maternity ward nurses
After my son was born, I felt awkward buzzing nurses for help. But by the time I left the hospital, three days later, my finger was practically welded to that buzzer. I adjusted out of necessity: The nurses were the keepers of ibuprofen. Following vaginal delivery, Cheney says, oral ibuprofen and ice packs applied to the perineum often provide sufficient pain relief. But after a C-section, women commonly need to take narcotics for one to two weeks.
In addition to administering pain relief, maternity ward nurses help with the first post-delivery bowel movement, demonstrate how to care for any stitches or tears and monitor vital signs to prevent infection. They also help take care of your baby while you rest and recover. Use them as a resource: They’ve mastered the swaddle, can change a diaper in seconds and always know what a crying newborn needs.
Maternity ward doctors
Once you’re in the maternity ward, your obstetrician or midwife might stop by for a visit. There will also be a doctor on call and potentially residents floating around too. Maternity ward doctors will check your stitches, answer questions about pain, evaluate your healing progress and constantly ask you how you’re feeling.
If you plan to breastfeed, ask about speaking with a lactation consultant before leaving the hospital. While your baby may seem to be latching well, getting a professional feeding evaluation can save you worry and pain later on. The American Association of Pediatrics recommends that “formal evaluation of breastfeeding, including observation of position, latch and milk transfer, should be undertaken by trained caregivers at least twice daily, and fully documented in the record during each day in the hospital after birth.”
Not every hospital is staffed with a certified full-time lactation consultant. In these cases, maternity ward nurses usually have some training in breastfeeding assistance. According to data collected by the CDC, 93 percent of mothers who breastfed received instructions and advice on how to do so in the hospital. About 89 percent of breastfeeding moms were formally assessed and observed while breastfeeding to troubleshoot for potential problems. When I took a tour of my hospital prior to delivery, I asked questions about what kind of breastfeeding support would be available.
The pediatric team
Hospital guidelines vary when it comes to pediatricians being present for delivery. “In smaller centers,” Gupta said, “the pediatrician may be called in if the labor is anticipated to be difficult or there are other high-risk factors such as preeclampsia, gestational diabetes or low fetal heart rate.”
In any case, you will definitely encounter the pediatric team in the maternity ward. Newborns are subject to all sorts of tests during their first few days of life. Before my son and I left the hospital, he had his hearing and eyesight checked, and got weighed multiple times each day. He also got blood tests to check for genetic abnormalities and to register his blood type with the State of New York. I was exhausted and overwhelmed, but the pediatrician and pediatric nurses on staff had plenty of experience communicating with new parents.
The team that helps you give birth may seem overwhelming, but they’re all there to help you and the baby. Use your time in the hospital as an opportunity to share your feelings about delivery and new motherhood. “Ask questions,” Cheney says. “Don’t be afraid to be vulnerable.” Part of preparing to give birth is gearing up for the unexpected. You can pack the perfect hospital bag and laminate your birth plan. But at some point, you’ll need to go with the flow.