Step-by-Step. What can I expect during a Vaginal Birth in a Hospital? -with Michelle Collins, Ph.D.


What to expect during vaginal birth

(With Michelle Collins, Ph.D. Certified Nurse Midwife, Vanderbilt University) What exactly happens from the moment you step inside the hospital doors to the time you go home with baby? Knowing what you can expect during a hospital vaginal birth helps you stay relaxed & focused. You’ll labor more efficiently, which means less pain, faster labor, more oxygen to baby & a bunch of other mildly important things.   

Michelle Collins, Ph.D., a former labor & delivery nurse, turned Certified Nurse Midwife- teaches us what happens each & every step of the way. Her 30 years of experience is gold. Having worked with a ton of different providers, she knows how much your doctor or midwife affects your experience & outcome. She gives you specifics…the things she’d ask any potential provider herself BEFORE hiring them. 

Plus we cover things like when should you go to the hospital, what happens when you get there, who will be stopping in your room at all hours of the day & night to check on you (and baby) & what they’ll be doing. And why it’s a good idea to stay away from proteins & stick with carbs once labor starts. You’ll feel more confident & know what to expect after watching this interview.What can you expect during hospital birth

You’ll Also Learn:

  1. How many machines you’ll be hooked up to, what they do, and how long they’re there.
  2. At what point can you get an epidural & is there a time that’s too late?
  3. Who will be in the room when baby is born and what they do.

Who is Michelle Collins?

Michelle Collins Ph.D., is a Certified Nurse Midwife (CNM) and has been for the past 10 years. Prior to that, Dr. Collins was a labor and delivery nurse for 17 years. Currently Dr. Collins is assistant professor at Vanderbilt University School of Nursing, specializing in Nurse Midwifery.  She has two boys of her own who keep her busy too! Dr. Collins talks about this Book- “Active Birth” by Janet Balaskas. (affiliate) 

Watch This Interview (or download MP3


What do you think? Share in the comments below…




Michelle Collins-Vaginal Hospital Birth


Sarah Blight:                           Hi, this is Sarah Blight from Your Baby Booty Interviews, where we cut to the fluff and get straight to the point of what you really want and need to know as you become a mom. So, what happens when you go into labor and you have a normal vaginal birth at the hospital? What happens? What’s the flow of what you can expect and what goes on? Well today, Dr. Michelle Collins is here with us. She has been a labor and delivery nurse, she was a labor and delivery nurse for 17 years, and now she’s a certified nurse- midwife and just received her Ph.D. She’s at Vanderbilt University and she is the assistant professor of nursing, with a specialty in nurse midwifery, and she also has a family, two boys, a husband—she’s a busy woman. So thank you so much, Dr. Collins, for being with us today.

Dr. Michelle Collins:               Thank you, it’s great to be here.

Sarah Blight:                           Um, so, congratulations on your PhD, by the way, I know you just defended and you’re getting through that, so I know that’s a huge accomplishment and you got to be thrilled.

Dr. Michelle Collins:               Yes, yes. My husband says if I go back to school for anything else, I have to do it from a different zip code, so…

Sarah Blight:                           [Laughter]

Dr. Michelle Collins:               No more school.

Sarah Blight:                           No more school. And you did tell me that you make your boys call you Dr. Mom now, which I think is very fabulous and I love that.

Dr. Michelle Collins:               That’s a joke. [Laughter]

Sarah Blight:                           I love that though, I love that. Um, okay, so let’s cut to the chase here. When a mama thinks that she’s in labor, at what point—and we’re going to use a hospital birth here for the purposes of our discussion tonight, at what point does she know that—when should she go to the hospital?

Dr. Michelle Collins:               Well, I think you should talk ahead of time with your provider about that, because every provider is going to be a little bit different. Some providers are going to say, “Come to the hospital when the contractions are 5 minutes apart”. Others are going to say when they’re 4 to 5 minutes apart for at least an hour, then we want you to come.

In our particular practice we say when they get to 4 minutes apart or so, give us a call, and then we want to triage over the phone and see what’s going on, ‘cause you can almost tell in a woman’s voice what stage of labor she’s in. And if she’s going, “Yeah, I’m great! I’m contraction, contraction—I’m having contractions every 2 minutes” and she’s talking to you in her voice never change inflection; you can sort of tell she’s not too uncomfortable yet.

Sarah Blight:                           Yeah.

Dr. Michelle Collins:               So.

Sarah Blight:                           I heard something that’s said when the cookies start to burn, then you need to go the hospital, which was, you know, you get that rush of like, you know, energy, you know, when you’re just starting out labor and you’re cooking and you’re doing all that stuff, and when the cookies start to burn [Laughter] and you can’t focus on the cookies anymore, it might be time to go to the hospital.

Dr. Michelle Collins:               That’s a really good one, I haven’t heard that, but that’s really good.

Sarah Blight:                           [Laughter] Um, so we’re going to cover the stages of labor in a different, separate interview, um, as to what women can expect from their body physiologically, what’s going on with them, but from a hospital perspective, when a woman first gets to the hospital and she decides to go, what can she expect when she first walks in the door?

Dr. Michelle Collins:               Well most hospitals, you have to go through the ER and they check you in, and then they either have you walk or put you in a wheelchair and take you up to the labor and delivery unit, and then  the nurse is going to meet you and check you in—she’ll usually have you empty your bladder and change into a hospitals gown if you want to. Um, most people wear hospital gowns just because they don’t want to get their own clothes, you know, messed up with bodily fluids, but you can certainly wear your own clothes if that’s allowable, and people do want—sometimes they feel more comfortable in their own clothes, and then you’ll get into the bed and the nurse will usually start asking interview questions, when did your labor start, did your water break, are you having any bloody show, how’s your baby moving, you know, all those million in one questions that they ask you, and then your provider would be called at some point—now it’s different for different hospitals, um, for instance if I’m on call, I’m in the hospital, I’d come  in right at the beginning and see the patient and do her examination, so forth right then. In some hospitals your provider might be at home, so the nurse might get her whole assessment and then she might call your provider, who would then come in. So…

Sarah Blight:                           Is—is there every a time when the hospital’s kind of expecting you and knows that you’re coming? Does that just kind of depend on how things work with your health care provider?

Dr. Michelle Collins:               Yeah, I’ve worked with both, like some providers will say, “Just show up at the hospital and they’re do—they will do their assessment and they’ll call me. In our practice, because we take call out of the hospital, we want patient to call us first, so that we can meet them at the hospital.

Sarah Blight:                           Okay.

Dr. Michelle Collins:               So that’s one thing you want to know ahead of time, what—who am I suppose to call when, or should I just show up at the hospital or—what should I do?

Sarah Blight:                           Okay, okay, that’s a good question to ask. Um, are there any tips or advice that you give to mamas before they check into the hospital, things that they should do, like, go to an all- you-can-eat Chinese buffet or [Laughter] drink a lot of fluids, or—what kinds of things would you advice mamas to do kind of at home and take care of that home before they go to the hospital.


Dr. Michelle Collins:               Well, firs of all I’d say stay home until you absolutely can’t stay home, at, un, it—for most women, and we’ll talk about stages later- labor, I  know a shepherd of– and a part, but, you’re going to  labor best in known environment, so because of all the adrenalin that’s kind of running through your body, when you get excited, you show up at the hospital, your labor’s going to slow down, so it’s better for women to labor and early labor a home, where; they’re comfortable and I tell them, go about your normal activities,  if it’s a daytime, go outside for a walk. Um, you know, go shopping, go to the park—a walk in the pack.

Um, if it’s nighttime and you’re certain has some regular contractions. Um, if you can still does between—on, they might wake you up, but still try to dose. Or if you can’t dose, get in the warm bath, the shower and see if that might relax you a little bit, but don’t get up and start jogging around the block, if it’s 1:00 in the morning, because your early stage of labor might be 8 or 10 hours, now you’re going to be exhausted morning when you really are in good labor. So…

Sarah Blight:                           Good point.

Dr. Michelle Collins:               Depending on what time of day it is, different, um, but also—yeah, go ahead and eat. Now some things digest better in labor. When you’re in labor, you’re whole body is concentrating on labor and not the other things that go in physiologically, so like digestion doesn’t occur at the same efficiency when you’re in labor.

Sarah Blight:                           Okay.

Dr. Michelle Collins:               So protein is the hardest to digest, so you don’t want to eat a lot of protein.

Sarah Blight:                           Okay.

Dr. Michelle Collins:               You think you’re in labor, you kind of want to stick to carbs and certainly foods with some sugar in it, like Gatorade, lemonade, soda, popsicles, jellos, soups—but a big greasy hamburger, not a great idea.

Sarah Blight:                           Yeah.

Dr. Michelle Collins:               Pizza, not a great idea, because it’s not going to digest and later on when you get nauseous, if you get nauseous, it’s going to come back up.

Sarah Blight:                           Yeah, okay.

Dr. Michelle Collins:               But, keep to your own—your regular activity, keep doing what normally do.

Sarah Blight:                           Okay, that’s a really—I like—that’s a really good point about digestion and just really—you don’t want to feel super heavy and, you know—I was joking about the all you can eat buffet. You don’t want to feel like you’re super sluggish when you get to the hospital. Um, so, you said that after you get to your room and you get checked in, then the nurse—it’s usually the nurse you said, right, who does kind of the assessment?

Dr. Michelle Collins:               The—you kind of froze—the screen froze for a minute, did you ask, does the nurse do the assessment?

Sarah Blight:                           Yeah, I was—sorry, I was asking, when you first get to your room, you said it’s normally the nurse who does the assessment, and she—can you go over that again, what she asks you and kind of what she’s looking for?

Dr. Michelle Collins:               Well, every hospital kind of has their own form as to what they use, but she’s going to ask your physical symptoms, when were contractions regular and strong, what’s your—and I don’t like this question, most of us don’t like this question—how would you rate your pain on a scale of 1 to 10. Well, you know, most women have never had that kind of pain before, if it’s their first baby, and it’s not pain like getting your arm of in an accident kind of pain, so most of us don’t think that that scale really applies to labor, but they’re going to ask you that anyway.

Sarah Blight:                           Okay.

Dr. Michelle Collins:               Um, has your water broken? Are you bleeding? How’s the baby been moving? They may ask you things like, are you having blurry vision, double vision, any visual changes, headaches, you know, just to rule out any signs of like preeclampsia. And then they’re also taking a visual, you know, looking at how you [0:08:35][and book?], you know, how you’re tolerating contractions. They’re going to check your blood pressure, your pulse, your temperature and they’re going to get all the information together and then give it to your provider.

Unless your provider’s already there and—for instance like if I’m there in the hospital and a patient comes in, I just come in the room when the nurse is gathering all that information, so that I could get it at the same time, and I don’t have to re-ask her the same questions. So it depends on—kind of depends on the scenario.

Sarah Blight:                           The system, okay. And so what kind of contraptions will a mama be hooked up to at this point? I know for a lot of women, myself included, I had never stayed in a hospital or been in a hospital room, and I know the machines and the things can get kind of a little bit intimidating, so can you walk us through what you might be hooked up to and what it does?

Dr. Michelle Collins:               Well, the fetal monitoring, um, there’s two types of really—of fetal monitoring, as far as the external, there’s continuous and there’s intermittent.

Sarah Blight:                           Okay.

Dr. Michelle Collins:               A continuous monitoring means when you have the belt—there are two belts, and one is hooked to the top of your uterus, and the other one is wherever the baby’s back is to pick up the baby’s heart rate. So continuous monitoring means that you have those belts on and they’re on throughout the entire labor.

Sarah Blight:                           Okay.

Dr. Michelle Collins:               Now intermittent monitoring means that there’s a protocol, there’s a standard for that, and actually most women, where all women who are low risk qualify as candidates for intermittent monitoring. Problem is, that’s what’s not done in hospitals, ‘cause it’s much easier, sometimes, for the staff to just put the belts on the patient and leave them that way.

Sarah Blight:                           Yeah.


Dr. Michelle Collins:               [0:10:14] [fortunately?] and then they’re monitored out of the nurse’s station, so that they can actually see what’s going on with the belts there, as far as the tracing.

Sarah Blight:                           Okay.

Dr. Michelle Collins:               So, um, but intermittent auscultation or intermittent monitoring is really just standard of care for low risk women, so for instance, if I have a patient in labor and she’s a candidate for intermittent monitoring, we don’t put the belts on her, she—we get an initial 20 minute strip when she comes in, but then we take them off, and every 30 minutes in the first stage of labor  we just listen to the baby’s heart rate through a contraction, so that contraction ends, so we start when you’re between contractions, listen through a contraction and end when you’re between contractions again then we take it off.

Sarah Blight:                           Oh, okay.


Dr. Michelle Collins:               And for 30 minutes, she’s, you know, unencumbered by the monitor…

Sarah Blight:                           Okay.

Dr. Michelle Collins:               [0:10:59][Inaudible] later we listen again.

Sarah Blight:                           So that’s what I was going to ask you is what would be the benefit of the intermittent monitoring for—at a low risk woman?

Dr. Michelle Collins:               Well, you wouldn’t have to be—if you’ve seen the monitor cords before, there’s like 6 feet of them, so they’re hooked to the machine and so you’re kind of, um, stuck with in a six foot radius of a machine.

Sarah Blight:                           So you wouldn’t be able to move around very well, right, if you’re continuously being monitored?

Dr. Michelle Collins:               And sometimes—because the baby’s position, it picks up better in one spot than another, so you might be comfortable in your hands and knees, but the monitor doesn’t pick up as well.

Sarah Blight:                           Oh, okay.

Dr. Michelle Collins:               On your hands and knees, so then, you know, it becomes a—where we’re nursing the machine and not the patient.5

Sarah Blight:                           Ooh, okay.

Dr. Michelle Collins:               [0:11:41][Phonetic]

Sarah Blight:                           Yup.

Dr. Michelle Collins:               So, um, most of us prefer to use—with low risk women, use intermittent monitoring, and that way she can get up in the shower, she can, you know, sit in the tub, she can, you know, do whatever, sit in the chair beyond the birth ball, be standing, be on her hands and knees, but she’s—doesn’t have the burden of this continuous monitoring if she doesn’t need it.

Sarah Blight:                           Okay, so it sounds like women—that was going to be my next question, you know, what do you do while you’re in labor in the hospital, and it sounds like moving is the best thing to keep labor going, and that can really involve going on a walk down the hallway or rocking on the rocking chair in your room, it just kind of depends on what you want to do, right?

Dr. Michelle Collins:               Yeah, and I think this is the conversation you want to have again with your provider ahead of time, because honestly, I know providers who like, once you’re water’s broken, you cannot get out of bed.

Sarah Blight:                           Wow.

Dr. Michelle Collins:               You know, you have to use a bed pan; they just will not let you get out of bed.

Sarah Blight:                           Wow.

Dr. Michelle Collins:               Yeah, that still goes on, so this is a conversation you want to have with your provider ahead of time, like, when you’re talking about your birth plan, way before like, even…

Sarah Blight:                           Even when you’re interviewing them maybe to…

Dr. Michelle Collins:               Yeah, yeah, like, you know, I want to have an active labor, active birth and we know that gravity makes the contractions more efficient because of the weight of the uterus and the weight of the baby being pushed on the cervix, so um, you’re going to have a more efficient contractions and just a better labor, shorter labor, by being upright rather than laying down on your back, that’s pretty much the worse place to be.

Sarah Blight:                           That’s a really good point, I’m glad you mentioned that, because that is something that needs to be brought up. Sounds like early in your case, so you can find out the philosophy of your provider to make sure you’re both on the same page.

Dr. Michelle Collins:               Yeah, you know, so I would ask questions like, um, you know when I’m labor, is it going to  be—am I going to be allowed to walk in the hallways, getting showered, getting—is there a tub? Not all units have tubs available or have policies to allow you to use the tub.

Sarah Blight:                           Uh-hum.

Dr. Michelle Collins:               In [0:13:43][Inaudible] Um, can I be in any position for birth? Can I, you know, some people are like, no, you’re on your back with your legs out and that’s it, that’s how to give birth, where that may not be what your idea of birth is.

Sarah Blight:                           Right, okay. What, um, how often will—so it sounds like if you’re—your nurse is going to be in and out a lot, probably, so you’re not necessarily going to have a nurse there constantly sitting with you the whole time you’re in labor. What about the healthcare provider, either the midwife or the physician, how often do you seen them during labor?

Dr. Michelle Collins:               Well—again, that’s really individual, because there are providers who basically have labor nurses do all the bedside care, and then call me when she’s ready to give birth.

Sarah Blight:                           Okay.

Dr. Michelle Collins:               And they want to show up at the end. Um, and there are other providers who are very—want to be there the whole time, want to be very involved in the entire course of the labor and the birth, want to be there for the pushing. Um, I would say in general, um, you know, midwives tend to be more of the bedside, more so than positions, because these positions tend to have surgery schedules and maybe more—maybe they’re in the office; have office hours while you’re in labor, whereas some midwives don’t have to be in the office while they’re on call. So it’s different philosophies. That way—and the nurses will be in and out. Usually they’ll check your vital signs, at least every hour or so and every policy’s a little bit different in every hospital. So that depends on what their unit policy is, as far as when they come and take the vital signs.


Sarah Blight:                           Okay, and that—that sounds like—and link, it would something that you should discuss with your provider ell before you even select them as your provider.

Dr. Michelle Collins:               Yup, absolutely and you want to know who’s going to be there, like, um, are you in a group of 6 providers? Okay, so I have a 1 in 6 chance that I’ll get you.

Sarah Blight:                           Okay, that’s a good point.

Dr. Michelle Collins:               Or are you with the practice that, okay there are six providers but I come in for all my own patients. You know, what is that—what type of practice. Are you in or joining up with?

Sarah Blight:                           Okay. If a mama chooses to have an epidural for her childbirth, when does that happen? And I’ve heard—I was even at a party the other night, and the women were all sharing their birth stories, and they were like, “My doctor said I could have one anytime, you know—up to 10 cm dilated” and another woman’s like, “Well my doctor said, that was way too late”. So, what typically is it—when can a woman get an epidural, when does that happen? Is it at the request of a woman as—how does that work?

Dr. Michelle Collins:               Well, again, that’s going to be individual, to the place and the provider. Um, technically, is there any long time to—that you absolutely cannot get it. The answer to that is no. Are there better times than others? Yes, probably. Um, there’s some literature, and the literature is conflicting on caesarean defect—of epidurals on caesarean rate, meaning does—do epidurals increase the caesarean rate? And there’s conflicting literature on that.

Sarah Blight:                           Uh-huh.

Dr. Michelle Collins:               There are some studies that say that if it’s your first baby, your first pregnancy, your first labor, and you have an epidural placed before you’re 5 cm dilated, you may have a higher risk of caesarean, if it’s your first labor. So a lot of us would encourage women to get as far along as they can and then get it. Now certainly, the epidural cervic covers the pain of labor better than the pain of birth, like the pressure and the discomfort with the baby coming through the vagina, so if a patient is 10 cm and says now I want an epidural…

Sarah Blight:                           Right.

Dr. Michelle Collins:               You know, I might try to talk her out of it, only because at that point, it’s not going to serve her purpose as well as if she had gotten it when she was 5, if that makes sense.

Sarah Blight:                           Yeah, and…

Dr. Michelle Collins:               Sort of numb up the ability to push.

Sarah Blight:                           Yeah, that’s what my friends were telling me too, they were saying that the epidural had worn off, which actually helped them get the baby out, cause they could actually feel how to push and it made it more effective, so that was an interesting point. Um, when the baby is getting ready to crown or is getting ready to come out, it seems like there’s kind of a change and a shift that happens within the activity level in the room. Can you describe for us what’s going on, who comes in the room, what are they doing there?

Dr. Michelle Collins:               Okay, I’m going to sound like a broken record here, but it’s going to depend again on your hospital. Usually there’s always a nurse for the patient and a nurse for the baby—but not always, the nurse for the patient might also be the nurse for the baby, so there’s at least your provider and at least a nurse, but probably two nurses—one for the patient, one for the baby. Now, depending on where you are at also, if the baby is having meconium stained fluid or had a bowel movement inside the fluid, um, some people will have a nursery nurse come in.

In other institutions, where I’m at for instance, we have the little team from NICU, the neonatal intensive care unit come, and in case the baby needs anything immediately after birth, so we’d have like a nurse practitioner from the neonatal unit, a respiratory therapist and a nurse, they come like a little team and they just stand over in the corner in case they’re needed and have like [0:19:01][Inaudible] all set up, so that’s going to be different according to where you’re at.

Sarah Blight:                           And why is it that they call those people if there is meconium present, if the baby’s had a bowel movement and you can see that in the water breaks or whatever. Why is that a concern, I guess, for—and a reason why to have these extra hands on deck?

Dr. Michelle Collins:               Well, we used to—up until a few years ago when the baby’s head came out, we would put a little tube in the nose and the mouth and suction so that any meconium that was in the airway and the upper airways, when the baby took its first breath, it wouldn’t suck that down into its lung tissue.

Sarah Blight:                           Okay.

Dr. Michelle Collins:               But the standards on that have changed in the past couple of years, and so we no longer suction on the perineum with the baby’s head only out. So you wait until the baby comes out, and the standard of care now is if the baby’s vigorous and crying, you don’t do anything, ‘cause they’ve already breathed, there’s no point in putting a suction tube in there to try to suction out what they’ve already, you know, breathed and cried. Um, but, if they come out and they’re kind of lackadaisical about breathing, then the standard of care is just quickly hand them over to the nursery people or your person at your warming table, and let them put a little tube down the throat and suction very quickly, before the baby takes its first breath.


Sarah Blight:                           Okay, so it’s just the concern is that they’re inhaling the meconium and you don’t want that get in their lungs, so…

Dr. Michelle Collins:               Yeah, Yes.

Sarah Blight:                           Okay. That makes a lot of sense. Um, so then after the birth and the baby comes and the baby’s on the mommy’s chest and everyone’s crying and having this amazing experience, then what happens next?

Dr. Michelle Collins:               Well, back up a moment because again, that’s something you want to talk to your provider about, because I’ve worked in places where it was the standard to go from mom to the warmer. There was no—or excuse me, from the provider’s hands to the warmer, there was no putting up on mom.

Sarah Blight:                           Okay.

Dr. Michelle Collins:               So, that’s an important thing, and most of us feel like—especially skin to skin, so we pull up the gown, put the baby right on the mom’s abdomen, and leave it there until we’ve clamped the cord and cut it, but in some places the cord is clamped and cut quickly and the baby’s handed off to the nurse at the warmers, so again, something you want to talk about.

Sarah Blight:                           Great point.

Dr. Michelle Collins:               Um, if it’s on the mom, then we get to cord clamping and that’s another controversial type of practice in different places. All of the newest literature says we should not clamp the cord and cut it until it stops closing, which is usually about two minutes. So we should let it keep pulsating and then the baby’s getting a transfusion, basically, from the placenta. And there’s some really good—the New England article just out couple of weeks ago on babies who have to delayed cord clamping have better blood counts later on, like three or four months after birth, so there’s lots of good evidence to do that. Um, and in fact, like, in our institution it’s standard practice. We don’t cut cords before—at least before two minutes.

Sarah Blight:                           Okay.

Dr. Michelle Collins:               Unless they need some resuscitation that we needed to quickly get them over in the warmer for.

Sarah Blight:                           Okay.

Dr. Michelle Collins:               So, um, hopefully people would start coming around to that. So we would—the baby attached and then after the cord stops pulsating, we clamp the cord and ask the partner if they want to cut the cord or maybe the mom wants to or whoever wants to, and then we just leave the baby there, mom then gets to know the baby and that she may put it to breast right away. Um, now in other places, you might hand the baby off to the warmer, and they might do the initial wiping of the baby, warming, do the vitals, do the baby meds, the vitamin K and the eye ointment, and then give the baby back to mom.

Sarah Blight:                           Okay.

Dr. Michelle Collins:               So…

Sarah Blight:                           Another good thing to ask your provider about.

Dr. Michelle Collins:               Yeah.

Sarah Blight:                           Okay. And then what happens now? A lot of people kind of forget that you have a placenta that you also need to deliver [Laughter] And that usually, no one even talks about it, because that is definitely in the shadow of this amazing baby that came out, but how does that work when the placenta—when you have to deliver the placenta? Does it hurt? How does the placenta come out?

Dr. Michelle Collins:               Well, it usually comes out on its own, and sometimes we put just a little traction on the cord to kind of help or know as it’s coming out. So providers are a little bit more aggressive with helping it come out, and so again that’s something to talk over your provider with. It’s generally considered up to 30 minutes as a perfectly fine time for it to just separate on its own.

Some providers will massage the uterus very vigorously to try to get it to come out. Sometimes you might be given oxytocin through an IV or as an IM— a muscular injection, to facilitate the uterus separating that placenta from it, so everybody’s practice is a little bit different with that, so that maybe again something you want to maybe ask your provider.

Sarah Blight:                           Okay. So the placenta comes out and then, is there anything that is—the mama is being taken care of, I guess. If the mama has tearing, is this when they would be doing stitches and stuff like that?

Dr. Michelle Collins:               Yeah, um, sometimes we suture while the placenta’s still in, like while we’re waiting for the placenta, we might just have a clamp on the cord and just kind of put the cord up on the sterile towel on the mom’s abdomen, and then we just might be suturing underneath while we’re waiting.

Sarah Blight:                           Okay.

Dr. Michelle Collins:               And sometimes we get the placenta first, and then we do the suturing, so kind of depends on what sort of laceration you might have, um, you know in that sort of thing, and we do use local anesthesia. If a woman has an epidural, we’ll sort of test the area by pinching a little bit of the skin lightly, and if she can feel it then we know that we need to put more anesthesia locally into the tissue.

Sarah Blight:                           Okay.

Dr. Michelle Collins:               But most of the time if people have an epidural, they are pretty well anesthetized in that vaginal area.

Sarah Blight:                           Okay, great! So now baby is here and what happens next? Is everyone kind of leaves the room and as long as everyone’s stable and doing well, what—typically how long do people stay in the hospital if there are no complications with baby or mom?


Dr. Michelle Collins:               Well, they’re in there—if you’re in an LDR unit, which means labor- delivery recovery, usually you’re in that room for an hour to two hours, and then they transfer baby to the nursery and mom in a wheelchair over to another room on the post- partum unit.

Sarah Blight:                           Okay.

Dr. Michelle Collins:               Other hospitals have an LDRP unit, where you labor, deliver, recover all in one room.

Sarah Blight:                           Oh, okay.

Dr. Michelle Collins:               Um, so it depends again on where you’re going to give birth.

Sarah Blight:                           Okay.

Dr. Michelle Collins:               And it depends on your stay. Many patients want to go home after 24 hours, especially if they have other kids and they’ve nursed before and they know what they’re doing. You’re going to get a whole lot more rest at home than you are in a hospital. Um, so, you know, then we assess if they’re candidates for early discharge, and part of that is, if a woman is group B strep positive, has she been treated adequately in labor with antibiotics. Let’s say she came and gave birth very fast and didn’t have the chance to get any antibiotics for her group B strep, the baby’s provider is probably not going to be comfortable sending that baby home at 24 hours or 12 hours. They may want the baby to stay that full two days just to watch for any signs of infection. So kind of depends on both mom and baby. Even if mom’s doing great, if baby hasn’t been—wasn’t treated adequately with the penicillin in labor, then we don’t want to send the mom home while the baby still has to stay, so…

Sarah Blight:                           Right.

Dr. Michelle Collins:               The two providers kind of talk to each other and see, you know, if baby provider is okay with baby going home at 24 hours and mom’s stable, then we’re going to send them out.

Sarah Blight:                           The one thing I think I was surprised with, with my first birth, which was at a hospital, was how many people were in my room at all hours of the day and night [Laughter]. Can you talk about this a little bit to give mamas an idea of the people who will be coming in and what they’ll be doing.

Dr. Michelle Collins:               Yeah—and sometimes in the morning, I feel—when I’m doing rounds—I feel sorry for the moms, cause I’m, you know—I’m the third person in line to go in the room.


Dr. Michelle Collins:               So you have the people bringing in the breakfast trays, and you have the housekeeping people cleaning up your room, and you have your baby provider doing  rounds, and you have your OB provider doing rounds, and then you have the picture lady from the nursery coming to ask you if you want your baby’s pictures taken, and then you have the nursery nurse coming out to ask how’s your baby fed during the night or how’s your baby doing, how many dirty diapers has it had.

And then you have your post- partum nurse, asking you about yourself and how you are doing to the [0:27:30][Phonetic], so you have this sort of endless stream of people that’s why I say, lot of women want to go home.

Sarah Blight:                           Yeah, yeah [Laughter]

Dr. Michelle Collins:               They’re doing okay.

Sarah Blight:                           And are people allowed to have visitors pretty much right—I mean, obviously it depends on, every hospital is different, but generally speaking, people can come and can people bring food in if people—if the mama doesn’t want to eat hospital food?

Dr. Michelle Collins:               Yeah, I’ve never seen a hospital that didn’t allow you to bring your own food. Um, and especially we have so many cultures now, that they—they eat special things that we don’t have available, so they really want to bring their own dietary foods in. In labor, every policy’s different about eating in labor, and that’s a whole—another topic for another day, but it’s um—all we know from research is that it is actually more harmful to labor on an empty stomach, but most hospitals go by this old rule of, you know, she can’t eat when she’s in labor, you know, for crying out loud.

Sarah Blight:                           [Laughter]

Dr. Michelle Collins:               I think [0:28:25][Inaudible] it’s like running a marathon, you have to have calories and you have to [0:28:29][Inaudible] coming in.

Sarah Blight:                           Yeah.

Dr. Michelle Collins:               So—yeah, I would say that—and as far as visitors and labor every unit, again, is different. Um, what I worked at different places, we’ve had up to 30 people in the room, no kidding, but when there was a birth [0:28:41][Inaudible] that. I mean, that’s what the patient was comfortable with, that’s what she wanted and that’s what [0:28:45][Inaudible] mine, but then you work other places where they allow three people, and that’s it.

Sarah Blight:                           Right.

Dr. Michelle Collins:               Or four people, so it depends again on where you’re at.

Sarah Blight:                           Depends on where you are. Good question to ask. Last question: is there anything that mamas need to know before they check out of the hospital? I know, one of the people that usually comes in the room is the person who does all the paperwork with like, the social security cards and the birth certificate and all that stuff, is there anything besides that stuff that needs to be addressed or mamas need to remember or think  about before they leave the hospital?

Dr. Michelle Collins:               Well, I was trying to think about this when I got your list of questions, and I think things that I would have to say are, um, asking when you should bring your baby back to see your baby provider.

For some people, will say two days, three days a week. Um, also, if I were first time mom, I’d want to see if there were lactation consults available that—um, somebody has observed me nursing, and made sure that I’m nursing well, cause sometimes I’ll go in a patient room and I’ll say, “You know, how’s it going with the nursing?” and, you know, mom will say “Fine” and the baby is rooting, so I’ll, you know, I’ll say, “Well I’m going to stay here and watch the baby latch on” and the baby’s not nursing fine at all, but she’s never nursed before so she doesn’t really know what fine is.

Sarah Blight:                           Right.

Dr. Michelle Collins:               So, you know, if I were a first time mom, I’d want somebody to watch me and make sure that I have the appropriate latch and that baby was nursing well and that the mouth was placed where it’s supposed to be, with the lips blanched out and so forth. So, those are probably two things that I would think are most important.

Sarah Blight:                           Okay, that’s a great—those are great ideas. Well I want to thank you, Dr. Collins, for joining us today. I have to remember to say that, that’s—you worked so hard for it. Um, to all the mamas who are watching, if you have any comments or questions about vaginal births in the hospital and what happens, please let us know, we’d love to chat with you. Thanks again for watching and we will see you guys next time

[0:30:43]                                  End of Audio


  • Francis W

    I read your “when should I go to the hospital”…Dr. Collins confirmed a lot of what that article said. It’s helpful to hear someone talk through it- even though I’ve read that article 3 times.

    Question…Dr. Collins mentioned if her patient checked into the hospital, one of the first things she’d do is a quick exam her to see how ‘far along’ she was. That study you linked to in the article basically said after our water breaks, there isn’t much risk of infection unless we’re being ‘checked’ repeatedly. So why would Dr. Collins check if the mom is obviously in active labor with contractions, etc.? Doesn’t that introduce the chance for infection as that study mentioned?

    • yourbabybooty

      That’s a great question Francis and since I’m not Dr. Collins, I can’t elaborate on the “why” behind what she does. Maybe it’s to establish a baseline? At any rate, as the patient, you can always say you don’t want to be checked at any time. For me, I didn’t want to know how far along I was (or wasn’t) because I didn’t want to get discouraged if I wasn’t as far along as I hoped. It’s up to you mama:)

  • Laura Green

    For low risk women…”Intermittent monitoring is the standard of care, but the problem is that’s not what’s done”…the reason that it’s not done is just b/c it’s easier for the L/D nurses?? Did I hear that right?

    • yourbabybooty

      Correct. L/D nurses often have multiple patients they are attending to at one time. In order to ensure they don’t “miss anything” (read: lawsuit) they will do continuous monitoring instead.

  • Lindsey Alvarez

    Thank you guys for this…I learned a ton! It helps so much to hear about all these things I’m learning about from a real person, not just a book I’m reading. I love Dr. Collins…wish she could be my provider! I didn’t quite understand all of what you guys talked about, but I’m getting there. I’m gonna watch this one again too!

    • yourbabybooty

      haha. We love Dr. Collins too. She rocks. Sometimes it takes a bit to let it all soak in. You’ll get there mama:)