When Will You Doctor Show Up in the Delivery Room?
Hint: You'll probably see a lot more of your labor and delivery nurse than of your ob-gyn!
"She's not really leaving, is she?" one patient asked me, looking up with panic as her ob-gyn left the room. I let her know that her doctor would be readily available if needed, but wouldn't be able to spend her entire time with just one patient.
The truth is, you'll probably spend the majority of your labor without a doctor physically in the delivery room; rather, a labor and delivery nurse will be the one caring for you, monitoring your progress, and giving your doctor updates.
Although your doctor may not be in the room, that doesn't mean she doesn't know what's going on. Almost all hospitals have a central fetal monitoring system, which essentially means that your contractions and your baby's heart rate are continually monitored by health-care staff -- including your doctor or midwife. Some providers even have the monitoring stream to their smartphones, where they can check in on you on the go.
It's important to realize is that every labor is different, and every mother's needs during labor and delivery are different, so care is individualized. There are three phases of the first stage of labor, which is the process of reaching full cervical dilation. But in general, the first phase of labor can take up to 14 hours in women who have had babies before and 20 hours for new moms -- which means you can expect less hands-on care from your doctor. If your doctor is in the hospital at the time, she may stop in once you're admitted and let you know what the plan for your labor is. Otherwise, she may wait to see you until your nurse lets her know that your labor is progressing.
Once you're in active phase labor and about 4 centimeters dilated with regular contractions, a doctor, nurse, or midwife will check your progress approximately every two hours. "You may see your physician for about five minutes every two to four hours," says Draion M. Burch, D.O., a board-certified ob-gyn at Magee-Women's Hospital of the University of Pittsburgh Medical Center. At smaller hospitals, nurses may perform cervical checks -- the vaginal exams that check for dilation, effacement, and descent of the baby; in larger facilities, a doctor or a resident will do them. Every hour (or more, depending on complications), your nurse will also check your vital signs and alert the doctor if there's a problem.
During the active stage of labor, your doctor will still likely remain focused on her "routine" work -- checking on patients who have delivered, performing circumcisions, or doing office visits -- unless she is urgently needed during your labor. Your care provider may order an epidural for you at this time, which will be administered by an anesthesiologist or nurse-anesthetist. Often, a doctor will stop in to check on you about halfway through your labor and may manually break your water (if it hasn't already broken) to keep your labor going.
Even when you progress to the pushing stage, it might be your labor and delivery nurse who gets you started; she may call the doctor in only when you're ready to actually deliver. "I try to be in the room while a patient is pushing, though practices vary and pushing can last from a few minutes to a few hours," says M. Kathryn Buchanan, M.D., an ob-gyn with MedStar Franklin Square Medical Center in Baltimore.
Of course, all health-care providers are different, and some doctors prefer to spend more time in their patients' room than others do, even during early labor. "We are totally aware of everything that happens; every labor and every patient is different, and it depends on what's happening," explains David Garfinkel, M.D., an ob-gyn at Morristown Medical Center in Morristown, New Jersey. "I could be there the entire time or I could be there less."
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