Amanda Wilde (Host): Expectant parents often choose hospitals as the safest option for giving birth, with experts at the ready to address any possible complications. We'll discuss what to expect when delivering a baby at the hospital with Maria DeMarinis Smilios, Director of Nursing for Maternal and Child Services at Flushing Hospital Medical Center.

Welcome to Flushing Hospital MedTalk, a podcast from Flushing Hospital Medical Center. I'm Amanda Wilde. Maria, thank you for this conversation we're about to have for those about to have a baby.

Maria Smilios: Thank you, Amanda. I hope that I'll be able to answer some questions so that we can allay some of the fears of those coming to have a baby at the hospital.

Host: Can you outline the advantages of giving birth at the hospital?

Maria Smilios: Well, certainly, having been a long time employee in a hospital, I do think it is advantageous. We have experts in every area, whether it's Obstetrics, Neonatology, and certainly within the Medical and Surgical field as well. We always hope that a birth is uncomplicated and as natural as possible. However, there is always the possibility that something may not go exactly as planned and we have every opportunity to be able to intervene immediately for the health of both mom and the baby. And that's the major reason that I think that it's advantageous to have a baby in the hospital.

Host: I think the only downside I see for people is that hospitals can be stressful. How do you address that?

Maria Smilios: Absolutely. And my team working here at Flushing Hospital is very aware of that. We are involved in our Birth Equity Improvement Project. We understand how important it is to have the word of our patient and family involved in the care, so having a plan that you have devised together as to what you would like and what you perhaps don't want to have during your birthing process. It's something that you should share with your obstetrician as well as with the team when you come to the hospital.

We try to make it as comfortable as we can. We want the room to look to you as something that is comfortable. Bring items with you such as a relaxing picture that you look at and you may want to focus on. We have different types of balls. We have alternative means of trying to walk around as opposed to staying in bed. These are all things that we utilize in the hospital to make it comfortable. But we understand it can be stressful. It may be the very first time they have actually come to the hospital as a patient.

Host: Well, let's talk more about that experience. But first of all, how will moms know that they're actually ready to go to the hospital for delivery?

Maria Smilios: So, it can be different for different women. But most commonly, when we start labor, we start feeling what are called contractions. So, the uterus, the muscle contracts. And at first, it feels very similar to as if you're going to have uterine contractions when a woman has her menses. At first, she may not be certain that it is labor. She may feel lower pressure, down low, above her pubic hair, or perhaps in her back, may be uncomfortable. If she walks around, it may go away. If she's lying down when this occurs, it may go away when she gets up to walk. Though, those contractions, certainly, you'll know you're in labor when you're in labor. Contractions get stronger, get closer together, and last longer.

So typically, we would tell someone who is in labor or thinks that she's in labor to come to the hospital when she feels this cramping, this tightness, where she can see that her abdomen is feeling harder every three to five minutes. And they've been that way for at least an hour. That would be a time to come to the hospital to be evaluated. And at that time, we can determine if it's early labor or if indeed we will actually admit her into the hospital.

Another indication may be without contractions, a woman may start to rupture her membranes or break her water bag, where she sees and feels liquid coming out of her vagina and that would be a reason if we're certain that it's not or not sure that it's not urine, come to the hospital, get checked. We're open 24 hours a day, seven days a week. Come here. We will determine whether it's labor or not. We can evaluate the contraction pattern. We can evaluate the baby's heartbeat, and determine if it's okay for you to go home, walk around, stay in your comfortable environment, and come back when those contractions are more frequent, lasting longer, and getting closer together.

Host: Well, that makes sense since labor can progress at different rates and it's reassuring to know that you're fine with evaluating and either sending someone home or admitting them. So, that's the first thing that happens once you've arrived at the hospital. If you are ready to deliver, what happens next? What should you expect?

Maria Smilios: So after the triage process, initially, it may take at least an hour to be evaluated. If we determine that you're going to stay, we will then explain to you that there is a consent to sign, which most women will sign for a vaginal birth at that time. And we go into one of our very beautiful new labor rooms. Everything has just been renovated, so they truly are beautiful. We bring your significant other, your labor coach, and perhaps your doula with you to the labor room.

Typically, we will be starting an intravenous in the expectant mother's arm. During that time, we will also withdraw some blood so we don't have to stick her twice. And we will then wait to see how labor progresses. You'll be attached to a monitor. That monitor will record contractions as well as the baby's heartbeat. Not necessarily must you stay in bed, we also have a telemetry set, which allows for the expectant woman to be able to walk around within the room and perhaps a short distance outside without having to stay in bed, and we can then still record the baby's heartbeat and contractions.

And this continues. And eventually, there will be some vaginal examinations, and we will determine when it's time to start pushing, at the end of the first stage of labor, when the cervix is 10 centimeters dilated, fully dilated. Of course, there is a time span in between there, so we help to make you as comfortable as possible. We have balls to sit on. We have peanut balls to put between legs to help for the process of labor, utilizing some massage, utilizing maybe even not only visual imagery, but utilizing aromatherapy if necessary, if that's something that's appealing to our expectant mother.

Host: So, you're there every step of the way.

Maria Smilios: Absolutely. There is a nurse assigned to you that is with you most of the time. She doesn't hover over you, especially in the earlier parts of labor, but is constantly observing the baby's heartbeat and contractions. So, the nurses and the doctors have the visualization of this, even when they're not in the room. They try to give the family time together, but will be in and out very frequently and more often as we get to the end of labor.

Host: You said earlier that when new moms are admitted, they sign a release, the expectation being they're delivering vaginally. However, what about the moms who have a C-section or a scheduled induction?

Maria Smilios: That is a possibility. Here in New York, the cesarean birth rate is approximately 35% of all births are delivered by cesarean for many different indications. And definitely, an induction of labor is a possibility. If a woman has diabetes during pregnancy, if she has hypertension or some type of complication, the labor may be started or induced where there may be a set date, where she may come to the hospital to have that labor started. And she would go into a labor room and we would start the process or, if it's a scheduled cesarean birth, again, she would be given a select date and time to come to the hospital and we would start the process of the Caesarean birth at that point.

Host: Let's talk a bit about after giving birth. What can new moms expect?

Maria Smilios: After the birth of the baby, which is an exhilarating time, the baby is placed immediately skin to skin. So if the baby is vigorous and doesn't need any intervention, we place the baby immediately on mom's abdomen, on her chest, and allow for them to bond, allow for the baby to feel the warmth of her mother, allow for the baby to be close to mom, and we will dry off the baby on mom's chest.

This is the magic hour whereby we encourage all of our mothers to consider breastfeeding. And we talk about the benefits to breastfeeding for both mom and to the baby as well. And the baby will be encouraged to breastfeed at this point. We have to do very little encouragement because it's something that the baby already knows how to do in many ways, knows how to suck. We just have to allow the baby to be close to the breast so the baby will find his or her way to the nipple and areola.

While that's happening, we also have the second stage of labor which is the birth of the placenta. This generally happens within minutes of the birth and the doctor sometimes assists that or it happens spontaneously. It could take 15 minutes, perhaps even longer sometimes. After that point, the doctor will examine and make certain that we don't have any fragments of the placenta that have remained, as well as any lacerations that may have occurred at the time of birth. And if all is well, we are left to recover for approximately an hour in that labor room prior to moving over to the mother-baby unit.

Host: Anything else moms should expect in the postpartum recovery?

Maria Smilios: She will certainly feel relieved. This is a time of excitement. This is a time where pictures are being taken, families are called. We will be taking her blood pressure every 15 minutes, checking for any excessive bleeding at least every 15 minutes. We're watching closely for any signs of any type of emergency that can happen, certainly, but any complication that may occur. And generally speaking, it goes without that. And we will observe very closely the blood pressure, the pulse, the respirations, pulse oximetry of mom and observing the baby as well, making certain that the baby is transitioning to newborn life well, and both together can go over to their room in approximately an hour to an hour and a half.

Host: And then, when will mom and baby be released from the hospital?

Maria Smilios: For a vaginal birth, I would say for most women, it's between 36 to 48 hours that they're released. It's all dependent on mom's condition, because certainly we're taking her blood pressure, we're checking for any excessive bleeding, but also for the baby. We want to make sure that the baby has had a certain number of feedings, is feeding well. There's a great deal of education that occurs postpartum, where we talk about newborn safety, helping the mother to assess baby's feeding cues, safe sleep habits, infant safety, what mom should expect after birth, perhaps even signs of complications once they're home, looking for any signs of even depression which can occur perhaps within the next month or so, talking to the family about this. For a cesarean birth, generally, mom will stay in the hospital between two to as much as four days after the birth.

Host: Do you have a role as the hospital once mom and baby have gone home?

Maria Smilios: We will call mom within five days after discharge, because we don't consider the hospital to have four walls. We extend into the community and we very much want to care for our mothers, our babies, keep them healthy. So within five days after birth, they will receive a phone call to see how they're feeling, making certain that they remember to go for their postpartum visits, as well as for the baby, the baby has probably already gone for a visit. We ask what the transition is like, wanting to understand if they're adjusting well. Perhaps this might be a phone call that may lead them to seek additional help. Our nurse practitioner gives them a call and, if it's determined that they need assistance, she'll arrange for assistance at that time.

Host: You give really comprehensive support. This has been very enlightening as you've given such a clear and detailed picture about what giving birth is before, during, and after in the hospital. Thank you so much for your insights, Maria.

Maria Smilios: At Flushing Hospital, we're here to help our communities. So, this starts prenatally where we give infant feeding classes. This starts also during the hospital stay if we've not met our expectant family yet, and we continue even afterwards.

Host: Maria DeMarinis Smilios is Director of Nursing for Maternal and Child Services at Flushing Hospital Medical Center. To schedule an appointment at Flushing Hospital's Women's Health Center, please call 718-670-8994. For more information about the services Flushing Hospital offers, visit our website at flushinghospital.org. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you at flushinghospital.org/podcasts.

All content of this podcast is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Please consult a medical professional before adopting any of the suggestions discussed on this podcast. This is Flushing Hospital MedTalk, a podcast from Flushing Hospital Medical Center.