What happens in the delivery room: monitoring, procedures, eating and the first hour, step by step

What happens in the delivery room? In a Singapore hospital, a midwife first checks whether you are in established labour. Once you are admitted, you change into a gown, a drip goes into your arm, and two belts on your bump (CTG) track your baby's heartbeat and your contractions. A doctor or midwife checks your cervix about every four hours. You are asked not to eat, but sips of water or ice are fine, even though UK guidance now allows a light diet for low-risk women. When you are fully dilated you push, your baby is born and placed on your chest, the placenta follows after an injection in your thigh, and any tear is stitched. You stay in the delivery room for about an hour before moving to the ward. Here is each step, with what KKH, SGH and NUH say, what you can ask about monitoring and food, and the complications worth knowing about.

Step by step: from arrival to the ward

Arriving and triage

At KKH's Delivery Suite, midwives assess you on arrival and advise whether you go straight into a delivery room or are seen by a doctor in the triage area. After that check you may be admitted to a delivery room or the antenatal ward, or advised to go home if labour has not really started. That happens to many first-time mothers and is no reason not to come in when unsure.

KKH runs 28 delivery rooms and handles 30 to 35 births a day, with one midwife or nurse for every two women. SGH has its Labour Ward 52A, and NUH a Delivery Suite in Ward 22. If you are booked under a private obstetrician, the delivery suite calls your doctor; SingHealth notes that if your baby comes too fast, a delivery suite nurse delivers your baby until the obstetrician arrives.

Monitoring and procedures during labour

Once you are admitted, expect the following. Most are routine and done for every woman.

• A drip: KKH sets up an infusion line in your arm. SGH says IV cannulation and blood tests may be carried out.
• CTG: two transducers strapped to your bump, one for contractions and one for your baby's heartbeat. KKH monitors continuously and watches the readings centrally; SGH attaches CTG once you are admitted.
• Vaginal examinations, about every 4 hours at SGH, to see how far your cervix has opened.
• An enema: NUH gives a fleet enema to clear your bowels once labour is established. Ask your hospital; not every hospital does this.
• Oxytocin drip: if labour is not progressing well, KKH says your doctor may prescribe an oxytocin infusion to regulate contractions.
• Breaking your waters: the midwife or doctor may break them to help labour along. SingHealth says this does not harm your baby or drain all the fluid.
• A urinary catheter: with an epidural you may lose the urge to pass urine, so a catheter empties your bladder.

Why the drip and the CTG belts

The drip line lets the team give fluids or medicines quickly. You need one before an epidural: SingHealth's pain relief page says a drip is started in your hand or arm first, and NICE, the UK guideline body, tells staff to always secure one before an epidural goes in. An oxytocin drip to strengthen contractions runs through the same line. If your womb does not contract well after the birth, SingHealth says an oxytocin infusion is often needed to control the bleeding.

The CTG belts show how your baby copes with each contraction. HealthXchange, written with KKH, explains that strong contractions in active labour may reduce the blood and oxygen reaching your baby, and the tracing lets the team watch your baby's wellbeing. At KKH the traces also feed a central system, so staff outside your room see them too. NICE adds that changes in a baby's heart rate during labour are common and do not always mean something is wrong.

Continuous or intermittent monitoring

KKH monitors your baby continuously once you are in established labour. The UK sets a different default for women with no risk factors. There, NICE tells midwives to listen in with a handheld doppler or a Pinard stethoscope instead: for at least one minute after a contraction, at least every 15 minutes in the first stage and every 5 minutes once you are pushing. Its reasoning is that for a low-risk woman, continuous CTG raises the chance of interventions, which may outweigh the benefits. NICE also notes the belts can limit how much you move and whether you can labour in water.

NICE still advises continuous CTG when there is a reason for it. The common reasons are:

• an epidural, or an oxytocin drip
• a previous caesarean
• high blood pressure or diabetes that needs medicine
• bleeding other than a show, or a temperature of 38C or more
• green or brown waters (meconium)
• labour that has stalled, or 5 or more contractions in 10 minutes
• a baby who is breech, small for dates, or has moved less in the 24 hours before labour

What you can ask before labour

These are fair questions for your gynae at the 36-week visit, or for the midwife when you are admitted. The answer depends on your hospital and on your own risk, so treat them as questions to ask, not demands.

Put your answers in your birth plan so whoever is on shift sees them. If your plans change once labour starts, that is usually because the reasons for monitoring have changed too.

Pain relief in the delivery room

KKH offers Entonox (laughing gas), pain relief injections, and an epidural or combined spinal-epidural. An epidural takes about 15 to 20 minutes to set up and another 15 to 20 minutes to work, and you get a drip first. Our epidural guide covers the options and costs.

Who can be with you

KKH encourages your husband to stay with you in the Delivery Suite, and may make an exception for your mother or sister instead. SGH allows your spouse, or a nominated female companion in special circumstances, and no other visitors. KKH allows photos and video, including during the delivery, when no procedure is going on; staff cannot be filmed without their consent.

Can you eat and drink during labour?

Not at Singapore's public hospitals, once you are in the delivery suite. KKH advises you not to eat during labour and encourages sips of water or ice cubes. NUH also asks you to refrain from eating and allows sips of water. After the birth, KKH serves a hot drink and biscuits. If you are delivering at a private hospital, ask your obstetrician what applies there.

The advice elsewhere is looser. NICE, which writes the UK's maternity guidelines, says a woman can eat a light diet in established labour if she wishes, unless she has had an opioid such as pethidine or develops risk factors that make a caesarean more likely. It says to drink when thirsty, that isotonic drinks may be better than water, and that drinking more than normal brings no benefit and can be harmful, because too much fluid can dilute the sodium in your blood. The NHS suggests eating and drinking in the early (latent) stage, because you will need the energy later.

The reason for the no-food rule is the chance of an emergency caesarean, which is why NICE's own exceptions follow that risk. In Singapore, SingHealth puts emergency caesareans during labour at about 10%.

What this means in practice:

• Eat a small, plain meal at home in early labour, such as porridge, toast or a bun, and keep sipping water.
• Pack an isotonic drink and ask at admission whether you may sip it.
• Pack a snack for after the birth, and food for your partner, who cannot leave easily either.
• If you are coming in for an induction, ask what you may eat before labour starts.

The birth

When your cervix is fully open, the second stage begins. SGH starts with a passive phase of one to two hours, in which contractions bring your baby down before you push, to save your energy. Then your midwife or doctor coaches you through each push. Our guide on how to push during labour covers breathing and positions, and labour positions covers what works with a drip and monitoring.

When your baby's head stretches the skin between your vagina and anus (crowning), SGH says an episiotomy, a small cut, may be made to reduce the risk of an uncontrolled tear. Forceps or a vacuum cup may be used if you are too tired or your baby needs to be born quickly. Our episiotomy and perineal tears guide explains when and why.

The placenta and stitches

After your baby is born, SGH uses active management to reduce bleeding: an oxytocin injection to contract your womb, a uterine massage, and gentle pulling on the cord while your womb is supported. The placenta usually comes within 5 to 30 minutes. For healthy babies, SGH delays cord clamping for 1 minute; elsewhere it is often done on request in uncomplicated births. Your doctor then checks for tears and stitches any tear or episiotomy with dissolvable stitches. Our delayed cord clamping guide covers the trade-offs.

Your baby's first hour

As a Baby-Friendly hospital, KKH places your baby on your chest for skin-to-skin contact and starts breastfeeding within the first hour if you are both well. In the first few hours your baby gets a vitamin K injection, and before going home the two vaccines MOH recommends at birth, hepatitis B and BCG. Blood taken from the cord is tested for G6PD deficiency, thyroid function and blood group, and a hearing test and other screening follow on the ward. SGH monitors you for one hour in the labour ward before you move to the postnatal ward. Our newborn care basics guide picks up from there.

Possible complications, in numbers

Most labours go to plan. These are the figures Singapore hospitals give for when they do not:

SingHealth also lists heavy bleeding when the womb does not contract, retained placenta and wound problems among the possible complications after a vaginal birth. Our guide to C-section in Singapore covers what happens if you need one.

Frequently asked questions

What happens when you first arrive at the delivery suite?

A midwife checks you to see whether you are in established labour. At KKH you then go into a delivery room or see a doctor at triage, and you may be admitted or advised to go home.

Can I eat or drink during labour in Singapore?

KKH and NUH both ask you not to eat during labour. Sips of water, and at KKH ice cubes, are encouraged. The UK's NICE guideline allows a light diet for low-risk women with no opioid, so ask your obstetrician before your due date what your hospital allows.

Can I say no to continuous fetal monitoring?

You can ask. KKH monitors continuously by default. If your labour is low risk, with no epidural and no oxytocin drip, ask your gynae beforehand whether your baby's heart can be checked at intervals instead, as NICE recommends for low-risk women in the UK. If a risk factor develops during labour, continuous monitoring is the safer choice.

Do I have to have a drip in labour?

At KKH, an infusion line is set up for everyone admitted in established labour, and you need one for an epidural or an oxytocin drip. You can ask whether it can be capped off when nothing is running through it.

How often will they check my cervix?

SGH reviews you about every 4 hours and does a vaginal examination each time. KKH says regular examinations are done to track your progress.

Can my husband be in the delivery room?

Yes. KKH encourages your husband to stay with you, and may allow your mother or sister instead, while SGH allows your spouse only, or a nominated female companion in special circumstances.

How long do you stay in the delivery room after giving birth?

About an hour. SGH monitors you for one hour before moving you to the postnatal ward. At KKH, mothers usually go home 24 to 36 hours after a normal delivery.