Mumsnet Talk

Hello,

I am dwelling a bit on the birth of my DD, at the time I was just thankful to have a healthy baby but as I start contemplating trying for DC2 I want to understand more of what happened.

After being overdue I started contractions whilst I was waiting for induction but was only 1cm dilated. After many painful hours (shared room with other inducees trying to muffle contraction related screaming, cold showers that were supposed to relax me, G and A, epidural) I eventually had an ECS as was still only 1cm dilated and DD was distressed.

Please share experiences of similar situations and VBAC attempts for subsequent DC . . . .

I recommend reading Ina May Gaskin's book - guide to childbirth - she is a very experienced US midwife who has done a lot of research into birth - and she says evidence shows that women who are very stressed, in a place where they do not feel safe, simply will not dilate.Your body will hold on to your baby if you are not in a safe place - it's evolutionary. Animals bodies do the same. Women can actually go backwards - ie. the uterus can close up, if a woman starts to feel unsafe or anxious. Also - worth reading hypnobirthing by Marie Mongan who demonstrates the same, and Grant Dickly Read, doctor who wrote about impact of tension and fear on birth progress. They would suggest making sure you will be in a better place next time, a birth unit for example or at home for as long as possible.

You were in the worst place possible for you to feel safe and secure - it's natural that your body could not relax and do what it needed to do.

I'm not convinced its from stress - from a personal point of view I was about ad relaxed as I could be and it still went on for a long time and ended in an emcs.
However, hyperstimulation (lots of very strong contractions with slow dilation ) is a very common side effect of being induced. I think thats the most likely reason. If you're struggling to work through it, it might be worth requesting your notes from the hospital and reading through them. You can get an idea of what happened and investigate why so you can incorporate any issues into your birth plan.

The cervix has a lot of work to do before you get to established labour. It has to move from tucked up behind the back of your babies head to a forward position. It has to go from being long and thick, to being short and soft. All this happens in conjunction with dilating the first few finger widths.

I'm very interested to hear the responses on this thread, OP, as a similar thing happened to me and it's left me confused as I never had an adequate explanation.

I had been in labour for 27 hours (no induction at that point, had had G&A, TENS and two doses of pethidine) - contractions were every 60 seconds for over 4 hours, I was in absolute agony and screaming the place down, and I was still only 1cm dilated (same as I'd been at my sweep 3 days earlier!) not to mention exhausted.

What was really weird and annoying was that I could hear the midwives talking to a woman in the bed next to me and saying, "We're concerned because you've been labouring for a long time and with extremely frequent contractions, but you're still not dliates, so we're going to need to look at a CS for you." Yet with me, DH had to threaten to sue them just to get me an epidural, after which they induced my and allowed me to labour for another 15 hours before I pushed (fruitlessly) for 2 hours and my poor DS had to be born assisted by ventouse (which cut his head open and left him with recoil compression of his skull plates).

They later admitted that they should've given me a CS "with hindsight" - why such different handling of two virtually identical cases?

thanks for the posts, plenty to think about

basically a bit scared about what might happen if got pregnant again and never thought I would but contemplating an ECS

Baby's position is also a factor. Dilation happens best when the apex of the head rests on the inside of the cervix. If the baby wasn't engaged (likely if you were inducing for being "overdue" and baby wasn't ready) was OP or was a brow presentation, you would dilate much less efficiently.

As a student nurse I had a placement on the labour ward and remember the comments about people coming in too early, I was determined not to that.
I had regular contractions at home all day feeling very relaxed and in control before I smugly went in at midnight to find I was half a cm!
I dilated half a cm a day for 3 days then had a CS.
I tried for a VBAC next time, I refused to go in for hours and when I did I was, guess - half a cm!
I don't know if it would have been the same as DD was distressed so a quick CS followed.

I remember the midwife home-visiting a few days after DS3 was born making some comment about how lucky I was that I only had a 4 hour labour. In my head, the labour was hours and hours and hours - but they start officially calling it "labour" at 4cm or something. The hours you put in getting it to that 4cm are irrelevant - I was very annoyed. It felt like she was dismissing the whole period before that point - yes, I was lucky it was quick and straightforward afterwards, but it was not a 4 hour labour.

Hi. Totally agree with the recommendations for ina may and Marie mongan. I was very lucky to find them with my first baby and so I sought out independent midwives to give me gentle care. Ive had 2 wonderful births because I found them all - I'm in no doubt that it would have been traumatic on the nhs as there is no way I could have kept to their timetables. The NICE guideline for intrapartum care has a flow chart for how fast things have to go. If you look into the science of it, there's very little evidence base for it, yet It's used as the benchmark by which we are judged to need intervention. My IMs were able to look after me as an individual and not have to bother with the flow chart. So for dc1 my labour built up slowly over a week. It was knackering but meant lots of work happened before things got going in earnest. I would definitely have had my labour speeded up based on the flowchart but the IMs just kept an eye on me and we chilled out at home. I could do what I wanted and had noone to bother about. I sort of went into a trance - which would have been impossible in hospital listening to other people, limiting my noises and under bright lights..... So there's a lot to be said for being left and supported just to get on with it in your own space (I had 2 homebirths). With that sort of care I could look back on nearly a week of prelabour positively because I "did" it and nothing was "done to" me. Control plays a massive part and makes one look at it all so differently. I run a homebirth support group and have helped many women to have wonderful second time experiences. So have a look at homebirth.org.UK and see what you think. Vbac is possible at home but you might have to fight for it. But no matter where you birth no 2 births are the same so next time it will be completely different! Good luck.

I am really sorry your birth happened this way, me too - they call it 'failure to progress' - the most awful term when you already feel like you haven't done what everyone else manages.
I had a crash section after 26 hour labour of very strong regular contractions without waters breaking. Cue one very, very ill baby and feelings of absolute failure and terror.
For dc2 I wanted an Elective cs and they didn't quibble, this time round it was an amazingly positive, beautiful experience which laid to rest the 'ghosts' of the first birth
Have been told that if you 'fail to progress' once there is a good chance it could happen again. How true this is I don't know, but I didn't want to risk it.

I wish someone had told me that, I would have gone for an ELCS.

Sorry I'm on my phone and pressed post before I managed to edit that stream of conciousness. I wanted to say:
1. First time early labour, more often than not, goes on a long time. It's not something mentioned in books but it's common.
2. I had a long prelabour but no internals so I could have been contracting for hours but not dilating, but I didn't know. Internal exams are unecessary as a routine intervention. It is only because nhs midwives have to follow protocol that they do them. Also because they don't just sit with the woman to monitor her. If you had had that care instead of ve's and flowchart comparisons you would have been 2-4 times less likely to have had a Cs compared to being in a midwife led unit or at home. Google the birthplace study 2011 for more info.
3) cold showers in labour bad idea. Cold releases adrenaline which cancels out oxytocin - read ina may for more.

So basically it's not you, it was the system. You had little chance of having a gentle birth there as hospital units are not set up for that. They are set up for getting high numbers of people through "safely". My friend who had one in hospital (traumatic) and one at home says it was like comparing ryanair with first class - it's healed her and given her back her faith in herself. She even muttered about having a 3rd so she could do it at home again!

The best thing I read was from an obstetrics textbook. Labour generally goes quicker & easier when women:
Are in good health.
Have trust un their caregivers.
Have baby in a good position.
Have a positive mental attitude.
Understand birth physiology

I would also add to that:
Labour starts spontaneously.
Because as soon as induction or augmentation come in it all gets heavy duty.

Sorry for the ramble. I hope some of it helps. Find positive people to support you and I'm sure no.2 will go just fine.

Oh just read what vogon posted.
" Have been told that if you 'fail to progress' once there is a good chance it could happen again. How true this is I don't know, but I didn't want to risk it."

That's just not true, but with a thought like that in your head you would have to be superwoman to have a successful vbac! Jesus that's a terrible thing to be told! If you want to know why read ina may, but if you're set on an ecs for self preservation already, I wouldn't blame you and you shouldn't feel bad or worry what anyone else thinks. Good luck.

I wish I'd had an opportunity to stay at home longer - was polyhydramious so was told that if my waters broke at home, then I needed to admit myself post haste in case of cord prolapse. I feel certain that I would have managed by myself for at least the first 18 hours or so, but after that there was no way I could have managed the pain - it was otherworldly, for want of a better word.

Fio I know, made me feel like my body didn't work properly, and I was mechanically inferior if you know what I mean.

I was induced and after going through all the stages (gel, waters, syntocinon) had been having contractions every 2 minutes for about 14 hours, got to 2cm and then they found that the baby was in a terrible position - back to back and face presentation. The midwife was prodding his nose through my (fairly undilated) cervix! I had an EMCS as they said I would most likely end up pushing him into my pelvic bone rather than out. To be honest I was very happy with the outcome as despite being an 'emergency' CS it was actually very calm. I had only got to 2cm so was nowhere near pushing stage. I was exhausted by that point as I had been awake for 36 hours by then, so very happy to have an end in sight- and the epidural was AMAZING! DS was born with a swollen forehead, nose and top lip from pressing against my cervix for hours but he was otherwise fine, as was I.

If you had told me that I would have an EMCS following induction I would have been terrified, but actually it was a very very positive outcome.

I had this with my first labour, 70 hours of contractions and got to 3cm. DD1 had a swollen cone head from pressing against my not very open cervix for hours. The last 24 hours were f'ing painful full blown labour. I saw an osteopath when I was pregnant with my second and she thought I had pelvic problems which had caused problems. I also did the hypnobirthing course, but I had done a lot of pregnancy yoga stuff first time round and was super relaxed so I do not think that was the problem. Didn't like the hypnobirthing stuff second time round because I just knew relaxation was not the problem.
Second labour I got to 9cm but she was again in a bad position, back to back, and although I spent 4 hours at 9cm with her trying to turn she was clearly wedged in. Actually didn't mind having a c section this time round, felt I'd given it a good go and decided that my pelvis just wasn't cut out for having babies with my 6'4 rugby playing husband.

OP I had a similar first labour ending in EMCS. I was examined by a consultant who told us DS was brow presentation, so like FutureNannyOgg says positioning was the main reason I couldn't dilate. At the time we felt that we'd been very lucky that that consultant had been on the ward and available to examine me, but afterwards I wondered whether he'd been overly hasty and whipped me off for EMCS when I could have kept trying. But DS was absolutely fine, only a very little distress literally as I was being prepped for surgery so overall very thankful for a very positive result.

My DSIL had a great experience of VBAC by hiring a private doula. I'm planning to go that route for number 2.

I can sympathise with so very much in these posts.

I 'failed to progress' (how I hate that phrase too) with strong back to back contractions for 5 days (no sleep during those days and over christmas too!) with OP baby 12 days overdue - 1cm dilated and was then induced which took another 18 hours, but luckily a healthy baby at the end of it. I was in a bad way though - completely traumatised - felt ripped apart by huge feelings of failure and disgust and weirdly even violation - torn front to back and swollen so much I couldn't sit down for a month even on a rubber ring - beyond exhausted and a significant hemorrhage that wasn't spotted for two days - I was then given a 2 unit transfusion by evil evil agency nurses (another story). Couldn't bond with beautiful baby for a couple of days and vowed never never to go through with it ever again. But ...

When I was first pregnant with DC2 I was terrified - and felt I was having a panic attack every time i had to go back into the hospital for antenatal appointments. I was referred to the VBAC team (inspite of not actually having a CS the first time) and they talked me through my previous labour - taking as long as I needed. I can't tell you how much this really really helped.

I was allowed an ECS section for number 2 because they accepted my anxiety might make for a tricky birth second time round. Same hospital but the most magical magical time of my whole life. Calm and beautiful. I was healed in every way imaginable. It felt like a miracle. Sometimes I wonder what it might have been like to have had a positive vaginal birth, but for me I couldn't risk that I might feel the same again or worse if it ended up being like the first time.

It is such a very personal personal decision. Take all the time that you need to to exorcise those ghosts from your first birth by talking through your notes. Do whatever you think is right for you and with the right support it will be. Good luck with it all. xxxxx

thanks again, Ina May on route to kindle

Ina is on my kindle too

i read about it on here and downloaded it when i was only about 13 weeks

i do already feel a bit more confident having read it, I'm also doing the VBAC natal hypnotherapy cds. I'm only at 28 weeks with dc2 so not done the birth prep one yet.

i got to 6 or 7 cm even after being on the drip to try and speed things up. DS was, as mentioned above, in a funny position so i wasn't dilating effectively.

i felt pretty crappy about my eventual cs, but have kind of got my head round it now and know I'll feel more in control if i did need one again.

looking forward to vbac attempt now...i think!

i think i was in hospital too early too, i had to go and get checked when my waters went though.

I had a 3 week pro-dromal labour with DD3 - 1 min long contractions every 3 mins every day for approx 3 hours a day without going into labour. When I did it was fairly quick - about 8 hours from waters breaking to birth.

I even had the MWs out the week before she was born but it all fizzled out by the time they arrived.

And no it wasn't BH as I could have those at other times but these were take your breath away, stop talking, focus on breathing proper contractions. They were effacing my cervix but not dilating it.

The same thing happened to me. My waters broke and I didn't start contractions so was induced, pessary got me to 2cm after two days of congractions and then it stopped so they eventually pit me on the drip which got me to 9cm and I had to have a forceps birth.

I have had three missed miscarriages - my body didn't naturally expel any of them and I needed medical and surgical management. Perhaps some bodies just don't do things "naturally".

"I recommend reading Ina May Gaskin's book - guide to childbirth - she is a very experienced US midwife who has done a lot of research into birth - and she says evidence shows that women who are very stressed, in a place where they do not feel safe, simply will not dilate.Your body will hold on to your baby if you are not in a safe place - it's evolutionary"

I read Ina May and Mongan and was very relaxed at home and in hospital but took 3 days to go from 1cm to 6. Not everyone is lucky enough to have a birth they feel happy about. It's often a combination of things and I think women can beat themselves up for not being good at it.

Did you get a chance to talk through your birh OP, with the doctor or midwife? I found that hellped me a lot.