What happened?

(34 Posts)
Nunyabiz Wed 30-Apr-14 20:07:48

Sorry this is going to be a bit of a drip feed as I need to figure out what happened in my last labour, and am including all the information in case anything is relevant. Will also try not to add to much emotion and stay as factual as I can. I have sent away for my medical notes but they were sent to wrong address and now they are having trouble tracking them confused I'm due with DD2 imminently so want to run this by hopefully someone who is clued up about this (a MW?) and can avoid it or similar happening again.
Also please if you are nervous about birth and trying to avoid horror stories this is not the thread for you.

So 3 years ago at 40 weeks + 4 days I went into labour with DD1. Normal healthy pregnancy, nothing out of the ordinary. Due to this I opted to give birth at a midwife lead birthing unit.
At 1.37am my waters broke. No prior contractions/Braxton hicks/tightenings nothing.
After my waters broke I had my first INTENSE contraction. They were regular and lasted a long time so all was going well and progressing perfectly. Text book.
I stayed at home and laboured in the bath until 5am. I then asked DH to drive me to the MW unit.
On arrival the midwife checked and I was only 2-3cm dilated. She helped 'break my waters' a bit more (just released some pressure).
We drove home.
I got back in the bath and laboured a further 2 hours.
At 7am I told DH I wouldn't be able to move if we did not make the journey again.
On arrival I was pleased to hear I was 5-6cm and would be able to move onto the birthing suite.
The MW immediately filled the tub and I laboured about another hour in the bath. I was offered gas and air but I didn't like it.
By about 8.30/9am i was 10cm and felt the urge to push.
At this point my contractions died off a bit. Her head was crowning but I couldn't push her out because the contractions weren't strong enough. I was advised to get out if the pool. I knelt over a ottoman style couch thing and continued to push... And push...and push. The MW I had in the room called in another midwife to assist her. At around 10.30am her head came out! Finally! I was told just a couple more pushes, but nothing happened. 5, 6, 7... It felt like eternity. The midwife flipped my on my back and reached in and hooked under her shoulders and pulled her out. She was born at 11.07am the same day weight 4.7kg (10lbs 4oz).

I held her for a brief moment before they took her. The MW said I was bleeding a lot and she was giving me a synto shot to expel the placenta.
They waited a few moments and the placenta wasn't dislodging so they said they would try another shot of synto (I was in agony at this point- far far worse than normal contractions).
The second MW said she would going to give the chord a 'little tug' to see if it would dislodge the placenta.
It didn't.
The chord snapped.
The placenta was still lodged inside.
The room filled with people very quickly.
They told me that I needed to go to theatre but there was no anaesthetist available.
They were going to attempt to manually remove it.
Attempt 1.
Attempt 2.
Attempt 3 and ANOTHER shot of synto.
I was taken upstairs to 'wait' until I could go to theatre.
Meanwhile I had more new people attempting manual removal. They actually had their hands up me - up to elbows, reeding around.
I was screaming in pain and DH told them to leave me alone now.
Finally at around 12.30 i was taken to theatre. They forced the gas and air on my fave even when I told them I didn't want it. They gave me pathadine (sp?) and an immobile epidural.
The surgeon removed the placenta in tact.
He commented in the size.

So when I went through this with my new MW she told me it wasn't a retained placenta.

Can someone please explain to me what it was then???

Thanks if you got this far!

Spinaroo Wed 30-Apr-14 20:11:48

Well I think she is just being medically correct. i think a retained placenta usually refers to part of the placenta which has broken off and remained- leading to profuse bleeding. In your case, it was intact- although the cord had broken. Sounds horrific, sorry you had to go through that.

Nunyabiz Wed 30-Apr-14 20:12:48

Thanks- I think what i want to know is why? Why wouldn't it come out?

Spinaroo Wed 30-Apr-14 20:17:04

Sorry, am not a midwife. Hopefully someone knowledgeable will be along soon. Hope you have an easier time this time round.

Did they ask you to push at all? When I had dd the midwife was gently pulling on the cord and it snapped. She got me on the birthing stool and told me I had to push it out. Which I did. I don't know if the fact that you were bleeding and had the synto injection made a difference though. I didn't have the injection so was waiting for the placenta to come out by itself.

Nunyabiz Wed 30-Apr-14 20:20:50

Thanks spinaroo. Me too! I am attempting a water birth again so just want to be as clued up as possible. Another big baby unfortunately (well- healthy is the aim but obviously giant children aren't much fun to push out) but hopefully this will be a bit of a healing birth. Sorry for all the typos btw! Was distracted trying to get DD to eat her dinner confused

Oh and I'm sorry I don't know why it wouldn't come out.

Nunyabiz Wed 30-Apr-14 20:23:43

No they didn't quiet ninja. That's a good question though. I have a feeling (although really can't be sure until I speak to someone more educated on birth) that the urgency was due to the bleeding as I was offered a blood transfusion later but told them no. (I couldn't sleep at all on the ward and a blood transfusion would have meant an extra night or 2 in hospital).

Shaky Wed 30-Apr-14 20:24:59

Oh bless you, that sounds awful for you to go through. It must have been really traumatic for you. I hope you have an easier time with this birth flowers

I have found a link for you which my help explain things more fully for you. It defines retained placenta as "when the placenta remains inside the uterus for more than an hour"
Link here

Wolfiefan Wed 30-Apr-14 20:25:00

My first birth was a water birth. Pushed for about an hour (back to back). Got out to deliver placenta. Given injection. It didn't budge. They seemed to get a bit worried. Tugging on it and one (I seem to remember) massaged my tummy. Eventually a huge contraction and it all came out. I think the next stage would have been surgery.
My second birth I asked for no injection. DD was born so fast they didn't have my notes/birth plan. I got jab and placenta delivered vv soon after.
Hoping your second goes well. X

Shaky Wed 30-Apr-14 20:27:29

Also bloody well done on managing to push out a baby that big! She was a whopper! I am in awe of you!

Nunyabiz Wed 30-Apr-14 20:31:28

Thanks so much shaky.
That's even more confusing then as when she said it wasn't really a retained placenta I thought oh I must have it wrong but now I feel like she was sort of disregarding my experience.

bakingtins Wed 30-Apr-14 20:31:35

Hi nunya

I had a fairly similar experience after birth of DS2. He arrived very rapidly, only just got to hospital, was not given syntometrine because they hadn't checked blood pressure (which is correct, but I now know they could have given syntocin) so physiological 3rd stage. placenta was said to be intact when examined but I then started to haemorrhage, the rest similar to yours - room full of people, multiple injections then drip of syntocin prompting mega painful contractions, bimanual compression (otherwise known as hands stuck inside you) had to sign consent ( extremely wobbly x marks the spot) for a hysterectomy, eventually taken to theatre under GA, woke up in high dependency unit and later had a blood transfusion. I was quite out of it and don't remember much, my husband was completely traumatised. We were not offered any debrief.

I'm now 35 weeks and have been consultant led / high risk because of this, but it has taken until this week for anyone to actually listen to me, go through the notes and come up with a plan that both parties are happy with. The NICE guidelines say any major haemorrhage should trigger a review of procedures to make sure it shouldn't have been predicted/prevented and a debrief of the couple involved with a senior doctor to explain what happened. It took me 4 years to learn that I had a 10 x 20 cm piece of my 'intact' placenta retained. For 4 years I've believed that my uterus was just rubbish! I've no interest in laying blame, birth is unpredictable, there wasn't reason to suppose a natural 3rd stage would end badly, but I deserved a proper explanation.

Sorry, that turned into a bit of a rant!

Demand a meeting with a senior obstetrician to go through your notes in detail and come up with a plan for next time. I think you MW needs to be called on saying yours was not a retained placenta, I've come across several dismissive people, though not my community MW who has been fab, but once the doctor actually read my notes he took my concerns very seriously. I feel so much better for having straightened it all out, and I'm hopeful of avoiding a repeat performance. Good luck!

Nunyabiz Wed 30-Apr-14 20:31:53

Wolfe that's very reassuring thank you thanks

Nunyabiz Wed 30-Apr-14 20:41:09

Baking shock that is shocking. I'm so sorry for your experience but thanks for your reassurance. Yes my DH was left a bit traumatised too. I feel a bit more confident now in pushing for more advice and will definitely request a senior OB appointment (if I can get hold of my blasted notes before this baby makes an appearance!!)
Congrats on your pregnancy.

Wolfiefan Wed 30-Apr-14 20:48:58

My first labour was a similar length to yours. My second was under an hour!
I wonder after over an hour of pushing properly (for all I was worth) my body was so relieved to get the baby out it kind of have up and needed a break before getting placenta out. Problem was that they had jabbed me so they needed it out ASAP or I'd need surgery.
As I said better second time!

Shaky Wed 30-Apr-14 20:51:02

[baking] I agree that you should have been fully debriefed following your experience. Where I work "a post partum haemorrhage of 1000 mls or requiring a blood transfusion" is considered a "clinical incident". Also syntometerine is a combination of syntocinon and ergometerine, it is the ergometerine part that affects your blood pressure, that's why syntocinon can be given.

Good luck with this birth, hope all goes well for you.

Shaky Wed 30-Apr-14 20:53:05

Dammit, bold fail, sorry!

Nuny if you had told me your story, I would definately agree that you had a retained placenta.

SpawningSalmon Wed 30-Apr-14 21:01:14

I haven't read your whole post or any of the replies as my first birth was difficult and I am a month away from my second, so don't want to dredge up any
unwelcome concerns.
I just wanted to let you know that due to anxiety over my first birth I was referred by my midwife for an appointment with a consultant midwife who went through my birth notes with me, and talk through any concerns I have for the next birth.
I found this to be really helpful and it has put me at ease(ish!) for my next birth. I would really recommend doing the same.
I hope all goes well for your birth and you get some kind of closure on the previous one beforehand. thanks

Nunyabiz Wed 30-Apr-14 21:03:13

That link is really good shaky... Although I don't think I fit any of the 3 categories...
Placenta adherens (when there is failed contraction of the myometrium behind the placenta).

Possibly but I felt like I was having contractions! X100! What's the myometrium? Lol

Trapped placenta (a detached placenta trapped behind a closed cervix).

I don't think my cervix was closed. Pretty sure it was wide open as I had arms up me.

Partial accreta (rarely, the placenta invades the myometrium deeply - placenta increta - even to the external serosa - placenta percreta - preventing detachment).

Definitely not as once the placenta was removed the bleeding was stemmed.

HVB79 Wed 30-Apr-14 21:13:10

I had a similar experience and would definitely recommend doing the debrief once your notes have been found. The midwife told me my placenta was not technically retained as it was no longer attached to the wall of the uterus, but just wouldn't come out (cord snapped too, and manual removal didn't work).
Hope you can get some answers, and best of luck for next time!

bakingtins Wed 30-Apr-14 22:21:29

The causes of PPH (post partum haemorrhage) have been described as the "four T's":

Tone: uterine atony (failure of the myometrium - the muscle layer of the uterus - to contract) distended bladder.
Trauma: lacerations of the uterus, cervix, or vagina.
Tissue: retained placenta or clots.
Thrombin: pre-existing or acquired coagulopathy (clotting disorder)

I think you OP , like me, would fall into the Tissue category and from what you posted you had several of the following risk factors for severe bleeding.

Risk factors include

Antenatal risk factors:
Antepartum haemorrhage in this pregnancy
Placenta praevia (12 x risk)
Suspected or proven placental abruption
Multiple pregnancy (5 x risk). Also other causes of uterine over-distention such as polyhydramnios or macrosomia
Pre-eclampsia or pregnancy-induced hypertension (4 x risk)
Grand multiparity (four or more pregnancies)
Previous PPH (3 x risk) or previous history of retained placenta
Asian ethnic origin (2 x risk)
Maternal obesity. Body mass index >35 kg/m2 (2 x risk)
Existing uterine abnormalities
Maternal age (40 years or older)
Maternal anaemia. Hb <9 g/dL (2x risk)

Factors relating to delivery:
Emergency caesarean section (4 x risk)
Elective caesarean section (2 x risk) - especially if >3 repeat procedures[7]
Retained placenta (5 x risk)
Mediolateral episiotomy (5 x risk)
Induction of labour (2 x risk)
Operative vaginal delivery (2 x risk)
Labour of >12 hours (2 x risk)
>4 kg baby (2 x risk)
Maternal pyrexia in labour (2 x risk)

Pre-existing maternal haemorrhagic conditions:
Factor 8 deficiency - haemophilia A carrier
Factor 9 deficiency - haemophilia B carrier
Von Willebrand's disease

bakingtins Wed 30-Apr-14 22:22:47

Thank you shaky

bakingtins Wed 30-Apr-14 22:26:46

RCOG guidelines on prevention of PPH
WHO recommendations on prevention PPH

Just in case you want to read obsessively do your research before talking to someone!

Shaky Wed 30-Apr-14 23:20:59

I forgot to add that I am a community midwife, qualified since 2002, so 12 yrs experience. Approx 5 yrs in hospital and 7 yrs community. Although I loved labour ward and was always first in the room when the emergency buzzer went off, I feel that I do far, far better by my women in community.

For me, it is ALL about the relationship built with the woman, the trust, the knowledge, experience. That bond is far greater than a day spent on labour ward. There is nothing more special than supporting a woman throughout her pregnancy and then visiting postnatally for support and help afterwards with her baby. It is such a special time and I am humbled daily by the absolute awesomeness and strength of the women I care for. It is a privilege to be involved in this amazing phase of a woman's life. I am grateful every day and try to make a difference for every woman in my care.

Wishing you all the very best for your labour and birth. Good luck, hope all goes well. flowers

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