Birthplan Queries & OC - Mears/Prufrock advice please?

[GeorginaA]

I had my midwife at the Day Assessment Centre look through my birth plan today and she pulled up about 2 or 3 things that "wouldn't be possible/not advisable" in my particular circumstances (that being I will be induced at 38 weeks due to obstetric choelostasis.

I'm disappointed (especially as it felt like key areas in my plan to me) but resigned if they genuinely are necessary, but just wanted to run them by you to check they were genuinely necessary or whether I just had an unhelpful midwife today.

1. Apparently I have to have continuous monitoring regardless of type of induction or whether I go into premature natural labour. I'd understood from the literature I'd read that continuous monitoring was only necessary if oxytocin drip was used, not if natural or prostoglandin induced, but apparently due to OC I have to be monitored all the time? (This is the one I'm most gutted about tbh, as I'm concerned this will affect psychological pain management for me).
   
   
2. Mobile epidural I won't be able to move around with?! As the anaesthetist won't be on duty all the time, apparently they don't like you to move around even with a mobile epidural. Eh? Why call it a "mobile" one then... I'm confused!!
   
   
3. Have been told that allowing a natural third stage would be inadvisable due to the increased risk with bleeding. Apparently when induced your body is used to "extra help" so you need the injection to deliver the placenta. Is this right?
   
   Sorry ... I know I've queried just about everything in this pregnancy, but my low intervention birth has long since slipped away from me so I really want to feel that all these things are truly necessary. TBH, it's got to the stage where I'd really rather go whole hog and go for a caesarian ... it might actually be less traumatic for me (please don't think I'm making light of the serious nature of a caesarian... it's just I really had a horrible birth experience first time around and all this is just making me more stressed and hospital phobic).

[prufrock]

Mears will be far better able to help, but it sounds like crap to me.
The OC does not mean continuous monitoring - I've actually checked through my labournotes from last time and in the space of 44 hours I had a total of 5 x 30-40 minute CTG monitoring, and 4 doeses of prostoglandin. They did seem to be doing checks of the foetal Heart rate every hour or so, but I remember that as a 30 second sort of thing.
I was talking to the midwife at John and Lizzies (where they are very into natural pain relief, waterbirths etc) and she told me of a woman who was induced at 38 weeks due to OC (2nd pregnancy) had one dose of Prostin in the evening, went to bed and woke up in the early hours having contractions and gave birth in the pool 6 hours later. So I do think your midwife is speaking more about what suits your hospital than what suits you.

[snowbird]

I've just spent the easter weekend going to and fro the hospital to be told I have obstetric choelostasis and will be induced at 37 weeks.

I'm like you Georgina, in that I wanted a low intervention birth. The doctor I spoke to today has said that they will monitor with CTG but I should be able to move round, walk etc.

Not much help sorry but still trying to get my head round the news.

[GeorginaA]

snowbird... it's a big shock isn't it. I'm not sure my head is completely got around it myself, to be honest. Feel free to stay around and chat about it though - we can at least commiserate together! Prufrock is the mumsnet OC expert if you have questions - she's been a fantastic support to me since I learnt that I had it.

[willow2]

GeorginaA - I has a "mobile" epidural, as did several of my friends, and not one of us was able to move around freely, we all experienced severely limited mobility. As I understand it, the term "mobile" is a gross overstatement

I also have a vague memory of being told that a natural third stage was only possible if you had no intervention during the first two stages. However, all this was four years ago so a lot could have changed.

[Janh]

I wish all of you with OC lots of luck with delivery and after! Such a lot of extra worry - hope all goes really well

[GeorginaA]

Beginning to realise that about "mobile" epidurals, willow! I'm wondering now if I get to the stage where I feel that I would benefit from an epidural, I'd be better off going for a "full" epidural instead...

[snowbird]

Georgina - I went to bed after I'd posted last night so missed your message, thanks. I've been following the '28 week bloods' thread as I knew something wasn't right. The more I read from you and Prufrock the more convinced I became.

They think I had in my last pregnancy that wasn't picked up, I had just put it down to sensitive skin.

Ideally I wanted a home birth this time but as they found I had GBS after ds was born, that was ruled out straight away. I don't really want to stay in hospital overnight and its looking more and more likely.

[GeorginaA]

I know what you mean. The thought of staying in hospital longer than the bare minimum requirements is a pretty horrible one. I was going spare after about 2 days the first time around, not relishing the hospital visit this time around either. I have to keep reminding myself that it's really such a short time in the scheme of things - just have to get past this hurdle...

[snowbird]

I saw my m/w today, even though I now come under the hospital consultant. She said the same 'dh wants to bring you and the baby home healthy. It doesn't matter how it happens'. I know shes right, I just need to accept its not how I had planned.

Just read on the due in may thread that we are being induced the same day, 10/05. So I'll be thinking of you going through it at the same time.

Got to go for a scan tomorrow to check I've not got gall stones. I can only have a light breakfast before 8am then sips of water only. My scan is at 3pm. Don't know how I'm going to last all day, I'm normally starving by 10am!

[GeorginaA]

Ugh yes, the gall stone scan is horrendous. Mine was at 12noon so basically I couldn't eat until afterwards AND they were running late. Ended up making a run for MacDonalds straight afterwards

[GeorginaA]

(hasten to add, the scan itself is not horrendous - the not eating for 6 hours beforehand when pregnant IS!)

[snowbird]

Phew was starting with palpations aboout the scan then
They are going to do the blood flow scan at the same time then back to the day unit for LFTs and CTG. I'm already planning a bag of goodies to take with me to eat after. It has to include some choccie I think

[GeorginaA]

Well there's a good choccie bar thread going on at the moment

Yep, the blood flow thing is the dopplers - that can be fun - my baby always punches or kicks the cord out of the way JUST as the sonographer is about to take the reading

The scans do get a bit time consuming, but it is quite nice getting lots of baby viewing time I quite enjoy that bit.

[mears]

Hi GeorginaA - sorry you are having such a time of it at the moment. I will give you my perspective but remember that even in my area I have a time of it convincing my colleagues at times - depends who is on!

1. Monitoring and induction of labour.
   
   If you are given prostin you are monitored for at least 30 mins before administaration which is then repeated about 2 hours afterwards, or earlier if you start contracting. If the CTG is normal, there is no reason why you should not be able to be mobile and have intermittent auscultation (baby listened to every 15 mins for 1 minute with hand held doppler) inductionguideline
   
   
2. Cannot comment on this as my unit does not provide mobile epidural service as anaesthetist needs to be able to top-up as required and that commitment cannot be made. Other areas midwives do it.
   
   
3. Natural (or physiological) third stage really is only advisable where there has been no intervention in the first 2 stages. I have done it when the only intervention has been prostin alone. Epidurals disrupt the natural flow of labour as does any other injectable pain relief. If syntocinon drip is used then actively managed third stage is recommended. There are 2 drrugs that can be used however. Syntometrine reduces blood loss but increases risk of headache and vomiting. Syntocinon 10iu given intramuscularly manages the third stage without those side effects. Blood loss can be greater though but it is the drug of choice for women with raised blood pressure in pregnancy.
   
   
   Georgina - please do not be too despondent. Second labours are usually more efficient than the first one as your body knows what to do. I was induced 3 times after the first and honestly did not find it to be horrendous experience.
   
   If the prostin itself puts you into labour then you can safely not have continuos monitoring if the baby's trace is good after the prostin has been given. A compromise can be traces every 2-3 hours. You cannot be forced to be monitored continuously if you do not want that.
   
   It might actually be an idea to speak to the senior midwife of the labour suite. That is what happens in my area when trying to accommodate a woman's wishes. The discussion takes place with the consultant and senior midwife and woman. Low interventionist midwifery care can be delivered to 'medicalised' women. HTH. When is D-Day?

[GeorginaA]

That helps a lot, thank you mears! I'd got used to the induction idea in general, but the monitoring in particular kind of threw me back into "eep, I really don't WANT this!"

The third stage information was particularly helpful, I don't actually remember my third stage in my first labour which probably doesn't help!!!

I think I will try and have a more indepth chat with the head of the day assessment unit when she gets back from holiday regarding the monitoring - I obviously don't want the baby put at unnecessary risk, but if it's something that can safely be compromised with then I think that would make a big difference to my labour experience. The other things I'm fairly happy to play by ear I think after your info.

D-Day will be booked at the last minute apparently. It's been made slightly complicated in that I've been exposed to chickenpox to which I am not immune in the last week - so induction date may need to be balanced against which poses the most risk to the baby - chickenpox infection or risk of stillbirth due to OC.

I'm obviously not destined for an uncomplicated life

[snowbird]

Mears - Thank you from me too.
Georgina - Can I ask how your itching is? Are you on Urso and if so has it helped? I only started taking mineon Sunday and I haven't noticed any change, in fact I'm not sure if its getting worse! I can't seem to sit still for 5secs without scratching or fidgeting. Have you found anything eases it? Hope this doesn't sound daft but I find the worse areas are skin on skin eg fold in arms or legs and under boobs.

Sorry for all the questions.

[GeorginaA]

I've actually had pretty mild itching up to now (I'm one of the lucky ones I guess)... in the last week it's got worse though in that I'm now finding it irritating and distracting. Still not to the stage where I would want to try using piriton (which the midwives keep pushing on me!) because I can sleep fine and it's more of an irritant than a problem, if that makes sense?

I've not been prescribed urso yet - I'm not sure at what point they do. I am on vit K supplements though.

Prufrock will probably be able to advise you more. There's also a support site which prufrock posted which may have more info for you: Itchy Moms

[mears]

Forgot to add Georgina that if you have an increased risk of bleeding, a managed 2nd stage is recommended but you might prefer syntocinon alone for reduced side effects such as vomiting. Check your previous delivery notes though - it is highly likely that you were given syntometrine. If you did not have problems with vomiting it is unlikely you will this time. I never did. Only had a physiological third stage with the last baby because the midwife was too preoccupied unravelling her cord from round her body on exit

[mears]

Sorry, meant third stage.

[GeorginaA]

Well I was sick last labour, but can't for the life of me remember which stage - I think it was before the baby was out though. I would think that I would be high risk for bleeding though, given that they're dosing me up with vitamin K "just in case"

[prufrock]

snowbird
Urso should help the itching, but it's a very variable thing. For me it tends to stop me from crying through the night from it, but I still have bits, especially on my hands, and in elbow creases. It's worse in the bits that get hot. If you haven't scratched the skin too much I find the body shop peppermint leg gel is quite soothing (the only thing that will stop the itching is coldness, because that constricts the blood vessels which are bringing the crap to your skin). But don't use that on irritated skin because it stings like buggery. Apart from that, cold baths, loose cotton/linen clothes, ice packs if you get desperate... Also make sure you keep your skin moisturised as otherwise you get into a viscuos cirle of scratching because of teh OC, which makes your skin raw, which makes you itch more..
DON'T TAKE THE PIRITON. It doesn't work. They really should't be offering it because the chemistry is just wrong - piriton combats the effects of allergens which casue itching, but OC itching is not caused by allergens, it's caused by the bile acids, which are toxins.
What dose of urso have they got you on. Whilst standard is 12mg per kilo of body weight, a recent study in Italy has found that up to 18mg is OK (it's not been published yet though) so if it doesn't start working soon you could ask for the dosage to be increased. Even if it's not helping the itching it should help to stabilise your bile acid levels.
Which hospital are you at (I only ask because there was another woman diagnosed at the RLH this weekend - it wasn't you was it?)

[snowbird]

Thank you Prufrock.
The doctor did suggest Piriton but I had seen you say it doesn't work, so didn't push it. I am on 4x250mg caps a day (not sure how that works out). It does seem to get me through the night. God, how many nights have I sat crying wanting to go to sleep but knowing as soon as I lay down it would be torture!
Because my LFTs came back ok at 28 wks the m/w said I would have to grin and bear it. So I thought it was sensitive skin and haven't been using moisture creams, bath gels etc incase it flared up!
I'm off to dig my foot lotion out now. It might take my mind of my growling tummy, only 2 1/2 hrs till I can eat!!
The hospital I'm at is in the North East so no it wasn't me.

Georgina-thanks for the link. In a strange way its comforting to know you aren't the only one and you are not going mad over 'just an itch' IYKWIM.