What can I do to make sure I don't repeat by last birth experience

[MrsTulkinghorn]

Before I had DD I was booked into the midwife led birth centre at our hospital. I planned a water birth with as little medical intervention as possible. However I was diagnosed with pre-eclampsia and induced at 38 weeks. I could not go to the birth centre. I had to be monitored throughout so couldn't really move off the bed. I had the oxytocin drip for the induction and the pain was unbearable so I asked for an epidrual. They had to repeat the epidural several times and it took 3 hours to work. It was meant to be a mobile epidural but it paralysed me totally.

Labour took 40 hours in total before DD was prised out with forceps. I tore and had an episitomy. I had four layers of internal stitching and external stitching. She was 9lb 4oz (at 38 weeks!). I then had a large haemorrhage and had to have several blood transfusions... .

I have been told that given my history the birth centre will not accept me again and I cannot have a water birth. I will have to be in the medical ward. There is a good chance the pre-eclampsia will not return but it is likely the baby will be big again. I am terrified that I will have a repeat of my last labour. Does anyone have any ideas for improving my chances of a good labour?

[EllieK]

get a Doula
I had a difficult first labour, epidural, 9lb 3oz baby, not allowed to use pool, came out feeling i had the birth they wanted, not me

but DaisyMoo offered to Doula for me this time round and it made all the difference to the experience. I ended up with just G&A and an amazing memory of a wonderful birth, just knowing someone was there fighting my corner helped so much

[goingfor3]

It sounds as if your epidural could have been the cause of many of your problems. Could you explore other pain releif methods and maybe look into hypno birthing.

I hopr you have a better experince next time.

[moopymoo]

i had an almost identical experience to you with ds1 and feel for you as i was totally anxious to avoid a repeat with number 2. i was induced with ds2 - they broke waters - and i managed to keep completely active and mobile and he popped out 2 hrs later with no pain relief. i used homeopathic remidies taht i think really helped (though dh thought it was a load of nonsense) saw a homeopath whilst preg. and i kept walking around. and i was loads more assertive thatn i was with first baby, only allowed monitoring briefly, they would have had to work hard to justify using a belt or anythign invasive. hth

[maisiemooey]

I had a 60 hour labour with my DD1, epidural, episiotomy (40 stitches), ventouse, severe blood loss. Turns out she was back to back and nearly brow presentation. Awful soul destroying, scary, horrible experience.
However, DD2 was 1/2 hour labour, four pushes, (9lb 10ozs) no stitches, just gas and air. A totally wonderful, happy, calm experience.
Wish I hadn't left it 13 years before I had teh courage for another childbirth experience.
Now 23 weeks pregnant with DD3!
Chin up chick, chances are you'll be absolutely fine.

[lulumama]

definitely find a doula!!
and have a look at this thread www.mumsnet.com/Talk?topicid=1365&threadid=314328 &stamp=070521215741 about birth trauma...make sure you are fully debriefed of your experience before you have another labour !

[Guard]

My vote like others would be a doula or a girl friend/relative who can support you. I had emergency C section with DD1 (with the works epidural, monitoring bla bla bla), DD2 with help from friend and brill MW was at home in 3 hours, just had DD3 (now 5 weeks), about 40 mins (10 mins pushing) . Remember you do have a choice - read loads of birth stories as these can be inspiring. Try Stand and Deliver and Other Great Ways to Give Birth (by Emma Mahony)... Sounds like you are doing a great job thinking about it and you will have a far more positive experince

[mrsmalumbas]

Sounds like the classic "cascade of interventions".

Induced when you probably weren't ready. Continuous monitoring therefore immobile and probabaly made the pain worse plus the oxytocin makes your uterus contract very fiercely but does not always dilate the cervix. Epidural undoubtedly contributed to need for forceps as it causes the pelvic floor to be too relaxed so you cannot push effectively (also made worse because you cannot move, use gravity etc). Episiotomy often needs to be done for forceps. Sadly, I'm afraid this scenario is pretty common.

What can you do this time? Firstly true pre-eclampsia very rare with second babies. read up on it - look at this website - www.blueribbonbaby.org/ - basically recommends a high protein diet to prevent blood pressure issues.

Ridiculous that you have to be in a high intervention ward when the very fact you had all those interventions last time was what caused the problem! Grrr.

Can you discuss your concerns with your consultant and see if they can allow you to at least labour at home for as long as possible, no induction if at all possible and certainly not at 38 weeks. Can you have intermittent monitoring instead of continuous?

Agree with lulumama, sounds like you could use the chance for a good debrief and also more support this time around. Consider a doula!

[mrsmalumbas]

And of course, consider a homebirth?? With a private midwife if NHS will not support?

[DaisyMOO]

Hi MrsTulkinghorn, sorry you had such a difficult time with your last baby. It sounds really traumatic. From what you've said it sounds like a fairly classic cascade of intervention, going back to having the induction, which of course was necessary because of the pre-eclampsia. It's not uncommon for the syntocinon to make contractions particularly painful so that you need an epidural. This in turn can cause further problems because of being immobile, and increase the chances that forceps will be needed. Long labour, big babies and instrumental deliveries all increase the likelihood of postpartum heamorrhage and the forceps and lying down increase the likelihood of tearing.

I think you stand a really good chance of having a better experience this time. If you don't develop pre-eclampsia, what's the problem with using the birth centre? Is it on the main hospital site or would transfer take a while? If it's within the same building then help would be close at hand if you should need it. Sometimes birth centres turn away 'high risk' women in case they make their stats look bad, which is understandable as it can put the whole unit at risk - not much comfort to you though! I think it would be worth pressing the case to use the birth centre if your pregnancy remains straightforward and you go into labour spontaneously. You could even call their bluff a bit and threaten to have a home birth if they refuse which can sometimes cause a dramatic shift in policy!

If the birth centre option remain a no-go then again, assuming a normal pregnancy, I think it would be worth having a frank discussion with the doctors and the midwives to make sure they understand your wishes. If you don't have an epidural in situ or use pethidine then in theory there is no problem with using their birth pool. I would imagine their concerns will be a)they will probably want to do continuous monitoring because you're 'high risk' and b) they may be concerned about another heamorrhage. It's worth bearing in mind that continous monitoring has not been shown to improve outcomes for the baby. If intermittant monitoring picks up concerns, then it's a different story obviously but be aware that monitoring 'just in case' does increase the likelihood that you'll end up with interventions again. You could also negotiate getting out of the pool for the second stage in case you do haemorrhage again, but if you have a straightforward birth then chances are you won't, but it might make them more likely to agree to use of the pool. Sadly it's one of the things they can withold whether or not you give informed consent.

Whether or not you get the go-ahead to use the pool and are on the monitor, staying mobile and upright will help your labour progress and should help you deal with the contractions too. You could also stay at home for as long as you feel able to in the hope that your labour will be well-progressed when you get to hospital and there's less time for unncessary interferance.

If you do need induction again, or need sytnocinon for some reason, then don't feel as though you are destined to have the same experience as last time. You might want to negotiate taking the induction very slowly, giving you time to build up some tolerance to the contractions as they increase in strength. If you do need an epidural again hopefully the mobile one will work this time and enable you to keep upright which may be particularly helpful in the second stage as it opens up the pelvic outlet and make it less likely that you will need an instrumental delivery.

Phew, sorry that ended up so long. As the others have said, I think a doula could be really helpful in supporting you and making sure your wishes are heard and she may be able to come to antenatal appointments with you to give some support if you're trying to negotiate stuff with the medical staff in advance. I hope it goes well for you this time!

[maisym]

if you can have monitoring that enables you to be mobile - this will help you lots. Once you're upright and moving it really helps things.

Epidurals can lower blood preassure - was this also a factor in you having one?

[olliebird]

I had epidural first time (because they interferred and this cause unbearable pain, nothing like it) adn big epistiotomy because they had to cut cord before he was born because round neck, but second time was so so much easier. the baby popped out twenty minutes after arriving at hospital - no time to get in the bath! I took the midwives advice and stayed at home as long as possible (perhaps too long, but hosp is just round the corner). At home I took paracetemol/nurofen(whatever the midwife recommend, can't remember now) and for each contraction I got into squat position and relaxed as much as pos and counted breaths (not seconds) during each contraction. Back to sleep in between. Then my waters broke and I knew I had to go to hospital. I took a double dose of the pain killers and set off. I can honestly say I had one painfull contraction and then the baby popped out. It was so incredibly easy (much easier than those painful period pains I used to get as a teenager). Baby was 8 1/2 lb. Had one little stitch. (Whole labour at home took 24 hrs from first onset of very very light contractions till waters broke). I left hospital 6 hours later (waiting for paediatritian) and was out gardening the next day. No hangover from all the chemicals they can fill you with. My mum was with me and husband was not.

Second labours are completely different, and many people say this, even hear of babies born at home before the ambulance arrives because they just pop out. So you never know it could be really easy and if its not you just have to follow doctors advice - they are teh experts. The midwives don't give out over-the-counter pain killers when in hospital although they are happy to advise you to take it while in labour at home (strange), so you may want to take your own supply in with you. asprin was first used by the greeks specifically for child birth. Find out which one is best for you given the pre-eclampsia, it takes the edge of the pain, if there is any. Try not to take any in months running up to labour because the more you take these things the less they work.

Also, the week before your due date, try what I did - a visit to a good cranial osteopath, they believe they can help encourage the onset of the birth and is good for other reasons ive now forgotten. It worked with me.

I know the drips are terrible and induce terrible pain which means epidural is necessary as it was for you, this won't be the case in a normal second birth, you will be able to manage the pain - probably easily. A doula may help in that she will encourage you to have the confidence to carry on and cope if it does get a bit painful and so avoid the epidural. However if you get the drip it may well be too painfull which I understand.
Skip the advice if it sounds wrong (check it with midwife) but do take on board my very easy second birth experience and I hope this helps allay your fears.
good luck

[MrsTulkinghorn]

Wow. Thank you all for your really helpful and encouraging responses (sorry for delay in replying - I had a rare night out yesterday ). Having just read your advice and experiences I feel so much more positive.

I have heard that second births can be much easier and quicker but I was worried this would not apply to me as I don't feel my body would have learned much from my last labour. I mean it didn't learn to go into labour naturally, it didn't learn to push naturally etc. I did not feel empowered at all by my last experience. Anyway it is great to hear that some people with similar experiences to me had brilliant second labours.

I will look into a doula (any recommendations in West London?). I will also try and get a proper de-brief about my first experience and I will fight my corner on the birth centre (which is one floor up from the medical delivery unit).

Thanks again .

[hertsnessex]

mrsT

try doula.org.uk and type in your postcode. also try marslady - she isnt west london, but may be able to help you!

cx