Epidurals, shoulder dystocia, ventouse, SPD... lots of questions for 'next time'...

[happynappies]

My dd is 14 months old now, and although hoping to ttc in the next few months I am still very anxious/upset about her birth, which fills me with dread about going through it again.

I had a normal-ish pg, but suffered terribly with SPD to the point that I could barely walk, but it went undiagnosed because my mw wasn't familiar with the condition, and said it was part and parcel of being pg.

Contractions started on my due date, and I was examined but told only 1 cm. I managed 12 hours with no pain relief, and when I look back on this part of the labour I feel quite positive that I was managing with just breathing. (But also worried that might not have been 'established labour' so no wonder I was 'managing'!)

The mw's changed shift at this point, I was examined and told baby could be breach, my waters were 'bulging' and would need to be broken in a controlled manner, so I was put on a stretcher and taken by ambulance with blue lights from the mw unit to the local hospital with dh following in his car. It was excruciating and terrifying, and this is when things started going pear-shaped.

I had my waters broken which was agony, and was told baby wasn't breach but head was high. I was put on a syntocin drip to 'speed things up' and four hours later couldn't stand the pain and was given an epidural.

I was told epidural would have to wear off in order to push, so some 32 hours after first contractions, they let the epidural wear off and I tried to push for an hour and a quarter but tbh I don't think I could properly feel when to push although I felt lots of pain. I was frightened because they told me I only had an hour to push, and I was tired beyond belief, and was repeatedly told my efforts were 'pathetic', 'no good', 'useless' when I swear I was pushing as if my life depended on it. My lungs were in agony as if they were going to burst, and hurt for days afterwards.

Eventually they stuck my legs in stirrups and said they would do an assisted delivery, and used the ventouse. Dd was born not breathing and had apparently got stuck (shoulder dystocia) - with the oxygen mask she was fine with a couple of minutes - she was 9lb 3oz.

I couldn't walk the next day - intially thought I'd been paralysed by the epidural - I really couldn't move my legs. Nurses unsympathetic and told me to get up otherwise I'd get a blood clot. Four days later I broke down and a more sympathetic mw diagnosed SPD, I was sorted with v. strong painkillers, crutches and a support belt plus community physio, and was allowed home, mentally and physically wrecked.

Sorry this is long...

My questions now are do you think it is likely that if I'd been allowed to carry on without intervention (a) the birth would have been any easier? Part of me thinks yes, which reassures me for next time, but then I think if I had been allowed to carry on without the drip, waters being broken etc, would my dd have survived, because of the shoulder dystocia?

I'm terrified that SPD will be back, worse next time because I'll have a dd to carry around too, but at least it will be recognised by the medical professionals, so that shouldn't be too bad.

I'm also worried that a second baby might be bigger than 9lb 3oz, particularly if a boy.

I get so upset when I think of this experience, and worry that although I'm writing this quite calmly now, if I was pg a second time it might come flooding back to terrify me, if not immediately, when I actually went into labour. I do wonder about getting counselling so that I might be able to put dd's birth behind me, but my real fear is that the second birth will go the same way or worse, which counselling won't really help with.

Thanks for reading this long story - any advice or thoughts very much appreciated.

[whomovedmychocolate]

Gosh you sound like me a few months ago!

Okay, first of all, it would be really worth you getting in touch with the hospital you delivered at and asking them if they have a birth afterthoughts service. Basically you get to go through your notes with an experienced midwife who can explain what happened, when and why the hospital took the actions they did. Often it's hard to remember what happened when you are knackered and in pain and if you can just talk it through it can help - it helped me.

If you have syntocin labour can be very painful - double headed contractions etc. ARM is bloody painful too - had both, ended up with a section - nightmare scenario urgh!

However just because this happened once does not mean it will happen again. Here's some practical things you can do to help next time:

(1) Ask for a 36 week scan to assess position so you will not be told you are breech in labour. Be as stroppy as you need to be to get this to happen.
(2) In terms of SPD, yes it does recur, it has for me and it does get earlier in pregnancy - BUT importantly if you know about it and understand the problem you can avoid some of the activities (like pushing shopping trolleys etc) which make it much worse. Also I am finding that because I know I need to take it very seriously I'm sitting on my birth ball, taking lots of rest, not picking up my daughter too often etc. I'm also more ready to seek advice upfront.
(3) Babies do tend to get bigger BUT if you have a non-inducted labour you will stretch in a more natural way and there is less likelihood of the baby descending before your body was ready and you'll also be less knackered so you will be able to cope with the pushing.

I hope that helps. Honestly after last time I know my next baby will have an easier birth. Because I've had my nadir already That's strangely comforting

[lulumama]

how horrible, what a traumatic experience. my first reaction is to complain aboout the (lack of / disrespectful ) care you were given.

breaking waters on an undiagnosed breech is not something i thought was done, as the key to vaginal breech is not to accelerate the birth process AFAIK

anyway, as baby was vertex, that is a bit academic.

were you offered any other pain relief other than an epidural?

legs in stirrups is not good with SPD, am not surprised you were unable to walk afterwards. all fours or left lateral are far better positions for SPD. as you do not have to open your legs too far.

am amazed that no-one else picked up on it, before you had the baby... how distressing.

sounds like with some decent support and being LISTENED to , given better advice re pain relief and birth position, you could have had a far better birth experience. being told your efforts at pushing are useless is hardly going to fill you with confidence and make you feel empowered and able to give birth.

am so sorry it was so awful for you and so frightening.

it is so important that this is all dealt with before you have another baby , there are two organisations that help with birth trauma

www.birthtraumaassociation.org.uk/

www.sheilakitzinger.com/BirthCrisis.htm

do contact one of them.

it is more than likely your second birth will be far more positive, as you will be far more able to understand what you want to happen/ not happen. chances of an assisted delivery are greater with an epidural. and a big baby does not neccesarily mean a shoulder dystocia. again, different positions can be helpful for a bigger baby.

you could think about having a doula with you next time to support you through the pregnancy and birth.

[lulalullabye]

Next time, get yourself an independant midwife, homebirth and bobs your uncle. Nice untraumatic birth !

[MumtoCharlotteMay]

Oh happynappies very for you.

Your worries sound perfectly justified to me. I had a natural birth with my dd, but I was induced and had my waters broken when only 1cm as they were 'quite busy today' and needed to 'get things moving as quickly as possible' I think you have to sometimes wonder with some people! It was not very pleasant to say the least.

When I had dd, although the staff were, generally speaking, quite good, they constantly threatened me with a section for the thirteen and a half hours I was in labour. This scared the living piss out of me. Looking back, they probably should have sectioned me instead of letting me go as long as they did. I had a fairly good labour, but I suffered very badly afterwards. I couldn't walk properly for a couple of weeks because I had quite a big cut. Which, shall we say, required more than one set of stitches. I had an epidural as well, although at no point did they tell me I couldn't have it anymore! Is that standard practice? I had complete control over my epi drip, every 30 mins I pressed a button and it kept me topped up. About 45 minutes into the pushing stage I stopped topping up as I knew it wouldn't take much longer for her to come out. She was born 30 minutes later, and I knew I'd need some time for it to wear off.

You will be worried for sure, and I don't know the answers to your questions. But, every baby, every pregnancy, every labour is different. There is no guarantee you will go through what you did first time round, but there is always the possibility too. Try and stay positive though, could you perhaps seek some advice from a doctor or midwife whilst you are ttc? Explain your worries and they may be able to offer some help.

[happynappies]

Thank you for your advice. I did complain about the care I received, both before and during the birth. Initially the hospital was adamant that my SPD was triggered by labour, but I knew I had the classic symptoms (not being able to sleep for about 4 months beforehand because I couldn't lie in bed properly, not being able to walk up stairs etc) and told two mw's and a physio who lead our antenatal relaxation classes but somehow it slipped through the net, and I thought I didn't have it because I was sure that if I had it they would recognise it if that makes sense! Anyway, the hospital apologised for the way the mw treated me the day after the birth and explained why (because she was concerned I would get a blood clot) and wrote in my notes that I did have SPD from earlier in pg.

I went to the 'talkabout' session with the mw offered by my hospital 6 weeks after the birth, but still can't say it made that much sense. I asked why things had happened the way they had, and her attitude was that I should be grateful I didn't have a CS, and that dd was alright. She wasn't that blunt - but it was what she was suggesting.

In terms of pain relief, I did have gas and air from the ambulance journey onwards, but once the contractions were 'coupling' as they called it, I was beside myself and they gave me a shot of pethidine which helped a little, I had a second shot, but it was only taking the edge of things, and I just felt delirious (sp?) with pain.

I am usually quite assertive, but just felt so out of control in the hospital, and my DH didn't know what to do either - we just put our trust in their hands, and thought everything would be alright.

I will look at those websites, and will definately think about the 36 week scan. The idea of a doula sounds very appealing - was also wondering about hypnobirthing... I definately want to make every effort to make sure the next time is different - still fearful though. Thanks again for listening.

[Divastrop]

i just wanted to add my experience of shoulder dystocia.my dd1 got stuck and needed oxygen,i had been given pethidine against my will,so i was too tired and drugged to push properly,also i was made to lay on my back due to having the heart monitor on,which didnt help.

i have been induced and had the drip with all 5 children,and i just want to say that it doesnt have to be awful should you ever need it again.

my last 3 births were wonderful experiences.i only had gas and air,and was allowed to move around and give birth on my knees despite the monitor being on.knowing the difference now,i really think being laid on my back caused alot of the problems with dd1.

i am on your behalf though,they should have turned the drip down if your contractions were doubling up.

[lulumama]

I went to the 'talkabout' session with the mw offered by my hospital 6 weeks after the birth, but still can't say it made that much sense. I asked why things had happened the way they had, and her attitude was that I should be grateful I didn't have a CS, and that dd was alright. She wasn't that blunt - but it was what she was suggesting.>>

This sort of feedback makes me of course you are glad your DD is ok and that you did not have a c.s. BUT that does not mean that what happened to you and the way you were treated was acceptable. That sort of thing totally undermines women and piles guilt on top of everything else to do with the way they feel after a traumatic birth. You are allowed to feel upset/ angry/ dissapointed/ cheated..whatever else it might be.... and to work through those feelings. anything you feel is perfectly valid and should be acknowledged and heard.

[christmaspixie]

Happy Nappies, your labour experience sounds very, spookily, similar to mine - right down to the ambulance ride to the hospital from the MW unit, the oxytocin, the sudden terrible contractions for 36 hrs, and being forced to give birth on my back (despite the baby being in a back to back position,) the epidural wearing off completely at the end, and the undiagnosed SPD which meant I couldn't walk for the last few weeks of pregnancy or properly after the birth. I didn't have the added trauma of baby not breathing, or shoulder dystocia, but baby ended up in Special care for a week after the labour (due to blood incompatibility). I SO SO understand how you feel about it all. And how awful it must have been for you. Like you I am usually quite assertive, but found the whole experience totally and utterly soul-destroying. I actually felt angry about the treatment I got for well over a year afterwards, and recently when I asked to see my notes and tried to discuss with a midwife she just said - oh it just says natural birth, no complications, I felt totally flumoxed...they hadn't even written my labour down properly. My dd is now nearly 3 and it has taken me this long to go through pregnancy again (i'm now 28 weeks with 2nd)and I am pretty terrified of the next labour. I am reading a hypno-birthing book though, which is helping me to feel calmer about it. Like you I felt in retrospect that if they hadn't mindlessly interfered I might have felt more in control. I've booked for a home birth this time, but I'm terrified that I won't manage it, or that I'll be putting next baby at risk if it has same condition. (Though can't get any answers from docs on that, again, they don't appear to have any notes ....
Good luck with feeling better about it all. ((((((hugs)))))

[Flllightattendant]

God, no notes is appalling

[Sabire]

So sorry for you happynappies that you had such a horrible experience and were treated so badly.

I read through your whole post and my thoughts were this: that if you managed to give birth to a 9lbs 3oz baby lying on your back, exhausted, demoralised, hampered by an epidural (because even if it's allowed to wear off it disrupts the normal hormonal response of labour that are helpful to second stage and turns your pelvic floor to mush), and with so little sympathetic encouragement, then you actually must have a pretty roomy pelvis and with better management of a second labour, would be able to shunt out a much larger baby without help.

Shoulder dystocia is a worry for those of us who have bigun's for sure - but I do think in your case it sounded like the way your labour was managed wasn't helpful to this situation. If you have a big baby you REALLY need to be upright and mobile so that you can open your pelvis right up.

I felt sick when I read how you were spoken to during second stage - how appalling. I read a really interesting article in a midwifery journal a while back about how interference during second stage can disrupt the normal hormanal response of the body and slow down second stage to the point where the mother is really struggling - I immediately thought of this when I looked at your post.

My understanding is that there's NO good evidence that allowing epidurals to wear off reduces the length of second stage or the likelyhood of assisted delivery - it just results in loads more pain for the mother. I'm also shocked that you were bullied to push your baby out within the hour. Most hospitals are ok with two hour second stages or even longer, for first timers who've had epidurals.

Anyway - second time round I would suggest this: write your concerns in a letter, explaining that you feel traumatised by what happened during your first labour. Send this to the supervisor of midwives at your local hospital with a request for a meeting to discuss putting together a special plan of care for labour that takes into account issues of shoulder dystocia, your SPD and your emotional anxieties. I think you should also seriously consider getting an independent midwife or an experienced doula to be with you for your next birth - I'm sure you'd find it would make a huge difference to your levels of confidence and your experience of the birth.

[happynappies]

Christmaspixie thank you - it is very reassuring to hear from you. I'm sure your home birth will be a totally different experience, and I'm sure you WILL manage it. Part of me wishes I could have a homebirth next time (but classed as high risk after shoulder dystocia and haemorrhage (sp)) but in a way pleased decision will be taken from me. I hope you can enjoy the rest of your pg, and that you get the support you deserve in labour.

Divastrop I think you're right about the lying down - I will know for next time.

Lulumama - it helps to hear people say this

"that does not mean that what happened to you and the way you were treated was acceptable. That sort of thing totally undermines women and piles guilt on top of everything else to do with the way they feel after a traumatic birth. You are allowed to feel upset/ angry/ dissapointed/ cheated..whatever else it might be.... and to work through those feelings. anything you feel is perfectly valid and should be acknowledged and heard. "

because I was worried about approaching anyone about counselling, or even about posting on here - thinking people would tell me that labour is supposed to be hard, and to just get over it. I really appreciate your kind words. Thank you.

[Sabire]

Sorry - just wanted to add, I'll never forget the midwife who said to me that second babies were usually 'beautiful to birth'.

All things being equal your second labour is likely to be far shorter than your first - this was so true of me (36 hour first labour resulting in forceps birth of 9lbs 6oz baby, second labour 7 hours with 10lbs 12oz baby) and almost everyone I know. If your labour is short you have loads more strength left when it comes to pushing your baby out, and second stage will take a fraction of the time it takes a first time mum with an epidural in place.

You really need to remember this and factor it in to the way you imagine what your next birth might be like - it's not down to 'luck' - it's biology and it's the way things turn out for MOST people (ok, ok - I know there will always be exceptions, but we're talking about what's most LIKELY to happen - no guarantees of course!)

[carmenelectra]

Oh dear, what a sad story. You experience was mangaged very badly. Im shocked that your waters were broken with a'high' head.

Anyway, it doesnt have to be like this again. Pleaase voice your fears when you do get pregnant, to a midwife or doctor.

Baby could be bigger but not necesarily. both mine(boys) exactly same weight!

The epidural does not need to wear off at all. In fact i would encourage regular top ups so that head is closer to being born before rather than pushing for yonks!

There is a risk of blood clots when immobile but if SPD happens agin you must ask to be referred to a physiotherapist.

[madmouse]

Happynappies that sounds like something very scary that should not happen in a civilised world!!

Shoulder distocia does not happen particularly in big babies, half of all cases are small babies.

You should have been diagnosed with SPD much earlier and the golden rule: No stirrups!!

The best position apparently for both SPD and a big baby is upright/on your knees or standing.

Waters should not be broken if they were not sure whether baby was breech and while head was high, they risk cord prolapse.

So yes, it sounds like with a bit better management you could have had a much better labour.

IMHO you are a total hero for the way you coped and the fact that you are having another one. Read up, clue up and be assertive. Even if you are not planning a home birth the www.homebirth.org.uk website and the www.aims.org.uk website have lots of great advice.

[lulumama]

glad it helped

the reason i know this is because it happened to me when i had my first baby, and had an em c.s. I got so tired of having my feelings dismissed by people.... talk to any woman who has had a traumatic birth and very often you will hear something very similar... feelings need to be acknowledged , heard and validated,then the healing process can begin.

please think about contacting one of the organisations linked to below

or your local branch of the NCT might be able to help too

[Klaw]

(((Happynappies))) I am [shocked] and at your treatment!!!!

Your feelings are entirely valid and you need to have someone listen to them. Lulu and the others have said most of what I would day so I just wanted to add my support.

Read up on normal childbirth, Ina May Gaskin and Dr Sarah Buckley to name but two, and regain faith in yourself. You do not have to go through the same ordeal again.

I wish you all the best with ttc (enjoy! ) and planning a wonderful birth next time. MN can support you to get the best birth for you

[JingleyJen]

I haven't read all your replies but if no one has suggested it I would recommend getting a consultant midwife to talk through your notes with you. each hospital can do this if you ask, it can help explain some of the things that have happened and why they were done.

it can also give you chance to ask questions about avoiding these scenarios next time.

Good luck - sounds like you have had an awful time.

[middymee]

Most shoulder dystocia's (approx 75%) occur in women with NO RISK FACTORS. Try not to worry too much, the recurrance rate is relatively low too.

It is not rare to rupture the membranes in a controlled manner if the head is high, its done usually to bring the head down. However, removing this bouyant cushion of water often prevents the baby from rotating to a good position and this could be why you had a SD.

I would ALWAYS question why synto is needed to 'speed things up', why do they need speeding up at all? Are there signs of distress etc?

On a personal note, I HATE epidurals! They remove the urge to push in many women, can stall labour, result in a high incidence of instrumental deliveries (particularly in 1st time mums), increase the risk of malpositions (baby in an awkward position) and increase the risk of DVT etc due to restricted movement.

Try not to worry too much, rarely is a 2nd delivery the same as the first.

[Mintpurple]

Sorry to hear of your horrible experience, honestly, I really despair about the attitudes of some midwives.

It sounds like the typical 'cascade of intervention', and unnecessary intervention at that. When you had your waters broken you probably were still in tha latent phase, (otherwse it would not have been difficult or particularly painful), which started the chain of events. It would have been better to have left you to get into better labour, either at home or in the ward, to give the baby a chance to descend into the pelvis.

The epidural does not need to wear off to push, in fact, if someone has been painfree most of the labour then gets severe pain, of course they wont push! And its cruel!

As for the SPD, if you had a shoulder dystocia, they would have had you in McRoberts position, with your knees up round your ears, so your SPD will be instantly made worse. The shoulder dystocia is what made baby a bit flat though and that is an acute situation, so if your labour had been longer or shorter, it should have made no difference to babys survival.

With SPD, you are more likely to get it next time, but not necessarily, so keep your fingers crossed there, and you know the symptoms now, so you can get help if you feel it coming on.

As for the midwives - well it sounds like you met some real bastards there!
There is so much to comment on in your post, it would take me most of the morning, I am so angry for you

If its any consolation, your next birth will almost certainly be better and it may in many ways be quite cathartic - I see this all the time in the labour ward where I work.

You may get SPD, but you will know what to do about it. If you are having a gap between babies of less than 2-3 years, it is statistically likely that the second one will be smaller, as your body has not had a good chance to completely recover yet. You will know not to let anyone near you with an amnihook again until you are at least 4-5cm dilated, and then only on your terms. You will be well within your rights to tell the horrible m/ws to f**k off and stay away from you if you ever see them again. You will have the support of all of us on Mumsnet, and we will help you get through your worries in pregnancy.

Also I would strongly support the advice from Lulumama and others to get some counselling, and a doula would be worth her weight in gold next time too.

[WaynettaSlob]

happynappies.
just have time to do a quick post...
DS1: 30 hour labour, back-to-back; ventouse, foreceps, post partum haemorrage; 10lbs; I was knackered.
DS2: 9 hours, I remained upright until the very last bit, really straightforward birth (although I did have an epi), 8.5 lbs.
So just wanted to reassure you that a bad first birth in no way means a bad second.
Good luck
x

[jeanjeannie]

Wow happynappies- what a horrendous time I thought I had a rough time with SPD - but you've way trumped me. Only advice I've got is about my experience of managing SPD.

My DD is now 14 mths and I'm now 20+5 with 2DC and so far (touches wood) SPD hasn't arrived. Like you I could barely walk and was offered crutches by a physio - unlike you mine was taken seriously. But by far the best help was going to a pregnancy yoga class where they helped me enourmously. Everyone else was stretching open their pelvis while I was learning how to control and hold the muscles inwards. Oh how it helped - especially for sleep. I'd never been to yoga before but that really didn't matter - met loads of other mums-to-be, so that was another big plus!

And a big blow up ball was great- just flopping over this - watching tv - Ooo it was marvellous..no pressure on the hips or pelvis - again great before bedtime. I'm doing the same thing this time in case it comes on.

I had a rough time after the birth (infection and discharged after CS less than 48 hrs with a massive infection!!!) and I have an appointment with the nursing director to go over what happened and try to reassure me about this next birth - and that I will be properly looked after. Although I'm plumping for doing a lot of 'helping myself' to manage the pregnacy (and any problems that may occur) and I feel more confident that I doubt the same thing will happen twice.
So just a few tips that helped me...sending loads of good luck x

[Tangle]

Oh Happynappies {{{hugs}}} that sounds awful .

I'd second the suggestion to talk to independent midwives. We decided to use IM's when our community midwife was less than supportive about the idea of a home birth. The care I received ante-nataly from my community midwife was absolutely fine in many ways, but we always felt very time limited. The contrast when we started getting IM appointments was huge - suddenly it felt as though they weren't watching the clock and they had the time to deal with any issues, niggles, questions... without making me feel like I was holding them up. At the time we booked them we were very focussed on the birth experience, but looking back the ante and post-natal care was priceless.

You're not committing to a home birth by having an IM. If you do labour in hospital then it's possible they could do the paper work to act as your midwife, but even if they don't you'd still have a very knowledgeable advocate that has got to know you and your partner who can help you evaluate the recommendations given by the NHS.

I feel I really benefitted by being at home, but I know other people who were terrified by the thought and relaxed as soon as they walked into the hospital - each to their own. It's worth bearing in mind, though, that there's very little that can be done for shoulder dystocia in hospital that can't be done at home, and that PPH's need evaluating as individual cases (I had a PPH, but a lot of it came from a tear rather than my uterus) and there seems to be a significant link to the level of intervention... If you haven't seen it, the homebirth webiste has lots of information on birth in general including these two issues.

Really hoping you can get some better answers and find some peace of mind - and go on to have a wonderful, peaceful, healing birth for DC2

[Klaw]

I would also suggest going to an osteopath or chiropractor to see if your pelvis needs any work done as this may help with the SPD, and it will be easier to do this before getting pg again.

Check out the Pelvic Pertnership if you haven't already done so.