My birth experience looks like a disaster waiting to happen due to: (1) Dangerous midwife (2) Lack of consensus between health practitioners

[nothingsoextraordinary]

This is my first pregnancy (37+3) and it's all going pear-shaped! Advice about how to avert disaster would be much appreciated.

In a nutshell:

(1) I'm immobilised and in terrible pain due to pelvic girdle pain. I also have other health problems requiring strong medication that knocks me out for about 6 hours at night. Luckily I have a very supportive DH, who is caring for me at the moment and looking forward to playing a key role in our daughter's care too. However, we are told he will be allowed in the maternity ward for only a few hours each day, and there will no care available for my daughter from nurses. This is despite paying for a private room. I have no idea how either my daughter or myself will manage to eat and get washed. This is stressful and humiliating. I am at risk of PND already and really feel my dog would be promised better care at the vet's.

(2) Both an NHS physiotherapist and a private osteopath have emphasised to me that I must NOT lie back/have an epidural/put feet in stirrups/sit down for labour, at the risk of suffering permanent pain and immobility. The physiotherapist was very strong about this and I got the impression there were internal politics going on, as I had said nothing to indicate I was planning this sort of labour. That said, I have no idea how I would hold a squatting/kneeling position for any length of time in my present condition, and felt forced to consider a planned C-section. I was still weighing up my options yesterday when a most unpleasant midwife informed me, apropos of nothing, that they will do 'whatever they have to do to get the baby out' and 'physiotherapists swan in for half an hour but they don't know what labour involves'. She clearly does not consider permanent damage to my pelvis a real risk - and I will be definitely going ahead with a planned C-section as a result. However, I feel caught in the middle of some professional bad-feeling, with no real support in making a difficult decision. I feel I didn't get the chance to talk through the pros and cons surrounding natural labour with a professional.

(3) My consultant is on holiday and I haven't yet had an opportunity to request a C-section. Of course, I'm on tenterhooks in case labour begin early! I spoke to an SHO who said she could do nothing in the consultant's absence - and it won't be possible to speak to him until I am 38+5, which seems to be leaving things very late to plan and book a C-section. The possibility of ending up in the labour ward having that midwife 'do whatever they have to do to get the baby out' is causing me great anxiety.

(4) Regarding pain medication, the SHO has prescribed a cocodamol regime (30mg). I understand this drug can affect the baby's breathing, and I'm concerned that our local maternity unit has no special care facilities and won't be able to cope. However, I'm also at a loss to know how to manage such unbearable pain. The midwife I spoke to yesterday told me that the medications I was taking were very dangerous and I was to stop them. She also said that the doctors were untrustworthy because they thought only of the mothers, and couldn't be relied upon to consider the baby's position. I'm very reluctant to trust her on this, but I'm also concerned that she may have a point.

Any thoughts/advice gratefully received. I simply want to make the wisest decisions for the health of myself and my daughter.

[dinkystinky]

Are you in the uk. If so get a doula from doula.org to be at the birth and be your advocate - they will help you get the birth you want and be someone you can trust in.

[theboobmeister]

How appalling, I'm not surprised that you're so worried. You need someone to intermediate between the midwife, SHO and physio right now - surely in this day and age they can relieve your pain without compromising your baby's health?? They should be pulling in another consultant for you if yours is on holiday.

Could you go via hospital complaints dept and ask for immediate action? If I was a hospital manager reading your story, alarm bells would be going off.

[nannyl]

"a most unpleasant midwife informed me, apropos of nothing, that they will do 'whatever they have to do to get the baby out'"

Umm NO, its your body, if you dont want to be in that position say No, and refuse to lie on the bed etc... the cant "make" you. Its up to you what position you are in, end of.....

[activate]

1. tell DH to ignore them and just turn up and not leave - my partner was never removed from any of the births of our children
   
   
2. get it in writing from the specialists - get it in your file - tell them again and again that you will hold them responsible if they do not help you avoid permanent damage
   
   get another midwife - the doula advice is very good too

[QTPie]

Hi

Where are you?

There simply MUST be another Consultant covering for your Consultant whilst they are on leave: you are getting very conflicting information and I would imagine that this (as well as the "limbo" is causing you a lot of stress)...

If your hospital is able to do C Sections, then they MUST have immediate transfer to special baby care available. I had an ELCS in a hospital without SCBU, but they did have a paed available and good procedures in place to deal with any emergency transfers.

I am so sorry that you are going through this :(

QT

[breatheslowly]

Your consultant should have some sort of cover while on holiday - there is usually more than one consultant in a department. I think you should get to see a different consultant ASAP. There is very little point in adding this level of stress to your already difficult condition. As an alternative go and see your GP (or one that seems really switched on at your surgery) as GPs often have good contacts and will have a decent knowledge of the maternity department at your local hospital. You could also try the supervisor of midwives. I certainly wouldn't return to a MW who described doctors as untrustworthy in general as I would be concerned that she would overstep the mark during birth and not get the doctors in when they were really needed.

[catsareevil]

Hopefully your pelvic pain will resolve after delivery. It is standard for partners to not be allowed in the postnatal wards all the time.
Even a CS doesnt have to mean a prolonged stay in hospital - some of people leave after 24 hours if they feel able to.

Its never too late to book a CS (pre labour), if you need one then they will have to do it, the same as if anyone who is booked for an elective goes into labour - they still have a CS. I realise that you dont have agreement yet that they would be willing to perform a CS in your case, but the timing shouldnt make a lot of difference to it.

Co-codomol is not recommended for pregnancy, but is certainly used a lot. The midwife doesnt really have a point, because there is no evidence here that the SHO wasnt considering your baby too. What was the alternative? To manage without them? Could you?

[nothingsoextraordinary]

Thank you for these words of wisdom. I feel like I know what I have to do in the morning now!

dinky and QPie: I'm in Northern Ireland. I'll look into seeing if a doula can help.

catsareevil: No, I couldn't realistically have managed without the painrelief in any case.

bm and activate: I'll contact the complaints department tomorrow and see if that speeds things up.

breatheslowly: I'll call the maternity ward in the morning and insist on speaking to whichever consultant is covering.

[Tangle]

I'm sorry you're finding yourself in such a stressful situation :(.

If it were me I'd get on the phone first thing tomorrow and try and talk to:

1. Consultant MW if they have one or, if not, the Supervisor of MWs (they have to have one)
   
2. PALS
   
   Start waiving a big red flag that your care has become fragmented and that the advice you are being given is contradictory, causing you stress and distress, and that you are being told that neither you nor your baby will be given basic personal care for the duration of your post-natal stay and that, due to your PGP, you have reason to believe that this will be required to maintain a basic level of health and dignity.
   
   The CMW (and/or SMW) should be able to do some joined up thinking and work with you to come up with a care plan by which you feel supported rather than abandoned (be that for a vaginal birth or a CS). Getting PALS involved should also help to get your case taken seriously rather than being sent from pillar to post.

[spudulika]

You need to talk to the supervisor of midwives.

Soon.

She'll sort you out - I'm sure!

[jenniec79]

There will be a consultant on call every day, any time. Ask to speak to him/her. Transfer your care if needs be, they'll understand.

There will be a midwifery sister in charge too. Speak to her too - if only to explain how this midwife has upset you.

Codeine isn't ideal (same drug family as morphine and pethidine) but in these circumstances is fine, esp as prescribed for you after a full assessment. I've never met an O&G doc who doesn't consider the baby, as well as the woman.

Did your PT/osteo have any suggestions for alternative birthing positions?

[VivaLeBeaver]

Concerning point one. Paying for a private room is not the same as paying for private care. It's likely that the care ratio could be one midwife to anywhere between ten or fifteen women and babies. At night this could be one midwife to over twenty women. There is no way that any of the midwives can care for your baby for you, I'm not sure what you want them to do. Hopefully your spd will resolve after birth. If it didn't and you had a vaginal birth then you could be treated the same as any other immobile woman on the ward ( post sections, etc), you would have the cot by the side of you, you'd be able to reach and feed your own baby and meals would be brought to your bedside. You'd be assisted to the toilet as required. They're not going to leave you to starve or soil yourself. I think they just mean that there won't be a midwife/nurse available to look after your baby 24/7.

I think you'll manage better than what you think you will.

[MissusTulip]

nothingsoordindary - if you are in NI, there will be a consultant covering your consultant's leave. Definitely need to speak to him or her sooner rather than later to arrange your ELCS but I don't see how this would be a problem, quite the opposite! Can just imagine the SHO getting a thick ear for not raising this with someone more senior...

I'm sure you have been on websites like the pelvic partnership.org which have advice on labouring with PGD - don't think you should be squatting tho, as this will put a lot of pressure on your pelvis. There is a good leaflet provdied by the associated of chartered physios available on the web www.csp.org.uk/sites/files/csp/secure/acpwh_-_pregnancy-related_pelvic_girdle_pain.pdf - brandish this at any non-physio!


My physio got down on the floor and demonstrated kneeling holding onto the bedside / the frame at the head of the bed. She also suggested all fours. If you have a birthing ball, kneeling over it might be comfy and you can sit or bounce on it during labour too. I have PGD too (sucky isn't it!) so I've been researching a lot!!

Hopefully that will be moot and you'll get the help / support you need from the hospital tomorrow morning. Midwives in NI can be right dragons, I speak not from experience as a mum-to-be but as a former medical student... Some of them bloody hated female medical students and made life as difficult as possible on placement (I was dead keen as Obs and Gynae was one of the specialities I was interested in at the time) while flirting with the male medical students. So you may well be spot on about the politics going on unfortunately.

I don't think that cocodamol regime will do your baby much harm - he or she may be a bit sleepy and / or irritable after delivery, but talk through this with the SHO or consultant. It shouldn't affect your baby's breathing. Some centres will try to get you to stop cocodamol 48 hrs before delivery so that it's out of your / baby's sytem by birth but most places should recognise how best to manage your needs too and balance this with any risks to baby.

I would advise you to get a bit arsey with them over your PGD - make it extremely clear that you will hold them responsible for permanent damage (pain/incapacity/mobility issues) to your pelvis after delivery. Midwives are NOT experts in this, too many are of the 'it's just a normal part of pregnancy' school of thought, which is rubbish when thinking of what you describe! Your physio and osteo are experts so don't let yourself be bullied by someone being ignorant and rude to you.

good luck, hope it goes smoothly and fingers crossed it'll go away once baby is delivered!

[QTPie]

Good luck and let us know what happens.

I am not familar with NI (am in the UK), but agree that you need to (for your health and sanity) progress things tomorrow (with Consultant-on-Call, Senior Midwife, whoever).

Are there any options for truly private maternity in NI? In which case you might get much better care (leaving you feel much less exposed and unsupported after the birth).

Hopefully your pelvic problems will ressolve very quickly for you after birth - I have everything crossed for you.

QT

[MissusTulip]

also here is a leaflet from the association of chartered women's health physios for health care professionals:

www.csp.org.uk/sites/files/csp/secure/acpwh-pgp_hp.pdf

which is really clear, pages 10 (also section 10) onwards is specific to labour

HTH x

[thehairybabysmum]

I had SPD and found the best position for labouring was sat upright on the bed but on my side. I also found that after the birth I was in less pain and had better mobility despite em c/s.

Second what others say to contact the hospital first thing tmw and play merry he'll until you speak to head midwife.

[LisMcA]

I had SPD/PGP and was on Dihydrocodiene from around 28 weeks. I think 30mg?? Iwas taking about 2 or 3 a day. The level I would have had to take to have any lasting issues for DS would have been double or treble the doses I was taking. IME the MWs had heard of SPD/PGP but really were clueless around the pain management of it. My painkillers were prescribed by a Obs consultant, who certainly took "the baby" into account.

I was planning to labour naturally and had written a birth plan. This was looked over by a MW when I'd gone in for monitoring at about 36 weeks. She basically ribbished it and said there was no way I could labour on my side or have internals without lying on my back, and if I needed stitches stirups were the only way i could get them. She ws not helpful in the slightest. My consultant read my plan and said there wasn't anything in it that she would refuse to do.

I ended up being induced at 40+12, and that failed spectacularly! No dilation, not contractions, not a thing! But they did do my internals without me having to lie flat and oblique my legs. I had a semi planned CS at 40+14. My pain went almost immediatly! I felt like skipping round the room from about day 2 post CS. I obviously didn't, but the relief was immense!

Your midwifes comment about them doing what ever they had to to get the baby out is crap. They still need you to consent to certain things. If you have in your BP no forceps, they have to respect that. They ay ask you if you will reconsider and should explain all the reasoning behind it to let you make an informed choice. This may not be easy if youa re n the throws of labour, but make sure you birthing partner knows your wishes and can act as your advocate if need be.

Hopefully you will get to speak to someone who can put your concerns to rest tomorrow. I fyou do go down the CS route, it really isn't as horrific as you may think. Well my CS wasn't at all adn I can only go from my experience.

You have my sympathy, I was where you are 14 weeks ago. But onc eyou have your baby in you arms you will quickly forget all this crap.

Good luck :)

[Friendlymum67]

Contact Supervisor of Midwives - every hospital has one. You should not feel caught between health professionals!!

[wigglesrock]

nothingsoextraordinary are you simply paying for the room or are you having the baby in Johnson House (RVH). Sorry rereading your original post, if you're concerned about the baby receiving specialist care you obviously aren't having the baby at RVH. Can I ask which hospital you're giving birth in? Partners will not be allowed to stay with you indefinitely on maternity wards regardless of you having the private room. The baby will be bathed by midwives initially all 3 of mine were and didn't need a bath after that.

[ShoutyHamster]

1. As others have said, your consultant will have a cover. Start kicking up a fuss - the phrase 'my care has become fragmented and I am being given contradictory advice, which I am concerned will put me and my baby in danger' is a good one. Get onto the consultant's secretary, say this, and tell them that you need an urgent appointment, or you will be making a complaint and going through PALS. Hopefully this will get you advice sooner rather than later on the CS.
   

1. Next, contact your supervisor of midwives and make it quite clear that you do not wish that particular midwife to have anything more to do with your care. Say that she made it clear that she was willing to a. disregard the advice of HCPs outside her area of expertise (the physio) and b. was willing to bully and override your preferred wishes in labour. Make it clear that you see this as an issue of the highest concern, and if your are not supported in labour with the precise aim of avoiding permanent damage due to your condition, you will make a complaint. Make her aware that right now, your care has become sub-standard and you are very anxious all round.
   

1. GET A DOULA. To give you absolute peace of mind that you won't be bullied either in labour or post-CS, get a doula now who can advocate for you in hospital - then you won't have to run the risk of arguing about birth positions. They will literally stand in front of you and say 'No' to the midwives with a smile.
   

1. Try not to worry too much about the post-birth scenario. Wait and see - if you have a private room, it's very possible that 'on the day' the midwives might let your husband stay - mine did, after my CS, on the floor for three days - not really allowed, but it meant that I didn't have to bother them at all, and his presence wasn't affecting anyone else. They certainly won't kick him out until the baby is here. Again, a doula could well help give you numbers on your side here. Worst case scenario - you have a CS or a difficult birth, you are left without support. What do you do? Along with both husband and doula you threaten to check yourself out and make a massive complaint unless they a. care for you properly or b. let your husband be around in the private room in order to do so.
   

This can all be sorted - try not to worry too much!

Good luck!

[notcitrus]

Write to the Supervisor of Midwives, and PALS for good measure.
I was in this situation (SPD and deaf) and it was agreed I could have someone stay with me through labour - which went overnight, and they would try for a private room so I could have someone stay with me there. Do you have a female friend who could stay if you can't get the private room?

I found a one-page birth plan with warnings was invaluable as in many cases staff read that but not my notes. I also had a fluorescent post-it on the front of my notes warning about SPD and deafness - I put it there.
I was taking 60mg codiene 4x daily until labour - the problem with that was not telling anyone when I arrived at the hospital in labour and they didn't ask, which meant I didn't get any after birth for 36 hours. All the staff I met during labour were great - they're all supposed to be trained to do exams on women who use wheelchairs and can't move their legs, so just refuse to allow internals unless you are lying on your side.

If they might not have enough pillows, take some yourself, but I managed to be propped up on a mountain of them for pushing, and then they made a nest for me and ds in the bed with them on the postnatal ward so he couldn't fall out. I have to admit that postnatal was still grim at night, but that was because ds needed antibiotics and we had to stay 3 nights. Otherwise we'd have scarpered ASAP!

Good luck with it all - it's not the sort of hassle you need atm!

[Poppet45]

I can't comment on all your other points but like another poster I'd like to reassure you on point one. Hospital beds in the post natal ward are highly mobile, operated by simple controls you adjust yourself, to raise and lower the height of the bed, then tip yourself forwards and backwards with minimum effort from yourself so you can reach your baby on your own. They are designed for women who've had to undergo major abdominal surgery and are physically much less able than someone with pelvic girdle problems so you should be fine. I was looking after my son myself hours after I was released from the high dependency unit after his birth. Alternatively you can share your bed with your baby. I did that too and it really helped.
Also on point 4, cocodamol is frequently offered in early labour, prior to gas and air, by most midwives. I took some before needing gas and air from 7cms (so quite near delivery). My DS had apgar scores of 9 and 9, despite a subsequently traumatic delivery (nothing to do with the cocodamol). So try not to worry about its impact on baby.

[notcitrus]

Poppet - not all hospitals or wards have beds you can adjust yourself. My postnatal ward didn't and that's one of the largest hospitals in Britain!

Equally, given the height some hospitals or some staff in said hospitals will tell you you mustn't have the baby in your bed. I was lucky in that a senior MW decided to put a rail on one side of me and make a safe baby nest with pillows, but other women on the ward were told this wasn't possible or was unsafe.

All hospitals are different and the OP needs info relating to her hospital.

[Poppet45]

I stand corrected Notcitrus! I wonder if I was on the ward for women needing higher care, (I was also in a very large national maternity unit and it had a number of postnatal wards) as most of the other occupants looked pretty battered around too :) If so she may be able to have a similar bed. As for the not sleeping with your baby in bed thing, I did this between the 1am and 3am and 5am feeds and no one was ever the wiser. Plus my bed had side rails on it anyway. I don't know about all the other bells and whistles but don't all hospital beds have side rails on them?

[Restrainedrabbit]

Not had your condition but had to see the superviser of mws due to conflicting advice about a different condition and o wanted a hb. She was brilliant and sorted it all out in half a day after weeks of misinformation :)