Was the midwife right about my birth?

[LoobyLou33]

Sorry this is such a long post!

Last week I had an appointment with a senior midwife ahead of giving birth to DC2, who is due in April.
DC1 was born by emergency caesarean because of failure to progress and a dipping heartbeat. My appointment was designed to encourage me to try for a VBAC this time, and talk through how I felt about the first birth. I learned then that he was back-to-back and his head wasn't pushing quite properly on the cervix, hence slow progression.

Afterwards I wondered about some of the things she told me, obviously I would need to talk to her about it really but wondered if any of you could enlighten me too.

1. Labour. My contractions started at 6pm Tuesday, and continued every 5 minutes until midnight on Wednesday when I had the section. They were ok for the first 3 hours but very painful from then on. It took me til 3pm on Wednesday to get to 4cm dilated.
   

THe midwife said that all that time up til 4cm was the latent stage - not counted as proper labour - and that I wouldn't experience that this time round because the body's done it once already. However - I have friends who've still laboured for days with their 2nd child. Is it really true that I won't experience the "latent" stage again?

1. Epidural
   

By 3pm Weds my tens machine wasn't cutting it and I begged for an epidural, throwing out my original plan for a drug-free water birth! I could easily have had an epidural much earlier if they'd let me. The midwife told me the epidural was the reason for DC's heartbeat dropping off significantly, as epidurals often cause baby's heart rate to slow.
I'm sure this could be the case, but could it not also have been distress that he was pushing against the cervix and not getting very far? Or do I have to accept that the heart slowdown probably was the drugs?

1. Distress
   

The other thing she said was that a sample taken from the cord after the birth showed normal oxygen levels, which means DC wasn't distressed after all (e.g. the main reason for em-c turned out to be invalid.) However DH remembers DC being given oxgyen straight away and I think we even have a photo of him with a mask on, so presumably that sample was taken after he was helped out rather than before... We were told at the time he was distressed, but I really don't remember anything much about the whole process cos I was so out of it after 2 nights of contractions and no sleep!

Whilst at the time I felt encouraged by the meeting, later I found myself doubting a few things and like she was wanting to put intervention in a bad light and direct me to a more natural birth.

I must admit I swing drastically between hoping for a planned c-section and wondering about things like hypnobirthing and as natural a labour as possible!

Any shared experiences would be great, or thoughts from people with medical knowledge :-)

[CailinDana]

I don't have much experience to speak from (only had one DC vaginally) but I have no idea what she was on about wrt the latent stage. It does exist, and can be a slow stage of labour, but I'm not sure what she meant when she said you "won't experience" it this time round - does she mean it won't be as slow? Unless you're permanently 4cms dilated (some women can be about 2cms for weeks before birth) then you do have to go through this stage, though it is likely to be shorter second time round.

WRT the epidural - was she saying your DC was in distress and then the epidural made it worse? Or that it actually caused the distress? If she was saying it caused the distress then she's talking during her arse - there's no way any woman would get an epidural if it caused foetal distress. It can be the case that if a baby is already distressed the epidural can make it worse but as far as I know it's sort of an indirect effect - the epidural prevents you from feeling what's going and moving around to get more comfortable so the baby might end up in a bad position for longer. Overall though the epidural doesn't affect the baby (that's the whole reason it's used in labour) so it can't really be directly blamed for causing distress.

Distress - the sample was taken from the cord, so that tells them the conditions that were present in the womb. It doesn't matter whether he was given oxygen afterwards or not, that wouldn't affect the cord as he would already be detached from that. They probably gave him oxygen as a precaution because they believed him to be distressed, even though he wasn't. It's very hard to tell whether a baby is actually distressed (unless their heartbeat dips drastically and stays dipped) so they did the right thing giving you the EMCS - they were cautious, which is exactly what you need in that situation. Saying afterwards "Oh he wasn't distressed" doesn't really make sense, they did what they could on the basis of what they knew and it was the right thing.

Don't be swayed by what she says, just go with what seems right to you. Every birth is different and no matter what you know about your first birth, it won't make a difference to this one.

[LoobyLou33]

Hi Calindana thanks a lot for your response, that's very helpful.

Re: the epidural, she wasn't saying it caused any distress per se, but that it was the reason DC's heartbeat kept slowing down. His heart rate slowed several times (always after a major contraction) which is why they opted for the c-section.
She said if you have high blood pressure then an epidural can be helpful, but if it's normal then it often slows down baby's heartrate. I wasn't aware of that and like you say, I'd be surprised they would offer it if it commonly caused that to happen.

I'm pretty sure wrt the latent stage she was basically saying it wouldn't happen again, but maybe I misinterpreted her and she meant it would happen a lot more quickly. I will ask my regular midwife!

[Shagmundfreud]

"If she was saying it caused the distress then she's talking during her arse - there's no way any woman would get an epidural if it caused foetal distress".

Actually, although epidurals don't seem to be associated with higher rates of c/s over all (though see the discussion on this thread for my issues surrounding the research into this), if a c/s is done after an epidural, it is more likely to be done because of fetal distress. It tends to make a woman's blood pressure drop, and this, particularly in combination with the use of syntocinon, can result in babies' heart beat becoming dodgy sounding.


From the Cochrane review (the database of evidence on which NICE recommendations are based).

"The review identified 38 randomised controlled studies involving 9658 women. All but five studies compared epidural analgesia with opiates. Epidurals relieved labour pain better than other types of pain medication but led to more use of instruments to assist with the birth. Caesarean delivery rates did not differ overall and nor were there effects of the epidural on the baby soon after birth; fewer babies needed a drug (naloxone) to counter opiate use by the mother for pain relief. The risk of caesarean section for fetal distress was increased." (my italics)


"It's very hard to tell whether a baby is actually distressed (unless their heartbeat dips drastically and stays dipped) so they did the right thing giving you the EMCS"

Which is why all mothers should be offered fetal blood sampling in a situation like the one you describe (as long as the trace isn't absolutely pathological and there is time to do it) as this gives an accurate picture of a baby's current well being during labour. It's in the NICE guidelines that it should be used if possible when an emergency c/s is on the cards.

Should add, that everything the midwife is saying makes sense to me, other than not having a latent stage second time around. Second labours tend to be about half the length of first labours. My second labour was about a third of the length, as my first baby was posterior, and like yours my labour was very, very long (it ended in a forceps birth as I'd become exhausted and too weak to push).