Back to back babies during labour - Is enough to being done to detect and support(90 Posts)
Just wondering whether others who had back to back (OP) or ROT or LOT babies found that their local maternity services had the skills to detect and support labour in a way that would give mothers the best chance of avoiding interventions during labour in these cases?
My experience was that even though the labour played out as a textbook OP (anterior placenta, start stop extremely long early labour, very slow active labour) OP was not detected until very late (8cm dilated) and then no one told me and no one even suggested trying some different positions that might help the baby turn... Such a shame really as these births seem to have a much higher rate of intervention so really I could have done with all the help I could get! Did anyone else have the same experience?
I know some babies turn easily on their own so I'm not suggesting interfering if things are going well anyway, but if they are not progressing wouldn't it be good to have someone skilled to suggest some different positions, not do ARM, do anything else that might help before interventions?
I found this article which I thought was really informative about OP in labour in case anyone wants more info. wellroundedmama.blogspot.co.uk/2009/05/how-fetal-position-can-affect-labor.html?m=1
DD was OP. I had an anterior placenta and 3 nights of contractions before labour started. Then another 12 hours before starting active labour. Active labour was actually pretty quick, 3 hours? I think my midwife really figured out she was OP when I started pushing. She was brilliant and had me pushing in all sorts of positions until DD turned (squatting). It was quick after that.
I think I was lucky. I was ok without any drugs. My midwife did tell me if I had chosen to have an epidural I would have had rotational forceps.
I recently read this which was interesting and informative:
My DD was direct OP, and it was long hard slog but I managed with the pool, gas and air and water papules for the back pain.
I think I avoided forceps by being in a midwife led unit and I'm grateful for that.
Oh and I was never told during labour that DD was direct OP, but I think that was the right thing to do for me as had I known I think I would have panicked. The midwife just said baby is in a slightly difficult position.
I had two different midwives (plus two student midwives) who didn't realised DS was OP - one even told me I just wasn't trying hard enough to push baby out...
It was only when the consultant obstetrician was called to "help baby out" and carried out an internal examination that they realised. I wish I'd known earlier in labour (rather than 10 hours into an 11 hour labour) as I would've been trying different positions willingly to try and turn him naturally (and might have avoided two failed ventouse attempts, an episiotomy, forceps and a 3rd degree tear). No epidural though so I felt all of the sodding pain...
So, yes, I agree wholeheartedly that it would've been helpful where I gave birth if they'd had more knowledge/support to aid a birth with less intervention, given the position of baby.
DS was side on (not sure what the technical term is) and I am sure he had somehow got wedged on my bladder as I had agonising heartburn-like pain for a week prior to labour which got worse during labour. He was anterior placenta so (in retrospect) not so surprising.
I wish someone had diagnosed and advised me on this, I only learned afterwards that excruciating continual bladder pain throughout labour is not normal and I wish I had gone for an epidural rather than soldiering on for 36 hours of slow dilation to 5 cm. Labour was eventually augmented by ARM, then DS' heartbeat dropped and I had crash CS under GA. Again some of this seems with hindsight to fit with a badly positioned baby. Crash CS was horrendous but what really wrecked me was the level of exhaustion I was already at/
I had some sort of side-on or OP presentation with contractions from 5pm on the Tuesday. i went to maternity assessment after 36 hours of excruciating back pain and contractions with just a TENS machine to find i was only at 3cm. Went home at 5am on Thursday (my choice - they had offered me the antenatal ward) and continued labouring until i couldn't cope any longer and went back to MA at 10pm to be told i was at 5cm and could have gas and air and be moved to the labour suite. No mention of odd position, just told that sometimes first babies just took a while (despite family history of very fast and straightforward labours). Laboured on gas and air until 7am when I was 7cm. Three hours later was still at 3cm so they encouraged me to go on the sintocynon drip, so I requested and lwas very quickly given an epidural. Waited an hour to let the drip do its thing before starting to push, and DD was born after 35mins of pushing with the epidural but no forceps or ventouse (apparently she turned just as i started to push). The pushing stage was the easy part! Worst part were
1. not being able to sit or lie down when labouring at home as it made the contractions much worse, so after over 2.5 days of walking and standing i was pretty tired by the time i got to the labour suite.
2. Having to sit totally still while they sited the epidural. I was beside myself at this point, nauseating pain despite only being 7cms and so so tired and having to sit and not be able to rock made it a million times worse.
But the experience overall was great - amazing staff from start to finish and once i was examined and monitored in MA the first time and reassured the baby was coping, i was able to handle it more or less ok.
If i am lucky enough to have another baby but unlucky to have it be an OP baby, i would be more assertive about needing to be admitted earlier and be given gas and air as i would recognise the back pain as being a sign of OP and would be less willing to soldier on indefinitely with contractions jumping from 3 in 9 minutes to 3 in 45 minutes and everything in between, for 3 days!
Blueandgreendots - I was also in MLU without any specific OP advice and they did ARM which I've heard is the worst thing to do, so MLU is not a fail safe. There didn't seem to be anyone who had the expertise there to know what to do (or not to do in the case of ARM). Thanks for the links! Will take a look now
My midwives never told me during labour they just changed my position a few times and eventually I had an episiotomy. Dh said he heard one of the midwives mention it quietly. I had no idea about it really and I still don't know a lot. I know I struggled with the pushing stage and had to have help in the end. I would like to know more for next time to try and prevent etc (I'm currently pregnant)
Fratacula your experience sounds very similar to mine.
Lilac & foxesaocks - what this midwife did for u is exactly the kind of support I think would benefit women. I wonder why it's not always available...
My community midwife had told me that my son was in the perfect position all the way through, so I was surprised to get to MLU and be told he was back to back (by which point I was 5cm dilated). The midwife did suggest a few positions - I know I was hanging over the head of the bed at one point - but the only position I seemed to be able to push in was on my back with my feet in stirrups.
I did have pethidine and and episiotomy so it wasn't quite the birth I'd been hoping for, but I don't feel scarred by it. It was just one of those things.
Foxes - I've heard spinning babies and miles circuits are good ( u should find them on Google).. But alas I only found out about them after DCs birth
They didn't even know mine was back to back when they could see the top of her head. I mean they see enough surely they should be able to tell!! Also no one touched my bump once during labour. Maybe that would have been a giveaway?! A bit of palpating. Too much reliance on Machines in my opinion. I'm pissed off and have the prolapsed to show for it!!
DC1 was back to back. I was aware from about 2 weeks before that this was the case (midwife appt I think?) and was given exercises to do. Had no effect and she was born back to back.
DC2 I was monitored, I did the exercises as a preventative measure, and he was lying normally when I was induced. About an hour in and he turned back to back anyway (sod).
I really don't think it makes much difference.
I found out DD1 was back to back when I bothered to read through my hospital notes when I was about 38 weeks Probably should have looked at them before... But no one mentioned it to me! I had an extra scan when I was overdue and asked about it and they just said 'oh yes' and didn't offer any advice about it at all, so I just didn't really think about it. Then when labour started, my waters broke/leaked, went to hospital (UCLH) and they told me I was 1cm and to go home / out for a walk / out for dinner, despite the fact I was in continuous pain , doubled over, throwing up and barely able to walk... We just refused to leave and they put us in a room in the birth centre and ignored us. All night. A midwife checked on me a couple of times but they refused to fill the pool as I wasn't 'officially in labour' and they were 'too busy'. They also kept telling me my waters hadn't broken and asking if I was sure I hadn't wet myself (thanks, I know the difference!) and also basically telling me off because I was saying I was having a contraction but I apparently wasn't. It was just an intensifying of the unrelenting pain I was in for almost 24 hours... Only when my waters broke 'properly ' and there was meconium in the water did they pay any attention and then I was rushed down to the labour ward. There was a brilliant midwife there who did her best to help me turn her, but it didn't work and I went to theatre, had an epidural (as they thought I'd need a caesarean) but they managed to turn her with forceps and I pushed her out! I still remember the utter bliss of the epidural finally taking away the horrendous back pain - my god it felt miraculous.
I have no problem with the theatre/epidural/ forceps bit, it wasn't what I hoped for but that's life! My issue is with the lack of preparation for it, and the way I was treated when I got to hospital and in the birth centre - basically ignored, and implied that I was exaggerating/ making it up. That midwife was awful. I've since had another DD at the same hospital, not back to back, I was amazed to find that the pain stopped between contractions! And the care was excellent second time around.
NurseryRhymes -really interesting to hear that ARM might have been a bad decision, (I was also in MLU), can you give me a source for this? Sorry (but interested!) to hear you had a similar experience to me - I have spent far too much time googling 'bladder pain in labour' and finding almost no info, it seems to be rather rare. I hope your LO was OK if you had a crash section, mine happily was 100% fine, which was the one thing that made the experience bearable.
neomamma Mine sounds very similar to your labour, with the being unable to sit or lie down. I was really traumatised afterwards, worst experience of my life - pacing around like a madwomen for 3 days solid in fucking agony.
I had planned a home birth. Started having contractions on the Monday morning. By Monday evening they were coming every 5 mins or so. Got a little bit of sleep kneeling over a pillow mountain. Woke up 4.30am with a contraction feeling like I was being electrocuted in my tailbone or something. I think she must have turned from ROA to OP around then. No more sitting of lying down from that point. Some contractions would be one after the other and then they'd slow down to every 7 minutes or so, because of this the One2One midwives(shit by the way) couldn't give me any gas and air because I wasn't officially in established labour. Spewed up with every contraction and couldn't eat or drink. Tuesday evening rang midwife saying I couldn't cope and she laughed and told me the pain was going to get a lot worse than this and I wasn't even in proper labour yet.
New midwife on duty on Wednesday - more sympathetic but still suggested I go for a fucking walk. Examined me and told me waters hadn't broken and that it was just a lot of discharge. I made her promise me that she would try and get me some pethidine from the hospital if nothing was happening Thursday morning. Properly lost my mind at this point. Thursday morning dickhead midwife was back on. Wee'd on a dipstick and tested (v high) for ketones. Oh I couldn't wee unless I stood in the shower with hot water running on my back for some reason. Examined me I was 6cm. The look on her face, she genuinely hadn't thought I was in labour. Anyway, went to hospital to get some fluids in me. Staff were much more sympathetic there. Bickered for hours with doctors about going on the syntocin drip, I just wanted a section by this point because I was fucked. Examinations every 4 hours went 6cm-6cm-7cm-5cm(WTF I never knew your cervix could just ping back during labour!) didn't see how I was going to push a baby out without help and didn't want an instrumental birth. Got some gas and air - nowhere near as good as the balloons of nitrous oxide you get at festivals. v disappointed. Eventually agreed to drip if I could get an epidural. Got an epidural and cried with happiness and ate some toast. Went on drip, baby was immidiately distressed - EMCS. DD1 born in the early hours of Friday morning.
It's the first time I've written that all out, and looking back I'm so angry that anyone can be left to suffer like that for so long. In what other medical situation would not being able to sit or lie down, not sleep, not piss, eat or drink be acceptable for fucks sake?
Oh and also it turned out I had chorioamnionitis due to the massively prolonged labour, because my hind waters had gone days before. I then had a massive hemorrhage to add to the fun. Thankfully DD1 was absolutely fine and amazing I was physically fine a couple of weeks afterwards but a bit mentally scarred and bitter.
Sorry to whinge on - I had to get all that out.
to everyone who had crap back to back labours and shit care.
That's what upset me the most - when the midwife was making out I was being a wimp and overdramatic. I still get teary when I think how scared it made me when she said the pain was going to get a lot worse - it felt like my back was breaking interestingly the pain level stayed pretty much the same throughout - constant agony.
DS was OP, they think. Unsure as it was only 'diagnosed' when I was actually in second stage- long, hard, stop/ start. Was the most horrific experience of my life!
Burton - I really don't understand why someone can't use a bit of skill, think something sounds like it could be OP here, check the position properly and then give u a bit of info and sympathy and come up with a plan that avoids you getting so exhausted early on that even if the baby turns you will run out of energy long before the birth. And laughing at you?! That midwife should be ashamed of herself!
Fratercula - I've seen lots of references to it. The theory is that the water helps lubricate and cushions so without it it's harder to turn. It's mentioned in the link I posted at the top of this thread. Here's another one (see top of page 4) www.dendimim.com.br/public/Material%20de%20leitura/CONDUTA%20NAS%20OCCIPITOPOSTERIORES.pdf
Fratercula- yes Cat1 c section when heartbeat disappeared. DC was fine as we were at hospital by that stage and they had taken it very seriously so we're ready to go. DC was also side on when born and I'd had pelvic pain which didn't seem normal but was ignored by midwife. I now put it down to his head being wedged and pressing against nerves/things it shouldn't have been due to his position. and sympathies for your experience I know exactly what it's like
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