Higher chance of intervention or EMCS if first pregnancy had 'poor maternal effort' in notes?

[LillianFullStop]

I'm 26w into my second pregnancy and no closer to a decision on whether I will go for an ELCS. DD1 was a back to back labour, assisted delivery via forceps and episiotomy resulting in a 3rd degree tear. My notes said something about fetal distress and poor maternal effort.

I had to have pelvic floor physio for about 5 months after the birth and thankfully no long lasting effects from the tear. Now leading up to 3rd trimester I am finding issues only if I get constipated (pushing muscles feel weak)

The midwifes and drs have all expressed support for my choice of birth given a previous 3rd degree tear but I am a bit scared of major surgery/ELCS. At the same time I am scared to go through another traumatic birth with a long recovery if my pelvic floor issues mean I will have poor maternal effort which it turn will result in another assisted delivery. This time I may not be so lucky with recovery - could have been worse with prolapse/incontinence/fissures/etc

Maybe my body just births badly and I should just go for ELCS?

Is it possible to just breathe and let a baby come down the birth canal with contractions or is pelvic floor strength to push a baby out absolutely necessary? When they were wheeling me into theatre to prep for EMCS they said DD was coming down with each contraction (no pushing on my part as I was being wheeled in) and by the time we were set up in theatre she'd come too far down for an EMCS anyway.

[firstimemamma]

What do u mean by 'poor maternal effort'? Sorry.

[NameChange30]

I wonder if @sussexmidwife might have advice for you.

I'm sorry you first birth was so difficult. I'm not an expert but I do know that back to back labours are very hard so that must have been a factor, not that your body "can't" do it - you must have been exhausted from the pain? I also hear that second/subsequent labours are often easier than the first so you might be ok.

Perhaps you could request a meeting with the senior midwife to discuss your concerns and options??

[Sussexmidwife]

@LillianFullStop nothing you have said suggests that you “birth badly”. Back to back labours are tough and I think it is horribly rude to write “poor maternal effort” - you were probably knackered!
I think the issue of 3rd degree tear is more important because a vaginal birth may risk causing additional damage & consequent long term problems.
PM me if you want to- we could discuss more x

[LillianFullStop]

@firstimemamma I think it just means my pushing effort wasn't strong enough to get the baby out during the pushing stage so they had to opt for assisted birth via forceps.

[LillianFullStop]

That's what I was hoping @NameChange30 - perhaps a lower threshold to switch to EMCS if signs are pointing to another difficult labour that could lead to assisted delivery.

I have an appointment with a doctor to discuss birth options/cesarean and also my midwife made a note on my file that I require a senior midwife at my labour instead of a trainee if I do choose a VB.

Thank you @sussexmidwife - long term problems are definitely my main concern. I accept both VB and ELCS will require pain/recovery period so I accept I will have to go through it either way as the baby needs to come out somehow! I will PM you if that's ok

[firstimemamma]

I thought that might have been what it meant but I had to double check with you because I struggled to believe they could be that rude and disrespectful about your "efforts" - as pp said, you were probably very tired! I'm really sorry that they've written that.

"Is it possible to just breathe and let a baby come down the birth canal with contractions or is pelvic floor strength to push a baby out absolutely necessary?"

I don't really know, I'm no expert. I do know that I didn't have coached pushing - I very much let my body take over and it kind of pushed by itself. It was a bit like having an out of body experience and I'm not going to lie it was scary and painful!

I do think part of it comes down to luck though. 5 of my friends have had traumatic experiences in childbirth and for them all the 'trying to relax and letting your body take over' in the world simply would not have got baby out. Intervention was needed and it wasn't their fault.

FWIW it sounds like you had a very difficult experience and for getting through that I think you showed amazing maternal effort

I hope you get the support u need and deserve

[GrumpyHoonMain]

Your pelvic floor needs to be strong to have the baby pushed out with just contractions. And often pelvic floor strength has nothing to do with overall health or strength. Talk to a women’s physio if there is anything that can be done during pregnancy to help

[Vehivle]

@lillianfullstop my first birth was the exact same as yours. Same stuff written in my notes. They also had a senior midwife present for my second due to concerns I may retear to the same degree (3b). But 2nd labour was very quick, pushing phase was recorded as 5 mins and had only 1st degree tear. Baby NOT being back to back made a huge difference and the fact it was my 2nd and so my body delivered more efficiently. I'm so glad I chose vaginal over c section (I was allowed to choose which due to the previous tear). It was very healing for me after I felt a big loss of trust in my body after the first birth went so badly. Your risks of tearing to the same degree or having an instrumental delivery are so much lower for 2nd births. So dont let your first birth put you off.