I’m a midwife, ask me anything

[CatchingBabies]

Seeing as this has become a theme recently I’m jumping on the bandwagon because I need a distraction from my new house that is slowly becoming the worst decision I ever made.

Soooo I’m a midwife ask me anything! (Dons hard hat)

@aprilshowers16 you can refuse absolutely anything you want, it’s your body and the choice is yours.

@namechange30 I agree. It is the medical terminology so I guess I use it along with everyone else but my favourite saying has always been pizzas get delivered babies are born.

@notaregularpenguin ROT is a phrase commonly used but it’s wrong the occuput cannot be transverse. Transverse means lying across, horizontal like this - that occuput in those diagrams is not transverse. It’s lateral.

@therockinggazelle yes it sounds like you or baby received some resuscitation.

@majorintovert we have many women who lose control a little yes but I wouldn’t describe them as acting like a spoilt toddler. They are in pain they are scared they usually don’t have a clue what is happening and just need some reassurance and help calming down and regaining control I would never be cross as such a woman.

@lostmybaubles no there is nothing you can do to reduce your risk. If you placenta is low lying to the point it will block baby being born a caesarean is the only option as a vaginal birth will cause the placenta to rupture as the cervix dilates and that will lead to massive haemorrhage. Most low lying placentas are not low lying when rescanned however so hopefully all will be fine.

@fluctuacnecmarita hope I’ve spelt that right my phone won’t let me scroll back up to check it. Brow position isn’t common and unlikely to recover, a true brow presentation will never deliver vaginally.

@thechippendenspook yes you should have been told as you may wish to have a debrief or discuss reoccurrence risk etc. for future deliveries. Midwives have a duty of candor and that involves being honest with women. I imagine the resus was more related to the shoulder dystocia then the nuchal cord as nuchal cord is very common and not usually a problem.

If you have attended homebirths can i ask how can i make the surroundings easier/nicer for the midwives? I’m due to have one soon, i have clean towels ready, waterproof protectors, shortbread, cake and tea for afterwards and some wine and chocolate as a thank you. Anything else i can do to make things nicer for the midwives?

Thank you yes I received ressucitatation but I'm curious what form that would be, for someone to be ressucitate would their heart have stopped? Would the electric shock paddle be used? Or how do you ressucitate a patient? ( I had a pph by the way)

@mummytobe07 it all depends on what caused you to bleed, impososble to answer sorry. The birth pool can become soiled of course but we do have a sieve to take the worst out during labour. In terms of predicting labour everyone is different I’m afraid and some have signs for weeks and others nothing until it all starts, sorry I’ve not been much help there.

@mygreycat I’m so so sorry for your loss. I did wonder if your baby survived but I didn’t want to ask. It happened with the twins I delivered as they were identical so shared a blood supply, I suspect the second twin didn’t make it but I never found out. I hope she did. All I remember is being hugged and taken out the room as I watched the baby having round after round of chest compressions with no response. I hadn’t realised I was crying until I got outside. It really scared me for a long time and the memory will never leave me, worst thing I’ve ever seen and my heart just broke for those parents. The baby was transferred out of the hospital and I finished my placement and moved to another hospital so I’ll probably never know how she is. For your next pregnancy there will be extra precautions in place, as to what they will be I don’t know sorry as that’s beyond my remit. However as it was spontaneous and from what you say unpredictable it’s hard to really stop it happening again, unless there was a known reason that can be dealt with. However it is so so rare it’s very very unlikely to reoccur. I expect you will be consultant led next time and have regular growth scans, possibly offered ELCS if it occurred in labour but that would be something to discuss with the consultant depending on your preferences also. Everyone will be on hyper alert however so your baby will be closely monitored throughout labour and signs of anything amiss will be acted on immediately, sometimes they offer induction to make sure you labour when there are experienced consultants around to intervene if needed etc. I’m sorry I can’t reassure you more, it’s so rare that it’s not that well understood and most of us will never see it.

Thank you for answering. I did a lot of research and realised I’d have to do some telling rather than asking 😆. Reading your general thoughts on forceps has made me feel I’ve made the right choice should it come to that. Has been difficult being put in a position where I’ve had to research all this stuff that’s new to me and decide what I should and shouldn’t do. I naively thought I'd rely on whatever the consultants said but soon realised its policy over patient and so I’ve taken matters into my own hands.

ROT does indeed exist, and you could argue to call it ROL (lateral), but how do you explain a deep transverse arrest in labour without explaining that the head (occiput) is in a transverse position?

Thankyou for the thread @CatchingBabies.

Is an induction before term with an unfavourable cervix likely to succeed? Mine ended in a category 1 section 4 hours later at 5cm dilated and I often wonder whether I should have just asked for an elective section instead.

Why do midwife led units/birthing centres seem to have nicer "facilities" than labour wards like comfy mats on the floor, private rooms for postnatal with double bed so partners can stay etc? Do they get more money to spend on "home comforts" because they aren't spending money on drs, equipment etc.

Have you ever delivered a baby with a disability? Was it different from the non-disabled babies you have delivered? Was it a happy or sad occasion from your point of view? Just wondering as one of my babies was born with a cleft lip and I spent ages beforehand worrying that the midwife delivering him wouldn't think he was gorgeous. Of course when he was born I thought he was the most beautiful baby in the world and I couldn't care less what anyone else thought apart from dh's nan who just went on and on about what a tragedy he was, that was really annoying

Thank you so much for answering

Thanks for answering. They said recently that perhaps my uterus didn’t contract. I don’t know myself what caused the bleed and tbh I don’t think they are telling me what it was so I understand it’s an impossible question to answer unfortunately. Thanks for taking the time

@yougogirl150 forceps are more common in first labours than subsequent but it’s impossible to say what the risk of needing them again is without knowing why they were needed. It is certainly true that some women have a too small pelvis but that baby would not deliver by forceps either if that is the case as the pelvis is bone it can’t be moved if it’s too small a caesarean is the only option. It’s rare to have a pelvis too small to give birth however. Torticollis isn’t something I’m familiar enough with to answer that sorry but I believe that all of those things are risk factors so it could have been any or a combination. If you refuse to be induced which you have the right to do so they would either offer a caesarean or expectant monitoring where you come in daily for a CTG and have twice weekly scans, it would depend on why you were declining as to which route they took. If you refuse vaginal examinations they won’t know what stage of labour you are at, but why do they need to know? If everything appears to be going well, baby is happy, you are contracting and progress appears to be happening then we don’t really need to know unless there is another problems or you want to know. As for recommending a caesarean that’s a personal decisison and one to discuss with your consultant who can review what happened last time and why.

@mumtobeluc they work 50% of the time and if they are going to work it tends to be within 48 hours. Some babies just won’t budhe no matter how many sweeps you do.

@piratemermaid even if you didn’t want follow up the case is still investigated you just don’t get contacted with the outcome, not everyone wants to hear it especially if they are traumatised and want to forget it. It’s not too late to contact them and ask the outcome of your complaint, they keep records for 25 years.

Thank you for this thread, @CatchingBabies!
I’m wondering whether there are any extra risks in pregnancy if you suffer from PCOS? Both myself (living in the UK) and a friend of mine who lives outside the UK have it - I was told by a midwife at my booking-in appointment that my condition is of no interest to the professionals dealing with my pregnancy, and it was not even recorded on my notes, but my friend was told it makes pregnancy more risky and she is therefore having more appointments/scans. Why would this be?

Thank you @CatchingBabies I did wonder why they didn't let me go home, my labour was the slowest thing ever but scarily painful. Until my mother in law arrived and stood her ground for me when I couldn't, and got me some proper pain relief (ex midwife!)

What's your take on purple/coached pushing?

Thank you so much. Do you know if they still do some kind of scan to check the size of my pelvis, if I request it? If so, do I just ask my GP?

You and your colleagues do an amazing job, thank you x

How likely is it that I'd tear along my episiotomy scar during my next birth?

I had a waterbirth and it was mostly a good experience. When she was born I kept pushing past the end of the contraction even though I know you’re not supposed to as the midwives were telling me to push push push and I was having s waterbirth and was nervous that if I didn’t get her out soon I’d have to go to the Labour Ward and a whole string of interventions. I’ve got some pelvic floor issues but the GP says it’s not a prolapse - was this because I pushed too hard/long when she came out?

@coddlemoddle that is true, first labours are more likely to need intervention. Don’t accept bad treatment and say no if you’re not happy.

@bigkingdom put balloons or similar on your gate, end of street etc. to make your house easy to find in the middle of the night. If you can have some comfy chairs, cushions, beanbags etc. for the midwives to sit on. Have a hard surface in a well lit area for notes, doesn’t have to be in the same room as it’s better to have the room you are in dimly lit and relaxing, lots of tea and biscuits are always appreciated, have a birth plan so the midwives know what you do and don’t want, e,g some people enjoy chatting away in labour others want the midwives to remain silent unless needed, have a bag ready just in case you need to transfer in. I love home births, especially middle of the night ones, so magical and exciting and I love being solely dedicated to one woman and her baby with no other pressures of being on a labour ward.

@therockinggazelle resus can be many forms depending on your condition. It could simply be oxygen, rescue breaths or chest compressions, defibrillator etc. the notes should detail what form of resus was carried out.

@slinkier like I said it’s language that is used but it annoys me because it’s wrong. If we are taught that the occuput is the defining feature when determining position how can we then go on to say the occuput is transverse when it’s not! I accept it’s commonly used the point im making is that it’s wrong as it makes no sense in a logical way. We should be saying lateral as that’s what it is, transverse means horizontally across.

@elitejjtiny induction before term on an unfavourable cervix can work yes it’s just less likely but most do or they wouldn’t bother trying.

Midwife led units tend to have nicer facilities because they are trying to encourage normal vaginal birth and that involves mobilising and being relaxed etc. consultant units tend to be based on you being high risk so led on a bed strapped to monitors with drips in place and you don’t need the mats etc. it’s wrong but it’s the way it is. I don’t know how midwife led units are financed in relation to consultant led units, I’ve only ever worked in consultant led units but there may be some truth in that also.

I have delivered 2 disabled babies, that I’m aware of there may have been more but they were not diagnosed when I was caring for them. One of the most frustrating parts of my job is once that woman leaves your care you never know how they got on. The first baby was a baby that had Down’s syndrome, it wasn’t know beforehand. The first thing I said was congratulations she is perfect, she was perfect her extra chromosome didn’t change that. The other baby had pateu’s syndrome and as part of that a cleft lip and palate actually. It was known beforehand and the parents chose to continue the pregnancy. He sadly was stillborn. Again I told the parents how beautiful he was and congratulated them and I genuinely thought it he really was beautiful. I also said I was sorry for their loss of course and comforted them but I feel it’s important to recognise stillborn babies still as being a big event, they have still become parents, they still have a child and they are still beautiful. A cleft lip wouldn’t make me think any baby is less gorgeous, I think they look really cute with clefts actually, like they are smiling.

I’m off to bed, another busy day at work tomorrow. I’ll try and pop on tomorrow to answer some more. I didn’t expect there to be so many questions!

I’m intrigued about your training and how much information/education MW receive about the long term impacts of traumatic births (whether psychological or physical).

I ended up with multiple tears, the largest of which became infected and completely broke down and had to be resewn about 6 weeks after birth, plus a few other temporary health issues and long term pelvic floor problems that will require further surgery. I was discharged by the community MW team as normal at 2 weeks post-partum and my GP helped to pick up the pieces. In those 2 weeks I found the various MW who turned up pretty blasé and loathed to even do a swab at my GP’s request. They did say that I’d “be fine next time” as they’d seen other mothers go through it and come back for another baby.

It struck me that they never see the women who are too traumatised to ever have another child or, like me, ones who go private to avoid a repeat, have proper continuity of care and not have to battle for a CS.

Nor do they see the women at 50 who are getting prolapses fixed (which strikes me as much more significant surgery than an ELCS, having watched my mum with the first and me with the second).

So, is there anything in MW training about the impact of poor births?

And why does it seem that most gynaecologists would choose a CS over a VB, but the same isn’t true for MW?

I had a LOT of clots in my womb after my vaginal birth OP, they had to contract my womb, but no one ever told me why/how this happened; are there some things that can cause this specifically or was it just unfortunate? Also, I lost over 1.5 litres of blood during birth and I'm VERY anaemic; I was offered a transfusion (reluctantly) but they said it wasn't really necessary and that I could just leave; is this generally a normal response? TIA

Thank you @catchingbabies, the idea of forceps terrified me while I was pregnant and it still something that worries me about having more babies.

During my labour I remember the midwife writing pretty much the whole time. What would she have been putting in the notes? Is it possible to get a copy of my notes (even after 8 months)?

It is spelt (and pronounced) occiput, not occuput, just so you know.

I hear what you are saying about "lateral", but you will confuse women (and invalidate their birth experiences) by saying ROT "doesn't exist", when they have a caesarean section for a deep transverse arrest of a baby documented as being in an ROT position. The transverse part is referring to the main suture line felt, which does indeed run straight horizontally across.

@MyGreyCat and @CatchingBabies

I had a massive fetomatetnal heammoraghe with my DS at 27 weeks. He survived, despite a hB level 2. We had a rough ride. I still have no detail on why it happened. I think he survived as it happened slowly, caused his movements to decrease and I went in to get checked out.

My consultant at the time almost missed it, it was only another consultant checking whether he was exploring it as a cause of my son's IU anaemia that meant it got picked up.

I have since had DD. I got offered a place at the pre term prevention clinic, and growth scans, and she was delivered at full term.

I'm so sorry for your loss. It was a complete head mess for me. And still nobody really gets it, as it's so rare people haven't heard of it. And I'm fully aware of the high mortality rate, and so extremely thankful for my miracle DS.

Hi @CatchingBabies - I have a question if that's ok? We're thinking about ttc our first - which is worse / more likely to cause issues? Age or weight? Age like 38 or weight like BMI 37?
Thanks x