I’m a midwife. AMA.

[Clappyhapper]

I’ve been a midwife for 13 years. AMA.

Obviously not personal medical advice. :)

My waters broke but no contractions. They gave me a gel to induce me. I explained I was in pain, felt I needed to go to he loo. Was told to go back to bed. I was sick. Told I need to prepare and think about pain relief. If I'm struggling now and it's just baby getting into position. I explained to one midwife I was beginning to feel twinges and didn't want to sit down or lie down. They refused to examine me and said I was lonely and perhaps I needed visitors. I spent most of my labour terrified. I thought there was something wrong with me and the baby. They missed all the signs. One of them shouted at me when I struggled to lie down on the bed to eventually examine me, he was back to back and I was baby was on the way. When I finally got up to birthing room there was thankfully another midwife, 20mins later he was born. Most of my labour was spent alone in a toilet.

I don't think I can face a midwife again.

@thereinmadnesslies

That happened to me! Except they gave me more local and it wasn't the back passage. The trainee was obviously so unsure of herself, at one point I actually said, 'If you don't know what you're doing, feel free to let someone who does have a go!' Shortly after she did swap with a trained person and then they began taking it out to start again. Took an hour in total for a second degree tear, and I'm needle-phobic. It was only after this that I learned she was a trainee.

Question to MW: should they have asked my permission before letting the trainee have a bash at it?

I have a question that I've been thinking about since I gave birth but always forgot to ask ...

I started pushing but after being up for 48 hours I was so exhausted and found although I was giving it my best, the baby kept bobbing back up because I was tense. The midwife and consultant asked me if they could guide me to encourage by pressing down on what I think was my perineum each time I contracted. Is this quite common? I tried to look it up online but can't really find anything about it. If I didn't deliver I was told I'd need to go to theatre for forceps and episiotomy. I did deliver within 30 minutes though.

Thank you

Thanks for the thread.

Both of my labours started with my waters breaking. I know that this is relatively uncommon. Do you know what causes this to happen? Why do some labours start this way when the majority have them break part way through?

Ooh I could speak to a midwife all day! I have a few if that’s ok.
Do you think Midwife’s judge younger parents when they come in?
How common are general anaesthetic c sections?
How often are the emergency buzzers pressed?

I had 4 equally awful midwifes with my first baby, they were nasty. With my second my midwife was amazing, truly amazing and held my hand and wiped my tears in surgery. I really do believe a good midwife makes all the difference at such a vulrenable time!

Thanks Clappyhapper.

Yes DS2 hadn’t read the book. He was also a couple of pounds smaller than DS1.

Amazing thread.

When I had my second my waters went the day before I gave birth. I spent that day in and out of hospital being monitored as there was a bit of meconium in my waters and had to persuade the mw to let me go home and sleep rather than be induced. My contractions finally kicked off early the next morning as I was in bed. When I got to the hospital the midwife examined me and instructed me to lie down and push. She and the midwife really coached and put pressure on me to push and not pause or breathe through the whole thing. Was there a reason for this? Was it because the baby was in danger because of the meconium? I actually zoned out, ignored them and rested when I felt it was too much and baby was born within 10 mins with only a tiny 1st degree tear luckily but I felt angry I was pressured to lie on my back and push. Any idea why this was?

Midwives do an incredible job and I have so much respect for you!

If you have a precipitate labour, how likely are you to have another one? If subsequent babies are usually born slightly earlier than the last one, is each labour also usually quicker?

Thank you

PivotPivotPivottt

I had pre-eclampsia and went on to develop HELLP. I had no symptoms of PE it was picked up during a midwife appointment as I had protein in my urine. My blood pressure was fine so she wasn't too concerned but sent me up to the hospital the following morning as a pre caution. At the hospital I was sent home as my blood pressure and trace was normal. They told me there was no way I had PE due to lack of high BP but within about 40 minutes I was called to go back in and induced as my blood results showed I did have it. By the time of diagnosis and being took to the labour ward (about 15 minutes) my full body had swollen and my blood pressure was sky high and it went down hill from there with me developing HELLP. I have a few questions about this.

I had protein in my urine from around 34 weeks is it likely I started developing PE from then?

Have you ever saw this before PE with a normal blood pressure? Every midwife and doctor that spoke to me was completely baffled and had never heard of this happening before

The appointment I had with my MW that day was an extra one she gave me due to my anxiety I wasn't actually scheduled to be seen until the following week at 38 weeks. At the hospital I was told my sudden symptoms of PE were likely brought on by the stress after being diagnosed and told I had to be induced and that if I had been at home none the wiser I wouldn't have developed my symptoms as quickly and things may not have turned out well for me. Do you agree with this?

How serious and common actually is HELLP in your opinion ? I still can't get my head round the fact this happened to me and it's hard to believe that I was as dangerously ill as I was told I was. I've read a lot on the internet about it and the likelihood of developing it is so low and outcome not so great. I just can't quite believe that it's as uncommon and dangerous as it's made out to be. I'm not disputing it I think I'm in denial about it.

Sorry I know it's a long post and you probably don't have the answer to the first two questions as no one can know for definite but your opinion on it would be really appreciated. It's all the questions I didn't ask in my debrief and have wondered about ever since.

Thank you for taking the time to read my post I think the world of midwives after that birthflowers

Hi, HELLP is very rare and very serious. We see it very infrequently and treat it as an emergency.
It sounds like you had what we call ‘fulminating pre eclampsia’ which just means that it comes on quickly and aggressively. Again this is quite rare. The normal blood pressure with PET again is really unusual but I have heard of it and It’s mentioned in my annual training updates. I’ve never seen it myself.
Pregnant women shouldn’t have a significant amount of protein in their urine. Sometimes there will be a trace of it due to contamination or infection but any significant amount should be investigated. Possibly this was your first symptom.
I’m not sure about your symptoms being brought on by stress- you had severe PET, your symptoms are related to that. More likely it was coincidental that this is the point at which it ramped up and your body started to struggle. Most likely you would have called up and been diagnosed/treated at this point, but obviously sooner is better so it’s a good thing you were checked when you were.
Unfortunately you are more likely to experience PET/HELLP with a subsequent pregnancy and as such would be watched very closely.

ginyogarepeat

I had an emcs after baby's heartbeat became erratic and meconium was detected. I'd been having a very slow back to back labour with epidural up to this point. Baby was delivered safely but it was only some time later I noticed in my notes that I'd had a PPH and baby had been given oxygen. I was never told this or given an explanation why.
Are complications likely a second time around?

Hi, a pph is classified as any blood loss over 500ml. 500mls isn’t actually a huge amount for a healthy woman and most will cope with this very well. Lots of women having a CS would have a blood loss over 500mls but wouldn’t necessarily need any additional treatment or feel unwell if it’s closer to 500ml than 1000ml. For example, we will still keep women on our Midwife Led unit and consider then for early discharge home if their blood loss was less than 1000ml and they were stable and feeling well.
Re the oxygen for baby- the resus council guidelines recommend that initial resuscitation for babies is performed using air rather than oxygen as this is all they need at the early stages. Years ago we used to routinely waft oxygen under their noses if they were a bit slower to adjust but this is an outdated practice. If your baby had full resuscitation with oxygen ie, needed to be supported to breathe for some time, I would have expected you to have had this discussed with you. Do you remember the resus?

Re ‘next time round’ a smaller pph, less than 1000ml wouldn’t be of particular concern for next time. If it was greater than 1000mls we would take further precautions to minimise your chance of bleeding, such as using a hormone to contract your uterus after baby is born.

Hi, I had a cord prolapse on the ways. Obviously wasn’t very pleasant but the staff who felt with me were fantastic, quite a few said they’d never seen one before.

I guess it’s less common in a mlu but is it something some mw are likely to never have to deal with

milesandmiles

Not got a question but just want to say what an amazing job you do!

Thanks, I love it!

ChristmasAccountant

I don’t have a question (well I do, I could chat all day to a midwife!) but I just want to say thank you for the amazing work you and all other midwives do. Currently expecting no3 and the care I’ve received over all my pregnancies has been outstanding. So thank you, thank you for caring flowers

Thank you, this is lovely to hear. Everyone is trying so hard. It’s really difficult at the moment, staffing is low, staff are burnt out so sickness is high. Maternity leave isn’t covered, we just have to spread ourselves a bit thinner. 99.9% of us are really passionate and try so hard. Apologies for the 0.01% who are cows and should work away from people.

8DaysAWeek

Dying to know the answer to this...

How do you quantify time in labour? Is it from when first contractions are felt, or from when you consider it "established".

Technically I gave birth 21 hours after first mild contractions started, but I wouldn't say I was "in labour" until after my waters broke 8 hours before he arrived and the contractions really ramped up.

Good question!
We usually count ‘active’ labour- from when you have regular, intense, effective contractions AND the cervix is 4cm dilated or more. But we definately don’t discredit or minimise all those hours of hard slog that come before that point!

AliceRR

What’s your advice re anxiety about movements? I know the advice generally is if in doubt get checked but do you subscribe to the drink something cold and sugary and then lie down and see how much baby moves? Presumably it is normal to have quieter days? My issue is I KNOW I am v anxious about this pregnancy and currently the anxiety is focussed on movement. I think about it several times a day and feel anxious until I feel significant mkvement... so even I know not to seek help constantly as I usually feel baby move after some time (usually particularly when I sit down after a while or when I’m in bed etc). Once I didn’t and went to the hospital but don’t want to do that every day out of worry...
Hi, congratulations.
With movements we have moved away from the counting kicks towards getting to know your baby’s individual pattern. Every baby and pregnancy is so different that a one size fits all approach just doesn’t fit.
We advise women to start getting to know what their baby does, how often baby moves, times of the day they are more active etc and then being aware of changes to that pattern. If you feel your movements are reduced it’s always good to call. If you aren’t sure, then focusing in on baby is a good idea and the basis of the ‘lie down, cold drink, watch’ advice. We have such busy lives that sometimes we just don’t pick up on what baby has been doing for a while. Stopping and focusing on baby will usually give clarity. It’s never a bad idea to build moments of calm into your day, perhaps try some short mindfulness sessions which will also help with anxiety whilst giving you some baby focused time too.

HoustonBess

Do midwives who work in different settings (community, MLUs, delivery suites) have fundamentally different outlooks on birth which is why they go for those settings? I suppose I'm asking if the more medicalised the setting, the less woman-centred the midwife is likely to be.

Why is aftercare so terrible, particularly around breastfeeding? I had a fairly complicated birth via c-section but that wasn't the traumatic bit, it was being stuck in a hospital ward with an endless procession of midwives squeezing my boobs and telling me contradictory things, some of them being hugely insensitive (your baby is crying because she's starving, your large boobs will put lots of weight on the baby's face, etc) It seemed like the birth staff were much more professional than the aftercare staff.

Do you have thoughts on VBAC? I'm weighing up my options for second baby and ELCS is tempting versus hospital with monitoring, machines etc
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Re settings- I think naturally working in a particular setting can sway your thought processes. Midwives working in MLUs probably have a different outlook to those working in high risk settings. More belief in normality for sure, as we see it day in day out. If you work in a high risk setting where you see lots of complications you are probably more likely to be anticipating them. In our trust we all rotate around the areas for the first few years after qualifying, and then have some say in where we would like to work. People will naturally gravitate to the place they feel most suited if space is available. I don’t think this in itself effects how women centred you are, I think we all want to put women at the centre of what we do, but certain environments make it harder to give the care you want to give. Working on a busy obstetric unit can be very tough. We have 14 Labour rooms and sometimes only 6 midwives on shift- this will inevitably have an impact on the care given. Sadly this means that safety is understandably prioritised but TLC can be lacking at times.

This is pretty much the reason behind the problems with postnatal care. Chronically understaffed. The main reason for this is that in most trusts babies aren’t counted in numbers. So midwives will have twice the patients to care for ( usually 8 mothers and 8 babies at a time all of whom have complications or they would have gone home) and lots of babies have complex needs so again staff are spread thinly and while safety is prioritised the TLC can be lacking. It’s tragic, and one of the reasons I don’t and won’t work on postnatal wards- I can’t cope with running ragged for 13 hrs with no break and still going home feeling like I’ve failed.
WRT breastfeeding, things are on the up. Our local trust has been given BFI accreditation and the standards of feeding support are about a million times better than 5 years ago. We also have amazing feeding support volunteers who just have more time to sit with women and support them properly.
Vbac- for me personally I would choose a vbac if the reason for the initial CS is fairly unlikely to happen again. The success rates are good, and I would much prefer to be going home 6 hrs after a normal birth than nursing myself back to health after surgery with at least two children to care for. I think for me it would be worth taking the 75:25 chance of success. I’d be keen to make it as normal as possible. My trust has waterproof ctg monitoring equipment so vbac women can use the pool, keep mobile and improve their chances of a normal birth.

TClevs

I know it may vary between Trusts, but is there a time limit on having a debrief? I had a traumatic time and it took me a while to be able to talk about it afterwards. Although it still haunts me I can talk about it fairly comfortably now and am considering going for the debrief I was offered. My baby is now 9 months old, is that too long?
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No time limit although ideally in the first couple of years. Most women, like yourself, need to allow a little time for the dust to settle before feeling ready to go through the debrief process. This would be a really good time to make that appointment.

Debrief sun our trust are with a specialist midwife who has counselling skills. They sit and talk you through your notes and discuss what happened and why, and anything else you want to discuss.

Do you secretly judge or despair of some women who are just a bit pathetic in labour? Ie telling you they can't do it / crying / not being able to push the baby out? Cam you tell I spent 3 hrs trying to push out a back to back baby with my first?! ended in forceps btw and a 3rd degree tear

Elephantgrey

This is a really fascinating thread. Thank you.

When my DS was born he was covered in meuconium and he didn't cry. He was taken away to be rubbed down and eventually made a faint cry. Is this common? Would you worry if this happened. He is fine now.

I also never noticed my waters breaking during my labour. The only thing I could think that would have happened is that they could have leaked out beforehand. Is this possible?
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If the waters had very thick meconium in they may have taken him to check his airway was clear (there wasn’t big blobs of poo in his throat) before they gave him a good rub and encouraged him to take his first big breath in. If he was just given a rub and responded well to that he most likely was in a pretty good condition. A poorly baby would probably have needed some resuscitation. We observe babies born in thick meconium after birth because of the small risk of them breathing it in.
Re the waters- sometimes if the meconium is thick you don’t see such obvious large amounts of fluid. Sometimes you don’t see obvious rupture of the waters because you’re in the pool/ it goes just as the baby is born/it trickles very subtly. Hard to say.

Clevs

Oh, and massive respect for what you do. I'm a paramedic so have delivered a few babies myself and obviously have come across midwives through the course of my job. But until I had my baby I had no idea just how much your job entails really and it was interesting seeing it from the other side, even if a lot of it is a blur.

Tempted to retrain!
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DO IT!!

Ollivander84

Have you ever had someone completely terrified or couldn't cope with labour? Pain wise mostly
I'm adamant I won't ever have children as I couldn't cope with labour (I managed cauda equina!!)
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Occasionally. Most women who are well supported aren’t terrified. In fact people are always surprised how quiet our birth unit is because they expect screaming and that’s very few and far between. Good, one to one support reduces fear and makes labour more manageable.
Please don’t decided your reproductive future based on labour pain, do it based on whether you want children. There are lots of options to overcome the fear. Counselling, hypnosis, and if all else fails there’s always drugs and elective CS.