I’m a midwife. AMA.

[Clappyhapper]

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

Obviously not personal medical advice. :)

After my C-Section, I was re-admitted 5 days later with sepsis. I had a terrible infection which led to necrotising facitis. I was given the option: 1) be nursed with your baby in HDU on the delivery suite (!) by midwives or 2) go to ITU of the main hospital but baby can't come.

I obviously chose the former, but the care wasn't specialist enough, and the midwives (especially those who had never been nurses) struggled with my dressing changes, 6xdaily antibiotics via a picc line and my magot therapy...!

I've since had to have 5 lots of surgery including a skin graft to help me heal and I've got significant permanent disfigurement - I believe that this was as a result of my care coming from midwives (who predominantly care for 'well' women and babies) rather than surgical nurses.

I haven't ever complained, as I can't prove the above point and my care was good throughout, but I just wonder at what point someone should have said "I know is very difficult but we need to move you somewhere else and you can't bring baby"... I get that they try to keep babies and mum's together but it was so detrimental in my case

oveacupoftea18
Just wondered how often you see a second baby being born in a totally different way. I'd love to get my dream of a natural pool birth next time!

As an aside, please know that you are bloody wonderful. Every single midwife I met during my first labour and subsequent hospital stay was just incredible!! Made me want to retrain...
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Do it!
Nearly always the second baby is a breeze. I see lots and lots and lots of women who have long labours with ventouse/forceps for their first baby who then have super quick, straightforward second and subsequent births. It’s very emotionally healing.
This is also the reason so many second babies are born in the loo/car/car park- women think “oh I’ll have hours yet” after the first and that’s usually not the case.

BlancheM

What do you think of bounty salespeople being allowed on maternity wards?

And do midwives routinely send labouring women home until the very last minute because then they won't qualify for an epidural as it will be too late? Or is it because of a bed shortage?
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Bounty. I loath it. I totally disagree with sales people approaching women at a vulnerable time. They pay the hospital ££££ to do it and so it continues..., until women vote with their feet.

I am expecting my fifth baby this year (august)

Some things i have read online suggest i will automatically be classed as high risk? Is this true? If so how would my care differ?

I have had four natural deliveries, heaviest baby 8lb9. And have gone home from the delivery room with dc2 3 and 4. No stitches, large bleeds or other issues.

We don’t try and keep women at home to avoid them having epidurals. Or for bed space (although it is sometimes an issue).
The reasoning for keeping women at home in the early stages of labour is because a) reduced adrenaline levels and the feeling of being in observed help promote the natural processes of labour and support women to progress. B) if you linger in a hospital for hours and hours in early labour there’s a chance someone will want to interfere with you. We don’t have capacity to keep women in a birthing room for the hours/days of early labour so after assessing them fully we will recommend they head home to establish in their own environment. They can eat their own food, mobilise, rest in comfort, allow partners to rest, distract themselves, all beneficial to keeping things natural and working well. If a woman doesn’t feel happy to go home there is the option of transferring to the antenatal ward, but in early labour very little midwifery is required- it would just be sitting behind a curtain in a 6 bed bay surrounded by strangers which for most would be unpleasant. It’s a natural part of the birth process. However once you are on a ward, routine things start to happen. You may be put in a CTG monitor which restricts your movement and also has a high rate of showing up things that could start off unnecessary intervention. Also, in more medicalised units the doctors will review women and potentially suggest doing things to speed along what is essentially a normal process. Once you start messing with the process often other interventions will follow.
Going home where safe and happy to do so is really a protective measure for women.
The urban legend of being “too late” for an epidural is really just a physical situation whereby the baby is likely going to be born before the epidural will be effective. Most women hit transition (late labour/almost ready to push) and feel they can’t do it/want to go home/need an epidural or section. With good support most women will happily work through this tough patch and have their baby. If they adamantly want an epidural of course that is what they have. There’s no incentive for us to deny women pain relief. But, the flip side is that if a women is likely to have their baby in the next hour or so the epidural process is going to prolong it. Transfer to delivery suite, wait for an anaesthetic, do a CTG of baby’s heart rate, put in a drip, put on theatre gown, set up all equipment, administ epidural (this takes a little time) wait for it to become effective. At this point you then usually don’t feel contractions and lose the sensation to push. Because if this we allow an hour for passive descent once the cervix is fully dilated as we know getting a baby down with an epidural is harder. Then you push with guidance. This is usually longer than without an epidural as it is harder to do. This also increases the chance of needing a ventouse or forceps birth, which both usually involve an episiotomy (cut). Now if you go back to the woman at 9cm pre epidural she has probably had her baby by now, is eating her toast and getting up having a shower and thinking about going home.

M0reGinPlease

Is is true that if you leave a very large gap between babies it's like starting again? I had a very (very!) fast labour with DC1- less than an hour- and that was four years ago so scared if I leave it too long I'll have a long horrific one! Do some women just labour very fast?
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If you have a big gap, like 10 years, you are more likely to have a longer labour than a second baby with a small gap. However it really just puts you closer to the length of your first labour, so for you it would probably still be quick! Don’t leave it too late to call!

tubspreciousthings

If you're involved in the birth of a baby who may not survive (known medical condition/birth injury/very premature) do you ever find out what happened to them longer term? Would you want to know? Do you remember them?

Is bereavement care for families of babies who don't make it something a midwife can choose to do or does everyone need to take a turn?
Most biggish units have a specialist bereavement midwife to offer support but usually we each share looking after women having traumatic experiences because it shares the emotional load. Most midwives like to follow up the babies, visit them in NICU etc and we do remember them. Little footprints in our hearts.

I had a long induced back to back labour with DD. She hadn't turned by the time I came to push and I remember having a team at the bottom of the bed ready with the ventouse to help out. However, she actually turned as she was coming out and came out the right way. The midwife said that didn't happen very often, just curious to know if that was the case?

Also just picking up on someone else's question, DD had to be transferred the next day to another hospital for unplanned surgery and after a few days, the midwife who'd looked after me on the post natal ward came to visit us to see everything was ok. So I know you do care about the babies you've looked after.

And finally I was lucky enough to deliver my neighbour's baby a few years ago. All totally unplanned and I was only with her 5 minutes before the birth and before the ambulance arrived but it was the most amazing experience!

Good morning, great thread and a great career, thank you! I have two questions, one personally and one surrounding the career generally

I'm currently pregnant and pretty terrified of birth after my last resulting in EMCS due to failure to progress past 2cm on the drip. Had a subsequent cervical infection and frozen bowel so recovery was tough. Currently 14 weeks and SPD already. My concern is if I try for a VBAC that the pain from SPD will be too bad and because I only got to 2cm last time my body doesn't know what on earth to do. Do you think when there are things involved like SPD and previous failure to progress that it's better to elect or do you think the success rates of VBAC are still valid? I could potentially go for epidural but worried I won't feel the true benefits of having a natural birth if I do.

Secondly, I'm actually considering retraining in maternity care or midwifery myself even though my the time my baby is old enough to leave I will be in my late 30s/early 40s. Do you still think there is room for midwives to be starting their training later in life? Do you think it's realistic to undertake a full time course with the demands of midwifery when you already have a young family? How does your family cope when you have to work bank holidays/Christmas etc?

When I had my first baby, it was a really bad experience. I was in the second stage of labour and trying to push for nearly six hours, until my baby was eventually delivered via forceps.

I found out much later that the second stage shouldn’t be much more than an hour. Why do you think this could have taken so long, and what is the longest second stage that you have known about?

Lookingforadvice123

Why is pain relief (other than G&A and sodding paracetamol) discouraged? I waited for almost an hour to be stitched up after an agonising 48 hour back to back labour, well over 2.5 hours of pushing and an episiotomy. I begged for pain relief, and was offered a cup of sugary tea.

Also, how long do you really let women push for? I was told 2 hours, but I ended up pushing for 2 hours 40 minutes. I was exhausted.
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I’m not sure if discouraged is the word I’d use. We primarily aim to support women to give birth in the most straightforward, safe way. Drugs have side effects and lots of factors come in to what we would recommend. Paracetamol and gas and air are safe with low side effects so a good first option for most women. Depending how labour goes we tend to work up from there.
I think better communication and information would hopefully allay fears about being ‘denied’ pain relief.
For example, pethidine is not ideal to give when birth is close because of its effects on baby’s respiratory efforts at birth. Epidural as mentioned earlier. But women begging for pain relief and not receiving any is unacceptable and I’m sorry you experienced this.
Pushing wise, most first babies take 1-2 hrs to birth. Subsequent babies usually, but not always, much quicker. As a rule as long as there is progress and mother and baby are coping we aim for a max of three hours for first baby and two hours for subsequent babies.

Loving this thread. I have so much respect for midwives. How often do you find women experiencing contractions all in their legs, more specifically top of thighs? I felt none in my back or tummy. Wasn't expecting that.

Can I ask something else too, how is it that some women can go through birth on no pain relief but others find it excruciating? Surely peoples pain thresholds can't be that different?

Thank you for answering my questions. I thought there might have been particular reasons why I've been unlucky 4 separate times, I even gave birth on the floor outside to one of the middle DC because they just wouldn't let me in/admit me. Each time I was refused pain relief even though I have massive babies and the last one was back to back, I've been either fobbed off or outright told they wanted me to have a nice, natural birth.
So I know it happens as I've experienced it and have read and heard many, many other accounts of it happening to other women, too, but thank you for taking the time to respond and thank you for being a good one

I had silent labour, so only discovered I was 5cm+ dilated and having contractions every 2-3 mins when I went for a sweep. Once they broke my waters it all went a bit haywire - horribly painful contractions with only 30 secs in between, and DS was born very quickly. The entire thing was a bit traumatic and has put me off having any more to be honest - if you’ve had precipitous and silent labour with your first, how likely is it to happen with a second?

BLANCHEM
Sadly, there are bad eggs, or people who don’t listen, or have their own agenda. If you’ve experienced it four timed it makes me wonder if there’s a culture of it at your hospital. I’d consider writing to the head of midwifery and seeing how she/he deals with it.

AnotherUsernameToday

How often have you seen a massive fetal/maternal haemorrhages happen in your career and did the baby survive?
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I’ve not seen many, I’ve mostly worked in low risk settings so this is probably why. However we do hear about major events in the unit and it’s very rare for a big enough haemorrhage for the baby to die. The two biggest ones I can recall was a homebirth VBAC who had a uterine rupture where both mother and baby were very critically ill on ITU for several days but both recovered well, and a sudden abruption (placenta separating from uterus) cause unknown, both very unwell but again both recovered in time.

Moominfan

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.
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So sorry this happened to you, it sounds horrendous.
Birth is unpredicatble. It’s very uncommon for things to happen this way with induction but nothing is impossible and you should have been listened to better.
Have you considered having a debrief? It might be useful to discuss it with a caring ear, and possibly to feedback to the hospital so they can learn from it and improve things for other women.

I’ve just reread the bit where you were shouted at?!?! Unacceptable. Report it.

ReaganSomerset

@thereinmadnesslies
Question to MW: should they have asked my permission before letting the trainee have a bash at it?
Absolutely. I would expect you to have had this discussed with you. Ie “would you feel happy for student x to suture whilst I supervise”.

BobDobbs

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?
Hi
The most common reason is when the baby isn’t in an ideal position such as when baby is back to back. The baby’s head doesn’t fit so well in the pelvis so the pressure causes the waters to rupture. Occasionally it can be caused by infection. It’s fairly common though.

LunaNightSky

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.

Hi, congratulations.
As the baby starts to move down, especially with a first birth, the baby naturally moves back and forth. So you push and baby comes down a little, then rocks back up between contractions. It does this two steps forward, one step back as it moves through the pelvis because there is a curve in the pelvis for it to come round. This is totally normal and nothing to do with you being tense or not pushing effectively. It also allows time for everything to stretch gently so is a good thing. When the baby gets closer, and clears the bend it stops receding and moves forwards with each contraction. Occasionally when women have been pushing for a long time and are shattered, or the pushing isn’t quite where it needs to be the midwife may suggest guiding you by placing the two examining fingers into the vagina and gently pressing downwards in the direction of your bum. This can work wonders for helping the muscles to stretch a little and guiding the mother on where to push. However it’s oretty invasive and uncomfortable so only done when really needed.

My first baby was a brow presentation. It took 3 midwives and eventually a consultant to diagnose this at 6cm dilated. I was told by one midwife she had never seen one. I had to have EMCS as they said baby wouldn't deliver naturally. Are they rare? Have you ever seen one? I'm pregnant again and going for an ELCS as no one seems to know that much about them and the chances of reoccurrence this time.

Workingclass

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!
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Sorry to hear you had awful midwives, kindness costs nothing.
We don’t judge, we put our midwife hat on and support. I think sometimes we can be surprised by what we see, but that’s a different thing from being judgemental. I’ve been surprised by mother’s age at both ends of the spectrum, but never judged it.

How common are general anaesthetic c sections?
How often are the emergency buzzers pressed?
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We see GA sections fairly regularly, usually if its a Cat A emergency section and the few minutes to site the spinal would compromise mother or baby.
Emergency bells are pulled often, there’s loads of reasons why but it just means we need plenty of people straight away. Most commonly it will be for problems with baby’s heart rate, heavy bleeding after birth or if someone faints in the loo!