I'm a midwife AMA

[Jemima232]

Community Midwife with four children of my own.

Also worked as an Independent Midwife.

Breastfeeding Counsellor and Sleep Consultant.

Thanks jemima. My dcs are well past the baby stage now and not having anymore so won't be dealing with midwives again. I was just interested to know if there had potentially been a problem with the placenta.
I had the manual removal under GA and woke up back in post natal ward.
I was nevergiven the opportunity to ask any questions.

@foreverhanging

Home Birth

I am in favour of home birth for any woman who wants one.

I have delivered a lot of women at home who were refused for various reasons, particularly as an independent midwife.The reality is that women have an absolute right to have a home birth.

The debate will rage on and on but (most) obstetricians and the majority of midwives have neither the experience nor the confidence to deliver babies at home.

I haven't transferred many women to hospital, where labour started at home and the delivery was planned to take place at home.

However, since in my area we visit and stay with women in labour, whose planned delivery choice is in hospital, I have had quite a few women who have changed their minds once labour has started.

We carry gas and air and pethidine routinely, and all the equipment needed for a home birth. I think that a lot of women are afraid that they will not cope in labour unless they're in hospital, and they find that the thought of moving once labour is established is worse than staying where they are, in familiar surroundings.

I myself had a home birth booked for DD2 (my third baby, after two previous CS) and although I ultimately did end up in hospital (for another CS) I was glad that I had had the opportunity to stay at home. My transfer was not an emergency - my labour did not progress after 24 hours of contractions, so we went to labour ward.

Personally I think it's a shame that more women are not encouraged to have a home birth, especially the low-risk ones.

These statistics may interest you:

thefarmmidwives.org/preliminary-statistics/

Do you remember / find the time to do kegals everyday?

@Blondebob

Placental abruption

The cause of this is not entirely understood. Some women have a higher likelihood of having an abruption but being overdue isn't a risk factor.

Yes, your placenta had done its job but that is not a reason for it to start coming away from the wall of the uterus.

There is more information on this website:

en.wikipedia.org/wiki/Placental_abruption

@Changingagain

If you're asking me, the answer is no!

I mean, I tried, I really did. I did them, but not as often and not as many as are recommended.

My first labour was back to back I had no pain comparison but it seemed to go ok, I did have a lot of stitches afterwards 58 because they had to perform an episiotomy which a junior doctor stitched up badly I had so many lumps and bumps. After the 2nd birth the midwife put that right no more lumps.

My question.
2nd labour the pain was incredible so different from first DH and I were alone in suite, he saw the babies heart rate dropping so ran for help. Suddenly the room was full of people as a hand appeared first god knows what they did but when they finally got him out he was completely grey. His arm was over his head so terribly bruised ditto one side of his face and he looked lopsided. Does this type of birth have a name?

The third baby 18 years later (yeah I know) was a piece of cake, the gas and air thing was broken pulled out of the wall, I was not allowed pethidine but offered paracetamol which I thought was a waste of time I had started pushing then.

In my first, second and third labour I said I need to push every time the midwives said no you are not dilated enough 5cm. The third time my DH said to the midwife, if she says the baby is coming, it is coming the third one shot out like a champagne cork which amused everyone.

Hi

Both my sisters have had 2 babies and all 4 times had preeclampsia/HELLP syndrome. 1st babies for both of them were emergency section and second planned sections

what are the chances of me getting preeclampsia and is there any hope of me having a natural labour?

Thanks x

@SushiTime

Midwife not wanting to stitch you at home

I can only guess that she wasn't very experienced and wanted someone who was to oversee her suturing?

Thanks for doing this AMA. With my DC2 labour the pain was really unbearable, all in my back and bum. I couldn't put my bottom down on the bed and had to arch off the bed balancing on my shoulders and heels for each contraction. When I (thankfully) got an epidural the anaesthetist asked the midwife whether the baby was positioned normally and she replied yes. Labour was long. The pushing stage lasted well over 2 hours and DC2 was eventually pulled out with a ventouse after episiotomy. During delivery the ventouse kept coming off and they kept reattaching it. My baby was born with a bad bruise on the front of his forehead from the ventouse and his skin was broken there. My perineum wasn't in great shape either, took weeks to heal. I was exhausted and had been begging for a caesarian.

My questions are, should the midwife have known he was back-to-back? Is it OK to use ventouse in this situation and was it attached in the right place (on the front of his forehead)?

With my second birth, when I delivered the placenta it had a clot on it larger than the placenta itself. The midwife (who was a senior midwife) exclaimed that she'd never seen that before and took it straight away.
Turns out they estimated I lost 2.5L of blood and I required 2 transfusions.

My question to you is, in all your experience have you heard of this?!

I'm currently 38 weeks pregnant and have been warned I'm high risk to have "another pph" but no one has actually explained what happened before or why.

I had a retained placenta after my first birth, they tried to remove it manually using gas and air but I ended up in theatre as it was apparently “stuck like chewing gum.”

I’m pregnant again (a good few years later) and that’s the only thing I’m worried about. The midwife keeps brushing it off but is it likely to happen again? I’ve been told it will and I’m scared.

Thankyou!!

Hi Jemima, thanks for doing this AMA, it’s been really interesting!

I had obstetric cholestasis and was induced at 37 weeks. Because I was no further forward after 3 days of pessaries and then on the drip for 13 hours DS was born at 38 weeks anyway. The epidural wore off after 4 hours. Tbh induction was among the most horrible experiences of my life and as i’m told i’m highly likely to get cholestasis again I don’t see myself having another child. It has only been recently, actually via a thread on MN, that I’ve heard from other women that the drip is awful and more painful than uninduced labour. I have spent 19 months feeling like a wimp, not helped by the doctor and one of the midwives attending my labour telling me I couldn’t be in ‘that much pain’ and that there were respite periods between my contractions (there weren’t). I feel like there’s kind of a pact of silence around induction. I had no idea what to expect, and the midwife at antenatal class made it sound just like normal labour (except that it was undesirable because it could lead to interventions).

So my question is - do you think there would be any benefit to discussing the realities of induction in more depth with mothers or would it just scare women? I kind of feel like a bit of warning might have been helpful but that’s just me.

And thank you for what you do - the midwives who looked after me and DS on the postnatal ward (5 day stay) were wonderful, wonderful women.

@Chinks123 I wasn't offered gas and air! Worse pain ever them trying to get that out! And I still ended up in theatre!

I also had a retained placenta, removed manually under gas and air. I have so much sympathy for you, photogirl - even with the gas and air (and unlike while pushing, I could really go for it with the G&A during the placenta stuff, so got high on it - I couldn't figure out the breathing to make it work properly during labour itself) the manual removal was the worst bit of labour for me. As I said to DH, labour really, really fucking hurt but you kind of knew it was supposed to. The placenta stuff was agony, but it also felt so wrong - no one should be touching the inside of your uterus, it's an organ! I felt sorry for the poor doctor doing it, because I kept telling her I wanted to do it (I was very reluctant to go to theatre and have an epidural at that late stage in proceedings) but then shouting 'no, no, no' as she actually did it and she kept saying 'if you don't consent I'll stop' and I was shouting 'no, I want you to do it OH MY GOD STOP oh no do carry on, I'm so sorry about all this OH FUCK FUCK FUCK STOP DON'T STOP'. Christ knows what they thought they were doing to me in the next room.

Wow @photogirl89 that must have been agony!! Even with the gas and air it was absolutely excruciating. I’ve forgotten the pain of labour but I’ve never forgotten the pain of them trying to remove that placenta.

@LisaSimpsonsbff completely agree the pain was so much worse than labour and just didn’t feel right. I ended up having it removed in theatre anyway after all that!!

Wondering whether next time if it does get stuck to just tell them to take me straight to theatre. I’m still traumatised

@photogirl89

Retained placenta

When you've had a retained placenta, it is slightly more likely to happen again.

Your labour last time was just at term and it could be earlier or later this time, so impossible to predict, I would say.

Labour is almost always more rapid once you've already had a baby, so the likelihood is that you'll definitely have a shorter time of it this time around.

Thankyou for your reply, yes I will do, thanks x

Removal of retained placenta

*A few of you have shared experiences of having a retained placenta.

I believe that if one try by a doctor doesn't succeed, then you should go to theatre, unless you're not in a lot of pain.

I winced when I read some of the descriptions you gave of having a retained placenta removed under gas and air.*

@MagpieFeather

Not being listened to regarding pain relief needs

Yet another PP who has had a bad experience with pain relief. This is not acceptable or good practice.

Even if you weren't in the designated labour ward you should have received pain relief.

If the labour ward was closed, you were still in labour and your needs weren't met.

I believe in your cynicism, unfortunately. "We are telling you you're not in labour as the labour ward is shut and as you're not in labour you're not getting anything for pain*

Please ask for a debrief and bring this to the attention of the midwifery managers. It isn't good enough.

@Chinks123

Retained placenta yet again

I would just ask to go to theatre if you have another retained placenta. One awful experience is enough for one woman.

@BrokenBottom

Perianal fistula with Seton Stitch

I have not personally come across a woman in your situation so I cannot be any help, I'm afraid.

I'm sorry you're facing this dilemma. What does your obstetrician think?

winedayfriday

PPH

Yes, you should have been told. Every woman who has a CS loses (on average) about 1000ml of blood but 1300ml is more than usual. I think that women should have things like this brought to their attention.

You would have had blood taken to check whether a transfusion was required.

@riotlady

VBAC?

If you think you'd like a VBAC, go for it. But I have a feeling it's likely to be an either/or situation.

Ask to speak to the consultant midwife, or discuss it with your community midwife when she books you.

You'll get a lot of differing opinions about VBAC, I'm afraid, so this is something you have to decide yourself.

You could read "Silent Knife" by Lois J. Estner and Nancy Wainer Cohen to give you some perspective, although it's heavily weighted towards VBAC.

Hey

I'm currently 19 weeks with my third, my first baby was born in less than 3 hours and my second was 20 mins, I appear to miss out the 'middle' of labour have the odd twinge and go straight into back to back pain and push. I'm under consultant care this time around due to being over weight. In your experience am I likely to be induced early?
My reason being I have two young kids (5&6 at the time of birth) who id rather not traumatise for life lol

Thanks

@ComforthWhite

Previous Precipitate Labour

In your circumstances I think it would be more than reasonable to ask for an induction.

In my practice we would also suggest that you consider having a home birth as all the equipment for this is delivered in advance and two midwives always attend. They would know that you've delivered really quickly twice before and would come immediately you phoned to say that labour had started.

I do take on board, though, that you had a blissful induction with an epidural for your second labour, and that may be what you decide to have this time round.