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.

Thank you for your reply, hadn't considered a home birth but food for thought. I didn't get induced second time around he took a rather sudden arrival with no pain relief and I went into shock so rather avoid if possible lol.

@ButterflyBitch

Management of the third stage

Re - routine syntometrine injection - when this is given the commonest method of delivering the placenta is by controlled cord traction (CCT)

CCT is performed with the midwife's hand on your lower abdomen. The cord is gently pulled when the midwife is sure that the placenta has separated.

When your midwife pulled on the cord, did she also have her other hand on you? How long after the birth of your baby was the attempt made?

Again, without having been there it's hard for me to say what happened, but generally, when a woman has a physiological third stage (i.e. without the injection) it takes from 20 - 40 minutes and the easiest (and I think, safest) method would be to get you out of the pool, ask you to squat, then ask you to push, if I was sure that the placenta had separated.

There are so many ifs and buts with third stage management. The vast majority of women do have syntometrine and this significantly shortens the third stage, to about 2 - 5 minutes. Therefore most midwives don't see a physiological third stage and may not be confident about conducting one.

I'm not sure that my answer is very helpful. You did end up managing to push out your placenta and I cannot say for sure why your midwife was pulling on the cord.

Thank you for answering my question! I have another if you don’t mind-

You’ve answered a few questions about inadequate pain relief during labour, I was wondering what you think about what women should be given after labour? After my c-section I was just given paracetamol and had to ring a couple of times and wait several hours to eventually get some oromorph (in all fairness to the midwives, I think they were dealing with an emergency elsewhere) When I went home two days later, I wasn’t prescribed any pain relief and my partner had to go out and get me some codeine- I really don’t think I could have coped without it. I actually got given more pain killers when I went in for minor plastic surgery on my arm than my section. Do you think women should be given more pain killers after birth?

@SlipperOrchid

*Why do some women have www.nlg.nhs.uk/content/uploads/2014/04/Heavy-Bleeding-After-Birth-Postpartum-Haemorrhage-IFP-0773.pdf

The main reasons are:

• previous PPH

• having more than one baby (twins +)

• having had four babies previously

• induction of labour

• pre-eclampsia

• caesarean section

• placenta praevia

• placental abruption

• maternal obesity

• smoking

There are others, but those are the main ones.

PPH is a leading cause of maternal death so it has to be taken seriously.

Some women end up in Intensive Care because of a PPH.

Above - should have been titled "Post-Partum Haemorrhage

@riotlady

Yes, without doubt you should have had good pain relief after CS, both in the hospital and when you were discharged home.

Weren't you given diclofenac (voltarol) suppositories?

The lack of post-operative pain relief was the reason I became very distressed after one of my CS.

Where are these hospitals, whose policy is to give women paracetamol after a CS? It isn't the policy in my hospital. CS is major surgery.

Even after a normal delivery many women require something stronger than paracetamol, for after-pains.

Do you think they might have mixed you up with a woman who'd had a normal delivery?

@Thename is Weasley

Are you in labour (again)?

To all who have not had their questions answered - I am currently working my way through P7 and you will all (eventually) get a response

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

@Jemima232 thank you for your reply ☺️ would definitely just ask to go to theatre I think if a retained placenta happened again.
Have learnt loads on this post

Can I ask a question? I've suffered bad vomiting and sickness and so for the first 8 weeks didn't put on any weight at all, but I've finally been given some meds that sort of work. As long as I eat lots of plain carbs. Since I've started taking them I've piled on the weight, about half a stone in 2-3 weeks. But I already have a BMI of 35. I'd been steadily losing weight as we wanted to get pregnant but then actually got pregnant before I got down to a healthier weight. I'd had good eating habits up until I started vomiting in week 6. I'm terrified about how bad this will be for the baby and for the rest of my pregnancy but I can't seem to reverse it. The pills gave me terrible constipation so I'm eating fistfuls if prunes and dried apricots which I know are high in sugar but at least help (nothing else did) and popcorn seems to stave off the endless nausea. The pills just take the edge off.

What do I do? What is worse for me and the baby? Do I stop the pills and lose the constipation and cut back so I lose weight, do I just do what I need to to get through? Everyone says I will feel better in a couple of weeks - do I wait it out and then try to lose the weight?

I'm so ashamed to go back to the midwife knowing I've done the opposite of what is best for the baby. How bad is this for the baby?

@Jemima232

Thanks! It was a hospital in the North East. I don’t think they would have gotten me mixed up but possibly? They’re very into “active recovery” so I was up and about quickly and they encouraged me to go home the next day, but I said I didn’t feel capable.

I did get a suppository put in immediately after the section, while I was still on the table. I assumed it was to help me poop later on but now you’ve said that I guess it was pain relief? Nothing more after that one though.

Is the first full moon in September really the busiest time fir babies being born? This is what we were told when DS was born at this time.

Slipper
Why do some women have PPHs? Are they serious?
Mine happened, as explained by my midwife, because I have big babies.
Apparently the bigger the baby, the bigger the placenta and the bigger the gap on the womb wall (I don't know what else to call it) it leaves when it comes away. MW did not pull on mine, I had 3 lots of injection in my leg to help it but the gap my placenta left would not settle down quick enough and I haemorrhaged, quite badly. I needed a transfusion because of it. This was with ds2. When in labour with ds3 they were prepared for this happening again and had blood on standby for another transfusion if needed. It did not happen again even though ds3 was very very big.
It could have been because ds2 birth was extremely fast (literally 2 mins in stage 2, he flew out) or it could have just happened anyway i'll never know.
Jemima232
Regarding the arsehole birthing partners.
It's just disgusting really. like I said it's something that has stayed with me even after all of this time.

@BikeRunSki

All maternity units are busy throughout September, because it's nine months after Christmas and New Year, when people have more alcohol and either are more likely to have sex generally, or forget to use contraception.

I've never had a quiet September.

@PregnantAndSuffering

Severe vomiting in pregnancy and Hyperemesis Gravidarum

I'm sorry you're suffering like this.

Severe vomiting and HG lead to dehydration, which is far worse for you and the baby than eating carbs.

Extreme dehydration can lead to kidney failure in the mother and needs treating in hospital. Moderate dehydration also needs hospital treatment with I/V fluids.

If your anti-sickness meds only "take the edge off" please go back to your doctor and ask them to either add in another medication or change what you're currently getting. Using a glycerine suppository when you feel constipated is recommended.

HG is a miserable condition for the mother and always requires hospitalisation, sometimes for many, many weeks.

I have known three women, in the course of my career, who had to have their pregnancies terminated in order to save their lives.

Other women decide that a termination is better than feeling nauseated and vomiting thirty + times a day and I cannot blame them for choosing this. They always report enormous guilt and feel the burden of their decision for years afterwards. This has been in the news media only last week.

@riotlady

Yes,, the suppository you were given in theatre would have been for pain, not to make you poo.

There's "active recovery" and there's not meeting someone's needs.

It is likely that pain medication has been written on your drug chart but the midwives do not give it. (Waiting to be shot down in flames for writing this btw.)

This comes under the previous category of someone else (your midwife) deciding your pain level.

I'm going to throw this into the mix, for what it's worth - caesarean section has become so prevalent that we just see it as another way of giving birth. We do women a great disservice by neglecting to remember that CS is a major abdominal operation.

Thankyou very much @Jemima232 I think I’ll definitely ask to go straight to theatre this time then. I’m just going to try and relax and not think about it, since there’s no way I can prevent it happening.

Thankyou very much @Jemima232 I think I’ll definitely ask to go straight to theatre this time then. I’m just going to try and relax and not think about it, since there’s no way I can prevent it happening.

@Jemima232

I'm 10 weeks pregnant with DC3. DC1 was a crash CS under GA at 41+4 (sudden transfer from MLU when heart rate dropped after amniotomy 36 hours in to awful labour). DC2 was a spontaneous VBAC with a 45 min labour at 35+2, 24 hours after waters broke. Retained placenta had to be removed in theatre with spinal block. With this history what on earth would you anticipate/plan for number 3? (Homebirth not really an option as I keep ending up in theatre, also I actively like hospitals!) Preferred hospital is 40 min away, there is a closer one 15 min away - would you transfer care to there?

@Jemima232 scam labour again last night! I went to bed, ignored it and it stopped again. It's going to get to the point I won't believe it's actually happening when it does and will have an accidental home birth

@Thenameisweasley

How frustrating for you. You have my sympathy.

You're having a protracted latent phase of labour.

We have a saying in midwifery: Slow start, quick finish

Can I suggest that when you have contractions every five minutes for three or four hours, and they are becoming increasingly painful, that's the time to call triage and go in. That's when you'll likely be progressing into active labour.

Because you're OP the pains you're having on and off now are gradually softening and shortening your cervix, which is good.

Did you read my answer about effacement? It explains this.

Do keep updating the thread. I'm so invested in your labour now and I bet others reading this are, too.

@Jemima232 to be fair I kind of don't mind because I'm hoping you're right and it means once things get going they go fairly fast!! At check yesterday I was 3cm silted and 1cm long so they're definitely doing things. Would be much more frustrating if I wasn't dilating etc!! Thank you for all the encouragement and advice - you've been brilliant!!

@Ellijjtiny

Separation from baby in NICU

My DD1 was also in NICU (premature) and I had a crash section for abruption and suffered anaphylaxis afterwards and needed a lot of blood, too, so I wasn't able to go to NICU to see her as often as I wanted.

She was taken immediately from theatre and I only saw her briefly.

In contrast, my DS2 was also premature and in NICU, but I had a planned section and no complications, and was able to go and see him. He came back to the ward after a week and I breastfed him and topped up with EBM via tube.

I breastfed DD1 for over two years and she is an adult now. Despite our rocky start, we have a great relationship and she is a well-adjusted person.

DS2 has ASD and he and I were together as much as was feasible, despite a less rocky start. I have to be honest and say that despite this, and given that I breastfed him also for two years, he has a lot of difficulty with relationships generally and ours can be tricky at times.

I cannot answer your question about whether babies are more likely to have a more severe ASD if skin-to-skin isn't possible at the time of birth as I do not know.

I do think that as parents of children with ASD, we always wonder if it was our fault, or if we could have done something differently. I have sometimes wondered if some medication I took when pregnant with DS2 had an effect on him (it was prescribed, btw) but realistically, I look at my family generally and there are a lot of cousins etc. with ASD, and my sister also had it (undiagnosed). So I can see the familial links and tell myself that DS2 was always going to have ASD, no matter what I had done.

Please don't yearn for something you cannot change. It can break your heart.

@Thenameisweasley

Yay - 3cm dilated and cervix only 1cm long.

It's all looking good.

@PickleTickled

DPs who behave like arseholes when woman is in labour

Following on from what I said before, I think there is a difference between men who only want to encourage their partners and support their choices during childbirth, and men who are abusive.

What you heard was abuse. The midwife ought to have had a word in private with the man who was calling his wife a coward, and telling her she wasn't doing it right. If he then didn't stop being abusive, the midwife should have asked him to leave the labour ward completely.

She should then have asked the woman if she was in a DV situation, or coercive control, or verbal abuse generally. This is not easy to do when the woman is in labour and probably should wait until the woman has delivered and recovered.

All midwives are on the alert for domestic abuse and have policies and procedures which should be followed.

I myself have admitted a woman to hospital (without the violent partner's knowledge) when she called me out after he had beaten her (again) and she was given advice and support. Her partner had no idea that she was in hospital and the police made sure that he would be arrested if he came anywhere near her.

She chose to go 400 miles away to her family and had her baby there. That was an extreme case but I assure you that staff are on the look-out for abusive partners.