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.

@Staacey9

*Probable precipitate labour?

and

Fear of Dying - previous PPH & Sepsis*

To take the first point - if you had a rapid first labour, such as you describe, then it is highly likely that your next will be even more rapid.

Because you had a massive PPH (3500ml) you are at risk of having another.

There is no reason to suppose that you'll have sepsis again.

Bearing that in mind, and adding in your PTSD, which is entirely understandable in the circumstances, if you become pregnant again it would be wise to book for consultant-led care and to ask your midwife to see you more regularly than is usual.

In our practice if we have a woman with exceptional anxiety for whatever reason we always tell her to ring us at any time, day or night, and we plan to see her weekly throughout the pregnancy, if this is what she wishes.

If your community midwives are unable to offer this service, consider hiring a doula who specialises in ante-natal anxiety, or book with an independent midwife. Both are expensive options, though.

Many independent midwives will come with you when you're in labour to the hospital. They do not only deal with home births.

Do you think any of those options would be helpful to you? Many people with extreme anxiety/fear of dying do better with constant reassurance.

In your experience, is there any truth in the old wives tales regarding heart rate of the baby and it being a boy or a girl, or the train/horse thing. So if you're listening in do you think ah yes that sounds like a girl to me... or is it truly just a load of old twaddle.

Have really enjoyed reading through your posts.

JohnnyMcGrath

Ha! Derailing my thread. Aye, that WILL be right.

You weren't derailing my thread, girl. You described an appalling situation and I'll revisit this shortly because of the importance of validating what happened to you.

(Jemima disappears temporarily with a large gin and tonic a mug of best Assam)

Justasking111

Hand coming in front of head

This is called a compound presentation and might have caused the fetal distress.

@jemima232 I have waited 36 years for that answer now I know why it hurt that bit more. A scary time I still remember well.

@Jemima232

Thank you for your reply. I would always want to be consultant led after the first time round and I was told it is likely I would have OC in subsequent pregnancies, so I guess that is what would happen but it's a comfort to know there are services for women who may need extra support during pregnancy (I understand it probably varies in different areas)

A doula or private midwife is certainly something I'd consider in the future if finances allowed because I think I would need that almost constant reassurance you mentioned.

Another PPH and emergency theatre trip does scare me so I know I need to get some way to treating the PTSD before possibly having another. Still have flashbacks to being in theatre while they took out retained placenta. I feel for anyone who has gone through anything like that because it totally messed me up. I needed more support after the event than I ever actually received though, in order to process things properly.

Thank you again for this thread and taking time out to answer and help people.

my hospital allows partners to stay with women over night on the post natal ward. I was hoping to not have to stay in but a c section is looking likely now. I was sexually abused as a child and to be honest rhe thought of random men sleeping in the same bay as me terrifies me. I get that some women may want their partner their but for me it makes me feel very anxious and unsafe. Who would be the best person to talk to about this? I was hoping maybe I could request a side room, I get that I can’t demand that other women can’t have their partners stay but I also feel like I should feel unsafe at night time. This isn’t a minor anxiety, it causes real panic - I do not put myself in situations which make me feel unsafe but due to potential c section admission is unavoidable

@Justasking

Some thoughts

I was looking at your PP and I have to ask - you weren't offered paracetamol at the stage of labour just prior to pushing, were you?

If the gas and air equipment had come away from the wall, they could have brought a portable one in for you. I am struggling to understand why anyone thought that paracetamol was a reasonable painkiller in late labour, though I do take on board your description of your labours, in which you had an urge to push at 5cm ( this happens to some women and is very distressing.)

It sounds like there was sudden fetal distress just at the end of your labour, probably because of the compound presentation and rapid dilatation from 5cm - fully in a couple of contractions.

It's interesting how long women's experiences of labour stay with them. Yours was 36 years ago and you remember it very well indeed.

@mrssunshine

Sisters had Pre-Eclampsia and HELLP

Both pre-eclampsia and HELLP are serious conditions and there is a familial link, so if both your sisters suffered with PE and HELLP there is quite a high likelihood of your getting either or both, but of course it may happen that you don't get either.

There is more information and support on this website

action-on-pre-eclampsia.org.uk/

I'm sure you would explain all this to your midwife and doctor anyway, but I always think the best thing to do is to plan for a normal delivery and hope that you don't get pre-eclampsia or HELLP.

I keep waiting to see if @ThenameisWeasley has had her baby yet

No @Jemima232 up overnight with strong contractions again and a vomiting 2 year old so that has the potential to be fun!! They've subsided again now which I'm sort of glad off in these circumstances!!

@changerlenom

Ventouse delivery

This link includes a very good diagram which shows where the ventouse should be positioned.

I have never seen a ventouse attached to the baby's brow.

Yes, your midwife should have known (or at least suspected) what position your baby was in, although in some cases it is quite difficult to define - the landmarks on babies' heads are not always easy to feel if the labour has gone on for any length of time.

I'm sorry nobody listened when you begged for a caesarean. You did have a traumatic delivery with a lot of perineal damage, which always impacts a woman's life.

(At least you weren't offered paracetamol, which seems to be the new go-to in midwifery care, if this thread is anything to go by.)

Sorry, @changerlenom**

Here is the link

en.wikipedia.org/wiki/Vacuum_extraction

@ThenameisWeasley

Oh! I thought this was your first baby. I didn't realise you had a two year old.

Well in that case, there should definitely be a very rapid finish to this labour.

Hope your toddler is feeling better.

@Jemima232 thank you! The first was breech and so a section. So all new this time!!

@AnotherRubberDuck

Blood clot behind the placenta

This wasn't a post-partum haemorrhage (PPH) - it was a concealed ante-partum haemorrhage (APH.)

Yes, I have seen this on many placentae in my long and distinguished career.

Nowadays these bleeds can be seen on ultrasound pretty easily, especially the large ones, which yours clearly was.

I doubt if this will happen again, if I'm honest.

I would get your notes changed to say "APH", not "PPH" as a previous PPH is a risk factor for a repeat performance.

I'm not surprised that you needed a blood transfusion.

@AgentCooper

Induction of labour

I don't know about a conspiracy of silence surrounding induction of labour (IOL.)

There is an expectation from women that IOL starts the labour off pretty much immediately and progresses as normal labour would

But this is not true.

I would never accept an induction for myself. There is a school of thought which posits that if a pregnancy needs to end, whether for the mother's sake or the baby's, then a caesarean should be performed.

If a caesarean is not deemed necessary then the woman should be left until labour starts naturally.

Normal, spontaneous labour is significantly shorter than induced labour.

I tell women in my care that if they are booked for an induction on a Monday, they are not likely to see their babies until Wednesday or Thursday.

"Failed induction" is a reason why some CS are required.

Women who are induced need more pain relief and become exhausted more often than women who go into spontaneous labour.
They are more likely to choose an epidural for pain relief, which brings its own difficulties - the increased need for forceps/ventouse being the most obvious.

I think the points you made in your PP are extremely pertinent.

Women who are going to be induced do suffer more severe pain during the early stages of labour and seem (from what I've read on this thread) to be being told that "their labour is not bad/painful/far advanced enough to warrant painkillers."

Yes, you're right when you say that women need to be told what they're letting themselves in for when they agree to IOL and there is a conspiracy of silence surroundings inductions.

@FraterculaArctica

Third baby - which hospital

I think, given that your last labour was rapid, I would consider booking, or transferring to, the nearer hospital.

The next one will be faster so you may not get to the hospital which is 40 minutes away.

I take on board the fact that you don't fancy having a home birth with your third baby.

@IVEgottheDECAF

How fast will 5th baby be

It's likely that your fifth baby will come out faster than the previous four, but s/he (hopefully) won't come "flying out."

@baubled

Prenatal Depression

I do find that there is far less support for women who are suffering prenatal depression, as opposed to those suffering postnatal depression.

It has only been recognised in recent years and I don't think that the NHS has caught up with the phenomenon yet.

This is an area where there is a lot of room for improvement.

Hi @Jemima232, thank you for doing this post.

I also had placental abruption with my first, ending in cat 1 c section at 41+1. Luckily it happened in hospital so they picked it up immediately. I was low risk prior to this but had back to back labouring for 12 hours prior. They think it was either polyhydramios (can't spell) due to volume and speed of my waters breaking, possibly pre eclampsia based on the placental histology report.

I was advised next pregnancy I'd be consultant led and should have elective c section at 39 weeks. I'd have growth scans because of the water issue and small increased risk of PA.

Because of what happened we were unsure on trying for another. We did try and that pregnancy has just ended as ectopic with surgery/tube removal. I've been told because of this I'm now at higher risk for ectopic and would need early scan in future pregnancies. So essentially early pregnancy and late pregnancy I'm high risk to potentially 4 different things.

If I presented to you in early pregnancy, would you honestly be concerned about the potential outcome or risk? I know you can't expect medical professionals to make these big decisions but my husband doesn't want a 3rd pregnancy to end in more drama and risk to my life. I don't know how I feel other than wanting to add to our family but tempted to take the easy option of not risking it.

Thanks

@agteacht

Bleeding in early pregnancy

There are many reasons for this:

Chemical Pregnancy

Missed Miscarriage

Blighted Ovum

Insufficient Progesterone Production

Blood clot behind the placenta

Ectopic Pregnancy

to name but a few.

All women understandably panic when they bleed in early pregnancy. A scan usually determines the cause.

It's important to say that many, many women have bleeding where no cause is identified, and the pregnancy continues to term. A good many women report a lot of blood loss which does not always mean you're going to lose your baby.

If you're bleeding, and in pain, go to the EPU or A & E

If you soak a pad an hour, go to A & E

If you feel cold and shaky call an ambulance

Some women need a blood transfusion as a result of early pregnancy bleeding so never disregard it.

www.miscarriageassociation.org.uk/

And never underestimate the emotional impact that having a miscarriage brings.

As a proportion, how many of your colleagues are enamored by the magical qualities of a lavender bath?

I'll geg in again just to reiterate, bleeding in early pregnancy can be completely normal and the majority of people that come through our early preg clinic go on to have healthy babies. It's super worrying though as understandably you think the worst, and it can be hard waiting for scans and/or blood levels to see if they're on the rise.

Thanks for replying!
Re blood clot behind the placenta.

I'm worried now. Does that mean I had a placental abruption!? The cances of having another one are higher now aren't they.

I didn't mind it when I thought it was PPH, I'd come to terms with the risk to me. But APH is bad for the baby? Should my care be different this time round because it was APH not PPH?