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.

@JohnnyMcGrathSaysFuckOff

How appalling that you felt it would be better to deliver Twin 1 in the toilet rather than in the delivery room. (I bet that caused some chaos in the labour ward at the time.)

From what you say, nobody listened to you, throughout your pregnancy, and there was no continuity of care and no plan put in place with which you were comfortable.

If you were so opposed to having an epidural then it should not have been the case that they were so insistent about making you have one. As things turned out, due to them not listening to you, you made an executive decision to escape to the safety of the toilet.

I doubt whether your notes were lost when you had your debrief. Notes do go missing, but not usually the notes of a woman who has had so much going on and so many appointments.

Of course, it's too late now. What's done is done. But what can we learn from your story, which is shocking?

Your choices ought to have been respected. The doctors may have been "passionate about epidurals" but nobody should be forced to have one.

You didn't want CFM (Continuous Fetal Monitoring) so a compromise could have been reached whereby frequent CTGs/listening in to the babies hearts could have been done. If abnormalities in either had been detected I'm sure you'd have agreed to CFM at that point.

You didn't want a lot of people in the room. It would have been possible for there only to have been an experienced midwife with you for the majority of your labour.

For the delivery, if you'd been told that for the safety of your babies, a doctor and two paediatricians would be present, and that they wouldn't stand at the foot of the bed so that you had privacy, I think you'd have agreed to that.

Medical students should not be there unless you agree to their presence. Maybe you'd have agreed to having one present, if (again) s/he had stayed at the top of the bed.

I am so sorry that your birth turned out the way you describe. I do think that a lot of the issues could have been avoided if your wishes surrounding the birth had been listened to.

Please can I ask a couple of questions that I'm too embarrassed to ask in person?

Both my babies were big weights for my small (at that time anyway) frame. 9lb2 and 9lb8. First was back to back and ended up with a c section. Second was vbac with forcep delivery.

Both labours, I got the urge to push well before I was dilated , in my second labour I was pushing for a while before the midwife actually checked and realised I was only 8cm, she told me to push at that point too. All was fine but I wonder why would I get the urge to push so early or was it all in my mind?

Also after delivery of my second and for a few days, I completely lost control of my rectum, felt like I'd been kicked up the bum by a horse and it was so odd not being able to push out a poo or hold one in (apart from physically squishing my bum cheeks together while I made a run for it) what was that?
Sorry tmi but I guess you are used to poo talk, I might have to change usernames now 😆

Wow this thread is amazing to read, Thank you so much OP for spending your time doing this. Has actually helped me understand my last labour a bit better now.

I hope it's okay, I've actually got 3 questions.

1. I'm booked in for a birth reflection after I asked my MW about it. What can I expect to get out of this? My previous Labour was very long (week of latent and then couple days of 4cm onwards), back-to-back, ended in induction drip (which they kept playing around with) and forceps.

2. I also had an unconcented sweep when I first went in, on an open ward where male birthing partners were. The curtain was not fully enclosed and I was without my birthing partner, I felt very vulnerable and pushed into the VE already. How do I raise this as something I do not want to happen again?

3. my DS was delivered at 37 weeks (at a good 7lb 1), but as I said before the labour started quite early and was very long, is it likely this will happen again? I am hoping for a homebirth but understand this isn't really suitable if this one was to come pre term? Just feel so on edge that this baby could come any time, especially as I've already had rather strong BHs and already been in triage once with what looked to be an early start of labour at 21 week (thankfully everything calmed down).

This is a brilliant thread, thank you OP. I was induced 13 years ago and went on to have a horrendous experience and your recent posts about induction really reflect what happened to me and have gone a little way towards helping with my unresolved birth trauma.

My question is this: I ended up with a CS but my waters broke 'naturally' just as the midwife was talking about breaking them for me. After the CS when my MW came back on shift she came to talk to me about my placenta and told me it had a 'double artery' - by which she meant that there was a massive artery going from the bottom of the placenta, which they would probably have yanked out if they'd gone up to break my waters.

I've never really been able to find out more about this - when I googled it seems that most placentas have two arteries :) but she definitely said this was really unusual and that having my waters broken could have led to very serious consequences. Can you shed any light on this?

@AnotherRubberDuck

Placental Abruption

This occurs in about 1:100 pregnancies (so is quite rare) and although having had one does increase the likelihood of your having another, I wouldn't worry about it particularly.

I had one with my first baby and went on to have three more babies. I didn't have another abruption.

Your care should only be different if you have an actual abruption with another pregnancy, not because you had one before.

Your abruption was unusual in that it wasn't diagnosed until after the placenta was delivered.

There's a link below with more information:

www.babycentre.co.uk/a1024974/placental-abruption

tiredmama25

Fetal Heart Rate and Sex of Baby

Jeez. Everyone knows what they're having nowadays so it's kind of irrelevant.

However, I am old enough to remember the good ole' days when nobody knew in advance and I have noticed that a FHR in the 160s is more likely to be a girl.

Talking of which...………

Parents' first question, invariably, isn't "is it all right?" - No. They say "what does it weigh?" before you've even cut the cord.

And nobody wants to know the weight (when you do get round to it) in kilos.

I've really enjoyed reading the I formation and advice you've been giving. I'm due my 2nd baby in September in a different area as we've moved and have been booked in with a MH consultant as I had PND (and possibly antenatal depression triggered by HG as well both times)
It's been interesting reading about the effects of G&A as I have 0 recollection of my birth other than I experienced it 5 times as the world was in slow motion for me whilst on it. I also remember telling DH I didn't want the baby, purely for the amount of pain I was in at the time.

I've got 2 questions:

1. When does established labour start? I don't remember from my antenatal classes but we never knew for me as I ended up at the ward 9cm dilated after irregular contractions, so no one could guess over the phone like they try to. We got there 12pm and baby was born 1.30pm. Contractions started 3am that day. I want to say I feel it was about 10.30am for me from what I remember about the pain. I threw up and couldn't speak over the phone for a food 5-10 mins so DH had to relay messages.

1. With being under a MH consultant, I know I have more anxiety over the birth. Short labours seem to run in the family, although I missed out on the early births (me and siblings were 3-11 days early, mum and siblings were early too) so I'm worried that I'm not going to be able to tell when I'm in established labour if it happens the same way again. Do midwives get annoyed when women just show up on the ward without ringing? I almost dont want to phone in case I'm not believed, but I do know the consultant is fully aware I'm worried about it and has said we'll discuss it in a few weeks time so they're aware.

@DieCryHate

Previous CS/Polyhydramnios/Placental Abruption

I'm so sorry you've just lost your second baby, and one of your tubes.

If you decide to try again, I would ask if you wanted a VBAC.

Your care at the beginning of pregnancy would depend on whether you were unfortunate enough to have another ectopic. Assuming you didn't, then your care would proceed as usual unless polyhydramnios occurred again.

I would treat you as a normal VBAC patient unless any other complications happened.

You've had one abruption. It's possible that you could have another. But if you didn't have either polyhydramnios or an abruption then your chances of having a successful VBAC would be good, unless obvious signs of pre-eclampsia also became obvious.

If you chose to have an elective section, that would be reasonable, too.

But I wouldn't treat you as particularly high risk, going by what you've said. I would wait to see what happened and take it from there.

How many cm dilated were you when you were taken for your first CS? You say that you laboured for twelve hours.

@Jemima232 thank you so much for your detailed response, very much appreciated. That's reassuring to hear.

I only got to 3cm. So not even "labour", just frequent and intense contractions in my back from the baby being back to back. My waters went like a bucket, got to the MLU and they sent me to the hospital due to meconium. Once there they were in the process of sorting out an induction due to my lack of progression and loss of waters when the PA happened.

It's good to know I shouldn't be put off trying for a second

My DD2 was born with a chest infection.
How can this happen while still in the womb? My midwife gave me a sweep at my request (she told me she wasn't supposed to and didn't put it in my notes) at around 41 weeks. Could this have anything to do with it. DD was born 2 or 3 days after sweep.

DD was in SCBU for 5 days and then had antibiotics for some while after this.

Jemima232 Sat 18-May-19 08:36:54
@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.

................................
Jemima with the third, I stayed home for 12 hours with the third, seven hours with first and second, every previous labour was 14 hours. So reached hospital at 5.15pm baby born at 6.42pm. They did offer paracetamol whilst I was there, seemed a bit late to me so declined. I could have done with the gas and air though. Once I start pushing every baby has been born within 30 minutes. Actually getting the urge to push was not distressing, I had this huge sense of euphoria the first and third time, because baby was nearly here. I did not really feel the pain just knew I had to work hard.

The second birth with the compound presentation, was frightening because it just did not feel right the pain was off the scale, the sight of a grey still baby terrifying. No-one had any idea until his hand appeared that anything was amiss. It was worse for OH I think because of a room full of people all on a mission to deliver him safely and alive. I was away with the fairies with the pain at the time.

What was nice the third time was that I was put on my side rather than on my back that was more comfortable.

@teyem

Lavender baths and other natural ways of inducing labour

I don't think any midwives would not be enamoured of the lavender bath idea - it is relaxing, after all, to lie in hot water (and more use as a painkiller once you're in labour, than the paracetamol on offer in all maternity units, from what I have been reading on this thread)

but

there is nothing you can do to bring labour on unless it is just about to start anyway, and that includes sweeps.

Nuthin'

die cry hate. When my waters went with one baby OH suggested they get a dinghy sent into the room. Apparently it was quite impressive.

IMO paracetamol is about as much use as a chocolate teapot in labour. A headache pain it aint.

@DieCryHate

You got to 3 cm which is the slow, latent phase, and it often takes the longest.

So never say you only got to 3 cm. You had accomplished a lot, actually.

Wonder how @TheNameIsWeasley is getting on, ladies

Probably still cleaning up sick from DC.

Justasking111

Not fucking paracetamol again

So you were offered paracetamol just before you started to push.

Maybe all the other hospitals use paracetamol invested with magical qualities, because my hospital just has the ordinary kind, and we certainly don't use it in labour ward.

Actually, that isn't entirely true. We midwives take when we have period pains or headaches.

@NapsSaveLives

In your special circumstances I think a single room should be offered. Confide in your midwife and ask her to arrange it.

Sharptic

Urge to push before full dilatation

This happens in OP labour, a lot. It's one of the things that make us suspect you're OP, in fact.

When your MW told you to push anyway at 8 cm she probably felt that your cervix was so thin and stretchy, and the head so well-applied to it, and low, that a few pushes would get it open fully.

Also, when a woman has a strong urge to push and is almost fully and getting distressed it's better (in many situations) to let her get on with it.

We have to make a judgement call on this, and the advice is different in every situation.

Getting on your hands and knees is good when you have a strong urge to push and are asked to try not to - it takes some of the pressure off.

AIBU for asking DH to bring back a bottle of gin from the shops

@jemima242 my DIL`s have had five babies in four years, pethidine was never offered, is it out of favour for some reason. With one DIL labour for 26 hours, then seizures emergency c section, pre eclampsia, which I suspected she was so swollen two weeks before retired midwife dragged back in missed (rolls eyes). She and baby both nearly died. Second time she was elective c section, baby decided to come three weeks early, when she got in they tried to talk her into natural delivery, my son hit the bloody roof and demanded they call in a consultant surgeon. When he came she went straight into theatre. Other DIL twins first time mono mono, one not growing first twin getting too much blood, starving second so straight into theatre. Second pregnancy one baby, scheduled c section. Again early waters broke, they tried to talk her into vaginal labour, she spent 14 hours in labour before they decided to take her into theatre.

Our health board has been in special measures for three years, so maybe pethidine and c sections are considered too expensive, but it is pretty scary having babies here these days with the cut backs.

Sharptic

Temporary loss of bowel control after delivery

This is another of those delightful things women sometimes have to go through.

It is temporary - things are getting back to normal after being stretched and a melon a baby's head emerging via the pelvic musculature.

If it persists, see your doctor.

Can I just say the twins born at 31 weeks spent 6 weeks in SCBU who were absolutely fantastic. The care all the prem babies got in that unit was superb. As a visitor I saw babies who were too tiny to seem real, they all went home.

@TwittleBee

Unconsented Sweep

No procedure of this nature should ever be undertaken without your consent. It is an intimate thing in any case. This is one of the things that you can discuss at your....

Birth Reflection

Another term for a debrief. The midwife has your notes and can explain everything that happened to you, slowly and in detail. You can tell her the things that you thought didn't go as well as you'd hoped. You can definitely discuss the unconsented sweep. You'll get an explanation about all the things that went on. Make notes in advance so that you have your questions ready.

Possible pre-term labour this time

Well, I had two labours at 42 and 43 weeks and one at 35 weeks. My other baby was also born at 35 weeks but I wasn't in labour when I had her (non-labour CS for abruption.)

Having said that, you may well go into labour slightly early again, but as long as you're 37 weeks you can have your home birth.

I've just finished reading Hard Pushed by Leah Hazzard. Have you read it? What do you/your colleagues think of her stories about midwifery?

@LonnyVonnyWilsonFrickett

Cord Vessels

The normal cord contains two arteries and a vein.

What your midwife meant was this - after delivery, midwives have to check the placenta and membranes very carefully. Sometimes there is a small accessory lobe leading off from the main body of the placenta. This is completely normal. It just happens sometimes.

There will be a blood vessel leading from the main placenta to the much smaller piece. This can be seen in the membranes and what your midwife meant was that this vessel was right beside where the membranes broke by themselves. If that vessel had been punctured there would have been blood loss.

She didn't mean that your baby's cord had three arteries in it. That would be considered extremely abnormal and I have never seen such a cord. When a cord hasn't got the expected vessels it is usually associated with birth defects in the baby.

So nothing to worry about. You misunderstood, that's all.