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.

@Jemima232 thank you for such a thoughtful response to my question about induction (and silence from professionals about it). I feel like i’ve learned so much from this thread!

Sorry to ask another question (please ignore if you’re swamped). You say you would always refuse induction - do you ever see women refuse induction when they have cholestasis (as I had) in favour of waiting for natural labour? Not suggesting I would (in the unlikely event of another baby I would opt for elective section) but I would be interested to know if people ever do.

Yep @Jemima232 unfortunately. Though no more episodes since around 1pm and has had some toast and water so here's hoping she is over the worst of it! Where is the sun to dry all the washing when I need it?!

Love this thread

Honestly I'm shocked and not even a bit dramatic when I say, appalled at the amount of people saying they were only given paracetamol. It's for mild to moderate pain. I understand that some HCPs want to - rightfully - start off on the lowest analgesia and build up as there's not an awful lot available analgesia wise despite so many medical enhancements, but it's absurd to think a labouring woman could or should cope on paracetamol if she is begging for analgesia. I've worked in a lot of places and this would just not be acceptable at all and I'm so sorry for the women that experienced practitioners that think it is. All I can say is complain complain complain. It's something we don't do enough when it comes to women's issues. My god I've set PCAs up (morphine pumps) on women having miscarriages because despite it not being the norm to be in so much pain experiencing one, this woman was and we couldn't manage her pain with anything else. People are different and HCPs shouldn't be acting like gate keepers to pain relief, they don't benefit from it. It just makes the woman's experience worse as she feels she hasn't been listened to and her experience of pain has been shunned. It makes me sad and angry.

Thank you so much, Jemima. I knew something wasn’t quite right with how I was left. I requested an epidural quite early on and I think that influenced the way the staff on the induction ward perceived me (the changeover staff who hadn’t met me the day before).

I find it very hard to look back on my labour. I feel very anxious whenever I talk about it and feel as though other people just think I’m making a fuss over nothing. To me it felt like everything I didn’t want happened (forceps & c-section). So thank you for giving me some validation as I’ve felt quite stupid for the way I’ve been feeling.

Ty for the reply op!

I havent fully caught up on the thread yet so if this has been covered please ignore me!

I have been told i am high risk for PPH as this is fifth baby, i am meant to have cannula put in as soon as i arrive at hospital ready to go on a drip after birth and possibly have a transfusion.

What do i do if i do not think i am going to make it to the hospital for the birth? I saw some advice earlier about drying baby and wrapping in a towel but what do i do re myself and the risk of PPH? How long would i have before it became really dangerous?

I am due early Sept and will be home with 4 dc over the summer holidays and in fear of a quick birth at home with them around and it possibly all going badly

Should i just go to hospital as soon as i start contractions?

Dc3 and 4 both born in 5 hours, 4 was back to back

@Prequelle

Post CS Pain Relief

Some PPs have said that they were only offered paracetamol after their caesarean sections.

As a woman who has had CS x 4 I was given, in the post-operative period:

DD1 - i/m pethidine (many doses)

DS1 intrathecal diamorphine (heroine via epidural which was left in situ post-op)

DD2 i/m pethidine (two doses, then more when I complained and a doctor came to reinstate it on my drug chart after the midwives crossed it off

DS2 PCA with morphine (a drip you control yourself) followed by i/m pethidine

After all four babies, I then got co-dydramol, diclofenac (voltarol), tramadol and co-codamol 30/500 (strongest dose) to take home.

Since pain is as the patient reports it and not as the caregiver perceives it and as you're an expert on pain relief, please give us your views on the policy in some hospitals where woman have reported only being given paracetamol, and nothing to take home.

I accept that many women need far less pain relief than others.

*heroin not "heroine"

Although any woman who goes through childbirth is a heroine.

@IVEgottheDECAF

Don't worry. If you haven't got a cannula in already, and you start bleeding, putting one in is a quick procedure.

But do get to the hospital as soon as you reasonably can.

If, by any chance, you deliver accidentally at home, call 999.

Tell the paramedics that you're at risk of a PPH (even if your blood loss is normal) and they will insert a cannula. They also carry blood so you can have a transfusion if you need one.

It'll be fine.

@DeadDoorpost

When does Established Labour start

You're considered to be in established labour when you get to the end of the latent phase (that would be about 3 cm dilatation) but when a woman has a thin, fully effaced cervix and the head is well-applied to it, I would say around the 2 cm mark. It also depends on whether you've had a baby before and how often you're contracting, and how long they last.

Labour becomes faster in the active phase. You were clearly in established labour when you arrived at 9 cm and had been for some time.

If you have a history of fast labours and you're not sure, and you have anxiety, nobody will mind if you just turn up.

Plenty of women do this and nobody minds. Better to get there at all costs than risk being told to stay at home a little longer.

Thank you so much for your reply to all 3 questions Jemima and good idea about the prepared notebook of questions too etc

@jemima232 if a woman talks about possible pnd with her last baby and possibly wants to access some mental health support, would you need to trigger a refferal to Social Services?

I was told this by a midwife recently, but she made a lot of questionable statements, and I don’t know whether to believe her. I’d like some MH support but I’m scared of asking now.

Thank you x

@avocadochocolate

Baby born with chest infection

A sweep is when a midwife or doctor puts a finger into a favourable cervix (a cervix which is already slightly open) and rotates her finger round, sweeping the intact membranes away from the cervix.

This often dislodges the mucus plug and can release some prostaglandins. I have my doubts if they work - women who report labour starting were probably just about to go into labour anyway.

Since a sweep cannot introduce bacteria or viruses into the intact water bag, this did not cause your baby's chest infection.

Women's vaginas contain micro-organisms and once the waters break the baby can be exposed to them as they descend through the birth canal. This is very likely what happened to your baby.

@pitterpatterbaby

Hard Pushed by Leah Hazard

I haven't read it but I've just looked at the reviews on Amazon and I've ordered a copy.

Much better than the anodyne memoirs written by some midwives, who have jumped on the bandwagon after the success of the Jennifer Worth books (Call the Midwife.)

I shall write my own memoirs one of these days.

If I ever get to the end of this thread, that is.

Thanks Jemima all the midwives I've spoken to have seemed nice and ok about all possibilities but I guess it's the anxiety that's making me question everything.

@LauraPalmersBodybag fancy seeing you here

That sounds like absolute shite and I would complain. Obviously going to defer to Jemima here but I had access to the perinatal MH team and SS were never mentioned.

@AgentCooper

Refusing Induction when you have Cholestasis

No, I have never encountered a woman who has declined induction for this reason.

When I said I would always refuse to be induced, I meant for myself, if I was overdue (and twice, I was, and had CTGs to ensure that my babies were all right. I did go into labour with both of them, although I ended up with CS anyway.

If a baby or the mother is at risk in any way, and CS is not offered or necessary, induction would be a good idea. Even though inductions give you a higher chance of having a CS it's worth giving it a try (unless you really want a CS.) Some women do prefer to have a CS and that choice should be respected.

www.nhs.uk/conditions/pregnancy-and-baby/itching-obstetric-cholestasis-pregnant/

Ty op

@LauraPalmersBodybag

Asking for Mental Health Support

When a woman requests this, it is not an automatic Social Services referral at all.

It would depend entirely on the personal circumstances confided to the midwife.

As you're worried about the nature of the questions your midwife asked you, you can ask to be allocated another one.

I hope this will not deter you from seeking help. Your Health Visitor is also a resource you can use to get yourself help with PND, even prior to the baby's arrival.

Thank you so much, OP!

Ok this is probably hypothetical as you weren't there but you'll know if biological possibilities!

My ds was head down at 37 week scan. Gynae thought I'd have him a bout a week later and said "see you next week I think 😉" when I left that appointment.

Had false contractions on and off for a few weeks and at 40+6 passed the plug and contractions were every 3-7 minutes. Told to come in following day to have waters broken. Contractions all night and the bearing down pain in lower back. Waters broke at 7.30am in way to hospital. On labour ward (abroad and they don't let you get up and they don't do pain relief).

A few hours later i said I wanted to push. They said I didn't as was still only 1cm half hour earlier and on checking was still only 1cm. I was adamant!
They let my stomach and I'm sure they said something about ds being high up and started pushing down on my upper stomach. They then looked at the monitor of my contractions and his HR and I was taken for EMCS.

I've never been so grateful to have an epidural in my life!

However I was contracting and they seemed to be trying to time it right. They then said I had to lay flat for 24 hours afterwards.

I do fully understand you don't know what happened but have you any ideas? Is it possible ds breached himself mid labour?

Thank you for answering my previous question!

I also still have a lot of pain just inside my vagina near my episiotomy. It’s swollen and sore. Doc says nerve damage. My baby is already one, is there any hope it might still get better or will I now be in pain for life?

This induction thing. Because I was with my third an elderly mother a la Cherie Blair my consultant said, he wanted me to be induced at 37 weeks, risk of placenta failing.

Well I went in at 37 weeks, for two days they tried inducing me it was painful, I needed gas and air for the inspections. On the third day I woke up got dressed phoned my OH and said come and get me this baby is not cooked yet. The staff were concerned and wanted me to wait for the on duty doctor. I didn`t. I wanted to be at home for my sons speech day leaving school event. I went to the event, went into labour on my due date, easiest labour birth of all. The midwife examined my placenta showed it to OH and said it was a magnificent specimen

I think being older and it being my third baby I was more assertive with the hospital staff.

Youarenotkiddingme

What might have happened

Well, that's an interesting story.

Whatever the cause, you had an obstructed labour of some kind. Days of strong contractions + waters having broken early in labour + cervical dilatation not progressing generally equals a malpresntation

I wonder if your DS was really head down at 37 weeks. A breech presentation can be mistaken for a head presentation. The examiner thinks s/he is feeling the shoulders but in fact it's the breech.

Alternatively, let's say that DS was head down at 37 weeks. It was about a month later that you went into labour.

Did the baby turn around in that time? Possibly. Did you have an unstable lie (where the baby assumes different positions and lies obliquely or transversely inside you, and keeps changing)

Women with an unstable lie have usually had several babies before, though.

So maybe the baby was head down all the time, but was posterior. In that situation, if the mother's pelvis isn't big enough for this particular baby's head, the head can start to present by the brow, then the face.

There was enough fetal distress for them to perform a CS (eventually)

Possibly all that feeling about in your upper abdomen was them trying to feel if the head was under your ribs. If so - you had a breech presentation.

I'd love to know the truth of this. As your cervix didn't dilate you probably didn't have a head presentation.

How tall are you? What did DS weigh? Were his legs extended after the delivery (up around his ears) Is the earth flat?

I wish you could get your notes so that we can find out what happened. Mind you - the notes might not be terribly accurate.

I've got another question following your reply to someone else Jemima , sorry. You said that a sweep can't introduce bacteria as the waters aren't broken but with the unconsented sweep I mentioned, my waters were broken (that's why I was in hospital, they broke 36+5). Could this be the reason we both ended up on antibiotics and having to stay in hospital for a week? My notes state we had sepsis but no one's actually told me this in person?

NotmyPuppy

Pain one year on at episiotomy site

Ask your doctor to refer you to a gynaecologist for assessment and advice.

Some women have their episiotomies re-done. I know it sounds horrific but it may be the best option for you.

www.evidentlycochrane.net/perineal-pain-birth-help/