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.

@PIckletickled

Arsehole Birthing Partners

Oh yes. I have come across a few. What you overheard shouldn't have happened. Unacceptable.

My colleague went to a home birth once. The couple had decided (together) that the woman didn't want pain relief, no matter what.

No problem. Or so you would think. When women who have never had a baby say this, I always tell them that if they want to do without pain relief I will do everything possible to facilitate this. And I do, I really do. If it's just a case of getting through transition (when all women go batshit briefly) then it's easy. If they're having a long, hard labour (especially with an OP position) it can be hard to achieve.

Anyway - my colleague - let's call her Clare - went to this home birth. The woman got to the point where she said she couldn't manage without pain relief (this does often happen, needless to say) and Clare and the DH (let's call him Wanker Mike) talked the woman through hours of contractions. It was a feelgood situation. Massage, homeopathy, essential oils, constant encouragement of the labouring woman (let's call her Joanna).

Joanna got to six cm dilatation and was screaming the place down showing signs of distress. Mike and Clare carried on talking her through. She was doing well. Mike kept saying, "Joanna, we talked about this, and you didn't want any pain relief, and you told me not to let you have any."

He repeated this for many more contractions, and many hours, and the sun went down and the moon came out and still the labour continued, normally, relentlessly, wonderfully, painfully.

Joanna I'm going to die. I can't take any more. Give me something for this...…..

Clare You're doing well. I'll examine you in a minute and we'll see how much longer it's likely to be. Then we'll talk about it, okay?

Mike Jo, we talked about this. You said you didn't want anything for the pain, so I'm not going to let you have anything.

Clare Okay, let me examine you...…..wow, nine centimetres. Nearly there...………

Joanna How much fucking longer! HOW MUCH FUCKING LONGER IS THIS GOING TO TAKE I'VE HAD E-FUCKING-NOUGH OKAY AND YOU CAN FUCK OFF TOO MIKE I HATE YOU I FUCKING HATE YOU!

……...Two minutes later...….

Joanna I want to push I want to push I want to push It's coming It's coming fucking help me Jesus Christ I'm going to die!!

Mike Jo, you can push now.

Clare Not quite yet, but soon. Nearly there, Jo. Nearly there.

……..fifteen minutes later...…..

Joanna Can I push Can I push Can I push and if I can't GIVE ME SOMETHING FOR THE PAIN

Mike Jo, we talked about this and you said that if you asked for something for the pain I wasn't to let you have anything. No matter what.

Clare Jo, if you want some gas and air...…

Mike She doesn't want any!

Joanna Yes I do Yes I do Oh I'm pushing What shall I do Can I push Help me!!!

Clare I can see the head!

…….fast forward forty five minutes...….

Clare It's a boy!

…….an hour later.....

Clare Okay, Jo. I'm going to put a couple of stitches in now. First, I'm going to give you some local anaesthetic and...…

Mike She doesn't want anything for pain! We agreed!

Joanna I do! I don't want to be stitched without local! Fucksake!

Mike You told me that if you asked for pain relief not to let you have any, Jo.

Clare Okay, Mike. Let's put it this way. I'll make an incision in the end of your cock and then offer to stitch it up. Do you think you'd prefer to have that done WITH or WITHOUT local anaesthetic?

(She had the local.)

Why do some midwives allow the placenta to come out naturally and others literally yank it out?

@Jemima232 Do you mind if I PM you and ask you a question instead of posting on here?

@incogneto

Of course.

To anyone STILL waiting - I will answer you all as soon as possible. I will go back through the thread because I know there are a lot of questions unanswered.

@gluteustothemaximus

Delivery of the placenta

There are different methods of delivering the placenta. Some midwives prefer one way above another.

It also depends on whether or not the woman has had syntometrine (the injection which speeds up the third stage and treats and prevents haemorrhage.)

It should never be "yanked out."

The third stage of labour is where the midwife really needs to know what she's doing, and the mother is in the most peril if things go wrong.

The late Jennifer Worth (author of the Call the Midwife series) once said that anyone could deliver a baby on a bus, but would they know how to deliver the placenta? (In reference to the occasional stories you read where drivers on buses deliver women who have gone into labour and delivered rapidly on board the 329 night bus to Palmers Green.)

@Jemima232 sent you pm

Thank you Jemima. My first 2 children the placenta I birthed after the injection. 3rd birth (after reading horror stories about placenta being pulled out ) I asked midwife what she does and she said she pulled it out. I was horrified. Felt like I couldn't say no. When the time came she pulled/yanked really hard and then I pushed harder than when giving birth! Just so it wouldn't break.

Read the following week about a mum in our local hospital who died from placenta being pulled out and it broke leading to haemorrhage

What's it like working on a busy unit where you don't have time to deliver the service you actually want to?

@Angharad07

Dehydration and kidney function.

What you describe isn't normal, no. If you were in severe pain and were vomiting constantly, the midwives on the ward ought really to have noticed, and taken more steps to relieve your pain and vomiting.

This is another post in which women describe being left on their own in labour, with no real care until they reach labour ward.

It shouldn't happen, despite the workload most units face.

@Gingertom11

Home Birth This Time?

I would say that they were right to be wary of supporting your desire to have a home birth last time because of the risk of haemorrhage due to your having had Fragmin.

This time, I can see no reason (from what you've said) for you to have a home birth this time round. Are you going to?

@PassTheCherryCoke

MLU this time after previous PPH

I would rock up to the MLU despite the consultant's non-committal attitude, as that is where you're booked to be.

Some consultants are not keen on MLUs for any reason so maybe that's why you're getting this vibe from her/him.

@PassTheCherryCoke

Gas and Air?

It's a very good painkiller indeed. Yes, you get and "off your face" sensation but many years ago (and I mean before epidurals were commonplace) it was used throughout labour. Nowadays there are quite a few midwives who think it should be reserved for late labour.

The advantages are that it doesn't cause the baby's respiratory system to be depressed (as pethidine/morphine do) and you don't have the knock-on effects of an epidural to contend with.

Thanks so much jemima! I will check today what I need to do to be “booked in” to MLU as far as I know it’s an informal agreement based on nothing changing and I am still under consultant care so we shall see!

@FlopsyandFlim

Labour without VEs

and

Suppositories to stop pooing in labour

*To take the first point - an experienced midwife can tell where you've got to in labour without doing a VE, by your demeanour, how you're moving around and by the kinds of noises you're making. It isn't usual practice not to perform them but if you don't want any, discuss this with your midwife in the ante-natal period.

Sometimes a VE is essential (to insert Propess, for example, or to discover the position of the baby's head when a posterior position is suspected, to give just two examples.)

and

Years ago, enemas were standard in labour. Given that almost all women get diarrhoea as labour commences, and that it is a horribly intrusive and embarrassing procedure for women in labour, they were gradually phased out. See below if interested:

www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000330.pub4/abstract

I suggested the use of a suppository as it empties the bowels once and effectively when constipation exists.

@PassTheCherryCoke

Nobody can make you have either consultant-led care (or the MLU, either) any more than they can refuse a home birth.

It's your choice as a pregnant woman, to have the care and place of delivery you would like.

It was all a scam @Jemima232

Contractions every 5 mins yesterday lasting 1-2 mins and getting more painful, then stopped!! Had a cmw appointment though and she said the baby is ROP so this may be why it's stop/start. Aww well, who wants to be in labour anyway

Not sure if this has been asked as haven't read the whole thread but I had shoulder dystocia in my last pregnancy. What are the real risks associated with this and does this increase the likelihood of having it in a future pregnancy? Would having that happen previously exclude me from a midwife-led birthing unit in future?

@TheNameIsWeasley

Lame, as my DC would say.

A scam, eh? That's a good way of describing those days and days of contractions which never seem to lead anywhere.

If your baby is posterior, as you say, you may find yourself being scammed quite a bit more as the days go on.

Very disappointing for you. I am looking out for your updates and wishing you well.

@NicoAndTheNiners

Midwives as Mothers?

I think what I meant was that midwives who are mothers generally understand the impact having children has on the women in their care, not that midwives who are mothers should stop using evidence-based practice, because of course we should.
Perhaps I worded it badly.

Sorry if this has already been asked, but what age is the youngest girl you have seen give birth?
When I went into labour, there was a 14 year old girl there. She looked like a baby herself, it was horrible to see 😔

@Ihatemyjobsomuch

Previous PPHs

I wouldn't necessarily say that you'd be crazy to consider having a third baby, given your history of severe PPHs with your first two DC, but the likelihood of your having another PPH is high, so make sure (as I'm sure you would) that the staff know about this.

You would definitely be wise to choose (and it would be strongly advised) consultant-led care.

(See previous answer and link regarding PPH, btw.)

Is it common for women to say they don’t remember much about the labour? I had pethidine (but about 5 hours before baby arrived) and gas and air and I had hardly any idea what was going on. When my husband was telling me afterwards about what was discussed re the forceps etc I didn’t even remember those people being in the room let alone the conversation.

Is that haziness likely to have been gas and air, perhidine or is it just what tends to happen?!

Also I’ve been left with a stage 2 cystocele which causes me difficulties (caused during birth, not pregnancy, was fine during the pregnancy) - is a second vaginal birth likely to make that worse?

@NicoAndTheNiners

Previous Shoulder Dystocia

Given that subsequent babies tend to be bigger than their predecessors, and that CS is often recommended for more spurious reasons, I would recommend anyone who has had a shoulder dystocia in the past to opt for a CS in the future.

I agree that there could be factors which contributed to it.

I had a patient who had had three previous stillborn babies in Bangladesh, and she didn't know what the cause had been. She was booked for her fourth pregnancy with us.

When she had her baby there was shoulder dystocia. The baby did well, however, and she became pregnant again.

I delivered this fifth baby. The shoulder dystocia was severe this time and her baby was (eventually) born with a fracture, had low apgars and needed prolonged resuscitative efforts. It was a significantly bigger baby than the fourth.

She became pregnant for a sixth time. I booked her. As soon as I saw her notes I remembered her. I referred her for consultant-led care and wrote all over the notes in red ink, that I thought a CS would be appropriate.

Fast-forward a few months, and I got her as a post-natal patient.

She'd been allowed to deliver vaginally after a very difficult delivery with another shoulder dystocia, the baby was stillborn.

I really think that this was preventable.

@CuppyCups

Your scan picture

I'm hopeless with these. Ask the doctor or sonographer when you have your next scan, or your own midwife, who may be better at interpreting them than I.