I'm a midwife, ask me anything

[MidwifeAMA]

Midwife of 20 years, currently specialising in home birth.
Ask me anything :)

Could be back to back position or baby rotating round which gives terrible backache.
Pain relief could be pethidine which comes with an anti sickness injection too.

Thank you - can you elaborate on why it would be a big deal? It has literally only been diagnosed in the last couple of weeks so its all very new to us.

Also do you think that it might have been caused by something I did in pregnancy as I understand that it is a developmental problem rather than genetic. My DDs have been telling me (nicely) that I am basically rubbish at growing babies as the younger one had spina bifida occulta.

The main problem I had in both pregancies was that I was almost constantly sick but as I was a bit overweight no one thought this was a problem (sadly including me as I found that being pregnant was the best diet I have ever been on).

It's like having your uterus split into two down the middle, so it affects the size and shape and function of the uterus. It's associated with higher number of pregnancy losses as it can affect where the baby implants. There's less space in each half so a preterm birth becomes more likely. It's quite rare and quite complex.

Absolutely nothing to do with you in pregnancy, most likely a total developmental fluke.

Thank you

I have a few questions if that's ok

1. why does maternity care vary so much in different hospitals, e.g. why do some women get reassurance scans after 1 previous miscarriage and others don't and why is the criteria for getting anti sickness meds not the same everywhere?

2. is it common for Labour to slow down when a woman starts on the induction drip? Or is it just me? I've often wondered if it was the stress and I just can't labour without peace and quiet and I should have gone straight for a c-section.

3. Why do some midwife led units have nicer facilities than the Labour ward at the same hospital?

4. with more detailed scans and more accurate antenatal testing are you seeing less babies born with disabilities/health conditions? Are terminations for medical reasons on the increase? Do you get many babies born where the parents already know their baby has a medical condition/disability?

Thank you, that's good to know. I know I can make choices, but my understanding is while I can refuse any treatment, I can't demand anything either? So I could refuse a section, but I can't demand an induction? I've never smoked, no one seems to know why my babies were both so small.

Was after a bit more than that, how long would you wait before you transferred? How would you manage the incorrectly assumed retained placenta etc.

“Was after a bit more than that, how long would you wait before you transferred? How would you manage the incorrectly assumed retained placenta etc.”
if physiological third stage of labour we are anticipating a placenta by 60 mins post birth, but in reality they rarely take that long if managed well. Approaching 60 mins we would be suggesting using uterotonic drugs to actively manage the third stage.
if active management third stage from birth we would expect placenta to deliver by 30 mins post birth.
Depending on journey time we would be initiating transfer to leave address around these times if not actively bleeding. If excess blood loss we treat that and move rapidly.
On arrival at hospital the doctors would review and if not deliverable would go to theatre for management if retained placenta so they can aim to essentially scoop the placenta off the wall of the uterus whilst in a place where blood loss can be safely managed.
An accreta would be diagnosed at this point and potentially a hysterectomy would be required.
The RCOG will likely have a patient info leaflet if you google for more info.

“Thank you, that's good to know. I know I can make choices, but my understanding is while I can refuse any treatment, I can't demand anything either? So I could refuse a section, but I can't demand an induction? I've never smoked, no one seems to know why my babies were both so small.”
you should be able to discuss options and if you’re happy with pros and cons then opting for induction should be fine.

1. we should be all be loosely following the NICE guidelines with possibly done adaptation to suit local populations needs. You do find she units are more strongly governed by the preferences of their consultant obstetricians who may override the national guidance. It’s also down to local trusts where to put money and some of them have much less of it so they decide what to fund and what not to to some degree.

2. usually they start the drip to speed labour up. It’s possibly that early on when the drip starts it’s a really low dose which doesn’t make much difference but you’ve probably been laid on a bed in a clinical space and this affects labour. Laying down means you don’t have gravity pushing baby down onto the cervix which can reduced the oxytocin and effect the contractions. Also a clinical space, lots of people, bright lights etc will give adrenaline which knocks off your oxytocin so can slow contractions.

3. usually midwife units have been built later than the main unit and the ethos is around ‘home from home’ environment up funds are spent on comforts/lighting etc. however we should be pushing for these on labour wards also as they will benefit all women.

4. still lots of babies born with medical conditions or little anomalies as scans only see so much. I think we are generally more healthy, well nourished, aware of folic acid, dangers of smoking/drinking etc so babies will have less abnormalities related to these things. There are pregnancies ended for medical issues- I don’t think this is particularly increased.
   There are several conditions that parents know about prior to birth, some genetic conditions found in early screening, some conditions found on scan such as heart/kidney issues.

Feel free not to answer- this is just a casual question out of curiosity- but I'm wondering what is one thing that you would want everyone to know about being a midwife that they don't realise?

Probably how much above and beyond everyone goes. Working over lunch every day, working late all the time, missing Christmas Day with the kids, missing sports day and world book day and all that stuff. And that we do it because 99% of us really care about the experience you get, but despite all that sometimes you'll still feel like the care is shit because the system we work in is at times impossible. For example- a midwife has twice as many patients as a nurse on the postnatal ward as the babies aren't counted as patients even though they often need a lot of care. When someone goes off on Mat leave they often aren't replaced, they stay on our numbers and we just have to be magicians.

Thanks for replying. Like I said it’s been niggling at me for years. All I could think of was they’d have had to break my pelvis. But like you say it must be a very rare scenario and I wonder if the crash call was put out more for baby in preparation of them potentially needing some support.

my prem baby who’s waters went at 26 weeks was much less stressful than my first getting stuck!

I think you’re right, most likely anticipating baby might come out a bit shocked and need the neonatal team in hand. Plus it’s always good practice to call for someone senior if there’s a whiff of trouble, just in case another pair of experienced hands are needed.

Thank you so much!

I had my eldest nearly 21 years ago but I still think about her birth a lot.
I was over 41 weeks and went for induction - took 3 goes of gel and I went from nothing to needing gas and air really quickly. Had examination at one point and the Dr said that her head wasn’t in right place on cervix - by this time there was no way I could get up to help her passage as was in so much pain I thought I’d pass out and wasn’t even 3cm - only got to about 5cm w an epidural in the end, by the morning they said it’d have to be a CS, which I really didn’t want but needs must. Midwife told me that she’d never come out naturally so I had CS and it was all horrible!!
My question is they said dd was back to back hence the head being in’wrong’ position but I have heard you can still give birth vaginally like this. I’m just wondering if it was picked up at early stage of Labour, was a CS inevitable?
i went in to have an elective CS w DS which was a much more positive experience- I had booked in but he had some issues which meant he would’ve been CS anyway!

Who decides which midwives end up delivering babies vs being on post natal wards looking after new mums and babies? I (and most of my friends) all had great and very empathetic care from midwives while giving birth and awful awful care on post natal wards, with lots encountering midwives on post natal that were lacking in empathy ranging from brisk to actively cruel, verging on sadistic.

It’s made a few of us speculate that hospitals are putting the better midwives in Labour wards and birthing centres and the worse ones on post natal.

After a cervical smear my daughter had to have a Lletz procedure as she had CIN 2. She was told that because part of her cervix was taken away she might need to have a stitch inserted into her cervix when she is pregnant. Do you have any knowledge about this or know anything about it?

Also, she does a lot of running will that affect her ability to carry the baby safely with a reduce cervix or should she reduce it?

Seeing as this is AMA, here goes. Have you overheard inappropriate comments from staff if a woman has (intact) all the pubic hair that nature intended she should have?

Actually I'm ashamed to have asked that. Please don't answer! If there are ever comments made then I hope they are given the full force of a midwife's wrath.

Can I ask what happens if you had a previous high risk bad pregnancy?

I cant register with midwife till 10 weeks... but already ill 😅

I had severe migraines, hyperemesis, preclampsia and had very premature baby last time. What will happen this time around? I was hoping I'd dodge another awful one but already ill, I have become pregnant very quickly so worried that will be an issue too.. also I didn't develop stroke like migraines till 16 weeks.. but they've started last night and I'm only 5 weeks 😭

Hi not sure if this post is still going but I just wanted to ask.am I being ott after having my bloods done for a test wich was for toxoplasmosis in a private clinic and during the testing I noticed the phlebotomist had taken the fabric torniquet and put it over my wound are where the needle had gone in and then had taken it off and put a plaster on. Is this a cause for worry for cross contamination of a possible blood bourne infection say if the torniquet was used on a patient the same way before or am I being overly ott many thanks