I'm a midwife, ask me anything

[MidwifeAMA]

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

Can you explain this to me please, my first labour I was told baby was back to back and pain was all in my back/bum area. I got to 4cm and felt overwhelming urge to push but was told not to and that I could damage my cervix if I did. Labour went on for hours after with me fighting the urge to push the whole time and baby was born the right way around but 8 hrs later (I had an epidural to help but still felt the urge to push and crazy amounts of pressure) I was exhausted.

with baby 2 I was in a birth centre and was checked and told I was 4 cm again, then felt the urge to push and midwife said to go with it and baby was out in 30 mins.

why couldn’t I go with my body the first time? Did I slow my own labour down by listening?

What's your personal opinion on pain relief? Do you think people should try without first off? Would you encourage people they can do it without?

Sometimes when the baby is in a funny position like back to back you get an urge to push before the cervix is pulled up because the big chunky bit of babies head is near your bum rather than at the front. Some people think that pushing on a not quite open cervix will cause it to swell but I think that's outdated.
If you were feeling pushy because they baby was ready to come you wouldn't have been able to suck him in for 8 more hours though so probably it was related to him rotating round in your pelvis to get in the right position to come out.
With a first baby your cervix tends to open in a bit more of a steady way, with Second and subsequent babies it can go from not a lot to baby in arms super fast. Everything's a bit stretchier when it's done it before.

I think women need to feel safe and some women want an epidural from the start and that's totally ok, I have no agenda and support choice. If you're aiming for a home birth you're generally aiming to not use pharmacological pain relief, so there's always a bit of labour where you need some support powering through- it's about finding that balance.

I had a horror show of a Labour ending in a c section. It was an induction and all went haywire after they broke my waters, absolutely no break between contractions for around 5 hours. I was offered no pain relief and was completely out of it. They checked me and I was still 6cm at which point I begged for an epidural. They then put me on the drip and noticed 2 hours later that they had missed my vein and I hadn't been getting the pitocin at all! At this point I demanded a section as I had been in Labour for nearly 48 hours with no sleep.

It was only when the surgeon came down that they told me that baby was back to back and on no planet would be coming out vaginally that they then bumped me to the top of the queue as an emergency.

Do you feel that should have been dealt with differently? It was a frightening situation

That sounds really stressful.
The drip starts at a dose of 1ml and hour so it would be actually quite easy for it not to be going in for a while without noticing as it's such a tiny amount, I'd say that was bad luck.
WRT to baby's position, if you didn't make it as far as the pushing stage then I don't think they can say for sure that your baby wasn't coming out, a lot changes in the second stage, babies rotate. Sometimes they get wedged if you're unlucky, sometimes epidural/lack of mobility contributes to a naff position and makes it more likely baby will struggle to get out.
It's hard to say what could be done with hindsight, see if your trust have a birth reflections service so you can look through your notes with a midwife x

Whenever I see anyone on TV (real or fictional) giving birth the head comes out and then they're told to pant not push efc and they have to get the rest of the baby out.

That didn't happen with either of mine. I felt the urge to push and they both SHOT out, the head wasn't out first without the rest of the baby if that makes sense? With dc1 it took a few pushes but with dc2 for obvious reasons it was 2 pushes and done.

How come I never see anyone's babies just shooting out like mine did?!

Also with dc2 her head was completely round and not misshapen by the birth at all. Is that normal?

What would you recommend for a woman who wanted a homebirth for a subsequent pregnancy after a SD with first. First baby was not large, no GD but mother was induced after PROMS and kiwi cup was used. Mother feels as though the induction likely had more of a part to play in SD than anything else and doesn’t want to return to labour ward for this birth. No midwife led centres close by.

What do you think about elective Caesareans that are done purely on the basis of personal preference? Do you find it a shame that the woman is forgoing the chance to have a vaginal birth?

Thank you for answering!

What is the success rate of a VBAC after ElcS?

I had a section with ds1 20 months ago. Booked in for another c section next week but wondering if I should have made myself try for a vaginal birth.

Im worried about healing from a c section with a toddler but I’m too scared to try a natural birth!

There's tons of variation. Most people have a one contraction gap between head and body, but some babies just swizzle round and out in one big whoosh!

If you whizz out fast you don't sit in the vagina getting your head squished and trying to overlap the bones to make yourself smaller

Thanks!

Yeah that sounds like dc2. Not waiting or bending for anyone!!

If you were on your back, that closes the diameters of the pelvis and makes sd more likely. Epidural, instrumental all effect the natural passage through the pelvis. Sometimes with a 'delivered' baby the person is not patient enough and doesnt give enough time for the shoulders to rotate into position and then pulls and so they don't come.
Theres an increase in sd if you've had one before, but equally you may be able to
Mitigate risk factors from last time too. The majority of sd are easily resolved, few babies come to harm, but being at home means if you were the rare unlucky one there would be less support on hand to manage it.

I think it's personal choice. I don't have an agenda, it's neither my body or my baby.
I think it's helpful to have some time to discuss the reasoning and put in place any support that would be beneficial but ultimately if you know all the pros and cons it's your call,

It's about a 75% success rate which is about the same vaginal birth rate as first time mums generally so pretty good- I'd say often even higher. We support lots of women to have vbacs, they usually go smoothly;
Have a good think and a chat with a midwife if you're not sure. There's always time to change your mind.

Thank you for your answer and apologies if my question sounded accusatory, it wasn't at all intended! I was trying to find the right way to word it, as I was/am genuinely curious.

Some babies are just ready for the world

"Thank you for your answer and apologies if my question sounded accusatory, it wasn't at all intended! I was trying to find the right way to word it, as I was/am genuinely curious."
It's ok I didn't take it that way.
I think sometimes as a homebirth midwife people will assume that you think natural birth is the greatest or superior but although I see many benefits it's def not the right choice for everyone.

When I went into labour with my first I was having painful contractions every few minutes but on arrival at hospital I was only 3cm dilated. I stayed in due to transport issues. Within a couple of hours of arriving the contractions were pretty much continuous and very painful yet I was still only 3cm dilated. It took about 20 hours to get to 10cm. I was made to feel like I couldn't be in so much pain so early on in labour. The level of pain was frightening yet it was played down by staff. Is it unusual to have intense contractions so early on in labour. ?

What's the age of the oldest mother whose child you've delivered?

Firstly, thank you for what you do! I was so grateful to my lovely midwives, who were lovely when I was terrified.

I am clearly much just less refined than others, because I was wondering, do you ever judge women based on their genitalia / lack of intimate grooming?! I had always assumed not, till one of the school mums told us about having a full wax a few days before giving birth, and redoing her fake tan whilst in labour, which just astonished me! She assured us all that the professionals absolutely do judge / share gossip with each other afterwards. Which made me feel distinctly inadequate..

I had an induction at a week past due date, and ended up having a c section due to baby being in brow presentation after a long and exhausting induction attempt. I was having constant painful contractions but not dilating, and my waters had broken hours and hours before. When my baby was eventually delivered, he had acquired a group-b strep infection and was whisked off to SCBU. I had to have an epidural after 15 hours on the drip because I was exhausted. I couldn't bear to lie down during contractions so had been standing leaning on the bed the whole time. Is it normal to continue with an induction for so long after waters had broken with no progress really at all?

Thanks for the thread OP.

Did you train in the UK? Were you a registered nurse before training as a midwife, or went straight to midwifery? Is there a difference on the ward/clinic with those that a duel trained and those not?

How much training did you get on early MC, trisomies, TFMR and sub-fertility?

What is the oldest mother you have had for natural birth and from IVF birth?