I'm a midwife, ask me anything

[MidwifeAMA]

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

I am not a midwife but I had my first baby at home in a birth pool, for home births nationally the transfer rate for women who start off with a Homebirth that transfer into hospital is close to 50%, though lower in some areas (30%) in my trust. So I think it so safe to assume that the other first time mums who don’t transfer in have their babies at home without any interventions.

From seeing friends have babies a lot will depend on whether she goes into spontaneous labour anyway, so many women seem to be induced for one reason or another.

I'm not pregnant yet, but just starting to try and I'm a bit of an obsessive planner and over thinker!
My local hospital (8 minutes drive) has a poor reputation. I have heard many unsatisfactory birth stories from there, including one colleague who successfully pursued legal action. I myself have raised a PALS complaint about my care when I was there 2 years ago, so I'm reluctant to go back!
The next nearest hospital is 40 minutes away. Would that time delay be a stupid risk to take? Would a home birth be an option for a 36yo ftm?

I think every situation is an individual assessment. Usually we try to have a support person present all the time. It's hard to make a snap judgement on a two Minute glimpse of someone's situation.

I think it will probably just undo the cosmetic benefits of it, but I know people who have. I don't know if any terrible issue with going so, but your clinic where you had it done should be able to give you more info.

A good gap is at least 18 months between the two births, if all has healed well and your doctor didn't recommend longer x

I think I'd probs my just leave it and see if it spreads as he grows. If not the gp can refer for a second opinion when he's that bit bigger.

I had a severe PPH from an episiotomy, where I lost 2.5L of blood before the consultant managed to stitch me up to stop the bleed. I was physically sick a few times and felt like I was going to pass out, (though think I did stay conscious,) and I needed a few blood transfusions after - it took me a couple of months to fully recover.

The one thing I remember really vividly was the midwives saying I was at high risk of this happening again were I to have another baby, and it's put me off having another completely because I feel like it was touch and go.

Is this something that's really rare? I can't decide if my memory is making it seem worse than it was (I feel like I nearly died!) or if I'm being overdramatic and probably another one would be fine!!

I think we are inducing a ridiculous amount of women and putting them through a lot of unnecessary shit.
Induction absolutely saves lives, but for those who really need it- really small babies, medical conditions etc
Big babies are generally healthy well grown babies with an excellent nutrient supply.
Iol for big babies without medical concern (diabetes etc) personally I think has poor evidence to support it and actually induction means you start a cascade of interventions which actually are counterproductive to effective labour and birth.

Lots of fear of litigation, lots of fear of any kind of risk

I think birth debrief is best done with a specialist service like counselling midwives.

I feel absolutely FURIOUS when someone is induced for a big baby and has a normal
Sized baby. Our scan accuracy as a nation is poor. 10-15% margin of error is not good enough to make decisions like that.

It sounds like that chip was out there by some really crappy advice. I'm sorry this happened, it's so bloody awful

1. it was so hard. Staff with vulnerabilities or with clinically vulnerable family members had to be protected too, and no one knew what the risk was, it was like walking into an apocalypse that literally killed our colleagues. It was shit all round, for women families and staff.

2. shit culture. I don't think this happens very often at all where we are as we would challenge each other.

Huge question. It's more often environmental or what's going on than a physical inability to do it, although just occasionally there are underlying issues with hormones, receptors etc.

What you need is someone to look at all the details and throw some light on it. An hour session with an independent midwife and your notes would be a start if you have funds to do so.

Incredibly rare.

All basic and immediate resus started on site and continued during transfer, neonatal team on arrival and continued care at that point.
Likely a poor outcome if you lived far away and if she needed significant complex resus measures within those first 20-30 mins or so.

But as I say incredibly rare.
Rietsma et Al looked at 500k low risk home birthers and found no difference between outcomes of babies born at home and hospital. You will get some babies who do badly at home and some babies who do badly at hospital.

I'm glad she has had such a brilliant outcome, truly wonderful medicine

2nd births are usually so much easier than first births you wouldn't believe!!

Quicker, more straight forward, fast at the end, blinking intense, but usually mothers feel they were much more manageable. And much less likely to need any medical support. More likely to be born on the way to the hospital if you're going in.

Ask your midwife what is available to help process your previous trauma. It would be really useful to work on this now.

Look into home birth. Really look into it even if you've never thought about it before. See how you feel.

We have lots of bbas but that's because we come by car, large area, and some babies just don't wait.

Every hospital has a different service. We have a dedicated home birth team and so we do t have a suspended service, we are always on.

If it was your first baby they might have thought they had more time to get to you from the last birth as it's much less common to bba with a first baby.

It's Mother Nature at the end of the day and she. Will do as she pleases.

Freebirth needs a huge think. There will 100% be times in labour and birth where a midwife present is the difference between a brain damaged or dead baby and an alive one, as absolutely awful as that sounds it is the reality. If you choose to freebirth which is of course totally your right to do, you have to comfortably take on the power of nature and all the potentials that come with it, make peace with not knowing what your baby is doing in labour and not being able to react to it, be prepared for immediate actions you might need to do such a baby resus, managing bleeding, etc as all require you or your partner to be taking action straight away.

I'd expect to be in hospital for up to a week in total. You might have two or three days being induced (first baby and quite early so usually takes a bit more persuasion) a day on delivery suite and a day or two postnatal ward.
Take a bag then pack a 'back up' bag with two more days worth of stuff that your partner can just grab if they need

It's not usually a great choice for early labour, I wouldn't recommend it, unless you were likely to suddenly progress. There are other options that work bettter. With gas and air it's a slog to be breathing deeply on it for hours and hours and hours. Something like some Oramorph would provide some pain relief but also allow some rest in preparation for labour.

Just me and mum, a little gang of two, woman to woman in the dark on the bedroom floor. Totally empowered, totally in her space. Magical.

Haha sounds like you grow amazing healthy well grown babies. Get some bigger clothes, she will wear them eventually whatever size she is!

Fairly common to put a bit of pressure, it doesn't sound like something really exceptional or that would make me worry about the baby's wellbeing just from that information. The baby is still attached to the cord receiving oxygen at the time they are pushing her head down and getting the forceps on, so she should still be in a good condition.

Unlikely, and even if she is your body knows what to do and will spin her. Back to back is no big fuss with second babies, they just swizzle out.

"During my first induction, and during the antenatal care I had with my second I wouldn't have a bad word said about midwifery and the wider team, but staff like the ones that I had that night do no favours to the profession and I wonder if there is any appetite from within to challenge that kind of practice or is it just too complex?"

Absolutely, it's a culture within a unit if it's deemed acceptable by not challenging it. Appalling. It would be challenged in our hospital im Sure.

The antenatal ward can be so difficult, if they can't get a bed on the delivery unit the midwives are put in a really awful position where they can't give the care they want to and they are looking after lots of women at the same time so a labouring women isn't getting what she needs in that environment.

A really very good chance she will have her waterbirth.
A lot of the outcome is based on what comes before. Good education and preparation, choosing a birth place that suits what kind of birth you would like, sounds like she's putting the work in for the birth she wants.

"I am not a midwife but I had my first baby at home in a birth pool, for home births nationally the transfer rate for women who start off with a Homebirth that transfer into hospital is close to 50%, though lower in some areas (30%) in my trust. So I think it so safe to assume that the other first time mums who don’t transfer in have their babies at home without any interventions.

From seeing friends have babies a lot will depend on whether she goes into spontaneous labour anyway, so many women seem to be induced for one reason or another."

Also, our transfer rate is much much lower than this. The national rate of 45% for first time mums is based on all home births nationally in a big study called the birth place study. With a dedicated experienced home birth team you are much less likely to transfer as the midwives have confidence and skill in supporting , early identifying and optimising the birth process.

First babies usually take a while to be born, in a good natural positive way- that's the process so a 40 min drive is nothing. Lots of parts of the country you drive an hour to the nearest birth unit. Choose where looks best.

Home birth is an option for EVERYONE. There are pros and cons, particularly if you have complex pregnancy or risk factors, but the choice is always yours.

We have lots of first time mothers having home births.
Ps 36 is lovely and young!