Midwife AMA

[MidwifeMidwife]

I'm a midwife with 20 years experience.
I currently provide NHS home birth care.

AMA

Personally? Load of shit and I'd decline.

Professionally, you'd have to look at the slight increase in stillbirth seen for women over 40 and decide how you felt about that versus the increased risks associated with IOL.

Sorry this a depressing one but how often do you assist with late miscarriages/stillbirths and do you find them difficult to deal with? The care I had on the labour ward before and while I delivered my baby was amazing but then I had to go back in a few days later because of pain and blood clots and the doctor and the midwife i saw then seemed nervous and completely unsure how to deal with me (I was not surprisingly very upset). I don’t know why there was such a difference between the two experiences. Do midwives normally have any say about whether they’re assigned to women going through it?

Jesus. Jesus.

is this the sort of thing women worry about now?

Jesus. What a number has been done on women.

If a baby had been pushed so far down the birth canal (and pulled with forceps) that when a section was done the baby was stuck and couldn’t be freed, what would the next step be?

I'm not worried about it! Just curious based on the opinions of people I know.

@stonedaisy My son has 2 right at the bottom of his spine!

How prolific (in your experience) are the appalling behaviours and attitudes detailed in the Ockenden report?

I had my first baby via induction due to the fact I had IVF to conceive him. I was induced at 40+1. It was fairly quick with Pessary in at 10am 3 in 10 contractions by 2am and he was born at 6.30am. I tore badly 3c and needed surgery after pph too. Could the tear be linked to the induction or was it just 'bad luck'? I did everything I could to be in the optimal position for birthing him (I was hands and knees in the end) I have always wondered if the two were linked. I didn't have an epidural. I had two paracetamol and some gas and air. By the time it was too much it was too late and I was delivering him.

Second baby I delivered via ELCS as the tear left me with a double prolapse and I couldn't go through that again. The section was incredible really and very 'healing' for me.

My midwives in both births were incredible and I'm so grateful for what they did to keep me and my babies safe.

What do you think of surrogacy? Could you / have you ever taken a baby from the birth mother and placed the baby in the arms of someone else?

Absolutely the option is there.
There are pros and cons, you will be recommended to have baby at hospital due to the risk of the scar opening up, but having considered the risks and benefits the choice is ultimately yours.

Thank you for doing this.

If this is too specific, I appreciate if you can't answer but your insights if nothing else would be a great help!

Docs for 1st baby pushed me towards IoL at 39wks for "big" baby, no complications. Midwife talked me out of it (referring to the NICE guidelines, which I was in agreement with!) New plan was wait until 40wks.

Waters went spontaneously at 39+4, no progression in the 24hrs so they brought me in for drip induction (nothing else could be offered due to infection risk apparently?) 30hours later, failure to progress past 4cms, ?fetal distress which prompted EMCS, followed by PPH which they felt was in part due to the long induction.

Currently 35wks with 2nd, going "big" again without complications and docs again pushing for 39wk induction over a planned section.

I'd rather take my choices with an elective section this time at ~40wk if I don't go spontaneously. I REALLY don't want the drip again and would rather an elective over another emergency.

In your professional opinion, do I sound rational or why are the docs disagreeing with me?

I don't have a community midwife as under consultant care so haven't been able to get anyone else's advice this time but I really valued the midwifes opinion the first time as I clearly wasn't ready to go.

Also baby came out under 8lbs so baby wasn't so big after all!

Thank you!!

Thank you 🙂 I suspected that might be the response I got! And thank you for what you do under very challenging circumstances.

After my first birth my community midwife told me "Well that's because you had an epidural" in quite a judgemental tone when I told her I'd had forceps and tearing. In hospital after 2 days in labour with a back to back baby who was stuck the a lovely hospital midwife recommended the epidural to give me a break as I was exhausted after being left for 12 hrs on the antenatal ward. Do midwives judge women who have epidurals? Is it seen as weak?

I also internalised every time a less nice hospital midwife told me off for having keytones in my urine (was feeling too sick to eat) and that no I couldn't have any pain relief because my contractions weren't productive and therefore felt that somehow the productivity of my contractions was my fault. Do midwives blame women for slow labour? If so why don't they give better advice on how to speed it up. In ny experience you just get left in a room to get on with it until the actual active birth bit.

You advocate home birth but I have a disabled sibling due to a complicated birth so I was afraid of a home birth. Also with my large back to back baby would being at home have made any difference to my outcomes?

I wish I could go back and send a thank you card to the midwife who came to my home birth.
It was a tough time, I always wanted to enquire at the hospital who the lady who cared for me was so I could thank her, but I never managed to do it.
She was fabulous, so considerate and made me feel like I was a partner in the process, unlike the hospital birth is previously had where I was treated like a piece of meat.
Can I thank you in her stead and just say that any midwife who assists a birth and manages to make the mum feel heard regardless of what process the birth goes through in the end is doing incredible work. 💐

What's the biggest baby you have ever delivered? And what type of birth did the mother have?

Generally that's advice for early labour, if the surges are not very close together and you're looking for comfort measures.
Most often if it's a first labour there is quite a period of time where the body gets ready and so bath and comfort measures are common advice.
It's not a one size fits all though, and it's a little bit of guess work too, trying to judge over the phone based on what you're describing. Sometimes things don't go as expected.

A lot do, it's just anatomy- you have no choice and the worse thing you can do is to try to suck it in. It's really not a big deal and not something we should worry and or be ashamed about.

The induction rate is high, around 40-50% nationally.
Sometimes with good reason, sometimes with questionable reasons, sometimes with rubbish reasons.
The national guidance is now to offer sweeps from 39 weeks for all, so that's been brought forward. And to offer induction at 41 weeks for being overdue rather than at or nearer 42 weeks. Sara Wickham book "in your own time" is a valuable read.

No, I'm an atheist so they wouldn't want me!

I'm 44, have a bicornuate (heart shaped) uterus and so under a consultant. We agreed at my last appointment I'd be induced at around 39 weeks. Does this seem a good idea (he briefly mentioned my baby could be breech due to uterus shape) and would you say the people induced early end up having an ECS as the body just isn't ready yet and doesn't end up responding so have more issues?

Personally not because I generally work outside the hospital.
Care for women experiencing loss is usually on the delivery unit, so there will be midwives there who are more experienced with this. Most hospitals will also have specialist bereavement services so you may see a specialist midwife during your day. Possibly when you came back in you saw midwives from a different service who were just a little bit less familiar with caring for women having a loss.

Sorry for your loss

I had a precipitous labour due to overstimulation with induction pessary. Baby born minutes after pessary was removed. I was told by a midwife that this means I'm likely to have another precipitous labour next time even without an induction. Is this true?

I have 2 children, 1st birth textbook

2nd I feel was Iver medicalised I wanted a home birth, but was told I couldn't have one. First my placenta was covering the os, then it moved, then had excess water that was fine a few months on they think it was baby's position on the scan dates, the baby was measuring small, (even though my first was born small) I was on the ward being monitored 3 times a week for the last 4 weeks of my pregnancy!

I was gutted I didn't get a home birth and eventually settled on being in the pool on the ward. Then a few weeks before my due date I got covid, there was an issue with my placenta and cord and baby was suffering, I ended up being induced. It was a horrible experience, and even though I said I didn't want to birth on the bed again, and really wanted to be in the pool I ended up birthing on the bed strapped to the monitor because of an issue with baby heat rate. Baby needed resuscitation when born (they think it was shock as I birth fast!)

We are thinking about baby number 3, and I would want a home birth. Would my 2nd labour stop that from happening? And do you have any good info I can signpost dh to as he is nervous about home birth given all the complications we had with dc2.

Thank you 😊

This is something that is exceptional, I've never heard of it in my 20 years as a midwife. Years ago the doctors routinely used a different kind of forceps which was for a higher head whereas these days they will only attempt forceps if the babies head is lower in the pelvis and more likely to come through. They also will do a scan to check the position of the baby before they start so they can more thoroughly assess how things are likely to go.
I guess worst case scenario if the baby won't go up or down would be to surgically cut through the front of the pelvis but this is something you really only hear about in Third World countries not something that is done almost ever in the UK I don't think.

I've worked in three hospitals and haven't experienced anything like that but I'm certainly not blind enough to think that it doesn't happen, I've obviously been lucky. My experience of the three hospitals I've worked in have been staff that work well for the benefit of women, where safety is prioritised and where processes are transparent.