Midwife AMA

[MidwifeMidwife]

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

AMA

@MidwifeMidwife my last baby was born very quickly at home with no pain at all, just involuntary pushing that I tried to get behind but couldn’t catch up with! How was it possible to give birth without feeling pain? (My previous birth almost three years prior was incredibly painful).

This is top of my many reasons to not have a home birth - current ambulance wait times.

My 1st & 3rd babies had these, I'd never heard of it either, my eldest is now 13 & I've still never read/ heard anyone talk about them.

If I had really bad morning sickness in my first and only pregnancy, am I likely to experience this again if I get pregnant in the future? The nausea made me more miserable than sciatica late in my pregnancy!

Sorry to jump in, but I thought I might give some hope - my two pregnancies have been quite different sickness wise. My first I had constant nausea and food aversion throughout escept for a period of a few weeks but I had very little vomiting for that one whereas this pregnancy I've been triggered to vomiting a lot more but very little of the nausea or aversions. Last was a boy, this is a girl so it could be very different! I have much preferred this pregnancy to my first! It's went in quicker too!

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!!

The scans are so unreliable. Suggested 15% margin of error, but often seeing more.
I personally wouldn't act on a diagnosis of 'large baby' as the single risk factor. So many of them come out a normal size (like yours) and induction doesn't optimise the birth physiology which if you're having a good sized baby would be my number 1 priority.
Most likely your baby was in a not great position before labour, which increases the chance of waters breaking pre labour. The risk of infection does increase after 24 hours of broken waters but it's small numbers.
Induction means you're more likely to be stuck lying on a bed with a drip, monitor and epidural, all of which mean the physiology of your baby getting into a good position is less likely to work well which then lands you with that 'no progress' label. We don't know whether the outcome would be different if you'd been able to follow the natural course of events, the great unknown.
I think you sound very rational. The choice for elcs is 100% yours. But remember you out can also decline that induction if you'd prefer having looked at the pros and cons.
Why don't you have a community midwife? At our hospital you'd always have both and I think it helps to have more perspective and different discussions with another healthcare professional while helping you to make your choices.

Me.
Ventouse with 1 and 2
Natural birth with 3

I didn't have an epidural with 3

but

3 was my worst birth both in terms of pain and physical tearing.
I regretted it for some time afterwards
So yes - you can have ventouse twice then a natural birth - but just in case your body is like mine, I still didn't feel an "urge" to push. I'd put this down to having epidurals for the first two hence going med-free for the last. It made no difference.
I am now incontinent (was offered a mesh op but decided against which, given complications some have had, was probably a good thing).

Is 37 weeks considered full term or premature? 16 years ago it was full term, but that seems to have changed and I'm interested as to why.

Thanks for sharing! I only vomited a couple of times but I just felt so nauseous every day and went off lots of food well into the second trimester. It's an awful feeling. I have a daughter and I heard that women are usually more nauseous when they're pregnant with a girl!

Can I ask the question of a PP but in one part only - why paracetamol?! I've had two lovely ELCS for maternal choice (tokophobia), but with my last, I started having contractions 36 hrs prior to the CS date. They were and remained (thankfully) between 15 and 20 mins apart, but were immediately so incredibly painful that I couldn't breath until it passed, let alone talk. Triage didn't want to know given the time apart, but reluctantly saw me 12 hours in (where I was given a hideous internal that had me screaming and half falling out of the chair - is this normal?). Sent me home with instructions to take paracetamol. Did sweet FA. DS eventually turned after 24 hours and the pain faded to nothing. Looking back at comments from Triage, they must have known he was back to back, so why didn't they give me proper pain relief and instead left me to suffer?

No question but I admire you and wish I was brave and caring enough to become a midwife. I experienced loads of amazing midwives, in a challenging environment and kind of unusual circumstances. Big up yourself x

Have you ever came across Bandls Ring in your career?
Not that much information out there about it and would love to understand more!

Went into labour naturally at 41 and 1 - laboured all day at home, got to the hospital and was 5cm dilated, then 4 hours later was 9cm dilated! Was going so well, in the birthing pool and in the zone then the contractions started to space out. Did everything to ramp them up again, had my waters manually ruptured but no change! After many hours stuck at 9cm, I agreed to a c section. After the birth they said I had Bandls ring but didn't really explain it. Did the labour fail to progress because of Bandls Ring or did a Bandls Ring form because labour was obstructed? Apparently little ones head was not quite in the optimal position too!
Thanks 😁

My DD had one, she was prem so not sure if related or not. We were checked out by a consultant but never caused any issues.

Is epidural dangerous? Does it cause more complications? Why? How does it influence the baby's heartbeat?

I'd be interested in knowing how much training midwives have about effective pelvic floor exercises, pelvic floor dysfunction, spotting a prolapse etc. It seems midwives are in a position to make decisions that have a real impact over whether women suffer these issues after birth and to what extent, but it seems like most have very little knowledge e.g. can't diagnose a prolapse, don't know what happens at pelvic physio

Similarly I'd be interested in knowing what actual training they have about breastfeeding- initiating, overcoming challenges etc. At what point did they stop learning how to diagnose tongue tie, for example?

Hello, thank you for sharing your story. I am glad to hear of someone having no instruments third time around, but of course I'm saddened to hear of your tearing and complications. I'm so sorry you had such a bad experience and I hope you have been at least able to access some treatment and support to improve things even if a full recovery is not possible?

I have never actually had an epidural and felt the urge to push fine in both labours, just for unknown reasons couldn't manage the final stretch. I got further with DC2 than DC1 though, they were further down and had less pulls with the ventouse. I was also more mobile during labour with DC2 and spent most of the pushing in upright positions but still they eventually were getting antsy about his heartrate and obviously as a parent youre not going to risk your baby and continue for longer so ventouse again it was. I have had two episiotomies as you may expect and it does cross my mind that could have potentially had a protective effect with tearing too.

What was your reaction to the Lucy Letby trial? Were you shocked that something like that could happen?

How old were the youngest and oldest women in your care?

Firstly thank you for the work you do. This question is really outside of your remit but I’d be interested in your thoughts: What are your views on both short and long term aftercare for women following childbirth? What if anything can be done to improve this within the NHS? (Obviously my own view is that it could be better).

Thank you for all your work, I have been helped by some really wonderful midwives having my DCs.
I went to 42 weeks with both my pregnancies and never any sign of labour.
With my 1st, I was induced at 42 weeks and it was so very intense but never got past 3cm. I begged them not to increase the drip, but once they did it all went downhill and I was in stirrups for 4 hours whilst they took blood samples from baby's head. There was never any pain-free moments between contractions, just constant pain with worse waves. Ended in EMCS.
With my 2nd I held off the pressure of a 2nd c section until again at 42 weeks nothing was happening. I didn't want to experience induction again and had a smoother CS.

I had one midwive comment that I would just never go into labour naturally. I was so desperate for a natural birth and tried everything with my second. Have you seen this before?

Thank you for taking your time to answer all our questions

@MidwifeMidwife

I'm 37 weeks tomorrow with a stubborn baby who has been frank breech since 28 weeks 🙄 ECV is planned for Wednesday but if it fails I'll have to have a planned c-section which I really, really don't want.

I missed out on a water birth with my son as hospital wouldn't let us come in until my husband lied about my contractions. Arrived at 10cm after 34 hours of labour 🙄 Pushed for two hours and ended up with a 3B tear and an episiotomy but it all healed fine and you'd never know it ever happened if you looked down there.

Breech team are telling me that if the ECV fails I could have a breech vaginal birth which seems nuts to me given my tearing history.

They say intervention and tearing is no more likely with a breech vaginal birth than a normal vaginal delivery. Everything I have read suggests otherwise.

Who is right?

I was shouted at by mine, when I got up to have a shower, blood came from me.

She shouted "look, you've got blood everywhere"

I was shocked that she said that as I had just given birth and wanted to get cleaned up. Being my first I had no idea how much blood loss there would be.

Is it really that annoying to a midwife when that happens? Surely it's not unusual?!

You provide nhs home birth care, were you born at home or in a hospital?

How does postpartum care look different when comparing the healing and bonding to hospital births that you have been to?

Yeah the whole ‘let’s give women paracetamol for severe pain’ is a poor attitude from NHS staff.

I complained about this to PALS after being left in pain after my EMCS and their response was that the staff should actively be asking how much pain you’re in so they can offer you something stronger, rather than assuming the weakest form of pain relief is ok. Paracetamol didn’t even help my sore throat yesterday.

Hi op, what’s your opinion about partners staying on wards overnight to support women?

I’ve seen a lot of opinions on mumsnet that that women don’t want men staying overnight.

On the other hand, many women like myself have also expressed the trauma of not being able to rest and not getting enough help otherwise, especially if they have just had a c section.