Midwife AMA

[MidwifeMidwife]

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

AMA

My midwife spent the majority of my labour with her back to me, making notes.

Is this normal these days?

Do you feel midwives get sufficient training on supporting breastfeeding? I've had some great, but also some terrible advice on BGing from community MWs.

Sorry you've come across some unkind midwives. No one should be judging you for your choices of pain relief or how you've progressed.

There is an increased chance of forceps birth with epidural but that could be partly due to an increased use of epidural where labour is already long and tricky. Either way, using that info in anything other than a kind and constructive way is just totally unnecessary.

Being at home with good quality care supports the physiology of birth well. Whether this would be enough to have changed the course of your labours it would be impossible to say.
Some factors that could impact on that would be the impact on your hormones from travel and going to a strange environment (women often experience a slow down of contractions as a result), lack of ability to move around, feel quiet and safe, eat and drink as you like, remain upright and feel unobserved.

That's so lovely.
You could send a card and someone will be able to redirect it to her as her name will be in your notes.

4950kg/ 10lb 15oz
Home water birth.
Gorgeous chunky baby.

www.sarawickham.com/research-updates/induction-for-advanced-maternal-age/

Some good discussion above.
There is a higher than average chance of baby being breech but if it is you'd look at your plans with that in mind.
Assuming baby is head down, the induction recommendation is probably due to maternal age as generally women over 40 are recommended induction due to slight increase in stillbirth rate.
The bicornuate uterus increases chance of preterm birth. But depending on severity may not be a concern beyond that.

Best to find out exactly what the reason for the recommendation is, what's the evidence and stats, and then you can weigh it up and decide what feels right for you.

Hmmm, I'm not sure.
I'd prepare potentially to labour quite quickly but im not sure if it would be a given.

That all sounds very stressful!

All women have the right to choose where to give birth. They should have the opportunity to have a quality discussion re pros and cons of each place of birth.

It's hard to say what the recommendation would be for next time without all of the info.

What we are aiming for with homebirth is not anticipating requiring a doctor or advanced equipment.

Some things that happen in a previous labour are relevant and some aren't, often depending on if it's something which is likely to repeat and cause a problem.

Instagram has lots of good honmebirth info, and some wild stuff. Be judicious in what you read.

Sara wickham and Claire feeley are good resources.

Everything is an option.
You need a quality discussion and pros and cons then the decision is yours.
Vaginal birth after Caesarian carries some additional risks and the recommendation would be to birth in a hospital. Have a good read around the recommendations and see what you think.

Red flags for what?
I'd not be concerned about someone having a shower but I'd expect them to ask someone to keep an eye on baby.
I'd not expect them to hold baby 24/7, but I might be concerned if they aren't interacting with their baby at all.

Women very rarely scream at home birth and I think it's because you scream when you're frightened and overwhelmed and in agony.
It sounds like you were given too much to be able to manage and then didn't feel safe and cared for which is really sad.
Sometimes we would encourage you not to scream if you needed to be focused ie to help avoid tearing. But that would by helping you with breathing/coping methods/pain relief rather than just telling you to be quiet which is terribly unhelpful.

No idea.
There's so much to consider.
Some women have a really high chance of problems, some a very low chance, and then things can happen unpredictably in both groups.
I'd never suggest birthing without a midwife, as there's always a chance of a sudden situation that needs midwife intervention.
We do have lots of BBA's though, where baby comes fast before we can get there and it's uncommon for there to be problems- most are fine.

Have you ever come across a Bandls ring? Had one with my first and ended up with a classic T incision section, apparently very rare at my hospital.

We have anti sickness medication for both scenarios.
Women also report success with acupuncture/aromatherapy so that's worth a look too.

I've always wondered if my birth would have gone differently on the NHS? How would you have approached this.

I moved overseas during pregnancy. I lost all my waters in a big gush, arrived at hospital and waited overnight with nothing happening. In the morning I was told I had to have an epidural (I still don't know why but they were so insistent) and antibiotics (GBS). After that I wasn't allowed to get up from the bed but they didn't explain why. I lay around on the bed until 5pm when the OB said I needed a Caesarean because the baby wasn't doing anywhere and that was that. Afterwards they said I had been fully dilated but contractions were pushing baby sideways towards my hip.

I'm sure it's hard to know what might have happened but I still feel upset about how it all went.

’""Home birth is safe for most women’ ?? I’m afraid your advice is unprofessional and dangerous.
I had a ‘normal’ pregnancy and went to hospital once in labour. It lasted 36hrs and my daughter was finally delivered with Neville Barnes forceps. It was hell.
Four years later when I plucked up the courage to have a 2nd child she was luckily breach which meant they needed to X-ray my pelvis to see if she could be delivered vaginally. They discovered my pelvis was extremely flat ( no room for babies head to rotate properly, which explained 1st baby problems) so she was born via CS. Thank God, great experience.
Unless the NHS are going to start routinely checking for pelvis abnormalities people like me will always be safer delivering ""

The nhs don't X-ray pelvic size because it's a poor predictor of labour outcome whilst increasing CS rate, there is no evidence base to support its use.

Having a labour with lack of progress doesn't in itself make you 'unsafe' at home. We have a number of women who will transfer to hospital with a lack of progress but that doesn't mean their home birth was unsafe, just not what they eventually need. Most women who transfer in still value the time at home.

Also, in the nicest possible way, one case with an exceptional situation is not "most women".

First birth 4.1kg, shoulder dystocia and ventouse delivery.
Shoulder dystocia just 1 minute, baby’s APGAR was 9, 10, 10.

Second birth 3.9kg, no intervention, no meds, first degree tear, absolutely dream birth. I did a massive amount of research and preparation with a professional doula. Wouldn’t change a thing.

Both in hospital. The second one, it felt like it was so unnecessary to do the horrible 45 minute drive to hospital while I was transitioning.

For birth number 3, would you recommend a home birth? Or would the shoulder dystocia with baby 1 make it a no-no?

thank you

Usually the partner is present.
Occasionally they miss it as baby comes fast.
Occasionally the woman will choose mum or sister or friend as they feel they will be a better support.

Michel odent quite renowned for his birth knowledge is very anti men in birthing spaces, I saw him upset an audience full of men once but his information was very interesting. I don't think partners are always the best person to provide hands on support- it needs to be someone who can nurture and encourage and support and make you feel safe and that might not always be your partner. Home birth tends to be a couple of supporters, men often doing the practical stuff and verbal support and mum or friend wiping brow and changing pads.

They've always come really quickly and send 2 ambulances at least. I'm very reassured by our local services.

No, I'm gender critical.

I will of course be professional and use inclusive language and be respectful when caring directly for a trans person.

Yeah it's great :)

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

I don't think that matters these days.
El Popo is more motivated by numbers these days.

And those whimple thingies address those 'bad hair days' in the wink of an eye.

Good to have options!

If you REALLY need to monitor a baby's heart rate, and you can't do so by any other means then it's the FSE or off for a Caesarian section.
I've never seen a baby come to any harm from one, although I've seen the odd post on Instagram as they are getting a bad press at the moment. It's like anything, it's not ideal but it might be better than the next best option.