Any midwives/obstetricians about? Precipitous labour (v short)

[pandarific]

I'm pregnant with my second, and having a bit of a worry about a more than likely quite short delivery with them.

My first baby was born at 42 weeks after a 5 hour labour so fast and furious for a first timer (it probably would have been quicker but I sort of tried to hold him in in the taxi to the hospital). I had been booked for a home birth as we have excellent service here and only live 5-10 mins from the hospital but the midwife was at another birth, didn't send anyone else to check us despite numerous phone calls and 4 hours at home.

She assured us I had 'lots of time and to get in the bath and take cocodomol' when I was struggling with the pain). Cue transition in said bath and urge to push, panicked taxi ride to hospital, fully dilated on arrival, vaginal delivery about 30 mins later, second degree tear. I have a grade 1 cystocele but I think this may have happened post birth by me moving something heavy I shouldn't have.

So I'm worried about having a very very short labour, and having read up on it, it seems it's quite likely for a second after a fast first delivery. I'd love to some advice from mws or obs here on what they'd do, in my situation? Home birth (I have been ASSURED someone will show up this time and FAST will be all over my notes) or hospital?

My worries:

• Making my prolapse worse! I've read on here about precipitous deliveries making it worse and I'm worried about it. Hence I'd prefer to deliver in a birth pool, nice and calm and easy, tea lights etc as was the plan last time had the mw shown up. I'd still rather chance the vaginal birth with lots of hypnobirthing and go for a repair afterward if needed rather than elective c section up front (would really rather avoid c section if possible).
• Being alone with my husband (or worse the toddler) when the baby is born - this happens I know when people have half an hour to an hour deliveries. I really, really do not want to give birth alone in my house with ambulance people coming through the door, the idea just freaks me out, I was scared enough last time with no one there but us, I absolutely do not want that this time. This is my main concern with having a home birth, that they won't come in time and we'll be on our own.
• During my first labour when I was in the final stages my baby's heart rate kept dipping (turned out he had cord x2 around his neck, my cord was nearly 2metres long) so I was kneeling up on the bed with a monitor on. I am worried that if I go into hospital to birth I'll end up with cascade of intervention, monitored rather than in a birth pool which would be my massive preference (to help with a calm, slow, safer from POV of birth injuries, relaxed delivery), possible c section etc.
• I'm not quite clear on how they judge if a baby is in distress or not, or if the baby's heart rate is 'just' dipping from a really quick labour/cord compression etc which my midwife has said is quite common? I just would rather avoid major abdominal surgery c section if possible.
• Induction. I refused it last time, preferred to just wait, which was fine with the team. I don't expect to go so far over this time but they already have dated me a week further on than I actually am based on the scan so it may come up. I feel like if they touch me with a pessary etc it'll cause everything to go into overdrive, so I wondered if I get to that point if they'd agree to break my waters instead and see if that kicks it off (seem to remember high percentage of people go into established labour after waters go)? And I think I could still use the pool etc in hospital if we did that as it's not the kind of intervention you need the constant monitoring for. (?) So this time induction in this way looks more attractive to me, because I'll be in the hospital so not risking having no medical professionals there, I could in theory use the pool and have the chill birth I'm hoping for.
• any other advice at all for e.g. 1.5 hour delivery? I'll be hypnobirthing and doing the perineal massage as much as possible to minimise tearing.

Obviously I will do whatever is safest for the baby, but I would also like to give myself the best chance of having a nice calm birth this time, knowing it's likely to be quick. So... in my situation, what would you do? I will of course also be talking to my mw but a range of opinions would be great to hear.

OP, you are massively overthinking this and trying to predict/control something which is notoriously unpredictable!
The sensible advice would be to simply get yourself to hospital as soon as labour starts, and tell them you’d like to use the pool.
If they monitor the baby and find cause for concern, you might have to rethink your plan, but the baby’s safety is more important than having a “nice experience” in a pool.
Signs of possible fetal distress can’t be ignored on the offchance they are spurious.
Please just be guided by your obstetrician as to whether intervention is required or not - that’s why they have ten years of specialist training after medical school.
Best wishes for a safe delivery- with or without a pool!

I'm not a midwife but I can tell you my experience .....

I "suffer" with precipitous labours - my first was 4 hours, my second 40 mins from first contraction / any type pains to him being in my arms - subsequently he was born at home and the midwives/ambulance turned up as he was coming out ! So I delivered a 9lb14 baby on my bedroom floor with no pain relief or assistance ! Not fun !

So when I fell pregnant with my third, I was genuinely terrified of it happening again, I had therapy throughout to prepare myself and also had appointments with consultants to discuss what could be done to help.... I couldn't go through with the fear of the baby being bigger and quicker.

It was agreed that I would be induced a week early, so that
A. I could be monitored throughout, as in, have someone there, support etc and have pain relief
B. The baby wouldn't be as big and I'd have regular scans leading up to it to check this

Then COVID happened !

I was still induced at 39 weeks exactly, but instead of it being a nice experience- it was horrendous as I was on my own and experiencing "labour" for the first time - I'd never had contractions leading up to it in my previous births so it wasn't nice to have to do that alone - but that's another issue.

They gave me a pessary as it would be slower than balloon / gel and they didn't want to risk my body going into overdrive with sudden surge of hormones

I had pessary at 9am and she was born at 5.35pm the next day.

Honestly, I would not do it again - I would let things happen naturally if I had another, It was long and drawn out and painful, which I know is normal for most people, but for me, previously, it had been over so quick I naively thought it would be fine to be induced.

Subsequently her size wasn't an issue as she had slowed down growing from 35 weeks so we would've been induced for that anyway had it not already been planned.

Maybe if I hadn't been shut in a room on my own with no support or no one to talk to for over 24 hours I'd have been okay but sadly birthing in lockdown didn't allow that.

I'd have very frank discussions with your midwife about options, but I always went with the view that I didn't want an elective as I knew I had birthed before and that bit wasn't so much the problem, it was the speed.

Congratulations on your pregnancy

The thing is, OP, when you have fast labours, the only thing you can do is make sure you have plans A, B and C to get to the hospital, have arrangements made for care for your other DC.
I kept telling my midwife how fast my labours were and they couldn't have been less interested.
In the event it worked out ok.
I phoned an ambulance on the 3rd contraction, neighbour came round, baby born just as I got into the delivery room. Start to finish exactly an hour.
It was all ok in the end. Get your plans in place then try and relax.

Disclaimer: I know that nobody is allowed an ambulance on MN, but dh was at work an hour away and I wanted somebody with me if I started to deliver on the floor or on the way to hospital.

@Babdoc I never said I'd ignore signs of fetal distress! Far from it - what I said was I didn't understand exactly how fetal distress is measured/judged and then c section recommended, as I've heard from my mw that those dips in heart rate are 'quite common', and I think (?) this is what was happening last time but nobody ever mentioned c section to me so I don't quite understand how the risk is weighed up. Could you give any insight here? I'd love to understand better.

The desire for a pool (if no problems picked up obviously) is to aid a slower delivery, more stretching, less likely for me to have big tear from speed/worsen prolapse.

You can say I'm 'overthinking' if you like, but I have a fact at my disposal - likely to have speedy delivery - and a choice to make, home birth or hospital so I'm going to gather as much info I can to make that initial decision. I'm just like this, I'm afraid. I read a lot, think a lot, ask a lot of questions, make a plan - and then go with the flow, using my B.R.A.I.N. acronym.

Ugh that's just what I'm worried about with it being e.g. an hour long if I'm booked for a home birth. No medical professionals there and me just delivering on my own.

I was refused a home birth due to my age. It was just as well because my community midwife was 2 hours away. She would have missed the whole thing. My hospital was 20 minutes up the road.

My SIL has a pretty fast first labour (I think it was 6 hrs from first contraction to baby in arms), so the midwives thought she would deliver her 2nd very quickly. They gave her a home birth pack and told her to phone them at the first sign of a contraction. Although we live in a large city depending on traffic we are 25mins to 1hr from the hospital.

Fortunately for her (as the baby was breach and she needed a c-section) her 2nd labour was actually the same length of time. She went to hospital at the first contraction and was monitored for a while and then prepared for the csection, but she had to wait as they had a women who needed a c section quicker. She was still only 7 cms after the 5 hrs so I think if she hadn't had a section her 2nd labour would have ended up being longer than her first.

My understanding from what midwives told me is that generally if a labour is very fast things tend to be ok. My 2nd child was delivered within an hour of me being induced by having my waters broken. It was scary at the time because the contractions came on straight away with virtually no break inbetween, and I thought I was going to have hours of it so I started freaking out. Ds2 completely took the midwife by surprise as she had left the room for something and I ended up giving birth on a toilet! She came back after his head had been delivered. I know I was in hospital so had that safety net, but had the midwife not come in I don't think it would have been a problem as I don't feel I had to do anything. He came out without me thinking about it.

As a previous poster said I think the best thing you can do is have a plan for various situations, i.e. know who you can call to come and pick up your toddler very quickly. And if you are worried a midwife won't get to you in time then you can call 999.

Also I forgot to say my first ds had his cord wrapped round his neck. 2nd ds did not.

It can be normal for some dips in heart rate. What they would look for, is how big the ‘dips’ are, how long they last, and what the rest of the monitoring is like before deciding if it’s doctor/c-section territory. Also very different to have some decels whilst pushing (a normal response) and you know a baby will be born soon, compared to in early labour, when it could be a long time away.

@pandarific the one thing I would say, is get it put in your notes, and tell every single midwife / consultant that you see, make them aware that it's happened before and that your worried it will happen again.

At first, I was was completely dismissed by a midwife, until I was "diagnosed" with precipitous labours by a consultant and they agreed that I'd be induced early because of it and then people listened to my worries about it.

Hindsight is a wonderful thing and the consultant did warn me that induction might not necessarily be the "easy" option and they were certainly right about that

@magicalhello thank you! I'm veering toward asking my mw to make an appointment with the consultant just to discuss options ahead of time were i to go into hospital. Did you have the pessary/gel?

I'd be quite keen to have them break my waters artificially, but I'd rather not have the pessary/gel/drip as a) likely to be awful labour and b) all of those you need the constant monitoring for, and then I lose the chance at the pool. But I'm not sure if they'd consider that or if it's against guidelines.

@SanityClaus thank you, that's so helpful!

@pandarific they gave me a pessary as they said the gel was too risky as it could pontentially send my hormones sky rocketing, as I was 39 weeks they couldn't go in and break my waters, so I had the pessary at 9am, I only had one pessary, things started quite fast after they inserted it but then slowed down to a "normal" labour process.

Like I say, I would never chose it as an option again and I'd go natural, and just head straight to hospital with first contraction (which is what they advised me to do if I went into labour before induction date) they also had it flagged on the hospital computer system that I was to come in straight away if I called

Whether they would be happy to go straight to breaking your waters would likely depend on how much your cervix had changed/how favourable you were on that day. Your cervix needs to be softening, and already opening for them to do it- if not they would want a pessary/gel to get it ready.

Also whilst breaking your waters would probably be enough to start labour- it isn’t enough for everybody. Since once the waters are broken, the risk of infection goes up, so they would want to start the hormone drip after a certain amount of time (although after how many hours you could negotiate with them).

If when they broke your waters, they discovered bleeding/meconium- they would probably want you to stay on monitors. Just may not be as simple as them agreeing to break your waters to induce you, and you getting in the water. Although at least whatever happened with an induction, you know you would be in hospital with childcare sorted- depends what your biggest stressors are!

Good luck pandarific my births were 4h and 1h 45m.

I made it to hospital fine, but didn't manage a water birth 2nd time round, I think it was being used/they didn't think they'd have time to clean it before DS2 was born.
I had 2 midwives for delivery to minimese the risk of tearing (3rd degree tear first time but only 2nd degree tear with the next baby)

I've had three fast labours, my first was just over 2 hours, second 4 hours, third 3 hours.
First was induced in hospital and other two were home births. I wanted home births anyway but they also advised them because of the speed. The best thing is to be prepared. You know it's likely to be quick - have a plan in case you deliver before a midwife gets there. Mine were along time ago but I remember reading about the best position to slow labour (on all fours with bum in the air I think), what to do if it happens (don't do anything other than skin to skin to keep baby warm and wrap yourselves both in a blanket - don't try and cut the cord etc). The more knowledge you have the better.

My last two were both birth pools and I didn't tear for either of them. I did still end up with a prolapse though which I had to have surgery to repair. And getting in the pool calmed everything down for no more than 5 minutes!
Third child was born 20 mins after getting in the pool.
Finally, delivering at home alone (with husband) happened to my sister - they were on the phone to the ambulance call handler who calmly talked them through everything. The thought of it is probably worse than the reality - if it happens you just get on with it because you have no choice.

FWIW in your position with some degree of pelvic organ damage already I actually would avoid the pool, or at least get out for pushing - less likely to have pelvic floor injury when midwife can directly visualise and offer a controlled descent/perineal support - a ‘hands on’ birth - which cannot be offered in the pool. This link is useful www.rcog.org.uk/en/patients/tears/reducing-risk/

You may well find that your second delivery isn’t as fast as you think though - 5 hours isn’t actually a precipitous labour and you may well find that your second isn’t either, so try not to panic!

Hi, yes as a starting point definitely get an appointment with your obstetrician. Make sure they document clearly that you've already had a precipitous labour and the plan for this time around. I always write PHO precipitate delivery on the front of the notes for all the world and her auntie to see.
Midwife

That's interesting @ArmchairCritics, I was actually going to put 'prefer no coached pushing' on my birth preferences this time as I did have some last time, I remember the midwife wanting me to do a 'biiig push now' before crowning and during and I've read since the coached pushing can mean tears/damage and it's better to let your body do it without consciously pushing down / out?

Not a criticism of her, I think they were keen to have him out due to the monitor, and she was lovely and did the warm compress thing in advance too, but if I had a choice this time, I was thinking I'd prefer not to have hands on me / have it be a bit more private and just let my muscles / breathing do the work of getting the baby out if possible. Do you think that would be a bad idea to put on the birth preferences, with the cystocele? Or could I negotiate that with the mw?

I had ds1 in 2.5 hours from waters breaking to delivery and that contributed to my decision to have home births in future. All of my births have been sub 3 hours (my body seems to like holding on to them past the due date and then when it decides its time to evict them, slinging them out at a rate of knots) but they have all been very different. I spent 75 minutes pushing with ds1- with ds2 the second stage was just 4 minutes. With ds1 and ds2 I never really lost emotional control, with ds3 I went pure mad and screamed my way through the last half hour.

In any case, as the lengths of my previous labours were highlighted in my records, both times when I was booked for home birth, as soon as I called to say labour was starting the midwives came straight out.

No personal experience with precipitious labour (mine were 9 ish hours so normal length), but I have had 2 home births. My experience has been that with second time or more births, midwives tend to trust your judgement a bit more. If they know you have a fast labour and you call, I think they will be more likely to trust when you say you need them because you know your body and how you labour. It is not a bad idea though to set this up from early on. Tell them you will know when you need them and when you call, you will need them then, not later. With my 2nd, I called and talked to the midwife, she was on her way back from another appointment, asked me if she had time to stop at the hospital and do a few things first and then head over in an hour or two. I said fine. I gave it 20 minutes and thought, hmm, no. Called back and then can you please come right away? She made it there 50 minutes before he was born and second midwife arrived about 15 minutes before.

If you know you need someone, be insistent or better yet, make sure someone else can insist on your behalf. With my first, they didn't even believe I was in labour over the phone because I was so calm and comfortable. By the time they arrived I was pushing. It would have been harder to demand I needed them urgently the first time because I really had no idea if I did. But once you've had a baby, you know. And I think it just needs to be made really clear to the team that you labour fast and they need to not delay attending.

That said, lots of babies are born at home before midwives arrive. I know several friends this happened to. If that happens, it can often be safer than being born on the side of the road or in the hospital car park, so you may want to consider how you prepare for that, in case it does happen.

I'm a midwife and have had a precipitate Labour for my second baby. (I've also had a cystocele and rectocele..)

First baby was 6 hours. Second baby was 30 mins.

We get lots of mums who labour quickly and we are cautious regarding leaving 2nd time mums at home too long - especially if you had a quick labour the first time. First time mums normally take so long that it's encouraged to try and stay at home.

When you do go into labour - phone the hospital early right at the beginning of your contractions. Explain you had a superfast birth the first and nearly didn't make it in and that you think you should come in now.

I'm a midwife and have had a precipitate Labour for my second baby. (I've also had a cystocele and rectocele..)

I have a rectocele and am starting to suspect a cystocele is happening ( :( )... is there a link between these and fast births?

My first baby was born in sub-2 hours but my maternity notes recorded it as an 11 minute labour. I’ve since had a long one at 3 hours 45 mins - that one took longer because it was a back to back baby with a nuchal hand, but then I had a short one that delivered in under 45 mins. Every time I have been told I’m over reacting, that baby can’t possibly be coming, to take paracetamol and have a bath - even with my history of shorter labours, they aren’t short enough to concern anyone apparently.

The bath being pre run was useful to get in after the birth, though to be fair. I prepared my older children with what to do if I suddenly went into labour but in the event it wasn’t needed, I managed to get medical attention every time even if only by a whisker.

It’s unpredictable OP but second and subsequent can be slower.