Quick labour why epistiotomy

[Zok]

Hi I am wondering why when someone dilates 4-10cm in 20 min would doctors suggest a ventouse and epist . I was very distressed asking for epidural repeatedly and there were some heart decelerations in the 60s. They didn’t even to tell me to pause when head came out and I had 2nd degree tear as well. One midwife said they had to get baby out quicker as I was too “distressed” —-

they didn’t let me go in the water either saying someone was using the pool but this may have been a lie as I have 2 prior sections . Plus with continuous monitoring they’re always checking the screens.

they didn’t ask my permission for the epistio am I able to complain?

i lost 1.2L blood which is ridiculous for a natural birth
im curious if there was a medical reason for doing this to me or was just to make the labour quicker so I would stop shouting

one midwife even said “there’s no need for screaming “

how do some women not tear and go home hours after the birth and I had to stay 3 nights feeling weak and fainting ?

Decelerations to 60 are very serious. At this point we would start cpr as the babies tiny heart is not beating fast enough to adequately pump blood around its body.

The team almost definitely felt your baby was in distress and its life was at risk.

An episiotomy is done to control tearing. They should ask permission but the team may have been so concerned about your baby there wasn't time.

I am sorry you had this experience but it doesn't sound like anything wrong was done. A debrief may help to process things.

You can ask for a birth debrief if you speak to your midwife. She can explain how to go about it.

It sounds as though they needed to get the baby out quickly, perhaps due to the decelerations. It's easier to do a ventouse if there's more room to manoeuvre things so perhaps that explains the episiotomy. They are supposed to explain things and ask permission, but if the situation was presenting as urgent then they just get on with it. You'll have to ask why you lost the blood as this can be for a few different reasons.

Congratulations on your new baby 😃

If you feel able to complain, I would. I hate people telling women how they should act when they are in pain and stress.

Ask for a debrief if it helps, but remember they're only human, they get stressed too and they got your baby out alive. Ideal procedures and patient care might go out the window if they were worried about your baby's heartbeat.

Something similar happened in my first birth, I went from 3-10cm in 20 mins and baby was significantly stressed causing decelerations. They pushed the red emergency button and I very quickly had an episiotomy, ventouse, 3b tear and haemorrhage of 2L. I had a midwife by my head telling me what they were doing and why, but I was pretty out of it.

Didn't even cross my mind to complain about anything. They saved my child's life!

Hi Zok, oh you poor thing, you had a difficult time. I was a midwife for 20 years, so I can answer a few of your questions.
An assisted birth (ventouse or forceps) is recommended where there is fetal distress, maternal exhaustion, awkward position of baby and slower progress during the birth phase of labour.
Sometimes labour can be so quick, you can feel like you’re in a spin dryer! That can lead to panic and distress, especially if you feel you aren’t confident in your care team.
Your baby can also sometimes find a quick labour difficult and it sounds like that may have been the case here, as you say his / her heartbeat was down in the 60s. If there wasn’t signs that the birth was imminent plus the heart rate was not recovering, that would be clear indication for an assisted birth. However, you should have been consented and another explanation given post delivery.
An episiotomy can be used to expedite birth where baby is distressed and also with an assisted birth. That should be part of consent for the ventouse process.

With 2 previous c sections, a lot of units will have policies that say pool use would be inadvisable. Other units have underwater monitors and are more supportive. With your labour being so quick, it doesn’t sound like you would have made it in! Plus in any labour, where there are signs baby isn’t happy, you would need to come out of the pool.

PPH (very heavy postnatal bleeding) leaves you feeling so weak and ill doesn’t it. Not what you need when you’ve just had a baby. 1.2L is a lot to lose. I hope they cared for you well afterwards. Where there has been a quick labour, it can be like the uterus says ‘phew, I’ve done the hard work now, I’m going to rest!’ and it doesn’t stay contracted and bleeds. Where there are interventions, that is a common factor in PPh. Fear and adrenaline can prevent the uterus from contracting well. Things like warmth, baby skin to skin, dim lights, calm reduce the adrenaline. However, in some cases, bright lights and people are essential for what’s happening.

You’ve gone through a lot and will still be recovering. For some women, doing a birth reflections can be helpful or requesting a copy of your notes to understand what happened and why.

congratulations on your new baby 👶 xx

I was told that very fast dilation stresses the baby out and that's what the decelerations were a sign of. There is also no time to organise pain relief other than gas and air.

Ask for a birth debrief and a copy of your notes.

Decelerations and baby in distress are the most likely explanations here.

I do wonder how women without continuous monitoring manage
and also why contractions make some babies stressed this happened to me in 1st birth but I wasn’t dilated so ended up with section. I think when they attach the head monitor and take a blood sample that can make baby’s stressed

They don't attach the monitor on the scalp without reason to believe baby is already in distress, so I don't believe that theory could be correct.

Childbirth is risky. Always has been, and I think people often forget this. Years ago women routinely died in childbirth. Of course some women birth easily with little to no intervention, but there are many variables.

I had a similar birth first time around (no ventouse but 3rd degree tear in spite of episiotomy). I was very grateful to the medical staff for ensuring that both DC and I made it to the other side okay. I felt like I’d been run over but I always believed that the care team had been doing what was needed to keep me and baby safe. I found the reflections appointment so helpful, even though I didn’t think anything had gone ‘wrong’ just to know what exactly happened - it was too fast to know in the moment and then afterwards I was so out of it, then into surgery and all of that. Looking back on it now I do see that as a good birth, if there is such a thing. Congratulations on your baby and I hope you feel better soon.

They did the right thing

They wouldn't take scalp blood sample unless they baby was already in quite worrying distress. I had the fetal scalp blood sample done with my first and scalp monitoring with first and second. Both had to come out fast via assisted deliveries.

These things don't cause fetal distress, they are used for measuring / monitoring it.

I think you need to ask for a debrief because I don't think there's a one size fits all. One of mine came quick and had a scalp monitor but I didn't require an episiotomy. There must of been something of your situation that made them think it necessary- they should obviously ask for consent though.

It sounds like it was all a bit out of control and you and the baby were very distressed - particularly the comment about you screaming and they needed to act fast to save you and the baby.

By all means ask for a debrief but I would come at it with an open mind.

As for your last comment - literally every woman/birth is different.

When you say “One midwife said they had to get baby out quicker as I was too “distressed” “ could they have said the baby was distressed rather than you?

my last birth was a bit like yours very fast , haemorrhage. I’m studying midwifery atm. I would say from what I have studied is that to put the fetal scalp probe on they have to break the membranes. This is the controversial but because doing this will speed up labour usually and often makes it more painful for the woman, the waters also have a protective function during labour. Presumably they weren’t getting a good enough trace on the normal CTG.

Intermittent monitoring with a Doppler has a lot of advantages where there aren’t risk factors, but even with this method, if evidence of distress is heard, a switch to continuous monitoring would be needed. Intermittent auscultation is for when it is less likely for baby to be distressed, but still picks up problems.

It can be hard to know exactly what makes some baby’s become distressed by contractions and some not. It is more likely where there has been intervention with Labour or where contractions have been strong and quick (less time to recover in between) or actually a long labour where reserves are being used up. If a baby is small for dates (FGR) and / or problems with the placenta, this also makes fetal distress more likely. Sometimes it can be maternal reasons such as high BP which can affect the placental growth / blood flow.

A scalp monitor (FSE) is used when there are concerns with baby already and a closer monitoring is required. I think that was the case with your labour as you say you also had a fetal blood sample taken (FBS). The results of that most likely led to the birth being expedited.

Your labour went very quickly between 4-10cms. What happened before that?

Why were you screaming?

Why were you screaming?

What sort of a question is that? Don't most people scream? I certainly did and my dd's birth wasn't half as traumatic as the op's sounds

🙄

Christ.

thats a really awful thing to say. Women react to labour and birth in so many different ways. It is often an involuntary response to what is happening. Fear, pain, feeling out of control, things happening fast, emergency situations - just a few reasons why a woman may scream in labour. Of course, there will be others who go into themselves, no talking and some will be in between the two! No one has any business telling a labouring mum how to behave or that’s she’s ’wrong’.
I screamed through 2 of my 3 labours because it was excruciating, contractions close together and no progress. That’s now it was and you know what, I couldn’t give a fuck what someone else might think about that!

Decelerations to the 60s shows that the baby was in serious distress and needed getting out fast. Sounds like you might find a debrief helpful, but seriously, just from the information you give in your OP, this was clearly a case of needing to get baby out alive.

If its quick your body doesn't have time to 'warm up' that's probably why it was necessary, but speak to the midwife and Drs if you need more information