Quick labour why epistiotomy

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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 ?

Hey OP i'm so sorry you had a rough time. Outrageous that you did not consent to the episiotomy, that is technically assault on their part. Your feelings are valid. I would recommend following and listening to all this amazing lady had to say on birth --- https://www.instagram.com/kemibirthjoyjohnson?igsh=MWY0c2RxZHVmd2h6NA==

She is an incredible birth keeper and covers many of the concerns you mentioned. Your experience is unfortunately common.

Also in terms of your rights, follow www.instagram.com/when.pushcomestoshove?igsh=MWE0cnRqOXJuMmpzOQ== on Instagram too, maybe drop them a message asking for advice.

No she said as I’d been asking for an epidural /c section every 3 sec🙃

they also did a nerve block so wouldn’t feel head crown

A ventouse /epis for a mother that can’t handle pain sounds like the sort of thing I would cause . But surely lots of women scream during child birth.
An epidural from 4cm might have made me slow down. Pethidine would have made me sleep the gas wasn’t helping

also I didn’t understand their breathing advice they said breathe in during contraction but didn’t tell me if I should hold it or exhale and with Aspergers I like to know exactly what to do

echoing others, a debrief sounds like a very good idea. Re. epidurals - your OP says you went from 4-10cm in 20 mins - it takes about 40mins from starting to get an epidural sited and working. The reason we don’t often do them towards the end of labour or in a very rapid labour generally is that it exposes you to all of the risk of an epidural but none of the benefit (and may increase the risk of harm). If a person is very distressed and moving a lot then that can get dangerous. Siting an epidural when there are CTG concerns is also something that needs very careful thought because of the likely outcome of the scenario is going to be a quick trip to theatre then it’s generally safer to do that rather than attempt the epidural.

If a baby had been delivered and found to have an HR of 60 the midwives and neonatal team would have been performing resuscitation manoeuvres. Pretty much the only thing they can do if the baby’s still inside and that happens is to get the baby out ASAP, either by an assisted vaginal delivery or a category 1 c-section. The consent process can be very difficult in that scenario - the longer that’s spent discussing the pros and cons, the less chance there is of the baby surviving (or not suffering brain damage) - it really can be that serious. An epis may facilitate quicker delivery or prevent a more severe perineal injury. Obvs the above is all in general terms - a debrief will be able to answer specific questions you have. HTH a bit.

Yes it definitely sounds like you progressed too quickly for an epidural. Also as PP have said you need to sit very very still to have one put in place, and if you were too distressed to be able to safely do that the risk of harm would be too big.

I totally understand the feeling of being out of control, I was the same only I went into myself and very quiet instead of shouting and screaming. When you progress that quickly the contractions come back to back and there is no break, it's scary and exhausting and panicky for sure!

After my traumatic birth my midwife came to find me on postnatal ward the next day and said she needed to see if I was ok as she had been so worried about me and I had been through an awful experience. That meant a lot.

I'm a swearer and a shouter in normal day to day life. Love a good swear word. When I had my son I never shouted or uttered a single swear word. I was the calmest I'd ever been in my life. Most unlike me. So, what this tells you is that during Labour women behave and respond differently and so your question comes from a place of stupidity. If you were silent, good for you, have a medal or become a Scientologist.

Arrived at hospital around 3pm after waters broke half hour before
contractions started right away around 2 min apart in the front pelvis nothing felt in the back . Pain increased alot

tried to ask for epidural many times

by 9pm approx was 4cm and 20 min later they said 9/10. I think the decelerations were variable
baby born at 10.30pm

id always wanted a water VBAC and was told wireless monitoring was available throughout my consultations

after experienced both I’d say VBAC is only slightly better than a section recovery still tough but you can get around barely and shower . Piles and low iron is taking its toll the iron pills are terrible
I notice after each birth I feel shock for at least 6 weeks and can’t leave the house very panicky like heart in my throat . Being a winter baby I don’t think I’m expected to take him out on walks in the cold

I’m so sorry you didn’t get the epidural when you first went in and your contractions were every 2 minutes. It sounds like there was time for this on your initial admission. In some units, there can be a reluctance to administer epidural pre 4cms (latent phase) but in your case - a woman who has given birth before, plus very strong and close together contractions, it’s clear things were progressing.
Your feelings are valid. Your notes would say why they didn’t move you to delivery suite pre 9pm or listen to your request for stronger pain relief.
By 9pm, it was too late to give the epidural for the reasons someone explained above. You were in transition, which is just before pushing. A lot of women feel very out of control, distressed, ‘I can’t do this anymore’ ‘make it stop’ ‘give me an epidural’ ‘I’m going home’. So your feelings were normal.

You say you were fully dilated around 9.20pm but birth happened at 10.30pm. The birth phase is expected to be done or imminent within an hour for a woman who has given birth before. The length of time and baby having decelerations down to 60bpm would both be indications of needing some support with a ventouse.

You did so well coping with all of that x

I had ventouse with both of mine, first I didn't have episiotomy, tore, 2nd I had episiotomy and the healing was way better than for 1st. I could always feel the scar tissue from the first but can't from 2nd.

Both mine I dilated from under 4cm to 10cm really quickly then everything slowed down in stage 2 before needing a ventouse to get baby around the corner.

Don’t listen to people who tell you how to labour or how you ‘should’ react to things. They can’t see beyond their own experience and have little empathy for others.

After so many hours with contractions so close together and adequate pain relief not given, I’m not surprised you were in distress! Units can get very hung up on dilation and forget to look at the woman and what’s actually going on with her contractions. It might be that you were 2-3cms so technically not under the delivery suite, but listening to how you felt, were reacting and the contractions being so close together tell a different story! If you hadn’t consented to a VE before 9pm, your midwives would have to have gone on your external signs. Not saying you should have declined at all, but showing that dilation isn’t the be all and end all!

Breathing: very difficult to learn in labour. In for 3 out for 6 (or 4/8) can be good. Useful for postnatal feelings too! There are different breaths such as escalator and up breathing. Birth: it could be they were telling you to take a breath, hold it and push down into your bottom?

Thanks not 100% sure of the timings

I’d had 2 sections before and never got further than 3cm after 36 hours of moderate pain with the 2nd turns out she was ROT position and had meconium when they broke the waters - hospitals should know positions to turn babies

the chesterfield hospital second time round also didn’t follow NICE guidelines and later admitted as such

as they didn’t allow me to eat and drink except their cannula fluids :/ according to NICE I was allowed at least isotonic drinks ! Plus they gave me an antibiotic on an empty stomach which just made me feel sick :/

this time it was nice the waters went by themselves at 38 w
I had been taking raspberry leaf pills since 32 weeks not sure if they made the labour progress too quick lol

yes I was exhaling while doing the push into bottom are you supposed to exhale after the push is over ?

I guess after reading that epist is not always needed for ventouse I’m wondering why
is it because for a first vaginal birth the vagina has not been stretched before
I also think if decelerations are followed by normal heart rate why do they need to assist

someone who has dilated quickly means their body knows what it’s doing and shouldn’t need intervention

Your baby was distressed and could have died or suffered brain damage; you needed intervention.
I hope you recover soon and can understand that these actions ensured that your baby is safe and well.

Having had 2 ventouses, I'd chose epis over not any time.

1st had cord wrapped around foot and 2nd stage was getting pretty long, I tore. 2nd time I had the epis and it solved the issues from the tear from 1st time.

First of all, my sympathies.

I had similar dilation speed (it happened in the lift from the ward to delivery suite) and blood loss with ventouse and episiotomy. Luckily I was out of the hospital next day.

One of the most annoying things is people saying you had it easy because it was quick, but I understand the sudden shock and inability to even pause for a breath!

My baby was back to back because the rapid birth made it too quick to turn around.

Just to add my labour was 90m from waters to delivery of placenta, so it sounds like they did have time for you!

I had asked and asked about precipitate labour, and was brushed off!

When I had mine I saw the nurse wielding a metal implement and said "oh are you doing an episiotomy" and she said yes but it wasn't really a drawn out discussion about pros and cons. The last stages were very rushed and quite chaotic though (the pushing part was very very fast) and basically they had seen it starting to tear in the wrong place so very quickly needed to make an episiotomy. They couldn't ask me to slow down as the baby was in some distress (and also I don't think I could to be honest).
So its possible there were similar reasons to you - its quite common for an episiotomy to be done to avoid a worse tear and they don't have much time from noticing it to dealing with it. I know someone who was a midwife in an African country and their view is less intervention where possible is better but having seen the results of women NOT having episiotomies when they were needed its always better to do them if they are needed to avoid injury.

But they should have at least said "we need to do an episiotomy now".

You’re right that ventouse doesn’t always need an episiotomy, but the dr would have been watching to see if one was required, plus if baby was distressed, delivery needed to be expedited.

From what you’ve said, it sounds like you arrived at hospital 3.30pm roughly, contracting 4:10. Left?? In the antenatal ward with inadequate pain relief despite asking for epidural.
midwife found you were 4cms dilated at around 9pm and you went round to delivery?
by this point your labour was progressing very rapidly and you were understandably distressed.
Im thinking you were either beginning to push and / or ctg showed prolonged / deep decelerations down to 60bpm. There would also have been greater concerns if the pushing phase was taking a while and because you had had 2 c sections previously. It’s looking at the whole picture.

Your notes will tell you much more. On the face of it, I think your biggest issue here is not being listened to for 6 hours while in hospital contracting 4:10, requesting epidural for all that time.
it sounds like the team acted appropriately once you were on delivery.

Have I got the timeline right?

And yeah breathing out/panting almost helps relieve the pressure in a way. But when you really need to push I think its better to not be breathing out because you actually want that pressure/energy going down not out as you breathe. That said its almost impossible not to breath out/groan so I think its more something to aim for rather than something to castigate yourself for afterwards.

I’ve spoke to a birth doula from instagram who says stirrups would make labour slow down as it’s pushing uphill and it would compress major arteries causing decelerations

this makes sense as during pregnancy your advised not to lay on your back ??
so I’m wondering why they didn’t offer me other positions to try like all fours

I’d read a lot about active labour but I got overwhelmed by the pain and just handed everything over to them

didnt help that I didn’t take a birth plan and that my partner wasn’t aware of labour positions either

I would focus on the fact that your baby needed to come out quickly, if they hadn't acted and left things naturally your baby would likely have been starved of oxygen and have some degree of brain damage....I know which one I'd prefer!

the doula sounds like they may be advising outside of their expertise as they weren't there and couldn't see what was actually going on (and this is quite common on social media). There are lots of other serious reasons for decelerations/bradycardias which may have been more likely than aorto-caval compression [including for example, a very rapid labour, having the cord wrapped round baby's neck, uterine rupture (which may have been a real concern during a vbac), abruption, etc]. It would still probably be more useful to have a debrief with one of the team that were actually looking after you rather than someone on social media who wasn't in the room or from people on MN who also weren't in the room.