To question my obstetrician's decisions?

[NeedCurtains]

Due to have baby no 2 in few months, and have booked, like last time, a private obstetrician in a private wing.

Same dr delivered previous baby. birth ended in forceps and a very battered baby. I blocked the memory out for four years, but it is all coming back now.

We've booked the same consultant again, but as I think more about my son's birth, I feel maybe my labour was mismanaged (syntocinon, not being allowed to be mobile, epidural, theatre, failed ventouse, forceps), which lead to my son being so stuck.

My partner, however, feels our dr potentially saved our child's life in a difficult birth.

We have spoken to this dr about my concerns. He suggested some steps we could go through this time (finding ways to make me more mobile 'if possible', proceeding to c-section sooner if issues arise) but was detached and didn't seem to really be 'hearing' me. My partner pointed out that you are unlikely to get a 'touchy-feely' response from an obstetrician, and he is right. But that has just made me think that I should go down the independent midwife route instead (but with a hospital birth), as they would provide the emotional support I need.

I've met a team of independent midwives who are happy to be at my birth (obviously in a doula capacity once we get to hospital) and really understand my issues surrounding the previous birth. They are warm, kind and would provide the hand-holding I feel I need this time. My heart says this is what I need. However, my partner says he will support me, but he can't pretend to be happy with the decision. And I can't completely discount that.

I really wish someone could make this difficult decision for me, but I know it is mine to make. Any input would be great though.

Your partner was frightened, probably thought they might lose you or your baby and was deeply relieved that you came through this. In your DP's eyes the doctor saved you. As they were an observer what they don't see is that the problems along the way could have been caused or worsened by the treatment you were given.

It must be terrifying to watch helpless as the person you love is struggling and not be able to do anything to help. It might be a good idea to remind them that you will be in a hospital and that the medical options are still there if you need them. It matters that your partner is concerned, but you are the one giving birth. It's your anxiety that can stall labour. Your fear that can raise the baby's blood pressure. Being supported and feeling listened to is important. An obstetrician should be a lot better at listening to patients than this. Reassuring patients is a big part of heir job.

Can they offer a mobile (walking) epidural?

Thinking about it, I'm not really sure exactly what your DP's problem is with you having midwives around in a doula capacity. Do they feel that you're saying they aren't enough to support you?

Thanks so much for your reply
He hasn't got a problem with midwives, more my plan to give birth in an NHS hospital and not under a private consultant

They say they can offer a mobile epidural but my experience last time was that they preferred to have me not mobile, I think because I was being closely monitored. Obviously if I didn't need continuous monitoring this time, that might be different

Why are you using the same doctor again if you feel (probably quite reasonably) that he bodged your first birth?

Sorry, missed your most recent post.

I would get your husband to read up on complications leading from over medicalization of normal childbirth.

It sounds like he has no faith in the natural body processes and would rather pay to make simple situation as convoluted as possible. SAeems like madness to me.

Possibly jack, possibly

There are reasons he made the decisions he did (too long and complicated to go into) but he certainly has a case for acting as he did. I suppose I fall somewhere in the middle of the whole natural vs
medical birth debate, so I'm not anti intervention and know it has it's place but yes I do feel things could have been managed differently

I do think it seems like madness to be doing this again though. I've always believed that you don't do the same thing twice and expect different results, and yet here I am

What's important to you? Your husbands feelings? Having a straightforward birth? You are just as likely to come home with a well baby with NHS care and a private midwife as you are with private obstetric care. But you are more likely to have an uncomplicated birth with a midwife in attendance than with a doctor managing the birth - there is acres of evidence for this.

damn wrote a long post and lost it :(

Summary - read up, get informed, I liked Ina May Gaskin books personally I felt very empowered and felt I knew my facts a lot more after reading her stuff.

Make whichever choice will make you and keep you more relaxed.

FWIW I was more scared of the epidural needle than of the potential childbirth pain. I had a TENS and birthing pool and was one of the lucky ones - quick, easy delivery. The stitches after were the worst bit.

good luck whatever you decide

You absolutely can plan the birth and care you want, regardless of your husband's wishes. He ought to be far more supportive of your choices to be honest and not trying to manipulate the matter by planting seeds of doubt in your head about how he "won't be happy". That is not supportive at all.

go and find a different consultant who will listen to what you want. If you are paying for this service, it should be with someone you have confidence in.

you don't really know the reasons for complications last time- i had similar complications with no.3 after 2 normal deliveries. my consultant did a complete debrief with me. I was happy that every decision they had taken was sound and it was a number of factors that produced the outcome. If i had gone on to have another I would have had the same consultant in a heartbeat- but she did say that she would recommend cs next time. This was NHS. If i had the dosh I would have gone private for comfort reasons so you should be able to find a solution

What sort of birth would you like and what are your concerns?

What are your partner's reasons for choosing private over NHS care?

Impossible to say from the info' you have given as to whether the birth was mismanaged.

i think you need to find another consultant.

If it does turn out that the management of your birth led to unnecessary interventions, then you will find it a lot harder to relax for this birth.

btw, the NHS is just as capable, if not more so, to give you the birth you want.

and less likely to go down medical routes when not properly necessary

Why not get a different obstetrician? There's no way I'd use him if I were you - in labour you need someone you trust.

Would your obstetrician let you have an independent MW as a birth partner?

I'd go down the MW route. Or find another obstetrician. Don't pay for the same one twice if he ballsed up. That tiny bit of doubt will grow as you get closer to labour second time around (been there, albeit different issues).

oh, and one last thing.

when our husband gives birth, he can make those decisions.
until then, it's your body, go for the care and birth you want.

Surely one of the main benefits of private healthcare is that it gives you choice? I wouldn't go back to someone in whom I did not have full confidence.

My NHS consultant was lovely - he talked to me as an intelligent human being, gave me the relevant facts, explained clearly, together with his assessment of the statistical risks of the various options (with reasons for his assessment) and encouraged me to make my own decision.

If your consultant isn't listening, I'd second everyone else on the thread saying "use a different consultant."

Is the expense of doing both too much?

Definitely wouldn't go back to the same doctor though. Not because he made any errors, none of us can know that, but because you don't have confidence in him to make the right choices. Have a look for another provider and make it somewhere that can provide cordless monitoring so you can be up and moving even if your baby needs monitoring.

Also, I know it's a bit too hippy for some but I used natal hypnotherapy for both my births and would heartily recommend. And I'm a very non hippy, highly sceptical type person!

I do think your DH deserves a say too, it's his baby and if, god forbid, complications arise, you don't want to be in a position where he will blame you. Get him to read the evidence, and meet him half way if you can. I believe you can have private care just for the birth, so maybe IM up to the birth and during, but give birth in a well-resourced private hospital?

Reason for intervention, put very simply, was that I was overdue, an older mother,, baby had been shown to be on the large size (although actually was just 8.5lbs!) and finally some meconium when waters broke on arrival at hospital, which my consultant explained would require them to speed up labour with drugs if I hadn't dilated beyond 3cm in a given amount of time, think it was an hour. We begged him to give us a bit more time but he insisted on intervening with syntocinon early

I have considered having an IM as a birth partner alongside him, but I think their practices will be at odds and the last thing I want is tension/arguing in the delivery room. I feel an NHS birth is more in tune with the birth I want, which is:

Calm, ideally no pain relief but not ruling it out, mobile, left to my own devices as much as is helpful, but given advice on best positions and pushing effectively (I was just told 'push push push' last time, and I'm sure there was more they could have said!)

I am a bit worried about antenatal ward, as our local hospital has a particularly bad rep, but hopefully with an IM, I could be discharged sooner

Oh and above all, I need someone around me to be kind. DH is lovely but practical and not terribly tactile! And the staff at my last birth were kind of the same. I need someone who I won't feel silly crying in front of and who will hold my hand!

Don't waste your money for hopeless and overpaiddr and go with your instinct.You need somebody, as you described who is going to look after you and be your advocate during labour and delivery and doula or midwife might be the best choice...
Sorry, but your hubby sounds like mine and feels that drs know best...not..
Good luck
..

Personally, I had a difficult first birth (although not as bad as yours) and it did put me off having a second. However, when second was born it was at a different hospital. The original hospital had closed down but I would not have gone there. The second experience was completely different. I could not have had same hospital, same consultant. But that is me.

We are very vulnerable during labour and need people with us on our side. If for you that is the independent midwife/doula route, as well as your DH, then IMHO I do think you should do that. But it needs to be a joint decision with you and your DH.

Do not be put off by horror stories about NHS maternity units. My second, lovely experience was at Queens, Romford which has had very bad headlines. I loved it and came away in a much better physical and emotional place than after my first.

Can you visit the unit with your DH? Most units allow visits and it might help you make a more informed decision?

What's wrong with NHS care? I gave birth in St Thomas' home from home unit ( pool, able to go in the bath, move around etc). My midwife was great. Plus they have the back up of a very good NICU. And we got our own room.

At my hospital there is a brusque, arrogant obstetrician and an extremely compassionate one. Can you get a second opinion before ruling out a consultant led delivery? Mine believes complicated deliveries are safest with an obstetrician rather than a midwife.