Delivery didn't go according to plan (but feel there were some things done poorly by midwifery team, should we say anything?)

[HSlant]

Not sure if right forum, we didn't have the best birth experience (partner posting on behalf of mum). Much of this was baby/mum related (progressed rapidly, and delivered within 3 hours of getting to hospital), things like birth plan therefore went out the window, tried to convey that one of the biggest concerns was of getting a 3rd-4th degree tear (trumped only by something like a hypoxic brain injury to baby), and if there was anything we could do to avoid this, would be keen to try. Ended up delivering in Lithotomy and (we think) instructions for pushing may have been incorrect - told to push hard, continuously throughout contractions. Left now with a 3rd degree tear, needed stitching in theatre. Wasn't all down to midwife, she needed help and used call bell twice (for Dr and then 2nd midwife but no one was available - it was a really busy night). Also this was 3rd midwife 3 hours (they were just too busy and hadn't accounted for us, and now rapidly we'd progressed, so had to be passed from one to the other), so not much continuity. Ofc very relieved baby is safe and hoping mum doesn't have any long term effects. I don't know if we should say anything? Is this normal? We have no frame of reference. The doctors said they'd explain things but they didn't really know why things happened the way they did and just left things at that.

Not sure if right forum

Here’s the forum you want @HSlant

Childbirth forum

You can have a birth debrief with your hospital to discuss what happened which might help you both understand why certain things happened. I can't tell from your post anything that the medical staff did wrong. Unfortunately births don't always go to plan - I don't say that flippantly at all but I think mums are sold an idea of birth that simply isn't always possible.

Congratulations on your baby!

I’d ask for a debrief with the matron, and go from there. They’ll be able to explain what happened and why, and between you you can highlight areas of concern and make comments as necessary

Birth isn't something you can plan for. You can have preferences but it's not unusual for those preferences to be ignored by medical staff when they need to get the best outcome for mum and baby. I don't mean to be harsh but I really don't understand when people get hung up on the fact that a birth did not go to plan. Every birth is different and some require a lot more medical intervention than others.

You can request a debrief but I think you'd both be better off focusing your efforts on bonding with the amazing new life you have created rather than dwelling on something that's in the past.

Tearing is unpredictable, no one knows if one woman in one position pushing in one way will tear and another won't.
There's no right way or wrong way to push.
In labour all women naturally push hard.
A large part of tearing is believed to have a genetic component, and also reliant on the presentation of the baby.
I hope you find the answers you are looking for, but I doubt you can blame the midwife here.

Lithotomy for delivery suggests the midwife was concerned about hypoxia or something similarly serious and wanted to expedite delivery.

Do ask for a debrief.

Start by asking if your hospital has a ‘maternity listening service’. They’re great, a midwife goes through everything with you blow by blow, based on your notes, and discuss any concerns and tell you how it works and why they had to make the decisions they did. It is also their opportunity to take accountability. I had a 3rd degree year due to poor pushing advice and they did take accountability for this. Which doesn’t change things but it did make me feel better.

I wouldn’t be happy with that birth either. We really need to raise standards for maternity care and that starts with expecting high standards for ourselves. The fact that they’re busy isn’t your problem and you shouldn’t have had to suffer because of it. Women need to speak out when they’ve had shit healthcare experiences otherwise nothing will change.

Anyway congratulations on the birth of your baby! Take care of your wife

And also don’t listen to people who say births can’t be planned - birth plans aren’t meant to ensure a perfect birth but to instruct on the motherMa wishes should things NOT go to plan. These should never, ever be dismissed or disrespected. Tears CAN be avoided. Did your wife have an episiotomy OP? Did they listen when she said she needed to push?

And folks, please don’t tell OP that ‘as long as they have a lovely baby’ or similar. We should never accept or forgot about poor maternity care.

Get a birth debrief.

Bit odd going in with the worry about a 3rd or 4th degree tear unless previous history.

Lithotomy can lead to increased chance of serious tearing and directed pushing is not best practice unless there is a really good reason. I would suggest first ask for an appointment to get some answers and if they don't satisfy them make a complaint. It's the only way maternity services instigate change and most people don't bother to complain.

Obviously no one wants a 3rd or 4th degree tear during childbirth, everyone would avoid that if possible.
Not sure if there's such a thing as pushing wrong, your body kind of takes over and does what it has to do.
Ask for a debrief if it will put you and your dp's mind at rest and help you process and move on

Did the doctor come when nurse rang? Was she looking an episiotomy? Was the baby in distress so needed out ASAP so told to continual push?

Make a list of everything you want to know for the debrief

I'm not sure tears can be 100% avoided? I birthed the head on all fours but was then turned to lithotomy (had to Google that) for shoulder dystocia release and then told to give one big push (baby was resuscitated after but just fine). Up until then I had done no active pushing (also v short labour), my body pushed with nothing from me. Was not surprised to have torn with a Dr's arm inserted, but was surprised at the great recovery.

Such low continuity of care in such a small time frame is pretty bad. Definitely ask for a debrief. In the meantime, recovery might not be as bad as expected. In case this isn't common knowledge (it bypassed me), avoid sitting crossed legs. I did this for feeding and read months later it's not advised with stitches?

Thanks for advice, I think they were concerned - CTG was a poor trace, so couldn't alway reliably tell if baby was fine or not, they also didn't know if membranes had ruptured or not (we think it hadn't entirely, baby came out with partial amniotic sac over the head), so the midwife wanted a doctor to do the examination. She had also gotten the episiotomy kit out but not sure if it was for the Dr to do or if she was planning on doing, but she had so much going on, needed another person help. The contacions were extremely frequent. When it was apparent Dr wasn't coming, she called for 2nd midwife but they could only pop their head in to say they had an emergency next door and poor midwife had to deal with any problems herself (think our midwife had been pulled down from the community unit due to short staffing and hadn't done labour ward in a while, which she disclosed to us quite openly). We're not looking to blame, but our experience felt quite contrasting to some of the things out antenatal class had taught us (led by a midwife at same unit) and just not sure if this is normal for labour and we shouldn't raise or if this is unusual. My feelings at the time were that things were not in control (and I asked at the time, if we should be worried or if everything was ok, and the reply was mixed), and I'm not sure we've had any feedback to close the loop on that. My personal reflection at least, is to not want to go through that again, and if given a choice would opt for an elective c-section (not sure whether that hammers home my 'feelings on the birth experience'), me and my wife will ofc debrief in the coming days too, and ofc we're treasuring every moment with our child, and consider ourselves quite lucky.

From the sounds of it, a request for a debrief doesn't seem unreasonable, so we'll do that.

In the nicest way you do understand this is childbirth, and not a day trip to Alton Towers? You can’t plan for it, in any sense. It isn’t an ‘experience’. And at the risk of being told I’m ‘minimising’ the experience sounds quite standard to me, nothing unusually bad about it. It’s supposed to be painful, damaging (to some extent or another) and quite scary, particularly when it’s your first.

Antenatal classes are there to sell it as some lovely day at the hospital where you light candles and breathe the baby out with minimum fuss. Because nobody would go back if they told the truth. Out of 9 of us in my class, 2 had instrumentals, 3 had c-sections and out of the 4 who had normal births none of them ended up with a ‘calm, water birth’ experience they planned - it was continuous monitoring on labour ward for various reasons.

As for ‘not wanting to go through it again’, well I’ve little time for that - it’s your wife who ‘went through’ it, and I can’t help but feel your unrealistic expectations have fed into her own feelings.

I'm so mad at PP who are minimising your experience. With the very recent scandals at Nottingham and previous reports into poor maternity care I'm pretty sure it's fair for you to say your experience wasn't what you expected or hoped for.
As someone else said above, we need to expect more. We need more. We have a right to better birth experiences and less birth trauma.

You Can definitely get a debrief and a step by step explanation of why things went how they did. I think it’s important to do if your partner felt out of control or not listened to. I did it for 2 out of 4 of mine

i think totally reasonable to ask for a debrief. it's not clear whether any change in care would have resulted in a different outcome but 3 midwives in 3 hours and a failure for back up staff to be available when asked for makes it sound like you really didn't get the best care possible.

and that might just be the reality/luck of the draw but it's totally reasonable to get to explore what this experience might mean for the future as well.

This is utter bullshit. Sorry Gochasing, but please don’t disregard this man’s pleas so flippantly

Yes, you CAN plan for birth. There are dozens of professionals helping women do just that. Being educated and having a plan doesn’t mean you don’t accept that on the day, things can change a lot though...

I had a traumatic time post birth (great delivery but then retained placenta and negligent hospital care leading to 6 hr wait and huge haemorrhage) and the debrief with my midwife was vital in helping my understanding.

• contact your midwife to ask about the birth debrief, that’s a great start
• contact the hospital trust about getting a copy of your notes; there will be a contact on their website, might take some digging. Can take a few weeks to arrive.
• let your partner know that you're happy to talk about it at any time she wants, as much or as little as she wants. For me, I’ve needed these chats even years afterwards
• consider finding some therapy for yourself too; you need to look after yourself in order to support her and the baby as best you can

with support, I learned to manage my trauma and go on to have a super second delivery.

Talking, asking questions, listening, finding out: this stuff is so important

Enjoy your baby and this precious (mad) time. You sound like a great partner and dad x

What a patronising, moronic answer. Please take your ignorance elsewhere.

’in the nicest way’ ffs!!!!

birth trauma is real, people can have terrible experiences and be treated terribly by medical staff: these things need figuring out.

maybe the staff did an amazing job in the circumstances, maybe the outcome from a debrief is that the OP feels grateful and happy in the end. But equally, maybe a medical professional fucked up. It happens. Lucy Letby anyone?!?

Please be more gentle with your advice to new parents in future.

It sounds like there were not enough staff. At the moment of birth there should be two in the room in case both mum and baby need help. Sounds like your midwife needed back up and a doctor and because she could not be sure your baby was coping, needed the labour to be over ASAP. She must have inwardly be really worried in case it suddenly became an emergency and there wasn't any back up. And yes that is the basis for complaint. Lack of staff in units is a massive safety issue.

Erm what rubbish did you read the OP?

Not having enough staff and the other aspects the OP describes are clearly not good enough.

Tears do happen and aspects go wrong. However you don't expect the staff required to be unavailable and your midwife to admit inexperience and the whole thing to be completely out of control.

Definitely ask for a debrief and if necessary complain.

I had a 3rd degree tear and gave birth in lithotomy. The difference is that I had an obstetrician there when things got tricky, and I felt well cared for throughout.

Don't despair most people heal well from severe tears. Seek women's health physio when the time is right. Private if necessary it's not that expensive.

I would thoroughly recommend a birth debrief. I had mine quite some time after the birth - it ended up being almost a year. While that is much longer than I expected and would be normal, I actually found it much better to absorb the information and ask my questions. I felt much too emotional and traumatised immediately after birth and don't think I would have found the debrief as useful. I think the midwife said they recommend waiting at least 3 months.

I had lots of things go wrong/not to plan and suffered birth injuries. Luckily my baby was completely healthy. However I found it really upsetting when everyone I tried speaking to about my feelings told me I should be grateful the baby was ok and to focus on how that was the main thing. Of course I was grateful my baby was ok but I needed the validation from the debrief to say that what happened to me was not ok and that I mattered too.

You sound like you don't understand a lot of what happened, so I'd fully recommend contacting the hospital to request a Birth Reflections meeting. A midwife will look through your wife's notes before the phone call/face to face meeting and talk through everything that happened and why each step was taken by the hospital. It'll really help both you and your wife to understand everything and put it all into perspective. If you then feel that the hospital did something wrong, or didn't give your wife and your baby the care they needed, then contact your hospitals PALS team to make a complaint.

Yes, your wife had a birth plan, but if things go super fast/change dramatically, they can't always be followed. The health of mum and baby HAS to come first. And remember that a birth plan isn't just about where your wife wanted to give birth or what pain relief she wanted, but also the little aspects like whether she'd want baby to have the vitamin k injection or whether she wanted baby to be cleaned before holding him/her. Were these details taken into account by hospital staff?

It sounds like you felt like most dad's during labour - helpless. That's completely normal!

After the birth reflections meeting you'll be able to understand what happened during the birth better and feel better able to objectively decide what your next step will be (if any) in partnership with your wife.

It might be worth getting in touch with www.birthtraumaassociation.org.uk/ as they can talk your wife through what happened and are really kind. She might get a clearer idea of what went wrong and be able to start dealing with the after effects on her.