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.

"Well the main thing is that baby is fine." Errr no, fuck off.

Hi OP, first up, congratulations on your baby! Second up, please ignore patronising folks trolling your thread - everything you and your partner are going through is valid and it definitely sounds like a birth debrief would be of use to you both.

I have 2 kids and my first labour was very challenging to me. I had 'done my research' and used a doula and expected to feel empowered and prepared.

Instead, in the moment of being in labour, I felt really disempowered. I experienced huge waves of panic, felt unsupported by midwives and doula, didn't understand why things were happening, wasn't asked for consent for a sweep which I'd said both verbally and in writing that I didn't want. Felt, as you put it, 'out of control'.

It was traumatic for me, although not classed by the hospital as 'a traumatic birth' in any way. I also sustained a birth injury to my vagina that was a real blow to my self-esteem and definitely contributed to me suffering with post-natal depression.

I had good support from my GP with the PND, and taking it slow and giving myself time helped a lot with processing the experience. The birth debrief didn't answer every query I had, sadly, but it was definitely some help.

I opted for an elective section with my 2nd baby, and don't feel any shame or conflictedness about that choice. For me the ELCS was a great experience and my recovery was very straightforward in comparison.

Wish you and your wife all the very best. Also, lots of this is the result of pressure and lack of staff on the wards, which is due to the systematic underfunding of our precious NHS by the Tories - so please vote Labour to give the best chance of better funding for maternity care in future and this not being 'normalised' - mums and babies deserve better.

YANBU at all. I hope your partner is recovering ok. Definitely ask for a debrief - also I really recommend this podcast episode on healing and birth trauma. All the best.

podcasts.apple.com/gb/podcast/the-birth-ed-podcast/id1485321117?i=1000463912656

It sounds like I had a fairly similar experience to you. I applied for a "birth reflections" appointment. Took over a year to get it because of covid, but it was well worth it to understand what happened and why those decisions were made. I recommend. But it is NOT a chance to complain or get counselling - if you wanted this then there are other channels.

In my case the midwives were very worried about the baby and telling me to push in lithotomy because of this. Ended up with an episiotomy and forceps. Nothing like my birth plan. But after talking it through, I would make all but one of the same same decisions again. Maybe this debrief would help you decide if complaining is something that needs doing?

Congratulations on your baby.
The birth sounds a bit frantic and like your wife did not experience the care she should have had. It is very dismissive of some to suggest that a healthy baby means you just forget about the scary and understaffed birth.
I would ask for a debrief, but right now your wife can still ask informal questions.
I would also suggest you take copies of all the notes, in my trust we took the notes home for the midwife to collect again on a home visit. I actually declined to give the notes at that time as I wanted to make copies. There were some out and out lies in my notes. My issues occurred after the birth, which was ELCS.
It's early days to be thinking of C-sections for next time, (early days to be thinking of a next time at all, maybe don't mention that to your wife!) but yes it is a valid choice, although some women find a subsequent better birth experience of any kind a healing experience.

Your body doesn't always take over. I had no urge to push at all, but my midwife was telling me to actively push. I kept having weird contraction-spasms instead. It turned out that the baby's head wasn't at the right angle so I assume that was the reason.

Hi midwife here. At my hospital a 3rd degree tear is a reportable trigger for case to be reviewed by the clinical risk/improvement team. We offer a 6 week postnatal review with a consultant obstetrician and in subsequent pregnancies elective Caesarian section is offered.

How patronising,unkind and unsympathetic of you to say this. What was your intention in writing that out - did you honestly think you were being in any way helpful or contributing positively to this thread?

I don't think anyone equates childbirth to a trip to alton towers. You're right that you can't have a rigid plan for birth, but it is a good idea to list your preferences - even if you don't get the experience (and it is an experience, you actually say so yourself in the your next sentence) you want, some parts may still be possible. A birth plan also helps you to be informed on the process and possibilities end to end, it's not a guaranteed step by step - if that's what you meant then you're correct.

3 midwives in as many hours sounds unusually bad to me and childbirth often is painful, damaging and scary but it shouldn't be. We need to stop accepting poor standards around women's health care and question/challenge when something doesn't feel right. That way if practices are wrong they can be improved and if they're correct, the quality of information we share amongst parents can be improved so we are all better informed.

Your statement that antenatal classes are there as a sales pitch otherwise nobody would come back is nonsense. If that were the case, we would all discover the big bad secret after 1 and nobody would ever have a second child.

The birth partner aldo "goes through it". Sure they dont have the physical toll of delivery but from the sounds of it OP has been very involved in their wife's care and has been under some stress- birth partners/men are allowed to have feelings about childbirth too fgs. If OP was here saying "oooh I was so tired and hungry I didn't eat my lunch that day" then fair enough. That's not what is being said here at all.

@HSlant ignore comments like this one, your feelings are completely valid as the birth partner and I think it's great that you have been and still are advocating for your partner and child. The experience you all had sounds stressful and worrying - I'm very glad you're all safely out the other aide and I hope your wife recovers well.

You are absolutely entitled to ask for adebrief to understand why certain decisions were made, and to look for an explanation for any failings in procedure/care.

Good luck, I hope you both get the closure you're looking for. And congratulations on your new bundle of joy. It goes by so quickly, try and soak up every second - even the tiresome, stressful ones.

I’m sorry you and your wife had that experience. Unfortunately maternity services in the U.K. are failing women, and getting worse as the NHS is collapsing.

You can ask for a debrief with the matron. However, be prepared to be fobbed off and your concerns dismissed. This is exactly what happened to me. It is also well documented that many trusts try to cover up their negligence by withholding information from families, including in harrowing cases involving losses. I would therefore go into the meeting with low expectations, a specific list of questions, and accepting you may not achieve resolution or get closure over your experience. Be prepared to be told that your birth went well, and that you should consider a home birth next time - even if this flies in the face of your lived experience or wishes.

The patronising posters on here make my blood boil. This isn’t the Handmaid’s Tale FFS. Women have rights too. No wonder the U.K. is trailing behind Albania in female medicine.

I’m not trying to be unkind, I just don’t think it all sounds that bad to be honest - I think his/his wife’s requests were too specific, and it’s not surprising that the NHS can’t cater for them. You can’t really make specific plans anyway as it goes how it goes, and good midwifery care can only change so much.

Childbirth is inherently painful, a bit dangerous and damaging - there’s no way around that no matter how great the healthcare is. I don’t really understand people who seem genuinely surprised afterwards that it was one or all of those things.

I agree that it sounds like a debrief would be very helpful, congratulations on the birth of your baby and I hope your partner recovers well. it’s so good your partner has you there to advocate for her and support her and by asking about this on here you’re clearly ready to continue to do that.

For those who have mentioned the debriefs and birth reflections etc, is there a time limit on when you are able to have those conversations? I had a traumatic birth several years ago and I still get very distressed when I think about it, so I wonder if it may help me to understand what happened.

Did you have a third degree tear, out of interest? Did you have 3 midwives in 3 hours? Did you have midwives scrambling around to find a doctor who never came? What is it that sounds not that bad to you?

It sounds like you're trying to justify poor care. If what you experienced was as bad or worse then that's not ok either, whatever you've been told. Saying "I experienced bad care too so you shouldn't complain" is not the answer.

I don't think there's a time limit no. What happens is a senior midwife goes through your notes in detail. So I don't see why that can't be done years later as long as they still have the notes. Also you can order your notes to be sent to you if you want.

The op says they didn't want a hypoxic brain injury for the baby or a severe tear for the mother...that doesn't sound overly specific in terms of birth plan. I also don't see where the op has expressed surprise about it being scary or painful. This isn't the place to grind your axe about your own issues.

9 out of 10 women tear giving birth, it’s unfortunate but I’m not sure how it’s ‘poor care’ - it’s luck more than anything else. 3 midwives in 3 hours is not ideal but that in itself wouldn’t be enough for me to complain. We need to be a bit realistic about what the health service can manage at the moment. Ultimately complaints will go nowhere as it’s a nationwide staffing/funding issue.

This sounds very scary I'm sorry OP

Birth is a very unpredictable experience so when it feels all out of control on top of that it leads to trauma

If you of your partner feel it was traumatic, then it was, simple as that. It's not a competition for others to say there's was a worse birth or you birth was standard, the care you recieved was understaffed and substandard.

I highly reccomend as suggested before a birth debrief, you may find it under birth reflections

Talk to each other and work through it, you mentioned another child in the future, be prepared for these feelings to resurface again at that point.

Tears are unfortunately common in first births, it's one of those things antenatal classes don't go into too much. Make sure she heals well and reach out if any problems either end. She will probably be asked if she wants an elective section next time due to the degree of tearing.

How old is baby?

That does sound like a scary experience OP. Asking for a debrief sounds like a great idea, when you are both ready.

I had a birth experience that frightened me deeply, even though the outcomes were ok. I had both fear and guilt about it. It took me over a year to get support from the right place and I’m so glad I did. I still feel a little sick thinking about it - DC is a teenager - but not nearly as much as if I’d just swept it under the rug.

Please disregard @Cuppasoupmonster’s contributions. Your hopes were perfectly reasonable and your wife deserved to be looked after well.

Of course the birth didn’t go to plan. You can’t plan a birth. You can listen to all the mindful podcasts and pack all the battery operated candles you want but you can’t make birth a calm magical experience. Most of the time it’s brutal, that’s just part of it. Many, many women used to die in childbirth. It’s a difficult experience that leaves lasting physical and mental damage a lot of the time.
That’s not to say things shouldn’t be followed up if there were mistakes made but I think mindset is largely to blame for birth trauma sometimes. If you go in with too many expectations women end up worse off at the end in my experience.

tried to convey that one of the biggest concerns was of getting a 3rd-4th degree tear

Doesn’t everyone want to avoid a severe tear though??
Midwives and drs don’t want women to tear and be in unnecessary discomfort, of course they don’t. But at the end of the day a safe delivery of the baby is important and it’s a fine balance.

Your wife can request a birth debrief if she thinks it will help. It honestly depends on the sort of person you are whether it’s helpful or not. It could give her closure, equally it could drag the whole ‘getting over it and moving on’ process out for her.

Definitely get a debrief and ignore those posters who are minimising what your partner has been through.

Births never go like clockwork but you need to know they did everything possible to reduce injury to the baby and the mum.

I echo everyone else saying ask for a de brief service at the hospital. If you mention this to the midwife/health visitor assigned to you now they will know what you mean.

I had a second degree tear and don't blame the midwife for this, but I wouldn't be very happy if the midwife had been buzzing for help and nobody came. It must have felt quite frantic in the delivery room from what you describe and although this is obviously more traumatic for your partner, it can be awful for the birth partner too. Ignore the poster who invalidated your feelings.

I think I was told to push too early even though I was at 10cm. I pushed for ages and nothing happened and I was really trying to force it. Then something changed and my body just needed to push and baby was born, so I do wonder about that advice sometimes.

Congratulations on your baby and encourage your partner to go for her 6 week post partum check up. It may help her feel more confident to have a doctor tell her that she is healing/healed. This was a huge milestone for me in feeling more confident in my body after a tear.

I think some PPs read “birth plan” and then just reacted.

Apparently only 6% of first timers have third or fourth degree tears in the UK. Lithotomy is known to increase tearing, lower the mother’s blood pressure and lead to ineffective contractions. There should always be 2 HCPs in the room imo, as PP also mentioned. Yes, sure there was a staffing emergency but it could well be a big help for the couple to understand why lithotomy and why nothing could be done - like counter pressure- if that’s the case, to reduce the tearing risk.

A third degree tear is not any tear and OP has explained it had to be repaired in theatre. The extent of the tear may make the mother’s recovery slower as well as increasing the risk of granulation.

This isn’t fight club. Have a bit of compassion.

In addition to all the people recommending a debrief, do take time to work out your response to what has happened and to allow your partner to do the same.

Neither of you have to feel ... 'of course we are grateful for a healthy baby'... you can put that to one side and allow your feelings about the birth to be heard.

Birth position and coached pushing do increase the risk of a tear, there is good evidence on this. It may be that there was a clinical reason why these two interventions were considered necessary rather than a more physiological birth position like on all fours or upright and allowing your partner to work with the contractions and to allow her to follow her instinctive pushing reflex rather than being coached to push.

A review of the CTG and the birth notes should explain the reasons why whose decisions were made.

It sounds like the midwife who was caring for your wife and baby had significant concerns for the safety of the baby and did not have the support she needed and should have expected to be available.

These are all reasonable things to be able to discuss. The adverse outcome of the physical and emotional trauma suffered by your partner might have been avoided if the midwife was adequately supported. It is also possible that your baby was indeed in distress and that a review will show that the actions taken were reasonable and proportionate at the time. If that is the case, then it is very likely that understanding that will bring healing in itself and make it easier for you and your partner to process the events surrounding your baby's birth.

I would encourage you both to review this with the hospital but also to seek independent support to help you through this.

This is why I was disappointed that they still call it a 'birth plan', as opposed to 'birth preferences'. Strikes me a plan is set up to fail if things don't happen as expected / there's any hiccups along the way: the focus is all on what was planned as opposed to what you'd prefer to happen depending on circumstances 'if this happens then I'd prefer that option', or ' if that happens then I understand z may need to occur, but if not then I'd prefer y to x'

But definitely get a debrief, it'll help you come to terms with what happened and why vs your expectations.

I am absolutely convinced you must be @Cuppasoupmonster posting under a different name because you sound almost like their echo.

Soem births are calm, magical experiences so it's not unreasonable for people to hope for that
While childbirth does push the body to the limit of human endurance we shouldn't expect people to walk away with trauma, physical or mental. Nor should we accept sub standard care because the system is underfunded and struggling. This should make us even more determined to challenge it. If we sit down and accept it things will never get better.

Nobody here, not the OP or PP, are saying OP and their wife were entitled to a lovely, gentle birth and the midwives had a duty to make that happen. What we are saying is its perfectly reasonable to feel secure, safe and well cared for during such a vulnerable time. The lack of support and uncertainty added additional additional stress. OP's wife ended up with such a severe tear she had to be taken to theatre to be stitched. That's not a minor thing and it will have slowed her recovery. It's possible that even if OP's wife had the same midwife consistently and had access to a Dr when called, the outcome would have been the same, but perhaps she and OP would have felt more confident in the process. They aren't bashing the staff who did look after them, nor are they whining about not getting what they want. They experienced some trauma, they have some questions and it's reasonable for them to ask questions of their healthcare team and to seek a little bit of support and validation from communities such as this.

Also @Swiftswatch can I just ask - what is your experience? Are you a midwife or consultant? A doula, birth coach, counsellor? How many parents have you had enough contact with before and after their births to determine that those who have "too many expectations" have a worse time? What are appropriate expectations anyway? We should be able to expect more than "oh well, nobody died".

I agree with this. I wrote my birth plan as the most lovely, ideal birth imaginable. Then I went through it, and made a note of the worst case options. I discussed both with my widwives and my husband.

We basically concluded that if we couldn't have the water birth we wanted that was fine. Said I'd prefer a c section to an assisted delivery with forceps/ventouse and that we wanted to delay cord clamping, let my husband cut the cord and for baby and I to have skin to skin immediately/golden hour unless there was a medical reason not to.

We were both so glad we did this as it was a very long and difficult labour that ultimately ended in an EMCS. We did however manage to delay the cord clamping, the surgeon cut the cord but left it quite long so my husband got to cut it to length, and we had skin to skin right away. As soon as we got to recovery baby breastfed.

I still had a debrief because by the time baby was born I was so exhausted and out of it I couldn't really remember what happened and it left me feeling unsettled. After going through my notes and just being able to fill in the gaps I felt SO much better.