To think that this could be possible - covid birth

[DaisyEM]

I had my first baby during the pandemic, and I’ve never fully understood why much of it happened the way it did.

As a bit of background, my waters went at 31 weeks but I didn’t go into labour, so I was induced bang on 37 weeks (with checks in hospital every 3 days to monitor for infection).

I was called in at 9pm for my induction, and by 11am the next day I was having contractions. After several hours I was recording that I was getting three contractions lasting around 60 seconds every 10 mins. I told a midwife to be told just to sit tight. During a 2hr period I pressed my bell three times as I was so sure I was in active labour and every time I was dismissed. By the time they finally said they would check me I was 9cm and rushed round to delivery suite. This was really stressful and at this point I already felt like I wasn’t listened to/ignored and it didn’t fill me with confidence.

As soon as I got in delivery suite I was 10cm and needing to push. I pushed for 1.5hrs before they did a forceps delivery, then and there in the room without an epidural or gas and air.

I still to this day have no idea why I had a forceps delivery. NHS website says to allow up to 3hrs for pushing for first babies.

I’ve since had my second baby and my experience was completely different. It was so much more positive and I felt like I was in control and could have a say in what was happening.

My hunch is that when I had my first baby, they didn’t have any space for me on the delivery ward and so they kept stalling me when I was saying that my contractions were coming close together. And then the only reason I can think of for the forceps delivery is because they needed the room back. Baby had constant monitoring during my labour so I know there weren’t any concerns with him.

What does everyone think? I suffered PTSD following my first birth and had counselling. My pregnancy was complicated and my baby was unwell after he was born so that has a lot to do with it, but the thing that bothered me the most has always been the forceps. I had a birth debrief and when I did my birth plan for baby 2 neither the consultant nor the midwife could give me a reason for the forceps delivery.

I also recently spoke to a friend who’s a nurse and mentioned that I wasn’t allowed gas and air first time, and she said that there was an oxygen shortage during the pandemic, so I guess that could be why they didn’t let me have gas and air 🤔

it’s always bothered me and I feel like I can’t get any straight answers, so would be good to hear what others think.

Thought I'd just suggest it as it might give the op some clarity. Didn't want to assume they were based in UK.

It is possible. If you have pprom (prolonged premature rupture of membranes) then you have regular monitoring including blood tests to monitor infection levels (FBC and crp twice weekly in my trust), once weekly high vaginal swab and ctg twice weekly dependant on gestation. We aim to keep baby in for as long as we can.

In my trust gas and air was never restricted, but I can't vouch for other trusts. The three hours for a primip tends to be a latent second stage for an hour (where you don't have the urge to push but are fully dilated). We would then do directed pushing up to two hours. We would only usually end up in an instrumental if there were signs of fetal distress which could mean it would not be safe to continue for the full two hours.

I would request a meeting with a professional midwifery advocate to discuss your notes and answer these questions.

There was either fetal or maternal distress. Much more likely to have been fetal, so the baby's heartbeat would have been giving rise to concern.

That's my guess. I'm a retired midwife and I'm very sorry that you had this truly awful experience of birth. Can you ask for a debrief with someone who has access to your notes?

Unresolved conflict around labour and birth can really play on women's minds, even years later.

@BellissimoGecko I don’t know what you’re suggesting here - this happened twice to me, with both of my sons. My waters leaked, with DS1 they just trickled, with DS2 they leaked much more heavily to the point where I had hardly any water left by the time I was induced. As I explained above, with both my pregnancies after my waters went I had monitoring every 3 days, bloods once a week, and at home I took preventive antibiotics and also took my temperature every 3 hours round the clock, to check for signs of infection. I lived through this and it was extremely worrying and upsetting. I held my breath both times waiting the safe delivery of my children. For you to suggest this isn’t possible is both ignorant and insensitive

Thank you. I know there wasn’t feral distress - my mum was my birth partner and she was watching the monitor very carefully, and she’s a retired nurse x

You have misunderstood my post. My reply was to the poster who said it wasn't possible for your waters to go at 31 weeks and not to have baby until weeks later. I was saying that it was, so actually agreeing with you and not being ignorant.

I can see you've edited it to change the name, thank you.

That's not the case when they go early in the pregnancy. It's a different situation.

sorry I realised seconds after I posted and updated my reply to tag the other poster (which you’ll see above), but you obviously got a notification and read my response before I managed to edit it. Thank you for standing up for me x

A nurse doesn't have the training to interpret a ctg to recognise fetal distress or hypoxia, unless she has trained in midwifery? There can be quite subtle signs, it takes three years of training for midwives to be competent in interpreting ctgs. It would be bets for you to meet with someone who could go through the ctg with you. It may not have been for fetal distress, but at least you would know that for sure. Contact your hospital maternity dept and ask for a referral for a birth reflection with a pma.

Thank you, I’ll see if I can get hold of my notes rather than just having them read to me. On my app the reason for forceps is down as ‘failure to progress’ x

Thank you, I’ll do that to be sure. I wasn’t sure if they would even consider talking to me about it now as it’s been so long x

I’m a fan of Gas and air. It didn’t actually affect the pain, but I didn’t care as much. I ran out with DC 1.

I really hope they do, as it will really help you.

@comoatoupeira i had gas and air (and nothing else) with my 2nd and did find it took the edge off a bit. Anyway, the lack of gas and air wasn’t my main concern or the main point of my post.

Depending on your trust, I remember a while ago (not sure if right timing for you) that a lot of hospitals stopped giving gas and air for a period because they found the ventilation in the hospitals wasn't good enough and workers were being exposed to above the safe limit. Think it was linked to adverse outcomes in pregnancies in those workers and maybe some other things.

Yes agreed! I had it with my 2nd and it definitely helped to relax me x

Thank you, this is really helpful x

That wouldn't matter in my trust, five years is nothing. You can also do a subject access request to get your notes, they have to be keptn for 25 years. Your hospital website should have a link to the SARs request.

I'll be honest, I think it's terrible you weren't given a debrief after the birth. That is standard where our births have ended up with an instrumental.

I hope you find the answers you need. Birth trauma is a very real thing and I'm sorry you had to experience it

I think its awful you weren't allowed an epidural or gas and air! What pain relief did you have.....if any?!

I will just preface my comment by saying I'm a midwife. I had a 4 hour labour with my first baby and had a ventouse delivery purely because I was screaming, it was too late for any pain relief and I had stopped pushing with any actual effort. Just kept screaming at my husband and my mum for it to stop, begging them for terbutaline to stop my contractions (I was having 8 in 10 minutes-with no induction medication) and shouting over and over again that another contraction was coming because they were so fast I couldn't get a grip of myself.

I didn't have any gas and air (they'd taken it off me) and I had local anaesthetic for the episiotomy for the ventouse.

When I reviewed my birth notes with one of the midwives (I gave birth at a different hospital to where I work) I'd been fully dilated for maybe an hour and 'pushed' for about the same amount of time as you. His heart rate was okay...he could've had a bit longer in there, and the reason for the ventouse was given as 'maternal distress'. Could the same be true for you? Which may not have been clearly documented?

I strongly disagree.
It really took the pain away for me.
I was late for the epidural and I couldn't have done it without the gas and air.
I had a retained placenta on no.2. Doctor hand up trying to pull it out, no pain, just discomfort thanks to G&A. I was drunk on the gas. 🥴

It’s very possible. A baby is safer inside than outside at 31 weeks. Obviously they monitor for signs of infection and can give prophylactic antibiotics. It’s a very different position from waters going if you are term.

But surely the risk of infection is still there?!

OP

• this is what the nice guidelines say.
• after 1 hour of active pushing, reassess the clinical picture, including progress, contractions, and maternal and fetal wellbeing:
• if there are signs of progress (in terms of rotation or descent of the presenting part), encourage the woman to continue pushing
• if there are no signs of progress, offer vaginal examination and consider amniotomy if the membranes are intact; if there is still no progress, diagnose delay and escalate for senior review
• if birth is not imminent after 2 hours of pushing, refer the woman for a senior review and a decision on place and mode of birth. [2007, amended 2023]

It could well be that after an hour/1.5 hrs there was no sign of progress and they didn’t expect baby to be born in the next 30 mins. So if after that length of pushing there has been little to no descent it’s unlikely anything would change in the next 30 mins. Prolonged pushing increases the chances of a post partum haemorrhage, and also risks your perineal muscles long term, ie incontinence. It’s all about weighing up risk/benefit. If it looks like the baby will be born within 2 hours then keep going, but otherwise there is no benefit to carrying on pushing for another 30 mins just so they can tick a box that you got the “allowed” 2 hours of pushing.

It’s very unusual for pushing to be for more than 2 hours, the 3 hour timeframe you’ll have seen includes passive (non pushing) 2nd stage for women with no urge to push or an epidural.

going for a birth debriefing is a really good idea.

And if that occurs then they’ll deliver if necessary and give baby abx as well if needed. It’s all covered in the evidence based rcog guidelines and is routine practice. https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.15803

yes infection is a risk, but so is prematurity.