How far down the intervention route do I go..

[AliGrylls]

I am getting really panicky about my impending labour - I am now 37+3.

The background is that in my last labour I had quite a painful induction (although I could not say traumatic). I remember having a cervical sweep 48 hours before being induced and then having a really incompetent midwife attempting to put a pessary in (it took her about 15 minutes). I went into labour after this pessary (when they eventually left me alone for a few hours) and then 4 hours later because my waters hadn't broken I had an amniotomy, which I found really painful because the midwife took 4 attempts at it before succeeding. I asked for an epidural because the contractions were so strong and this came to 2 1/2 hours later. It all ended with an emergency c under GA (the epidural had not taken down one side of my body and it was thoroughly painful) due to decelerations, which I actually blame on the epidural.

The query I am having is how far down the intervention route to go this time. I initially wanted to just say if I can't have it entirely naturally I would like a c-section. However my mind is in turmoil because yesterday my consultant told me that sometimes when the waters don't break it is the only thing that slows the labour down and I should let them do it and it is not normally painful. I wonder how much of the "slow labour" syndrome though is hospital induced stress (which I am quite vulnerable too) and I much prefer the idea letting things take their course unless I actually need a CS. Also, because of what happened last time I don't want people touching me in that area unless they actually need too.

Basically, I can't decide on my birth plan whether I should let the hospital staff do minor interventions (like an amniotomy) or whether I should just say I want to go straight to c-section in the event of a problem.

What would you / did you do in this situation? I am really turning this round in my head.

i think it is also well documented that a baby needs water to be able to get into a good position and early breaking of waters can prevent that happening. this happened in my first labour

with my next 2 labours my waters didn't break until just before babies were born... i don't think there is any "need" for them to be broken early tbh

i totally agree that a lot of induced stress is really not good for progression of labour.

i had numbers 2 and 3 at home and the difference was amazing. with my first baby i had g&a, waters broken, then pethidine which stoppped contractions so was hooked up to drip, then epidural and he was finally born with assistance of ventouse.
had the other 2 with no pain relief at all, both quick labours and just so totally different.

i truly believe that the setting, the people i had with me and being very prepared helped the most with my labours.
that isn't to say it would have been completely different in hospital, because if i'd needed to go i'd have gone willingly. just that it helped keep me very relaxed

meant to ask, can you do that? i mean say if there is a need for intervention then you want a c-section?
because that would = an emergency section wouldn't it?

i think they might go for a planned c-section with a trial of labour, which would give same results, but means the team are aware that you may need section

but not sure you can just turn up and then halfway through demand a section?

i have no idea how it works tho!

Well all of your post makes sense except for the breaking waters bit. You do NOT want to do that for any reason I can think of.

Yes, the waters in tact can sometimes protect the cervix from some of the pressure and therefore it dilates a bit more slowly and comfortably.

Why burst the protection, have the head slam down when the baby may not yet be in the optimal position and then have to deal with extremely painful contractions as well as a possible long 2nd stage and increased risk of an assisted delivery?

It's up to you of course, but personally I would avoid it.

sorry to crash your thread but Im very interested in starkandwitcheswillfindyou opinion. I too had my waters broken very early on after successful pessary induction and will not let them do it this time unless baby in distress. It sent me from coping well with timed contractions to as stark says having the head slam down and extremely painful contractions I couldn't cope with and then have an epi which made me bedbound and only worked half my body. I am 40+4 today facing induction next wed and feel definitely a bit more informed this time good luck

I have been told by my midwife that I can ask for a c-section at any point and because I had a cs last time they will take it seriously.

I have just found a paper on amniotomy at WHO amniotomy for shortening spontaneous labour on the web. I don't have the full address because I just closed the page.

I wonder if it was actually just performed too early in my last labour. Personally, if I was not at risk of uterine rupture I would go for a home birth as I hate the idea of loads of people being around. The only people I really want are my midwife and DH. Anyone else may just stress me out.

you don't have to have an induction you know.

is it not the case that a large proportion of inductions end in interventions, so you might stand a chance of a natural delivery by avoiding it.

i do know people who have gone considerably over with monitoring and delivered naturally.

don;t know any sites but there are some.

but you presumably run the risk of them not having enough staff in, or staff being busy etc if you do it that way?

First baby I also had a crash section under GA after massive decelerations and my epidural only working on one side. I wasn't induced but my waters had broken 2.5 days earlier so a dry painful labour.

I tried for VBAC at home, and I did decide that I was happy to try labour but I would not accept interventions except for CS. I failed to progress and went in, asked for a CS. They weren't very keen to do it, but I refused an epidural and refused to let them break my waters so they sort of had to do it[hsmile]

V glad too, baby was getting a bit distressed by the time he was out and I really really wanted to avoid a crash CS above all else. So it is certainly possible. I am a bolshy fucker madam though[hgrin]

I do run the risk of them being busy. One thing I don't want to happen though is to be persuaded to do something that is actually not clinically proven to work just because it is convenient for them (IYSWIM). In the paper I just read it actually said that amnio doesn't reduce the time spent in the first stage of labour and is most effective in the second stage so I am feeling a bit more like I know what I want now.

I am just aware that the whole thing could turn into a nightmare for me - I am always trying to please people and I do want the medical team to do their jobs. The labour to me is about me and baby and not about anything or anyone else but I know what I am like and I will probably let people prod me if they are persuasive enough.

Ghoulish, train me to be a bolshy madam?

absolutely. and you can refuse to let them do anything and allow you to labour naturally

have you considered a birthing centre if you don't want to have a home birth?

I can't do that because my CS was less than 18 months ago so the risk of uterine rupture is (comparatively) high. I would do it otherwise. Also, I have done the hypnobirthing course to help me feel calm about everything (not sure if it will work if I let myself get stressed out about it).

ahh ok. i hope it all goes ok for you.

Has someone told you that there is an increased risk of UR because of an 18months gap?

There is no firm evidence that I know of, although I have seen some research that found gaps less than 18m showed slightly higher risk. I would suggest that the risk of undetected UR would be minimised by careful one to one care from a midwife and frequent checks of oyur pulse rate. UR much more likely in a labour with intervention. All good reasons to consider homebirth IMHO.

I aimed for assertive rather than bolshy but they didn't listen I go for the broken record technique, and a crystal clear birth plan along the lines of 'I do not consent to X' rather than I'd quite like, if you're not busy, ...

I felt a hospital VBAC was higher risk for me than a home VBAC. Apart from CS, I had perfect pregnancies. Actually for me, it was elective CS or homebirth, I didn't trust my hospital enough to plan any sort of VB there after the disaster first time round.

It will be a 17 month age gap, so there is an increased risk. In my mind I definitely want a hospital birth, because I would find it really frightening at home (and also because I could not handle my DH at home). My midwife has suggested doing some labouring at home to keep things relaxed for as long as possible which is a sensible compromise.

I have been worried about what will happen once I am in hospital though. I know that sometimes they are not averse to a little intervention. I definitely want to take your view - if they think a procedure is medically necessary then give me a c-section otherwise leave me to it.