Unreassuring debrief

[FutureNannyOgg]

I had my birth debrief this week, 6 months on, and it's left me feeling a bit crapper than I did to start with

To give background, I was contracting regularly for about 48 hours at home (planned HB) before being admitted to hospital with meconium staining. I was still under 2cm at that point and they put me on synto. After 3 hours of this I was contracting 6 in 10 and my baby was having decelerations he wasn't recovering from fast enough. They stopped the synto, and even without contractions he kept having decellerations, I was only 4cm so we went to emcs.

I wanted to find out why I wasn't dilating, why he didn't engage, and generally what caused all this. I felt like I had lost a lot of the faith I had in my body to do "the job", and as someone who wants more children, and a trainee doula (who wouldn't want any lack of faith to "infect" my clients) I felt I needed to know why.

I had the debrief, I learned some things, mostly scary things from when I was too out of it to realise quite how distressed DS was. The notes from the surgery were just a ticklist of stuff like how they got the placenta out, and what kind of sutures I had.

The vibe I got from the midwife seemed to be that she wanted to show me that they did everything right, which they did, I have no beef with the way things were dealt with, I just wanted to know how we got to that place.

I know he was a brow presentation (which may explain why I wasn't dilating), he had moved from ROA at my mw appt earlier in the week, to ROL when she saw me at home the day before he was delivered, to OP when they checked just before I went to surgery. He also came back up out of my pelvis (he never got lower than 3/5).

I was really hoping to find out whether he was perhaps wrapped up in his cord and "bungeeing" so not descending, or some other explanation of howcome he didn't engage and move through my pelvis properly. Just so I could have the peace of mind to know that it wasn't anything I did, or anything wrong with my body. The midwife gave me several ideas about positioning, effect of muscles in the area etc, but nowhere in the notes was any indication of what they actually found, so it is all guesswork.

I feel kind of let down, my notes were full of all kinds of info, but not the part that is most important to me (or potentially a future consultant helping me consider VBAC). The surgeon ticked the box for VBAC for future births, but there is no explanation of why he thought that, so no opportunity for a second opinion.

I would love to have a home water birth for my next baby, but I feel like I have this niggle in the back of my mind, I "failed" last time, so what says I won't next?

I'm pretty much at peace with the fact that things happened as they had to. I spent 9 months growing him inside me, getting him out is only a tiny part, and that happened the only way it could have happened safely. I love DS to bits and he makes anything and everything worth it. I just wanted reassurance that it really was "one of those things" and no more likely than average to happen again.

I'm not sure whether I can pursue this any more, I think after my notes there's not a lot else I can find out. I think I just wanted to offload.

Thanks

Babies can't cope with being in labour forever- it is stressful for them too! It sounds like the problem was brow presentation (which you had no control over), and your baby just got tired from all those contractions- which is why vbac would be reasonable.

Regarding position prior to you going into labour, at an antenatal check you can tell which was the baby's back is, but the head and spine aren't necessarily in line- therefore the spine can be on the right, but the head could descend transverse, anterior, posterior etc if you see what I mean.

More importantly, you and baby are safe!!

I have to be brief (got to pick dd up from preschool) but I had a baby that didn't descend properly, got stuck, extremely distressed, ventouse (failed), emcs.

I've had counselling and birth debriefs. The questions I want answered will never be answered. Namely, why she was stuck (I know she was LOT but some LOT babies turn, why not mine?) and if it could happen again. And I repeatedly go back to if they've ticked the vbac box (they have for me) is it because they could see a valid reason for the emcs that time round. And why wasn't I told. Do they know my pelvis isn't useless?

Gotta go, but wanted to say that I understand. Some questions have no answers but they can talk about possibilities and chances of vbac next time. And you have to accept that sometimes as the best you'll ever get.

It gets easier. DD is 3.10 and everything I've done since makes her the child she is. I haven't failed her. Neither have you.

Will come back later...

Sorry you feel so low about it all but the truth is you will never know why your labour ended the way that it did. In obstetrics some things are unknowable, and that is very hard for mothers, midwives and doctors. It makes decision making for all very difficult, and does not mean there is anything they have missed in your notes. Brow presentation certainly sounds like a good reason for these events. I certainly see no reason not to try for VBAC next time, different baby, different time and no reason why it won't be successful. Your body did not let you down, if grew you a beautiful baby who was delivered safely and is now being loved and cared for.

I have 3 dcs, two were born vaginally with no problems, the 3rd was an emcs

I can empathise with how you're feeling. Ds2 is now 16 months and I still wonder why he didn't descend, why he was distressed and why I had an emcs, despite going over my notes several times. And I still feel guilty and a bit robbed that it didn't go well.

I think the only thing I can say is that every baby and every labour is different. Some babies are never gonna come out the way they should for whatever reason, ds2 allegedly had his head at an angle which meant he wasn't hitting the cervix causing it to dilate.

Sorry for the brevity last time, I'm back.

I think we probably had similar experiences in that I also planned a homebirth and had a long labour and transfer. I went from planned home waterbirth to an operating theatre and panic. It was a world away from what I planned. I'd gone into it reassuring myself that thousands of women did it every day, that it was the fundamental thing a woman's body was designed for, that women in comas could do it. Of course I should have been able to do it. And I asked why so many times. Why me? Why my body? Why exactly did it happen? And now I realise of course that the answer is, why not me? Babies will present incorrectly, contractions can be ineffective, sometimes for whatever reason somebody doesn't have a body that does it automatically. And that's not a matter of blame, just a matter of fact.

I think it's difficult as well because that single event changes everything. You will never have another pregnancy that isn't managed as a pregnancy following emcs, never give birth without it being a vbac, that invisible question mark hanging over you.

You feel robbed. 9 months wondering what it feels like to push a baby from your body, to feel it skin to skin, to produce this new life from you in a way women have for thousands of years. And in the end you're a passive observer, an in-patient. It's a shock. Physically and mentally.

It took me years to confront it. But I know now that it's common to feel that way. That it was never anything I did. That I didn't fail. Because I had not control. And in all the things I can control, in the way I raise, love and protect dd, I do my absolute best. I can't change or understand everything that happened the day she was born and the sadness will always be there a bit. But it's not robbing me of any more time with her.

Talk, talk and talk if you need to. It does help. Time does too.

And...

CONGRATULATIONS!

ShowofHands that's so lovely, the last bit not what you went through :( I didn't have an emcs but had failed ventouse and forceps so have that sadness but what you just said makes so much sense...I hope it makes you feel better too OP

I think the brow presentation was the problem.
Your baby's head just wasnt in the right position to fit into your pelvis deeply enough due to the larger dimensions of a brow presentation.
By not fitting snugly, this would then stop pressure on your cervix, making it dilate very slowly or not at all.

Hopefully next time your baby will be in a fantastic position for a lovely home birth

From what you have said, there was a combination of events that led to the EMCS.
I have supported other malpositioned labours that were contracting for a couple of days before labour progressed.
A couple of questions-
Were you overdue?
Did your waters break at the start of labour?
Was the meconium thick or thin (what colour was it?)
From your account, you transferred in when you were still in re/prodromal/early labour.
Once waters have gone and synto is set up, it is my experience that malpresentations can be made worse (contractions push the baby into a more stuck position) and of course its harder to be upright and forward leaning etc
Some babies cope better with synto than others.
In thinking about another birth, I would read this-
There are said to be 3 P's of labour
Pelvis, passenger and power
See www.askdramy.com/Part2.html
In my experience, if you have a baby that is large ish in a difficult position and/or a pelvis shape that makes labour more difficult (e.g. a male type andrid pelvis- sually if your shoulders are noticably wider than your hips)
See-
www.healthline.com/yodocontent/pregnancy/labor-birth-canal.html
and
www.spinningbabies.com/baby-positions/cpd
Any combination of these could make labour more difficult and make techniques to turn the babyt into a good position and wide the pelvis more important.
I would consider seeing a chiropractor in pregnancy, and getting your birth partners experienced in spinning babies techniques (I have used this to good effect in squbsequent labours after women had emcs or forceps births)
In this case I think it was the meconium that was the first step in the chain of intervention that led o the other steps, if you were overdue and the mec thin, some women choose to continue with homebirths
www.homebirth.org.uk/meconium.htm
Hoe some of that helps. My daghter was born persistant OP and I have a special interest in malpositioned bbies and stalled labours so have done lots of research!
I ue a rebozo antenatally and at births and also, shaking the apples, pelvic tilt, hip squeeze, inversion etc
Do contact me if you want to chat on here or on the DUK forum.
Selina

Selina, can I ask you a question? I had PROM, contractions started a while later and had a long labour (and an 8hr 2nd stage). Does your waters going first impact the natural descent? I mean, can it contribute to malpositioning do you think?

And do you know much about lot/deep transverse arrest? Is it ever caused by pelvis shape or is it just one of those things. Placenta was anterior and had a long, painful back labour so it was suggested she had been op and moved to ot.

Hope you don't mind me asking op?

Thanks for all the links. I've got my debrief next week and am concerned that I'll have a similar outcome to the OP, in that they won't know why DD wouldn't fully engage.

I had a failed induction, after being blue lighted into hospital at 38 weeks with PE on top of OC. Never got to ARM or drip as despite 2 pessaries and a sweep (and days of contractions) DD never fully engaged and I never dilated.

It sounds like your baby was in a difficult position and that was that really. Just to reassure you a little, my 1st ended in an emcs due to not being in a good position. My 2nd was a very fast VBAC with the only intervention needed being an episiotomy. No monitoring really due to being 10cm and fighting the urge to push by the time we got to the hospital. Bad positioning doesn't mean there's anything wrong with you, or that you did anything wrong, it can just be the luck of the draw.

Personally I wouldn't contemplate a HB after a previous c/s though. I'd be too scared about it all going wrong again. Esp as when my c/s happened it was all very fast and I remember the anaesthetist and the surgeon arguing over my head as the anaesthetist wanted blood tests before we proceeded and the surgeon was saying she needed to get the baby out right now. Time was of the essence (the surgeon won) and I worry a transfer to the hospital would have made it all too late.

As some of the others have said it is probably all down to baby's position. Vaginal birth is partly all about mechanics - getting baby through pelvis and dilated cervix. We need optimal fetal positioning to apply equal pressure to the cervix through effective contractions. In the case of mal presentation (brow, posterior, deflexed, transverse) wider diameters of the fetal skul present and it is a case of round peg through square hole - we are talking millimetres to spare before a labour is obstructed. Mal position doesn't stimulate the uterus to contract effectively hence the need often for synto. A brow is the widest presentation possible and a 'normal' size babe just won't get through the pelvis. Out of anyone's control I am afraid. No other outcome than cs delivery unless the babe is titchy. HTH x

Thanks ladies. I think at the time I tried very hard to be ok with things, but I probably should have let myself grieve a little. Showof hands, you've hit it right on the head. The loss of power once you get the barcode on your wrist is significant, DH was a rabbit in headlights and I was making decisions and trying to have sensible conversations myself. I found the whole thing very invasive and traumatic despite being treated really well. I planned a very private natural hb because I wanted the power and comfort of my own space. Ending up immobilised and half naked in a room full of strangers was just about my worst nightmare.

Showofhands
From what I have observed and read, PROM is indicative of malpositioning and posterior presentation and then contributes to continuing malpresentation (combined with limited mobility like continuous monitoring)
I think sometimes the kind of movement needed to shift a very malpositioned baby is dioficult for a woman to accomplish during labour (in this culture) unless very well prepared and supported.
For instance, a proper inversion for 30-40 mins or Vigorous belly dancing etc.
Most women know that being upright in the second stage enlarges the pelvic outlet by 30% and that gravityhelps with pushing, but still many women give birth on their backs or semi sitting.
Some info on deep transverse arrest-

wonderfullymadebelliesandbabies.blogspot.com/2010/04/transverse-arrest-two-stories-in.html www.midwiferytoday.com/articles/paininback.asp www.plus-size-pregnancy.org/malpositions.htm A friend of mine had a EMSC fot it with her first and a successful homebirth for her second! S x

Forgt to mention, deep transverse arrest can be associated with an android shaed pelvis. This doesn't mean it has to happen or that vaginal birth is impossible but just that it might need more movement in labour.
Some good info in this blog-
naturalbirthinkitsap.blogspot.com/2010_09_01_archive.html
S x

Selina, for the first 6hrs of the second stage I was largely upright, pacing, on my knees, squatting, dancing, assisted squat, leaning etc. I didn't lie down once. Midwives tried everything, even sitting backwards on the toilet! Problem was they couldn't tell she was transverse while I was at home, she was very, very high (not even at the spines). It was only once I transferred that they did an episiotomy and attempted manual rotation/ventouse and guessed LOT. Then they did the emcs and confirmed it.

Will browse links...

Hav you had a good look at Spinning babies?
Could be you needed help to relax the pelvic muscles (rebozo sifting etc) and perhaps babies head flexion was a problem too? (posibly combined with pelvic shape).
I would definetyely consider seeing a chiropractor too.
Sounds like you did everything you could in the circumstances!
S x

She was slightly asynclitic. I know this too. The prolonged second stage damaged her muscles slightly where her head was tilted. But I don't know which bit of malpositioning came first.

I've seen the Spinning Babies website, yes.

Do you mean see a chiropractor to find out if there's something wrong/fixable about my pelvis?

My labour with my ds1 sounds very similar to yours.I spent the following 3 years going over what happened,why things hadn't progressed? was something wrong with my pelvis shape etc?

I also had a very rose-tinted view of what the birth could or would have been like if things had progressed.

It was only during my second pregnancy and going over previous birth notes with my midwife that I realised we got off quite lightly!

Midwife explained that if I had got further along they would have probably attempted High cavity forceps and an extensive episiotomy would hav likely been needed,due to large head circ.

This for me clarified that no birth is ever perfect and you really have little control over certain aspects.

SOH we've talked about this kind of labour on another thread I think ... I was upright (walking, standing or kneeling over a ball) for the first 30 hours of my malpositioned/PROM/arrested labour - there was no way I couldn't be because the back pain was too intense otherwise. DD descended to spines but I stopped dilating at 6/7cm despite long active/unmedicated labour. Personally I think it was going to be very hard to get her out vaginally from the point that my membranes went & she was so badly positioned. We knew she was OP antenatally & I'd been OFP-ing for weeks prior to the PROM (with no success).

OP I really feel for you. My notes from that labour/EMCS are pretty crap & don't really go anyway to explaining what was going on/wrong. That's incredibly frustrating but dd is 11 this year & I'm coming to the end of my baby-making. I've made the difficult decisions about subsequent births (I went for ELCSs due to my wider medical history) and have accepted that I did the best I could & I honestly don't feel bad about it any more.

There are usually 5 P's in relation to labour, the ones Selina mentioned as well as: Pain & Psyche. These factors will also greatly contribute towards an effective labour.

I agree with Alimat, the brow presestation was the likely cause.

this thread has really struck a chord with me - I had a forceps delivery after a 2 day labour with DD (planned homebirth), strangely was 10cm but then there was meconium so transferred to hospital, she just didn't descend, and I had hardly any urge to push. Like NannyOgg (great name) I was fine with it at the time in that a) I was exhausted and b) I just wanted DD out and safe. In hindsight and reading this thread a year after the event I wonder whether I should go for a debrief. I have had a tough year with low iron, exhaustion, lots of low grade illness and eventually PND. All of which arose from the physical effects of my birth, and having a brand new baby while trying to cope with them. SoH you are very wise, thank you for your lovely words. Have to alter some pyjamas now but will be back!

When I say strangely I was 10cm - I really meant that despite being 10cm DD never descended any further

Very interesting thread, thank you. I ended up with a horrible Kiellands delivery as DD was in deep transverse arrest. Post-partum DD and I had a rough ride as a result. I feel very similar to the OP despite not having a CS.

I was induced for dates (40+12) DD was large for my size (8lb 9oz and 91st centile head circ.) I'm 5'3" and usually a size 8.

DD was OP BUT they knew that when they induced me. She had been the right way all day (arrived at hospital at 2pm, was given a bed at 9pm and induced at midnight) whenever I had been monitored that day.

At the last exam before they put the induction gel inside me the midwife muttered "this baby has changed position" yet they still induced me! (the prostin hyperstimulated me and for the whole labour I contracted 7 in 10 - poor DD it was hell )

Looking back SURELY it was a stupid decision to induce me when DD had just moved to a less favourable position. I was just on the production line to get me done and out again wasn't I? I'm sure NICE say you shouldn't induce overnight either.

Anyone with any experience/expertise know whether this is normal/a good idea? Thanks

In my experience hospitals and midwives take little notice of babies position. Quite often it goes undiagnosed and unrecorded. And OP babies, whilst oftwen leading to a longer and more painful labour, do usually turn into a better position for birth eventually.
In some ways its a good thing because pelvimetry is complicated, we dont want to get back to a situation like we used to have and where they have in America where they diagnose CPD (cephalo-Pelvic duisproportion) based on things like pelvis measurments and shoe size.

I think its much more complicated than that, but it does frustrate me when staff dont encourage or facilitate mobility in labour. If I thought my client had an OP baby in early labour (PROM, back pain, contractions that speed up and slow down, long pre labour) I would suggest sifting with rebozo for at least 10 mins and then an inversion for as long as possible (ideally half an hour or so) S x