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

Lots of interesting stuff there Selina.

The lowest my baby was recorded was 2cm above spines, he clearly liked the top bit.

I've been reading some interesting stuff lately on maternal positioning during labour. Michel Odent in particular emphasizes the importance of following the mother's instinct rather than a generalised "choreography" of positions. There is also an entry on the thinking blog about anterior lip, where she describes women automatically lying on their back to take the pressure off the lip. In my early labour I naturally followed the OFP method for correcting position (on all 4s during contractions, but resting head down between). I had been told he was perfectly positioned, and logically "knew" I should be in other positions, but actually, he was badly positioned and my instincts were doing the right thing trying to correct it.

just something else to throw into the mix as a possible explanation. i gave birth to dd (1st baby) 5 months ago and saw a uro-gynae yesterday cos i still have problems with my coccyx and pelvis which were badly bruised during the birth. anyway i got very painfully stuck at 5 cm and had a long 2nd stage. his explanation for all of this is that my pelvic floor was far too strong which meant i couldn't dilate properly and that i couldn't easily push the baby out, because the pelvic floor then went into spasm. he says a too tight pelvic floor is not that uncommon and women who have them do not have a great time with vbs. my baby was an average sized 3.4 kilos and perfectly presented, but i still had problems. just a thought. congratulations! and, showofhands - very very well said xxx

Cardamom, I think that may have been what my MW was hinting at when she talked about "muscles" getting in the way (I could have a whole other rant about HCPs who talk to me in vague simplifications even after I tell them it's ok, I did an Anatomy degree, they can talk to me in their language).
I'm a bellydancer, so I do have very strong core muscles, pelvic muscles and pelvic floor, it's possible this may have made it a bit squished in there.

Yeah - I'm a demon at pilates . If you suspect this could be a problem, I'd see a specialist uro-gynae and get it assessed, particularly when you are thinking of another dc. Mine says that some HCPs are oblivious to the problem in part because one of the symptoms, i.e. the inability to squeeze your pelvic floor after childbirth masquerades as a weak pelvic floor. He said that in my case the muscle is in such extreme spasm that it just can't clench any more when I try to squeeze. But when he did his exam and looked at MRIs I'd had done by an orthopaedic surgeon cos of my back problems, he said the inflammation and spasming was clear as day. BTW - are you hypermobile at all? Do you have low BP? I do - he says they often go together with the pelvic floor thing. Who knew your pelvic floor could be too strong!?!?!?! Mad!!!!

I really relate to this thread too. DD was a planned homebirth but we transferred to hospital after about 14 hrs at about 7cm when I was failing to progress & there was meconium in the waters. I too had gone into the homebirth telling myself that birth works, women do it all the time everywhere, I was young & healthy etc... & then to end up with a forceps delivery with a synto drip & an epidural...

Hmmm, I'm hypermobile too. Maybe all those extra exercises I did to counter early spd led to issues???

The closer I get to my debrief, the more stressed I get, especially as I'm now thinking I don't want DD to miss out on having a sibling.

I am very hypermobile, that's interesting. I also had terrible SPD until I saw a chiropractor at 38 weeks. I never had any issues with PF exercises though, even when very pregnant and just after. I remember being mortally offended when I told my MW I thought my waters went when I laughed at DH falling off the bed, and she told me I'd just peed myself! (They had gone too the cheeky cow)

Hello OP, Showofhands and other regulars on these sorts of threads. And Selina thanks so much for those links on deep transverse arrest - I've never been able to find so much info on the subject before - really appreciated. So much of it resonated with my experience.
It does make me sad that the articles confirm my fears that my second midwife did a lot of things that made a bad situation worse. They had no idea about DS's position, and I still remember staggering round the room trying to get away from her and the crochet hook because I was so sure I didn't want her rupturing my membranes. She did anyway despite my protests and DS got stuck LOT and with a massive caput to boot. No wonder he was a grouchy colicly newborn. I also had an anterior placenta and suspect I have the android pelvis shape. Can I ask where abouts on your notes the surgeon would have said whether you were suitable for a future VBAC? I've never spotted that on mine.

My surgical notes were a single sheet of tickboxes. One near the end was for recommendation for future birth with just elcs or vbac as options.

Mine told me when I was leaving theatre! Not sure he knew much about why I had the CS though.