What are the signs that something is "wrong" during labour (i.e. intervention may be needed)?

[minipie]

I am 28 weeks with DC1 and realising I know very little about childbirth. Hopefully antenatal classes will help but don't know how much (and they are NCT so I suspect I might get a rose tinted version...)

A friend has just given birth and had an awful time, caused mainly by the medical staff not realising her baby's head was twisted. This meant she was in labour for 3 days and told to keep pushing for 4 hours even though no progress was being made. Then an attempted ventouse and c-section. (no epidural until right before the c section despite asking, as anaesthetists were too busy).

This makes me realise I want to know myself what signs to look out for, at least as much as I can, and not rely completely on the medical team to spot a problem.

So for example in my friend's case, 4 hours pushing and no sign of the head should have been a sign that something was wrong.

Any other things I should be aware of? Or am I being unrealistic to think I can learn the signs?

Thanks

In my experience things can turn very quickly without there really being an obvious sign. I was managing perfectly happily through the early stages of labour in a midwife led unit with my first, feeling calm and positive, sitting on birth ball, really thinking it was all going well. Then midwives changed shift, and I was examined by someone new who thought my baby was breech. Things quickly felt out of control - I was whisked to the consultant unit in an ambulance with dh following behind, and when I arrived despite scan to show that baby wasn't breech they broke my waters and put me on a drip and I'm not really sure why!! There was then meconium in the waters, another sign of something to worry about, and a long cascade of intervention followed, but dd1 was absolutely fine, and all was well in the end, although at the time I felt that 32 hours of labour nearly did me in! Subsequent labours have all been different, but I always worry when I'm not just left to get on with it, because often the anxiety of someone examining and then saying 'oh you're only... cm dilated' etc can put you off and make you feel quite emotional/negative. I'd be wary of anyone wanting to 'speed things up' if you're not apparently making progress (assuming there are no 'danger' signs for baby) - I know with your first you are just anxious to get on and have the baby, but being stuck un-necessarily on the drip can quickly make the pain escalate without giving your own natural endorphins a chance to catch up. Obviously if there is an emergency then CS would be necessary to get the baby out quickly. It is hard to on the one hand trust in your own body and the natural process, but on the other hand be guided by the professionals who know what signs to look out for, and in my experience sometimes you feel that their intervention is un-necessary or unhelpful, but I guess from their point of view they know the risks and aren't willing to take too many for obvious reasons. It sounds obvious after the fact that your friend was pushing for 4 hours and nothing was happening, but I guess if she was well and baby was well they perhaps wanted things to continue naturally if there was a chance they could... perhaps if she has a debriefing when she's up to it she might have more of an understanding of why things happened. I wouldn't worry too much yourself about trying to learn all the signs and possible things that could go wrong, as you could end up really frightening yourself. Try to go with the flow but research your options carefully, be informed, have a super positive and assertive birth partner to advocate for you, but be prepared to have to follow advice and be flexible. hth

Mini

It is hard to know yourself as you dont know what the pain is supposed to feel like, you know it will be awful, but have no yard stick as to what is normal.

I felt awful pain in my lower back - " thats labour dear", turns out I learned Five YEARS LATER, my baby was back to back.

Some ladies have said they had both and back to back didnt phase them, my consutalt MW said - usually back to back is alot worse as obvioulsy you have two hard things rubbing agaisnt each other - ie her spine grating on mine!

At the time I trusted my MW's and got on with it as there wasnt much choice, I asked for an epidural from the start but wasnt allowed one.

One mistake I made was not finding out what my hsopital policy on pain relief was....you can ask your community MW or birth class lady but when you get into that hospital - your in different hands...

unfortunatly part of the process of labour and birth is that you dont know what will happen....so you have to let go a bit and try and trust in the process and your MW!

The thing is there's being informed and there's scaring yourself with all the 'terrible things that can go wrong'.

A straightforward labour and birth is normal not lucky.

Fill up on positive birth stories tellmeagoodbirthstory.com is good.

And prepare yourself as to how you will cope with labour pain 'Birth Skills: proven pain management techniques for labour and birth' by JuJu Sundin is a great book, informative about the birth process and the feelings you may experience but also packed with useful things you can actually do during labour to help yourself.

We attended NCT classes and found they were honest and practical about labour and birth but for us the main point of going was to make friends.

Very best wishes with everything.

Thanks for your responses everyone.

happy thanks for the advice. I totally agree that I would not want intervention without a very good reason (cascade of intervention and all that). I'd like to avoid induction drip if I can and there isn't a need for it.

The trouble is that due to my friend's story, I now have concerns in the other direction as well - i.e. what if intervention is needed but nobody has spotted it? I would love to just trust to the professionals but this is not the first time I have heard of women being left alone even when actually they needed help. My concern is being ignored or midwives telling me it's all fine when actually they haven't checked... Like my friend, I don't think they actually realised what position her baby was in which is why they were telling her to carry on - so it wasn't informed advice from them iyswim.

eliza exactly, your story is the sort of thing I mean. I would want to know if my baby was back to back. Doesn't mean I would automatically do anything differently but I would want to know. It seems like they didn't bother to check and just assumed it was normal labour? And you are another person who "wasn't allowed" an epidural, this seems incredibly common from what I have heard. Why do they even tell us it's an option when clearly they are strictly rationed?

Moon I very much hope that I will be one of the women whose baby is in the right position to be born naturally, but I can't exclude the possibility that she won't be. If she is not in the right position then all the positive thinking in the world won't get her born without help. So, I want to know what to look out for and what's likely to happen if she is in the wrong position or there is some other sign of distress/problem. I am the sort of person who is more scared if I have less information, so ignoring the "bad birth" stories won't work for me. I need lots of information!

Mini I think I understand what you mean and it probably isn't very reassuring to hear that there is no 'normal' labour - each one seems so individual, and probably depends as much on the woman involved as on the people there supporting her. If its any consolation my ds was back to back, and although it was not exactly easy, I didn't need pain relief beyond gas and air, and he was delivered naturally despite being 9lb 13oz. I've been surprised that some mw's are very able to tell the position of the baby - others don't even seem interested, as long as its not breech! Sometimes if there is a lot of fluid surrounding the baby it might be hard to tell I guess. I suppose you could think really carefully about your birth plan, and be armed with as much information as possible. You could ask for examination/2nd opinion/maybe scan? to reassure you about the baby's position? Not sure really. You shouldn't be left alone as it were when things are in full swing. Mw might pop out and pop back in, but not leave you for long periods if things are progressing at a pace. Would you consider having a doula with you to offer you extra reassurance and to be able to speak for you if you are worried that your concerns are going to be overlooked or dismissed?

I will be really interested to see what informed responses this gets.

In no particular order - OP, FWIW, the NICE guidelines actually say that for a first time mother, birth within 3 hours of the 'pushing' stage is to be expected, and that a diagnosis of 'delay' should be made after 2 hours, and after that an HCP brought in who can attempt an operative delivery. So.... you could argue that there WERE signs something wasn't right with your friend's birth, but no one acted promptly.

welcome to the world of NICE guidelines, btw. They exist but no one actually has to follow them.

Re: labouring for 3 days - I don't know long nulliparous women usually labour for, but while there are women who would rather head to theatre than go through a long labour, there are also women who fear being 'rushed' into intervention and would rather be allowed to labour this long. You can have a very slow and exhausting labour without anything being wrong as such.

Anyway - as to learning signs that things aren't going well that you could spot yourself.... that's a tricky one. tbh, it's only something like a baby's heartrate dropping, or blood tests from a fetal scalp sample that says something is badly wrong. CS's do happen because of maternal exhaustion, but I don't know how far the mother gets to make the call on that. Then there's 'failure to progress' (labour stalling) which presumably didn't happen to your friend, as she got to the pushng stage, so she must have been fully dilated?

MWs are supposed to be able to guess a baby's positioning to some degree - but there are plenty of stories here where MWs had no idea a baby was back to back (or if they knew, it didn't change their approach anyway...) - short of a scan, they don't really know for sure, and you don't get scanned during labour.

Being blunt, severe pain and stalled labour could be sign something isn't right - but then these can be features of a 'normal' birth. As a first time mother, you have nothing to compare it to anyway. (which I think is a reason some first time mothers are not listened to enough during labour, as per elizaregina's post).

Re: epidurals - well, yeah. If you are not put off by horror stories, read the thread asking who could have coped if they hadn't had an epidural. It is very misleading for any HCP to give the impression you just have to ask for one, and it will appear.

I will be very interested to see what responses this gets, anyway.

Thanks happy I thought that might be the answer - that there is no "normal" so there aren't really signs to look out for.

re birth plan - yes - I'd prefer to avoid reams and reams of detail on my birth plan because the midwives will just ignore it I am flexible depending on what happens. But one thing I will definitely be putting on is something like "please give me lots of information about progress, position etc as I am less nervous when I have information". I would consider a doula yes but don't know if they'd be in any better a position than me/DH to look out for warning signs and get me looked at?

wheres that's interesting thanks. I think maybe I should go away and read the NICE guidelines, I didn't know there were any. On the one hand I don't want to be the annoying PFB woman who quotes NICE guidelines in the hospital but on the other hand I'd like to know if there are particular time limits etc suggested in there like the one you have cited.

My friend was fully dilated I believe, but only after being given pethidine because epi wasn't available (she says the pethidine sped up dilation, I didn't know it could do that).

Sounds generally like there is not much self education I can really do as there is not much I can look out for myself. Perhaps the best I can do is keep asking the midwives about position/heartbeat etc in the hope they will check...

Sorry, having mentioned NICE guidelines, I should at least have linked to them (these are from 2007, I hope if there are more recent ones someone else can post them) - www.nice.org.uk/nicemedia/pdf/IPCNICEGuidance.pdf

I think to be fair a doula would be more able than you or DH to look out for 'warning signs' that something wasn't quite right. This is your first baby and unless your DP is in a particular line of work, I guess he won't have seen many births before.

Never used a doula, wouldn't know where to find one, but if you have a lot of questions and would like someone to be your advocate (it sounds after your friend's experience you aren't hugely trusting of MWs or hospital staff) then I think it would be sensible for you to at least look into it.

Er no he hasn't seen any births before unless you count OBEM!

Thanks for the link, will have a look.

I don't know whether I am untrusting or not TBH. The midwives I have seen so far have been absolutely lovely and I have no gripe against MWs or hospital staff. It's not that I doubt their good intentions or their expertise once they see a problem, but I get the impression they are often run ragged due to understaffing (esp in the larger London hospitals which is where my friend was and I will be). So if everything looks normal at first glance they may assume it is normal, without checking, and leave you alone because they are focusing on more obviously high risk people. Which means things can be missed... Perhaps that is too cynical/pessimistic?

You might find that when you're in labour you're not actually that keen on being kept informed and that you just want to work away on your own. I made sure I knew as much as I could before I had my DS but when I was actually in labour I went into my own head and I didn't listen to one word the MWs said. I trusted DH to relay any very important information. I wasn't keen to be examined, I just want to suck my oh so lovely gas and air and get through each contraction. Beyond that I just didn't have the headspace to think of anything else.

I was in quite a different position than your friend in that I felt they were too cautious with me. I was low risk and wanted to give birth in the MLU but when I got there my BP was slightly raised (possibly due to the very very strong contractions??) and so I was sent to the labour ward. In the ward I was given blood tests due to the high BP and my BP was monitored for the rest of my labour. My first MW was great and let me carry on storming around the room and kneeling etc, but when there was some meconium in my waters an older MW appeared and started talking about ventouse, episiotomy, the whole shebang even though there was no sign of DS being in distress beyond the meconium and I hadn't been in labour very long. She wanted me to get on a bed so I could be monitored but I absolutely refused. It was clear they wanted DS out as quickly as possible and in my mind getting on a bed was pretty much guaranteed to slow things down. To me it made much more sense for me to continue to be active and have intermittent monitoring than for me to get on the bed, and then need intervention to speed things along. They eventually bullied me into getting on the bed but at that stage I was knackered and there was only about 10 minutes to go. DS was born perfectly fine and with minimal damage to me (just a couple of stitches as opposed to the episiotomy/ventouse damage they wanted to inflict) after an hour and a half of pushing.

The thing to remember is that as long as the baby comes out healthy no one really questions the MWs actions. Unless the mother has something specific to complain about such as rudeness, neglect or incompetence, then it is assumed all the MWs actions were warranted and valid. Thing is, MWs are human just like everyone else and no two MWs are going to go about things the same way. I can definitely say that if I had had the second MW on her own my birth would have been a lot different. Without the first MW backing me up and supporting my decisions, she definitely would have bullied me into having procedures I didn't want or really need. In fact, I believe she would have given me an episiotomy without my consent as she was all set to do it before the first MW mentioned it and I said no. Had the first MW not been there it could well have been done and dusted before I realised it.

After all the waffle I suppose what I'm trying to say is that there is a lot of uncertainty in giving birth. The MWs were concerned about my DS but I wasn't, I felt things were going fine and I was the one who didn't want intervention in spite of their constant attempts to intervene. Clearly there were some signals there that things weren't quite right, but luckily in the end it was all ok. How things go depends on how you respond to labour, which you just don't know until it happens, and who you have looking after you, which is again unknown. It's great to be informed but when it comes to it you just have to go with the flow. On the day all you really care about is getting through it with a healthy baby at the end. Just remember that you have the final say in everything. Emergency aside, it's ok to question what's being done/not done, and sometimes making a fuss and refusing things you're not happy with is the best way to go. I'm glad I stood up for myself (though without the gas and air I'm not sure I'd have been so bolshy) and that in the end I got a straightforward birth in spite of the MWs rather than because of them.

I can fully understand your panic!!!

I too am someone who likes more information including the bad - as I am a balanced person and can understand that what has happened to others may not happen to me.

It really scares me when people dont seem to be disclosing full information about something....

Happys post just shows how different each person is, I have a very very tiny tiny friend who was able to birth largish babies - with forceps and not tear or have any effects at all.....

i was frightened but my labour was fine and for a first timer - was only 6 hours, 23 mins pushing.

It was too painful though and I would have fared far better with an epidural.

A problem with some MW can be - that they do of course know thier job, they have an agenda - and sometimes it can clash with what you want....

For instance this time, I am making sure its on my notes - I dont want any messing about re epidural - if the anethitist is there and ready and able to do an epidural - I dont care if the baby is coming out in an hour - i want that epidural!!!!

Just to give a quick example of how mad some MW are though...i had a meeting with a top MW because my last labour was too painful for me, I wasnt satisifed with pethadine and I wanted to talk to her about making sure this time - staff are aware I want an epidural ASAP. I am not a first time mother - I had a good first birth - so i kinda know what I am like in labour - it cant go any better really, it can be shorter - but its not like first time was a car crash and this time might be better.

She was still pushing me towards water birth and massage! I had massage last time and couldnt walk to birth pool, she kept talking about how women just dont get it - and water is so amazing,

I told her THREE TIMES I GOT IT - water is great - i was open to water - i would have gladly got into the water IF I WAS ABLE TOO!!!!

So after nealry two hours of that - we came back to me saying " so please put on my notes - even if only a short time to go - I WANT AN EPIDURAL!!!!
She wasnt taking a holistic approach and looking at me as a whole - just a body who was able to give birth!!

I agree that an epidural isnt really a proper pain relief option such as pethadine or gas and air because it is so hard to get one....

Thanks Cailin. I know what you mean about going into your own head and not having the headspace to think about other things. I really want to be able to do that. My concern is that I will only feel comfortable to do that if I know I'm being checked often enough, if that makes sense?

Sounds like your experience is similar to happy's in the sense of over-intervention rather than under-intervention. Shame that you didn't get to use the MLU, I would really like to use my local MLU too and will press for it if nothing is obviously high risk...

I am really that they could have given you an episiotomy without your consent, isn't that assault? Sounds like that is another thing going on my birth plan - "please tell me if you are intending to do anything to me before doing it".

Any tips on how to get midwives to check things that they haven't checked (eg position)?

Cross posted eliza. Have to say this thread is not increasing my trust in midwives

Mind you I'm not altogether surprised about their reluctance to give you an epidural, from what I have heard and read elsewhere they are basically rationed... My friend who I've mentioned above also had "definitely want an epidural" on her birth plan, as I say she didn't get one throughout a 3 day labour, even with a ventouse, until she was about to go in for a c section.

Minnie

I had it on my birth plan but THIS TIME it will be backed up by this other MW and hopefully consultant too....

ie rather than just my little request - it will have other people on there too.

My MW were great though, I put them under alot of strain I imagine more so than a normal first timer due to other issues - and they were amazing, so reassuring....yes she was back to back and I didnt know BUT i got through it - and wasnt damaged or anything apart from small labial tear with no stiches...

If i were you keep reading up - your way ahead of the game to already know about epidurals - lots of us didnt - innocently after lots of reasearch chose to have one for our pain relief - and were false stepped at a very vulnerable time!

So your already lucky there....as others have said - you may not need one - you may be alright - lots and lots of ladies do cope with other techniques - hypnosis etc and they are fine and love it - it can be done.

Then put your fears into your birth plan in a very strong succint way....

Well I'm hoping not to need an epidural (as I want to be in the MLU) but I have no idea how I'll find it really so keeping an open mind. But, I don't want to have a false idea that it's an option if it isn't really. I am looking into hypnobirthing etc. Basically I suppose my motto is "hope for the best but prepare for the worst".

Glad you will have back up this time round!

Just wanted to pop back and say thanks again for the link to the NICE guidelines to wheres. Had a quick look and they look like exactly what I need.