How much should women be told about complications in labour or birth?

[Flomaba]

Hello I am a midwife who does ante-natal classes and am studying medical law. I would really appreciate any feedback on whether or not women think we should tell them all of the risks all of the time, some risks all of the time, or any other variations so that women can choose whether or not to take that risk. Many thanks and best wishes.

EdgarAllanPond - what's BBA?

Birth before attendant arrival

But what do you do if all the dodgy parts of your birth were not put in your notes?

Before giving birth to DD I had no idea shoulder dystocia existed, despite having several pregnancy books, going to NCT classes, knowing lots of women with children etc. In the moment I remember thinking 'Oh my God, she's going to die' with absolute clarity, like a train hitting you out of nowhere. As it was she didn't die and she's fine, but the panic in the room was palpable and it was the most terrifying few minutes of my life. I really, really wish I'd known about it before giving birth-not that it would have made any difference to what happened, but just because I wouldn't have felt so in the dark, which really added to my fear.

Thanks.

I've just dug my NHS Pregnancy book out, and it says nothing at all about what you're meant to do if baby's coming imminently and there's no medical personnel around. Just has advice about trying to get to hospital in time.

Is BBA relatively common then?

My experience of an older midwife was quite different.

Ds1 was delivered by the senior midwife on the duty. She was amazing, despite me pushing for ages, she kept telling me I could do it. She mentioned she could get a doctor in to 'give me a big cut and yank him out', but she was sure I didn't really want that and that I could do it. She held the monitor on me at regular intervals, so I didn't get stuck on the bed. She was right I did do it.

I had a very inexperienced midwife deliver ds2, in that she wasn't actually qualified midwife, she was still a student. Luckily, I had a good outcome, despite having no contractions after delivering his head and him being stuck for a while. He wasn't breathing on delivery, but thankfully, dh was more on the ball than she was and pressed the button for help and all was fine. I'd have liked to have known that being delivered by a student alone was a possibility. When I complained, I was told that this was normal practice and the student was completing a confidence delivery near the end of her training and that a fully qualified midwife was in the corridor outside, I don't know of this is true or not.

So for me less experience, more of a risk.

Flomaba, this is really interesting. I would have lived to have a MW like you.

My an class involved a desperation of labour. When we asked any what of questions we were told not to be so negative. Induction was presented as a cure all for going over due. Csections were the work of the devil and poor us if any of us ended up with one. Then 2 classes being preached to by evangelical breast feeders!

My nhs trust run a dad to be class and I learned more from dh than I did from my mums only an classes.

I had spd and a miserable pregnancy. Was admitted for induction at 40+12. I was given a bishops score of 2 at 40+10, so I wanted to discuss the chances of my induction actually working after doing some research on here and elsewhere. I hadn't even been booked in to the ward properly when the doctor pitched up to examine me. It was only after he finished I had realised he had inserted the pessary during the examination. I did not consent to that happened nor was I asked at any point. The dr and MW disappeared for ages so I had to go and find someone to explain what had just happened. Thankfully is was the ward sister who immediately told me to take it out and brought me a cup of tea and summoned the doctor back. He said as I was there he presumed I was consenting! I was given the option to have the pessary reinserted or to go home and come back the next day to have it done instead. I was told monitoring was impossible (scans etc) as the machine as broken and the wouldn't allow me to have the pessary and go home where I felt safe. Nor would they allow me to go over 40+14. I opted to stay and try induction. Needless to say it didn't work. 2 pessaries, zero dilation, no contractions. 48 hours after I arrived in hospital a lovely sensible docotr came to me, read my note, saw the pain I was in with my spd and offered me a csection. I could have kissed him. He could have actually offered to pull ds out through my nostril and I would have agreed by then to be honest. My cs was arrange for the next morning and was a very calm and peaceful experience and I would recommend it to anyone who asks. I had no post natal problems physically, but I do have pnd and firmly believe my induction experience played a part in it.

I had a debrief, but their version of events and my version differed so much I was more or less accused of making it up with a parting shot fro the consultant of "do you feel better now"

I won't get into my bfing DSs TT and exclusively expressing as this post is already long enough.

How do you prove y didn't give consent to something like induction?

in some rural areas they have more BBAs than planned home births - so maybe 1-2%

i know two people who delivered at our local hospital with no MW present, let alone a student!

I should also say when I went to my go with my pnd, I explained about my failed induction and she said "I'm not surprised, the never seem to work!" Finally a HCP who admitted the it wasn't just me!

Surely you must have given consent to induction. Nothing to stop you removing the drip from your arm is there?

if you read her post star she had a pessary inserted without consent, then removed...then went in later for induction with her consent if i have understood correctly...

It wasn't a drip starlight, it was a pessary up the fanjo put in during an internal. I did not consent.

Thanks Edgar. I still get upset about it now so sorry if my first post is garbled.

I'm sorry Glaik, I got confused. God that sounds awful

I was given a sweep without consent and that was horrific enough.

You can still complain even 2 years later but trouble is everyone's memory has faded. Failing that, if having another baby it's worth telling the midwife at booking that you had a bad experience last time and ask for a debrief with a supervisor of midwives and/or midwifery manager. Can be really helpful. Yes versions of events can differ significantly as I'm finding out reading legal cases.

Sadly and shockingly it is possible that the prostin gel to induce can be given during a vaginal exam without you really knowing what is going on.

Anyone who has a student whatever stage of training should also have a trained midwife in the room as a second in case baby needs help at delivery = basic procedure.

Sweep without consent is a real no, no

If you're induced by pessary you don't necessarily have a drip. Syntocin isn't given with a very unfavourable cervix. Hoiking a pessary out is nigh on impossible especially if you're 40+ weeks and have SPD. That story of presumed consent is frankly terrifying because if you're having a VE you don't necessarily know if they're going to try and shove a pessary up there too.

Lots of x posts!

No-one should ever insert a pessary without asking if it's okay and you understand why and what will happen

If I do have another and it is a very big if, there will be no induction. Absolutely no chance. Thinking about it what I would like to do is plan a cs for maybe 41 weeks, but if I go into spontaneous labour before then, then I'll give vbac a go.

During my induction it was agreed by my consultant that if I had not delivered by 10pm I would have a section (overdue, pre-eclampsia, signs of foetal distress) 10pm came and went, and nobody appeared. I asked to see the doctor, who said they felt it was not necessary (staff had changed shift) I asked for a section, the doctor then turned to my husband and asked him if he thought I should have a section? DH was furious. He said surely a doctor should not be asking him that? Surely a f***g medic should know better than an unqualified dad-to-be, and should she not actually be listening to me!! DD was born 12.06 with ventouse and episiotomy, and the doctor screaming at me that I had three pushes or the baby could die. I then had a massive PPH and covered the bitch from head to foot in blood. Both me and DH thought I was going to die. The debriefing was helpful. Helped me realise it was not my fault. Not me failing. And as for the support with bfing... I fed DD for nearly a year despite them.

Main risks of a big baby are not going in to labour naturally, needing induction over several days, baby having a shoulder dystocia and getting damaged, bad teats or induction not working and needing to go for emergency CS. Good to think about how far along the induction line YOU (not the doctors) are prepared to go.

I was upset by lack of information which led to 'consent' being on very dodgy grounds which is so hard to prove.

I'll just examine you and see how stretchy your cervix is=sweep (and subsequent infection) I would NOT have consented

I think you need some help, is that ok?=episiotomy (and infection/ poor healing) I would have consented though in circumstances, it just would have been less of a shock to suddenly need repair

Are you in pain, do you need help?=epidural top up way too close to birth that I didn't need (in fact I didn't needit at all really but was too tired to argue the toss over and over as they wanted it for drip/ likely CS)