Strep b, past 3rd degree tear and previous traumatic labour

[onenutshortofasnickers]

Hi am 30 weeks pregnant (just over.)

To summarise I have tested positive for strep b and with my last birth ended up having a 3rd degree tear which has all healed okay; except some TMI issues, but nothing major.

Also my last birth was very traumatic and the hospital messed up (there was an investigation etc ;) I also suffer with depression and anxiety and the last birth they think set of pnd issues which I luckily got through very quickly.

I also have a large cervical erosion that was found and I had to have a colposcopy for and have to go back 8 weeks after birth. (causes alot of pain and some bleeding right now.)

I'm very worried and anxious this time as we live far from the hospital (or any hospital,) that I won’t get the i.v in time and that the maternity unit will be closed; it always gets full and closes, so we would have to travel to another hospital even further away!

Also with past birth going so badly I don't feel like I can trust the hospital at all and am terrified of the same, my consultant agrees that what happened wasn't right and shouldn't have happened.

Do you think they might do a planned induction for me if I asked? So I'm there in time for the I.v and staff can pre-know about what happened last time so the same mistakes aren't made. I would rather have a vaginal birth instead of c-sec. Or would they do a c-sec?

I just want to make as little risk to the baby because based on what happened last time I feel like I will go in and they won't put a drip in and do what they did last time.

What happened last time;

• Meconium in waters, ds was in distress the whole time with his heart beat
• was left alone in established labour, on a ward, for about 4-6hrs (not too sure!) not in with no one checking on me or the heart monitor, showing that ds was in distress
• mw injected me with pethidine and anti sickness without asking if I wanted it or telling me what it was, only found out after when dh went WTF?!
• No once checked how dilated I was before finally giving epi dural, they checked literally a minute after having at it to see ds head crowning

-at that point ds heartbeat really dipped and they told me forceps and partner c-sec, then said to me c-sec and changed back again; was wheeled to theatre to be put to sleep for c sec

• at theatre ended up having forceps so no c-sec all this time they were going back and forwards to dh says yes you can come, no you can’t, yes, no and so on.

-when I was initially wheeled in the staff didn’t know if I was having a c-sec or forceps and asked me what was happening

• When ds was born he was taken away (but luckily all fine) then brought to me but the lady wouldn't let me hold him and took him away to the ward after less than a minute
• had the 3rd degree tear and lost allot of blood where everyone in theatre started talking about me in third person and not too me
• staff forgot to tell dh that ds had been born and he was ds on his own on the ward for about half an hour while I was being stitched up and dh was still in the delivery suite, he ended up going to find someone where they went 'oops we forgot about you' (he though ds had died by now.)
• on the wards every night staff told us not to buzz because they were understaffed and wouldn't be able to come to us; they didn't come to you if you buzzed, I was also with a load of ladies that had epi's and we couldn't move to get to our baby's.

Any advice would be appreciated, thank you for reading the essay!

I'm not in the UK but under a similar system.

I have not exactly the same as you, but similar complications and have decided on a section. I don't think an induction would be much good, it can be fast and furious and might aggravate your previous tear. How would it affect your cervix? But I am not medical, so hopefully someone else who knows more might have more info.
I find it very hard to believe that the hospital would NOT agree to a section, in your shoes. I would not be afraid to use the previous bad care and investigation as a bargaining chip.

Best of luck

Thank you for replying, I think (based on what I have read through current NICE guidelines,) that I could hae a section due to my mental health anyway, but it is major surgery and my ds still is quite young and in nappies for one so would involve me staying with relatives for at least a month; plus all of the other risks.

But if I can avoid a sick baby and just have a better experience than last time (that won't be hard to do;) then I think I will be okay, I would rather have an alternative though.

I'm not that worried about previous tear, there really isnt any more risk of me tearing than there would be with anyone else; I am going to have an epi dural if possible so that if I do tear badly, they can stitch away and I wont feel it!

Hope you have a calm, straightfoward birth this time

onenuts, do you want an ELCS? It really doesn't sound like it. In terms of whether you would be able to have an ELCS you have a pretty good case in terms of both your physical and mental health but NICE actually say any women who wants an ELCS should have one. (In practice not every hospital is following this recommendation, but it does give you a much better case if you wanted to have one and the hospital were being obstructive).

The trouble is, that hospitals have such different policies on everything, that even if your suggestion of a planned induction was a possibility, whether your hospital does it is another matter. You can only arm yourself with information in order to question or challenge the hospital or reassure yourself that what ever they say, is actually right. And you can only find out what the hospital's policy is, if you ask them directly too. I know that sounds like stating the bleeding obvious but I suspect you have a lack of confidence in doing so and I think you need someone to encourage you to do so.

I hope I am reading what you said right, but my interpretation is that I think the issue here is more about your trust in the hospital and how you don't feel empowered, rather than how you give birth and more about the fact that you were not involved or informed about decisions about your care last time. So put your focus on that rather than how you give birth.

If a midwife gave you drugs without your consent she has actually assaulted you which is a criminal offence. I don't want that to sound melodramatic, but you need to know this, as I think you feel like you need to be more in control next time, so knowing what your rights and options are are possibly the key to helping you feel more able to ask questions and possibly be able to assert yourself more.

What might be a plan, is to explore the option of an ELCS as a backup plan, and to get that agreed even if the VB is a viable, realistic and safe option. You do not have to go through with it, and you could stress that when discussing your options, that you would only be able to go through with a VB with adequate support throughout your pregnancy. Basically use what has happened to you, to be a stick to beat them with, in order to get them to acknowledge your anxiety is problematic and you have additional needs - because you need that regardless of how you give birth.

I would actually be stressing your level of anxiety and your need to know about the risks that a VB might involve for you. The hospital has a duty of care to you, to protect your mental health. I know that an ELCS as an option is one that seems to be being pushed as the solution to a lot of people to regain that control when actually deep down thats not what they really want either. I know that my nearby hospital is taking the approach of requests for an ELCS as a way to rebuild confidence and trust by listening and supporting and many of the women who initially go down that route have ultimately had a VB as a result. I think their approach is different to a lot of other places but I think understanding the principle and how it seems to be effective, is helpful to know.

Don't think that you are being a pain by asking lots of questions or challenging what they say. There is no such thing as too many questions if you are effectively talking about your mental health. Don't forget that! It might be worth being prepared for your next appointment with a long list of concerns and making them go through them with you. Don't let them phobe you off!! You need to rebuild trust with the hospital and staff so you NEED this.

Hope I make sense and you find something useful/helpful in here! Good luck!

I don't really want an ELCS, no. i would rather have a nice straight forward vb.

I just want to completely minimise the risk to the baby.

In my rather irrational head my thinking is this....

That if I am induced I am at the hospital already, under treatment, they will have read all my notes before going in, so will be on their best behaviour to me and I will get the IV drip in time and for long enough and baby will be born hopefully without any sign of infection.

However I have read, somewhere, that they might not do this because apparently induction can make labour long and a long labour increases the risk of passing on the infection to baby and induction can end up leading to more intervention anyway e.g. forceps. But how true this is I do not know.

So if they wont do that would it just be better for me to have an ELCS? I go in calm, baby wont go through birth canal to help avoid passing of infection, I don't think it eliminates the risk of infection though. Again, they will have all read my file, no about how crap last time was and be on their best behaviour, in the short term that would be great, it is the 6 weeks afterwards that turn it into a PITA.

I'm scared of; going into labour normally, going to hospital and them being understaffed and overstretched again (which they are right now;) not realising to give me the drip, having shoddy care in wards too so if baby has infection it goes unnoticed until too late. I honestly believe the chances of that happening are high.

Or I can't go to the closest (but still far away,) hospital and then get to the other hospital and then have a fairly quick labour and don't get the IV in time. I also risk having the same quality' of care as above and same problems, but I have never been to the other hospital and have no idea what they are like.

I will talk this all over in Jan when I do the birth plan, I wish I had the choice of a nicer hospital but I don't. Due to being consultant led and the other issues, I also need to be in a hospital.

I think this
*What might be a plan, is to explore the option of an ELCS as a backup plan, and to get that agreed even if the VB is a viable, realistic and safe option. You do not have to go through with it, and you could stress that when discussing your options, that you would only be able to go through with a VB with adequate support throughout your pregnancy. Basically use what has happened to you, to be a stick to beat them with, in order to get them to acknowledge your anxiety is problematic and you have additional needs - because you need that regardless of how you give birth.
is going to have to be what I will do.

Thank you for replying and for the advice and making me feel less silly!

Your thoughts aren't irrational though.

They are understandable because you don't have trust in the hospital and you don't have all the information you feel you need right now to be reassured. You are worrying because you have had a previous bad experience which makes your fears have a firm foundation, which makes them far more real and possible. In order for you to relax you have to have some foundation in the other side of the coin, where you think you will get the care you need; basically have trust in those caring for you.

I think the best way to explain it, is to say that if you were involved in a serious car crash, people would understand if you were hesitant or fearful of getting in a car again wouldn't they? They would be sympathetic that your experience made you more wary of what had happened before, wouldn't they? They'd understand that you wouldn't want the same brand of car if the brakes failed and the car didn't do what it was supposed to do. They would understand that you'd want to give more space to the car in front, just in case. They would understand that you wouldn't want to drive down the same road because it brought back the memory of what happened.

The trouble is, when it comes to healthcare, we are taught to have blind belief in it and not question it. So when something goes wrong, people struggle to understand why you no longer feel able to have that faith. But its not irrational to feel the way you do when that sacred trust between doctor and patient has been broken in the past. Your mind will naturally run riot and think of all the possible scenarios that could go wrong, so you can mentally defend yourself against it all again.

You need to get that into your head as much as anything, because you are beating yourself up about worrying and telling yourself you shouldn't be. People don't just have an off switch for worry. You are allowed to worry and you are allowed to have a normal human reaction to difficult events. There is a way you can use it though, and thats as a positive force to prepare yourself this time round, so that even if it doesn't go 100% to plan you are better able to cope. Hopefully though, you'll be able to convey whats gone wrong in a way that they do listen.