What went "wrong" with my childbirth...?

[bt98]

I have a 17 month old son and am still getting my mind around the whole birth experience. I knew it wouldnt be a walk in the park but I was not expecting psychological trauma either. When I try to talk about it with my partner, he clams up, saying it's too horrible to think about, watching me suffer and seeing all the blood and guts on the floor (his words), he just leaves the room if I talk about it.

I really need to deal with this if I am every going to have another baby. Some of the questions I have which remain unanswered are things like...

• Why didn't my epidural work? After a brief period of relief I could once again feel all the contractions in my front and back after getting the maximum dose. I could move around on my legs and still needed gas and air all the way through labour. The anesthetist was too busy to replace it on the night. I expected this to be my lifeline for getting through labour but it failed me. Is it something that I did wrong or might easily happen again?
  

• Why did the midwife take away the gas and air at the crucial pushing stage, when the pain was worse and I was most scared? I remember arguing with her, she just refused and later another midwife said she would have let me have it, so is this really a judgment call and should you have to argue in the midst of labour for desperately needed pain relief? So much for freedom of choice and having a birth plan when they spring these changes on you at the worst moment.
  

• Why didn't they take pre-emptive action when they knew all along my baby was posterior and it being my first birth it would be that much harder?
  

• In the end I had maternal exhaustion and couldnt push at all. I had an episiotomy and forceps delivery, I hemorrhaged > 700mls, and there was concern over placenta remaining inside. Is this normal and is it likely to happen again? My haemoglobin was 88 after the birth and I was very fatigued, tearful and depressed for weeks afterwards, though this might be a normal effect of all the sleep deprivation?
  

I had a debrief after the birth with a midwife but all these questions led to vague inconclusive answers. I feel bad about my birth experience even all this time later, it was not what I had hoped for, and my partner says the only reason I could possibly contemplate doing it again is I have blocked out the worst bits and was too high on the gas to remember. Is he right?

I pretty much feel that the birth was the start of a psychological roller coaster ride that I am still on 17 months later, I have not felt sane for a day since, having a baby has changed me so much.

Thanks for reading x

[Jcb77]

Hi bt98. I'm sorry your birth has left you and your dp with such horrible memories. I just wanted to add a little that might help for next time.

Yes, about 1 in 8 epidurals don't work properly. Sometimes this is because the mum has unusual anatomy, sometimes it's because the baby is in a back to back position (these ones can be trickier to get to work but by no means impossible) and sometimes it really is just one of those things and the specific reason isn't known. The epidural space wasn't designed for them - it's something we take advantage of that doesn't always work! However, unless you've got a specific reason why it didn't work last time (eg previous dural surgery), then there's no reason to think it wouldn't work next time. It sounds as if your epidural worked initially but then wore off. Maybe you needed more volume than average, or a slightly higher concentration, esp as LO was back to back. Either way, you didn't get it and for that I'm sorry. If you wanted to chat to an obstetric anaesthetist in a future pregnancy about the pros/cons of epidurals, you could ask to be referred to one.
Sadly some shifts can be hideously busy and the anaesthetist is tied up all night in theatre. However, knowing that doesn't help you at the time (and the anaesthetist feels pretty crap about it too).

To echo the comments of other posters: 700mls isn't a huge blood loss and bits of placenta staying behind is also not uncommon (although it's important it's recognised and managed). A haemoglobin of 8.8 isn't that low, although it'll make you feel really rough. The usual transfusion trigger is 7 for an otherwise fit woman (balances risks of transfusion with problems of anaemia).

Birth is a natural process that we've been doing for millennia, but Mother Nature also has her cruel side. I think in this country we're not exposed to that side of things very often and not mentally prepared for when things don't go according to 'plan'. Obviously they often do, or at least close enough, but when they don't it can be a bit of a shock. Our society has also changed so that we don't see mothers, sisters etc giving birth as closely as we once did (and as still occurs in other places). Here it's left to 'the professionals' and is a but shrouded in mystery and fantasy. Which is not necessarily very real or very helpful. And the likes of Holby City etc have made it all white towels and fluffiness with smiling mums holding clean babies straight after..... Ha!

Hopefully some of these posts have helped reassure you that what happened to you wasn't massively out of the ordinary, that you certainly didn't do anything 'wrong' and that it doesn't mean that next time would be the same. Or at least you'd maybe be a little more prepared for it, which might help.

I would certainly hope that next time your epidural would work (should you chose to have one) as you haven't suggested that there's any reason that it shouldn't other than being in the unlucky 1 in 8. Remember - 7/8 chance that next time it'd be fab!

Good luck with whatever you decide to do.

[confuddledDOTcom]

I'm not suggesting anything about your birth plan as I haven't seen it. You asked if one side of A4 is too much and I said yes it can be. The only points I've made other than that are general and I certainly never said you included whale song and candles, that was more about backing up your point. I am what's called a complicated complicated. That means I am complicated and my pregnancy/ birth is too. I have the highest risk scar, I am a thrombophiliac, I am autoimmune, I have PGP/ other pelvis issues, I have IU, my babies all come early... so my plan had to include a lot of important things. I still didn't fill a page doing it in bullet points with headings. Generally what books tell you goes over the top.

I was with a mother who was back to back and had a uterine infection that proved near fatal to the baby. At the end of each contraction the baby went back up so they needed to do a lift. She wasn't prepared for how much it would hurt and yelled at them to stop. The obstetrician stopped and said "What would you like me to do? We need to get baby out but I can't do this if you don't want me to. Tell me when you're ready to go again" he didn't remove the forceps but he didn't do anything until she consented. There is very rarely a reason to not respect the mother's wishes and if you have to go against them you sit down with her afterwards and say "this is what happened". Usually it's life and death and they go ahead with the assumption of you're ok with this unless you say no. I have seen both sides - staff who didn't care what the mother wanted even though mother and child weren't at risk and total respect for the mother - and there is a big difference.

Totally agree about finding a doula now, Dougal. I wasn't having another baby (two babies ago) and had already worked out who would be my doula, she knew it too and we had spoken about my previous births. When I got pregnant I was confident in who I would book and what my options would be.

[DougalTheCheshireCat]

Mark place as there are some useful links on here I'd like to look up.

OP, as well as a doula to help with your next birth, it might be worth finding and working with one now, to work through your thoughts and feelings about what happened. And / or some counselling for you as your DH.

Think the medical de brief sounds like a good idea, but a bit of therapy an support may well help you get ready to do the debrief and ask the questions you want to ask, understand better etc.

My birth had similarities to yours (long second stage, no urge to push, assisted delivery (ventouse), episiotomy, assisted placenta delivery, haemorrhage (1200ml + blood lost).

It wasn't what I hoped for, and, I feel if the cards had fallen a bit better for me (I wanted the birth pool, someone was in it, midwife change right at transition and a new one that faffed and struggled to find the heart beat right at transition, a badly handled birth resulting in a death in my family v much on my mind) I could have had the natural birth I hoped for.

However, with a doula there I understood what was happening and felt consulted and respected if not in control. There were several moments where she stepped in to remind the doctors of my wishes. This meant they paused and explained to me, and waited for my reply, rather than passing off 'we're going to do x now' as asking for consent. For the most it didn't change what happened, but it DID help how I feel about it all.

Since (6 months later) I did a talk through process with my doula. It helped me resolve my feelings about it. It also lead to a very good and constructive discussion with DP about it who immediately afterwards was very 'oh well you are both ok that's all that matters'.

I sounds like you and you DP have a bit of PTSD about it at the moment. It's v worth seeking so help for you both to address those very understandable feelings.If your DP won't at the start, do it yourself. You may find as you start to resolve your own feelings he can go there with you too. I think it must be be so scary for the dad's to watch all this stuff happen - feelings of helplessness / being out of control as the person they care about struggles must be very difficult.

Good luck

[MyDarlingClementine]

bt98, I would urge you to look to MN as one form of research.

There are different views on epidural s and so called cycles of interventions.

I am sure someone can rolls out stats and so on, but my consultants were very clear with me that an epidural does not necessarily slow birth down and if you are so desperate for one, its probably due to other issues with the birth, like back to back and so on which may prolong it and require more intervention anyway.

Being trapped on my side and back through active labour was not the way to get my posterior baby to turn*.

I was not trapped on my back, I was on all fours, and leaning against a chair and so on, my baby was not turning.

It is better to be able to move around and help the baby get into position

I moved as much as I could and the baby was not going to turn.

In these circs, a working epidural would have taken the pain away and helped me birth without the horrendous pain I went through.

When I told my consultant I was being massaged she blurted out a wry laugh.

I originally thought an epidural would be the answer to all my problems, it probably made my labour that much more difficult

No, you will never ever know that.

As well as writing a birth plan I would ask to speak to some one senior at the hospital about your plan and will it be implemented and so on. As I said it often comes down to the MW you have that day, how busy they are and so on.

Also remember ELC should be an option for you.

[MyDarlingClementine]

Confuddled

I can assure you, although you seemed determined to imply otherwise that my birth plan was written in a clear and concise fashion.

I didn't include whale music nor candles .

[confuddledDOTcom]

It's called the cycle of intervention. There's an American term "pit to distress" that sums it up nicely. Staff know how to use that cycle against you although it's not as common out of the States. If you're brave enough the film The Business of Being Born is really interesting, threes a clip on YouTube from it about how epidural affects labour that I like.

You're right in your assessment of your birth I think and seeing that means you can learn for your next birth.

Don't think though that you can't feel bad about your birth (although if this thread has helped that's great) you are allowed to have different emotions about the same event - happy you have your baby and sad for what you went through.

[bt98]

Thanks weebles :)

I looked back to my original post and how I feel now. My perspective has changed (in a good way) from hearing all your thoughts and experiences.

This is how I understand the birth now - please do correct me if you think I have it wrong:

Sometimes epidurals dont work. You cant go into labour expecting they'll solve the whole pain issue and all the fear that generates. I had pinned all my hopes on this one solution and that led to despair.

The midwives let me down in not acknowledging that the epidural wasnt working either. This lack of communication made me more scared and confused. It was hard to be at all positive and confident for the rest of the labour. A doula might help when confusion like this arises.

An epidural also means the insertion of an IV (wow... ouch after 4 failures), a urinary catheter, a belly monitor, and greatly restricted body movement. It all adds to your pain and frustration when you really want to be calm and focused. Being trapped on my side and back through active labour was not the way to get my posterior baby to turn.

It is better to be able to move around and help the baby get into position. It seems like one medical intervention can snowball into several, because they each have a knock-on effect. So I'd leave an epidural in reserve next time, but as not an immediate go-to option.

Though the epidural was partially effective, the baby being posterior may also have removed any urge to push. I never knew this. I just thought I was doing it wrong. It was also the biggest contributor to then having an episiotomy and forceps delivery, not me just being too weak-willed to push.

I will have it in my next birth plan, to keep using G&A if I choose to during the pushing phase - unless it is genuinely hindering progress. To take it away preemptively and against my will was an error in judgment and caused more fear. A doula or more informed birth partner would have been able to speak up for me.

Having the right people at the birth is important. You want people you truly trust, who understand the type of person you are, what type of encouragement you respond to best, and who will explain what's happening at the time if complications arise. Giving birth is a mental trip as much as a physical one.

So.... while I originally thought an epidural would be the answer to all my problems, it probably made my labour that much more difficult. There are lots of things I would have done differently, and hopefully I will be more prepared next time, even though I know there are potentially lots of new issues that could come up.... that is the nature of childbirth. If nothing else I know that I have done it once, I made it through, and the next one might even be a bit faster.

I am also more appreciative now that, after all the mix-ups and trauma, my baby came out healthy and that has to be the primary concern. My heart goes out to all the parents who aren't this lucky. x

[weebleswillwobble]

Can I suggest a brilliant (IMO) book by Juju Sundin called Birth Skills. It has really helped me feel positive and empowered about the actual birth process (this one will be my 3rd), and is not wishy washy at all, lots of very very practical ideas of managing the process and pain of birth, but also extremely accepting of the idea that everyone's birth experience is different - lots of positive anecdotes from women who have had a range of experiences and used a range of pain relief too.

The friend that lent it to me had an ELC, but said that she used a lot of the techniques during the operation / managing pain afterwards too.

I's just like to offer a hug really, I completely empathise with the impact that a birth, any birth, let alone a traumatic one, can have on you afterwards.

[confuddledDOTcom]

If it's your first one there's a chance it will happen again, it's like when you always recharge a battery early and mess with it's memory, your body gets used to that size or that gestation - we think my 35 weeker only got so far as she was IUGR. I do know people who went on to have normal gestation babies so it's not a given. The reason why has something to do with it too. My first went at 20 weeks so I didn't have much chance of going to term really but it got me a diagnosis and they managed to get me further along in the next four.

There are always choices you can make, whatever gestation or birth method and understanding those before you go in, as well as having a supportive birth partner who has your back. I read a good article online called I think "difficult birth a dad's perspective" where a dad talks about how he felt and how dads can help.

I have a birth plan template that I made for my birth group if anyone wants it.

[mrsbug]

That's really helpfulconfuddled. Dd's early arrival was completely unexpected and my vague birth plan was to have a water birth at home which obviously went out of the window. I've been told there is around a 50% chance of me having another preemie so at least I can prepare for it next time.

[mistlethrush]

I can only help with the epidural bit... After 18 hrs of labour, and being told it would be likely to be another 9 hrs on a drip before I could get to pushing stage (had got to 1cm by 7pm, put on a drip and then only 2cm by midnight) I decided to go for an epidural. The first one didn't work and the anaesthatist resited it - this seemed as though it might be working and she left, aiming to pop back in 5 mins to check. She got called into an emergency. Meanwhile, drip on max and effectively no pain relief - gas and air did not touch it at all (I actually cracked the pipe I bit it so hard at one point). She came back in at about 3amish - and had to give me a spinal as she couldn't be accurate enough for an epidural as I was moving too much with the pain - and eventually did manage to site the epidural successfully. I could feel contractions but they didn't hurt (well not compared to the previous amount). I ended up having a section because DS got wedged.

[confuddledDOTcom]

Sadly the change in law is going to make it hard to get an IM. A doula can't do the medical stuff, but if you can't afford an IM (if you can afford both even better!) they are probably the next best thing.

[FancySpaceGloves]

If you can afford it (roughly 3k) an independent midwife is a godsend. Same midwife or pair of midwives does all the pre-natal care, is at the birth, does all the post-natal stuff. If a birth is difficult - my first was posterior - she does a detailed debrief to help you find closure (god I hate that word). Might be worth it for the next DC given your last experience.

It is a damn rotten shame the NHS can't won't do this. It would save them a fortune in all sorts of other ways.

[confuddledDOTcom]

mrsbug - I totally get where you're coming from as I've had 4 preemies myself (31, 34, 35 and 29 weeks) so I know to some extent you are controlled by the situation, but there are some choices you can make and personally I found that it helped bring some control back into an out of control situation.

I had to be monitored continuously because of gestation and a high risk scar so we had arranged with my consultant I would be on telemetric to allow me to keep mobile and the monitor would be out of the way. I included important health points (PGP, allergies, the fact I'm only allowed G&A for pain relief) and things that were important to me (delayed clamping, natural third stage, chance to see baby before they left). When my 29 weeker was born the paediatrician dropped the side of the babytherm and gave a running commentary as he treated my baby telling me what he was doing, how baby was doing etc. Although I couldn't get to the baby because I was trying to deliver the placenta and the room was full of people it helped me to feel like I was involved.

I also did a convert plan, I can't have an epidural so it said on there not to even try to go straight to a GA, it again stated my PGP so that they knew to take care with my legs, the fact I'm allergic to transpore and my children shouldn't have it used on them, that dad should have a moment with baby before being taken to the unit.

[mrsbug]

Hazchem for me i think control was taken away by circumstances which were mostly unavoidable, not by the midwifeor any of the other medical staff.

baby was premature - so no homebirth, and she was whisked off as soon as she was born to scbu

waters broke at the start of labour - so no waterbirth and i nearly ended up on a drip to speed things up

dd was in the wrong position - so she had to be manually rotated in theatre then forceps used to get her out.

as far as i can tell all of this was pretty much unavoidable and so my birth plan next time will be to not have a birth plan!

[confuddledDOTcom]

It's also midwives going beyond their role and taking over, trying to make birth about them, which it's not. As a doula it's part of our job to minimise that, empower the parents, the mother particularly but dads often feel powerless to support mum. Birth is not a medical emergency (unless it is but even then the power is almost always in mum's hands) and parents shouldn't be treated like they are not qualified to do this!

[confuddledDOTcom]

I missed that statement as I was posting on my pad

I think again it's down to what you include in it. It needs to be short and concise, definitive medical decisions only. Whale song and candles kept out of it.

[hazchem]

they lead you to believe you have choice and control which you don't. the MW on the day does and the dynamics she is in at the hospital at that time.
MyDarlingClementine that is one of the most sad and disheartening statements about the type of maternity care women receive. It just shouldn't be the case but I understand that it is for so many women.

[confuddledDOTcom]

Yeah it can be. mine was about half a page and bullet points. I had a second for if we had to convert which was about the same. Some books have waffly birth plans.

So tell me, how many births you been at? I'm guessing more than me and my own doula put together,right?

[MyDarlingClementine]

The power of a birth plan is in the writing - if you spend pages waffling on about the finer details then it will get flung


Mine was one page, is that too much? If so I should have been told that by all the books and people telling me to write one. I followed a template from a birth book.


They are disingenuous, they lead you to believe you have choice and control which you don't. the MW on the day does and the dynamics she is in at the hospital at that time.

[confuddledDOTcom]

MyDarlingClementine - as a doula I have to disagree with your description of birth plans. I had them myself for my third birth, my fourth was at 29 weeks so we were caught out, as we were with my first at 31 weeks and my second we already knew would be a planned crash so not a lot to write in a birth plan. I would always recommend them to mothers, whichever they were up to. The power of a birth plan is in the writing - if you spend pages waffling on about the finer details then it will get flung.

I also disagree the way you talk about a section. There is nothing that would indicate an automatic section unless bt wants one. I can understand it helped you and for many women it does but for some it is not the cure for the past - you don't know which way bt would fall. After one CS that left me with PTSD even the thought of the second one had me shaking and sobbing. My consultant couldn't figure out what was going on when she had me sign the consent forms.

Mooing is totally normal! What they try to discourage is when you expend all your energy through your voice - although there are still some of the "hold your breath and push" school. It's a bit like a tennis player though I always think. Actually, when you think about it there's two types of noises that tennis players make, the normal grunting as they hit the ball and the scream that some (usually female) players do that's totally pointless and gets criticised.

[hazchem]

I came across this yesterday it's a really clear outline of the stages of pushing

[hazchem]

I mooed, moaned ect. There is a difference between mooing and moaning which are deep and low down and come from deep inside and high pitched scream which is high up and fearful. The deep low sounds are helpful and also should provided good HCP with sings of how far along you are. High pitched screams means the women needs help to address fear and relax/embrace labour.

[mrsbug]

Bt98 I mooed too, it was completely involuntary and a bit embarrassing as I spent most of my labour on a ward