Evaluating/MLU/Epidurals- Advice needed please

[NickyEds]

I'm 20 weeks pregnant with dc2 and I'm very nervous and confused about giving birth again, mainly because of things that happened with ds. I'd really like advice on three specific things;

1. Evaluating. With ds my waters broke at home but there was some blood in them. I went into hospital and they monitored me and baby for an hour and I went into spontaneous labour (though obviously early stages). They said that I couldn't go home and would have to labour at the hospital where I could be monitored. The reasons for this were never really explained and the monitoring really only consisted of giving me paracetamol. I was in labour all day and only saw the mw maybe three times. Has anyone said no to this and gone home??
2. MLU. When they examined me in the evening I was 3cm there seemed to be much relief as i could be transferred to the MLU(just downstairs) as I think I was getting in the way on the ward! When I'd visited the MLU it was lovely, a great facility with birthpools etc and was where I'd wanted to give birth. The main problem I had was that the mw didn't really come when we called. I was due more pain relief at 12 midnight and when the mw hadn't come by 12.15 we pressed the call button. At 12.30 DP went to look for someone and found the mw who said she was on her way. She didn't arrive till nearly 1. I know it sounds silly but it was my first labour and I was very scared and nervous. She said that the MLU was much more hands off and they didn't like to "be all over us". Is this your experience of MLUs generally?? I understand that it might be totally normal but I really felt like I needed a bit more reassurance. We saw the mw twice between 11pm and 7.30am- usual???
3. By morning I hadn't progressed far enough and needed to be augmented (24 hours after waters had broken) on the synto drip. Safe to say that things progresses quickly on the drip. At around 10 contractions were every 3 minutes and unbearably painful. DS was back to back and I needed to be on my back for the monitor. It was agony and I asked for an epidural. A mw said "you're not even really in labour yet, so no". I can honestly say that my blood ran cold at that point. I was terrified and in pain. DS was born three hours later and it was just awful. I feel guilty about saying it as I've heard of much worse births on here and ds and I were both safe but I still wake up regularly thinking about it and it's effected me deeply. What is the criteria for getting and epidural?? I thought I'd just have to ask- ridiculously naive???

That was long! TIA

It sounds like you had very poor care. Were you at a very busy and understaffed hospital by any chance? it sounds rather like my experience of my first labour in London (which was a key factor in deciding on homebirths for the others).

I don't know about the monitoring but:

1. No, you shouldn't be left alone like that. Aside from anything, they should be monitoring the baby's heartbeat far more often than that.

1. That isn't her call to make. A tiny minority of mw's seem to get off on power (I had one too). I would say (i) you can refuse the drip until you get an epidural in place. Boy they moved fast when I said I wasn't having the drip unless they did!; and (ii) you need to get your birth partner briefed to ask to speak to the head midwife, or the registrar, if anything like this happens again. It wasn't her right to deny you an epidural.

Honestly, I am a non violent person. I'd never hit anyone. But I still have fantasies about, I don't know, maybe stamping really hard on the foot of or giving a Chinese burn to the mw i had in my first labour.

It wasn't busy at all in the MLU-I was the only woman there which also made it a bit...creepy(??) when we were left alone for so long.

I never want to see that mw again. Ever. It sounds soooo ridiculous but I'm actually considering a different hospital just in case I get there and she's the mw I get.

You can refuse a mw you know. If you arrive and she walks in, just get your birth partner to explain that you don't want her. They'll swap the staffing around.

Can you? I just thought you got who you were given. With ds I would definitely have felt very uncomfortable doing something like that and TBH I wouldn't relish the thought now but of the two hospitals I could go to this one is better on paper and more convenient.

Also, I'm worried that I was just over sensitive and they were all just doing their jobs and these things (gaps in being seen, refusal of epidural) are just normal in which case being at a different hospital/MLU wouldn't make a difference.

Refusal of an epidural is not normal. Not everyone who has syntocinon wants an epidural, but I'd go as far as saying most people on the drip will want one. Your request should have been respected.

You had a really, really mean mw. She shouldn't have told you that coping with a b2b labour on the drip 'wasn't established labour, so no'. FWIW, my MW said similar things to me (She told me I had a low pain threshold, repeatedly told me I wasn't in established labour, told me I was making a fuss). It isn't right. And it isn't normal. The other mw's I've seen have been lovely.

Gaps in being seen, well it does seem quite common if you aren't classed as established labour. You get lots of stories of women left alone. But that is normally because the mw's are trying to look after lots of mums. It shouldn't be the case when you're the only person on the ward and you're asking for support. That's poor care.

I do wonder whether you were fobbed off in the labour ward because of staffing? Once you have the epidural it is policy (at least in my hospital) that you have to have someone with you continuously. Or because the anaesthetist was with someone else and the mw had absolutely no beside manner (avoiding that set up is why I was very clear I'd not accept the drip without the epidural already in place).

Would a de-brief be helpful? You can ask to see your notes and talk it through even years later (though beware, they can be works of fiction).

Thanks Penguins. I don't think I was fobbed off on the labour ward due to staffing- i think that they didn't want me in labour on the post natal ward (wandering about etc) at night. In the MLU they definitely weren't understaffed, when DP went to find the mw they were watching reruns of the X Factor Final.

I might go and have a word with my gp. At my 8 week check she said i was displaying some PTSD-like symptoms and said if it continued they would perhaps look into de-brief or counselling. It did get better so I left it, it's only since I've got pregnant again that I've felt worse. It helps to know that it wasn't normal (if it had been I don't think I could go with the MLU again) and that maybe I'm not just being a total wuss!

I think that sounds a good idea.

I very much doubt you are being a wuss. As I said, I had a similarly mean mw with DD1. She told me I had a low pain threshold when I was writhing in agony on the bed. When I had DD2 without any pain relief and DS with only gas and air I seriously wondered if it was too late to track her down and shout in her face that she was wrong and that none of it hurt as much as that 'not established' labour .

The pain of being in a position which your body is screaming at you not to be in, and the pain in your back, is very different from your average labour pain, I have found. DD2 was also back to back and I'm not going to lie, it was agony. But my body told me to do X and Y and I did it, and the pain felt productive. Not less, but like I was working with it to get somewhere. The pain of being on my back being monitored felt helpless, and scary.

And you know what, I want to ban the whole low pain threshold/wuss/tough thing in labour. Because pain is what you are feeling. Even if you were the biggest wimp in the world (which I'm sure you are not), the way to help you would be to be sympathetic, give extra support, listen to requests for pain relief and explain gently if there was a genuine reason it wasn't possible. Not be dismissive of the pain.

I did a lot of stuff with my doula on processing my first birth. I suspect that things you could do to process yours might help too.

I would definitely go for a debrief and have a long chat with someone, either a MW at the hospital or your community MWabout how a second birth is likely to be different. I think each stage is likely to be quicker but I don't know the data.

My NCT facilitator was very good with this sort of thing. They run a refresher course for about £100 - I wonder if that might help you too.

I'm so sorry though - it sounds like you experienced poor care.

B2b on the drip was hellish for me. I couldn't be on my back, no way. It made everything much worse. I have a few issues with my care but I had every conceivable wire attached to me or baby and I was never forced to be on my back apart from briefly for examinations. They really should have been more proactive in helping you into a position to aid your baby to turn.

Long tall and short of it is that if you need a drip, you should be able to have an epidural, no matter how far progressed your labour is. And it's not the midwife's call to make.

Thanks again. I'm making an appointment with my gp this week. I'll try and have a chat with the community mw but they're busy and generally just have a "birth hurts and is horrible get over it" attitude. It's nice (and not nice) to hear that it is unusual to be refused an epidural and gives me some hope!
I didn't do nct courses last time but I'm happy to become a member if there's someway they can help with this. I'll have to look into it.

Would a doula be an option? If your confidence in the hcps is low, your own advocate might help?

You don't have to be a member to do an NCT course. The joining fee is lumped in with the course fee but you can remove it