Question re monitoring and blood pressure

[Plibble]

I am finding myself going over my DD's birth in excruciating detail every few weeks or so. In an attempt to get over it I have written the whole thing down (only 6 pages so far...!). I was continuously monitored virtually the whole time and was stuck on a bed from being about 3 or 4 cm. I can't help wondering if this contributed to what followed: "back labour", epidural, baby stuck in LOT positon, forceps and c-section. Right after the section, the doctor indicated that my coccyx was "prominant". Since then I have read the hospital's letter to my GP which suggests a trial of labour (lovely phrase) might be possible if I have another baby. I am trying to figure out what the heck happened to stop my baby from turning into the right position. Either she couldn't because of my body (in which case I won't attempt labour again!) or she didn't because I was immobile.

To get to the question: might I have been stuck on the monitor because of my blood pressure? It was pretty high- I had been briefly admitted to hospital at 36 weeks and was on Methyldopa to control my BP but did not have pre-eclampsia. I have requested my notes from the hospital to check, but was just wondering whether this could have been the case. The alternative is that, as I was due to be induced, my notes said that I was (i.e. someone jumped the gun) and so they followed protocols for induced labours. Frankly, I would be extremely pissed off to discover that I had been through all of that because of someone's shoddy paperwork, but I think that might be the case as I was briefly seen in the post-natal clinic (that BP again) and the consultant started with "You came in to be induced...".

Sorry this is such a rant- I've just re-read it and realised that my question is buried in the middle! If any midwives out there (or indeed anyone else) have any idea, your thoughts would be much appreciated. This is doing my head in!

bump

Hi PLibble

not a midwife, but i will offer some words if i may

I am so sorry you found DDs birth traumatic.....i really do think that writing it down is really helpful and cathartic. There are also two good organisations you can contact:

birth crisis

and

birth trauma associtaion

they can help debrief you , which is really important to help you move on ,especially before another birth

I had a similar expereince...induced due to bleeding, constant monitoring, drip, epidural, immobile in bed for hour...no progress past 2 - 3 cm...emergency c.s..followed by severe PND..due to feeling so low about the birth.

It would be, IMHO, exceptionally unusual to have the sort of pelvis that does not allow a baby to get into the ROA or LOA position....back labour would indicate an OP baby.

An active labour is the best sort..or at the least, the sort of labour where you can listen to your body, move if you want, lie down if you want, dance if you want.

I am inclined to think that the immobility excacerbated the problems you had ........

you can try

optimal foetal positioing

and

how to position baby correctly for birth

to get baby lined up for birth!

i don;t know if BP is an issue requiring constant monitoring, it might well be..what is a shame is that you don;t know why your labour happened the way it did.

FWIW - being scared and being anxious can slow and stall labour, being in control,which you clearly weren't, isnt a good start...

there is no reason to think that a vaginal birth is not possible....i had a VBAC and it was a remarkable expereince,

this is a really good site too.

yahoo VBAC group

i hope some of this helps........being strong, feeling prepared and confident for labour is half the battle !

sorry for going on.. this is something i feel really strongly about xxxx

I was monitored throughout ds1 labour I had raised bp.They also told me to have an epidural to lower my bp so they couldn't take me off the monitor.DS head was iin wrong position for normal delivery(immobility couldn't have helped)I begged them not to do a section so they turned and delivered him with a ventouse.The whole experience was horrendous.

Plibble, don't know if any of this will help...

I was on methyldopa during both my pregnancies (low dose - 250-500 mg a day) due to 'essential hypertension'. (Don't have BP probs when not pg). Like you, did not have any symptoms of pre-eclampsia whatsoever during either pregnancy.

Was induced both times (pessary only) but not continuously monitored. DS (8 hr labour) born with aid of forceps in 2002 due to cord round neck and awkward position. DD (4hr labour) born in July this yr, no intervention. Only pain relief with both was a bit of gas and air here and there.

So in summary, both labours fairly non-eventful apart from being induced due to BP. In your case I would guess that the reason you were closely monitored was that:

1. Your BP was much higher than they were comfortable with (although imo they are a bit over the top with monitoring - I felt absolutely fine throughout both pg's and labours and made it clear that I would call them if I felt something was wrong rather than endless mw visits etc);
2. There was a physical reason that made it difficult for the baby to come out naturally, hence c/s despite initial attempts with forceps. However, you had an epidural and imo this prolongs the labour so makes it more difficult to push the baby out as you are not feeling the intensity of the contractions and hence you are more likely to get tired (resulting in c/s); and
3. Ime the protocols for induced labours usually involve pessary followed by drip followed by epidural. I am a willful cow and made it clear that I was happy to be induced due to the BP issue, but that once labour was established (which luckily for me did not require a drip as well) I was to be left alone and I would shout if I needed anything (I was really determined to avoid epidurals and c-sections unless absolutely necessary.)

So were you happy to have the interventions you had? If not, suggest you be more forceful next time and state you don't want them, unless there really is a physical reason why a vaginal birth is difficult for you. Was there any hint during your ante-natal care that there was likely to be a physical problem due to 'prominent coccyx' or anything else?
Although I needed forceps to help get DS out, DD was fine and she was almost 2lb heavier than him! So just because you needed c/s this time, you may be OK next time.

HTH and sorry for mega long post

X-posted with lulumama - agree with everything she says!

Ok, when you say you were monitored - was it yur bp been monitored or baby's heartrate? If it was baby's heartrae then why were they monitoring it - were you on syntocinon drip for induction? Were you not allowed off the bed even though been monitored? Been monitored doesn't normally mean you have to stay on the bed, you should be encouraged to stay upright/on chair/ birthing ball.

Did they break your waters? Unfortunatly been induced does mean you are less likely to end up with a vaginal, non-assisted birth.

lulumama said it all before i could really.

you can have a vbac. forget epidural, or get a mobile one (if poss) so you can walk around. this will help.

good luck.

cx

Thanks for all your replies. I can't believe how much time I am spending thinking about this! Mamijacalys, I wasn't terribly happy on the monitor - I asked a few times to be taken off in the ante-natal ward (and, on the one occasion when they did take me off went for a walk around the park and then had a bath) but they mostly kept saying they needed to keep me on it for "a few more minutes" and then leaving me for ages. If I tried to move the monitor fell off. After they sent me to the delivery ward, they told me to get on the bed , hooked me onto the monitor (and to an automatic bp monitor) and then just left me like that. After that I didn't really bother asking to be unhooked. I think I was too overwhelmed to articulate how I felt, and had already been in the hospital for 7 hours by this point, mostly on the monitor.
I asked for the epidural because first labours in my family tend to be long (30 hours is the norm) and I needed to get some rest. Noone suggested that it might not be a good idea. It was a walking epidural but the anaesthetist told me (after giving the epidural) that I should not stand up without 2 people to support me at all times.
They broke my waters for me to speed up the labour - but not until 1am, by which time I had been at the hospital for 11 hours. I did get a drip at somepoint, but definitely not until after the epidural. Looking back, they seemed pretty keen to break my waters and I have no idea why. I mean, so what if it takes a while? Isn't labour meant to take some time?!

In the end I was fully dilated despite lying there for hours. The only problem was that DD was facing the wrong way and, although the forceps were turning her head, she kept turning back again.
During my various ante-natal visits I only had one internal and no potential issues were spotted (especially as I understand it is hard to predict how a pelvis might "stretch" during labour). One midwife did say when I was in labour that the gap in my pelvis felt small, but she didn't say it would be a problem in itself.

I think that next time I need to have a better idea of what I want. If my next consultant says I can have a vaginal birth, then I will be making a long list of things I want and training DH to be assertive on my behalf. And I will not be going to hospital until I am climbing the walls.

I really can't see any reason why you would need to be continuosly monitored. The (probable) reason baby didn't turn is because they broke your waters. Obviously she might not have turned anyway, but it is a lot easier for a baby to turn if waters still intact.

Plibble

your post says baby was stuck in the LOT position

do you mean LOP ? if so , then left occiput posterior is an OP baby..ie back to back

T would suggest a transverse baby, and there is no way to vaginally deliver a transverse baby

If LOP, then not a reason in itself to have a section

Yes, labour is supposed to take time..it is possible that if you had been able to move, or adopt different positions, then the baby could have shifted position...

and the epidural should have been explained before you had it..sounds like a lot of what happened was not explained fully

if the pelvic outlet is small.,then it might present a problem, especially if you have a large baby, but true cephalopelvic disproportion is not that common ie the baby's head will not fit through the pelvis

It's quite normal to want to talk about your labour in detail, particularly so if it was prolonged as in your case.

I agree that the whole NHS system/hospitals/mws/doctors can be overwhelming when you are not used to them - I was much more confident and vocal re my needs with DD due to having had it all before with DS.

MN is brilliant for support as there is bound to be someone who has had a similar experience to you. Next time you will be much more prepared!

Totally agree that OP not a reason to have a c-sec. But unfortunately it means a slower labour, then if you don't follow the hospital's policy on how fast you "should" be progressing you will get a drip up, waters broken. Then if you're more than an hour in 2nd stage you end up with forceps and possibly a section. Pants isn't it?

rhubarb..it is pants.

and shocking that modern obstetrics does still try to force women to labour by the book.....

She was LOT - basically, trying to come out facing my right inner thigh rather than my bottom.
I'm trying to work out what is making me so cross about what happened. It's not as if I am opposed to c.s. - I think a planned c.s. could be lovely. I think it is that, before the birth, whenever I spoke to a midwife they went on about it being best to move about, continous monitoring to be avoided etc. So when they stuck me on the bed I assumed that there must be a good reason for it. I would have hoped that a midwife's job is to encourage you to labour efficiently (e.g. by getting you to move about) but there was none of that. Then in the end the did the important bit for me. It just seems really odd and terribly unnatural to me when I look back on it. It's as if they were just going through a checklist - monitors, epidural, break waters, add drip, use forceps and perform section, which is a funny way to treat someone who is just having a baby and is not ill.

Do the words deep transverse arrest ring a bell plibble? Sometimes babies can get stuck in this way during second stage and there is really no way you can birth the baby on your own. It is to do with the way your baby enters the pelvis and birth canal and not your body failing you or because you were immobile.

Being in a supine position does narrow the pelvic inlet and can make it more difficult to birth your baby, but it would not cause a deep transverse arrest (if that was how your baby was lying).

What I suggest it that you obtain a copy of your labour notes from the hospital reords dept (free within 40 dyas of the birth) and ask fir an appointment with your head of midwifery or another senior midwife to go through your birth with you. You will then be able to get more info on what happened and be able to find a place of peace with for your birth story.

Agree it's pants. The did let me push for 90 minutes, but really nothing was happening. And I guess it is pretty hard to change the baby's position by that point in proceedings. God it makes me cross. Next time I think I will try to find somewhere where they do more than just pay lip service to the concept of active birth.

i can undersatnd where you are coming from

when i was booekd for inducion, not a single midwife or my obs said anything about the cascade of intervention that can stem from an induction....even though my birth plan spelt out i wanted a natural , active vaginal delivery

i was lucky the second time to get that birth, but it took months of preparation and work to understand labour and why things happen they way they do

and i was not prepared to be told the best way to labour, purely because it fitted with the hospital protocol

i do still feel angry , 7 years later.......

Does sound like DTA plibble, which never rights itself or can be changed by maternal effort - it really can only be sorted by using forceps to rotate the babies head or section. I am sorry that you have had a negative experience. Lots of mums have a difficult first birth but a joyful second (like Lulumama!) and it can be very healing.

Have a doula or independent midwife next time who will if possible help you achieve the experience you hope for.

aravinda....i think that you might well be right

DTA can occur with an OP baby and causes obstructed labour

can be rectified as you say, with forceps...but not always possible

Plibble..going through the notes might well give you answers and the knowledge to move forward and embrace the prospect of future births.

That's interesting aravinda. I can't find that letter from the hospital right now, but have just Googled DTA, and it does sound right. So it sounds like a bunch of things could have caused it.
I have asked for my notes, so hopefully they will shed some light.
I didn't have a particular idea about how my birth should go, but since all the midwives I met went on about active birth I just assumed it was standard practice (I was in a hospital with a v good reputation for that sort of thing). And I am not particularly attracted to the idea of vaginal delivery, but I do not like having things done to me (e.g. rupturing membranes) without proper explanation of the risks and will resist like mad in future.
Thanks all - it is helpful to get it out. I am sick of losing sleep over this.

plibble - it is not unheard of for notes to "go missing" or take a very long tome to surface please contact AIMS (aims.org.uk) if you have any trouble getting them. I have to say that IMO it is more difficult to achieve an active birth in hospital due to policies, timescales, procedures, staffing levels and some labour ward m/w are very used to active management as opposed to leaving you to birth your way.

Thanks. You wouldn't believe how helpful it is to get this out.