Back to back babies during labour - Is enough to being done to detect and support

[NurseryRhymesStuckInMyHead]

Just wondering whether others who had back to back (OP) or ROT or LOT babies found that their local maternity services had the skills to detect and support labour in a way that would give mothers the best chance of avoiding interventions during labour in these cases?

My experience was that even though the labour played out as a textbook OP (anterior placenta, start stop extremely long early labour, very slow active labour) OP was not detected until very late (8cm dilated) and then no one told me and no one even suggested trying some different positions that might help the baby turn... Such a shame really as these births seem to have a much higher rate of intervention so really I could have done with all the help I could get! Did anyone else have the same experience?

I know some babies turn easily on their own so I'm not suggesting interfering if things are going well anyway, but if they are not progressing wouldn't it be good to have someone skilled to suggest some different positions, not do ARM, do anything else that might help before interventions?

Slice - you sum it up perfectly

Blurton - I think you're right to complain. It's unacceptable to be laughed at and frightened by the people who are supposed to be helping you. If you don't complain it will happen again to the next woman. I actually was considering one-to-one or similar as cant face turning up to MLU and facing pot luck on which midwife I get. but not sure I would use them after reading your story. Would you update us? Let us know if the complaint was taken seriously?

Amber - what position did she suggest? this is exactly what I wish my midwife would have done for me.

My midwife had me push in the following positions: in the water, on all fours, back leaning against the bed sitting down. When those weren't working I think she realised DD was OP, so we then tried pushing on the toilet and finally squatting. Squatting is where DD turned but my midwife wisely didn't let me deliver in this position. She said it was too difficult to control and too easy to tear in that position (DD is my first). So DD was delivered 10 minutes or so later on all fours.
I know that might not be useful for those failing to progress but if you can get to pushing, that's what worked for me.

Nursery It does seem like they're concerned now, I'll keep you updated.
I think they can be good, but it depends on your assigned midwife. I had doubts about mine from the very beginning, I should have asked to swap. I think a lot of there midwives are young and inexperienced, it seems like a bit of a stepping stone job. A good few of the NHS community midwives here were previously one2one midwives.
Here the one2one midwives can't come in the hospital with you so if you have to transfer you have to face the luck of the draw anyway. Apparently there post-natal and feeding help is good though.
I didn't want to see my 121 midwife again after my labour so I transferred back onto community midwives in while in hospital. The community midwifes I saw afterwards were amazing - I so wish I'd been under their care instead.

I never knew until I read this thread that an anterior placenta raises the risk of a back to back labour. Dc1 was ROP and after 17 hours I was still only 1cm. When my waters broke they were full of meconium and the baby's heartbeat started dipping so it was emcs time. They didn't realise that she was ROP until they had to rummage around to find her during the section. Bloody ridiculous given that a simple feel of my tummy would have told them what was happening. The other thing I remember is the pain being a flat 10/10 agony that took over everywhere. Nothing like the other women I'd seen on the way in who were swinging their hips and breathing through the contractions.

Blurton good on you for complaining, clearly we all should! I hope they take your complaint very seriously.

hownottofuckup your story nearly had me in tears. You poor thing.

Amber high fives, cheers and for your midwife, if only there were more like her!

It is appalling how many of us have been treated so badly. I'm seriously thinking of writing to my hospital about it to ask what training if any the midwives get on handling this and if they did anything following my verbal complaint.

This thread is really interesting. I was told my first baby was 'sideways on' and a lot of the stories here are familiar - long, stop start early labour, which was only bearable if I kept moving. This meant three nights with no sleep, and in the end dd had to be rotated and pulled out with forceps. I never felt an urge to push but the midwife had me pushing for hours before I was sent to theatre. I didn't know this was all related to dds position until I had a birth debrief when I was pregnant with dc2.

I also had an anterior placenta, is this what caused dd to be in a bad position? I had an anterior placenta second time around too but I had a quick easy birth so I think he must have been in a better position.

Both my labours started with waters breaking so I've never had ARM.

Sorry to those who have had bad experiences

Lilac - To think my midwife left me without any advice on position for 20 hours. I want to go back in time and have your midwife! 😥 Thanks for the info it will hopefully help women who have a midwife like mine!

Blurton - I'm so glad they are taking it seriously. I hope they'll make sure that it never happens again. Yes please keep us updated!

for everyone who didn't get the help and advice they needed!

I had no idea why my labour and delivery were so horrendous until DH happened to mention, weeks later, that DD came out face up. Pain was constant and excruciating so I had no idea when my contractions were happening and MW was spectacularly unhelpful and unsympathetic, kept screaming at me to push with my contractions despite me telling her I had no idea when they were happening because the pain was constant. I was made to feel I wasn't trying hard enough to push her out and was actually asked at one point if I wanted my baby to die because I wasn't pushing. Ended up with a third degree tear, episiotomy and forceps and felt a complete failure. Was too scared to risk another pregnancy and had flashbacks and post trauma symptoms for years afterwards. Understand it all a bit better now but am 41 and feel I've left it too late for another baby which is a shame as I would have loved another. My active labour was quite quick considering, 3 hours 20 minutes from waters breaking to delivery but MW only checked me twice, once on arrival and I was 4cm and then left me on my own for 2 hours (no pain relief, did the lot on 2 paracetamol) before checking again to find I was 10cm and baby in distress. I do think she could have done more and that things may have been different if she'd listened to me and realised that things weren't quite 'right', think she just thought I was being a wimp, couldn't even get undressed as I was in so much pain and had no breaks between contractions, DH had to do it for me.

Both of mine were OP. First was horrendous as I was induced on the drip after 3 days of other induction techniques not working. The pain was constant and I couldn't stop vomiting. I had some diamorphine but then I couldn't tell when I needed to push and was lying on my back as was so exhausted and out of it. They managed to get DS out with episiotomy and ventouse but I feel that it could have been worse. Took a while to heal and I was very nervous about my second labour.

Second labour was only a few days ago and I have a 3 day old DD :) I went in to labour naturally thankfully but felt like I needed to stand up for all my contractions. When I was admitted to the MLU they diagnosed OP straight away and said it was important to remain upright as much as possible. The midwives were amazing and so supportive. I got through on just gas and air and spent most of my contractions leaning against the wall. Gave birth leaning back on my heels and didn't even need stitches.
Couldn't believe the difference in experiences and think the midwives made all the difference.

I wonder what we could do to try to improve things? if mumsnet would consider putting some info and advice on the site about long or start-stop early labour do you think you would have found that useful? Does anyone have any other ideas?

DD2 was OP and, actually, the labour was fine! About 16 hours from realising i was having contractions not Brixton hicks to delivery. The contractions weren't continuous and I managed the pain with gas and air from when I was admitted about halfway through and a shot of morphine at one point.

BUT I still ended up with forceps delivery, episiotomy and tearing. When I started pushing the pain ramped up enormously; contractions constant I think as DD was head butting me in the lower spine! After an hour a consultant had a look, realised DD had failed to make it past my cervix, tried to do this manually (OUCH), then I was whipped off to theatre.

Contributing factors with me
VBAC, so I had to be continually monitored on my back (and DD's heartrate was all over the place so it was non negotiable
Large baby with Huge (98th centile) head
I seem to carry babies in funny positions (DD1 was footling breech; Dd2 was also breech till about 35 weeks, in hindsight I wish she'd never turned!)

I obviously got away with it in terms of a relatively easy labour- some of the treatment of people on here is horrible. The delivery was another thing entirely (worst bit was trying to stay still enough for them to get the spinal in whilst in extreme agony-the anaesthetist told me off for swearing at one point, which didn't go down too well!) but I accept what happened was necessary to safely deliver DD.

In terms of the original question I knew she was OP before labour and nothing was suggested to me in terms of helping her turn. No one suggested it might present a problem in labour. I'm a bit different as due to the VBAC/monitoring issue I was confined to one position, although my midwife ramped the bed up as much as poss so I was basically sitting. However I do find it a bit odd that in the latter weeks of pregnancy my community midwife didn't suggest anything to help DD turn. She knew I was keen for the VBAC, she also must've known an op baby plus VBAC would make natural delivery even harder.

22 years ago I had a back to back baby. Nobody even mentioned it to me until I was in labour and feeling the pains in my back. It ended in a forceps delivery.

I found my midwife great about the fact he was back to back. My case is a little different as I was induced due to pre eclampsia. My consultant offered me an epidural and even mentioned elective section if I felt too uneasy about the back to back position. But my pre eclampsia came on that same day very severe so I think they just wanted baby out.

My midwife was great about helping me get into positions to help DS out despite being hooked up the the drip and monitor. She got me to try loads of positions when pushing didn't go well and made the consultants hold off on intervention as long as she could(my blood pressure went crazy High so of course at that point she got them to step in) in the end I had forceps and an epidural in theatre. But DS was trying to come out face first with the cord round his neck, he was never coming out on his own!

But it was diagnosed op from the get go and while I was given options everyone was very positive about it and seemed knowledgeable. Although I fortunate enough to live near one of the best maternity wards in the country.

Just a quick update!

I haven't made an official complaint with one2one I just had a good whinge at them. They lady I spoke to was very understanding and we spoke on the phone for about an hour about my experience. She seemed genuinely upset that I'd had such a bad experience.
She has told me that they are going to provide more training on supporting women who have OP labours. She also offered me the opportunity to meet the midwifes who I had contact with while in labour to talk with them how there treatment had affected me. I declined this opportunity, but thought it was great of her to offer! She has said that she will ensure that the midwives get my feedback though. Apparently the regional manager has been on annual leave but she is going to be in touch with me soon to talk with me as well. I feel so much better about it now that it's been acknowledged that my care wasn't ideal. I'll provide further updates.

I also had my hospital debrief (Liverpool Women's) the other day, which was really interesting. I asked the consultant what she thinks the ideal care protocol should be for women who have long latent phases and she swerved the question a bit by saying that she thinks that I'd been in established labour for quite a while before I went into hospital. She said she thought this as my contractions didn't respond well to the syntocin drip so it was like the muscle was already knackered. But, she did say that apparently NICE are in the process of writing new guidelines for the care of women in the latent phase, so let's hope that the new guidelines will recommend better support for these shit labours! The hospital debrief was really great for me - it cleared up a lot of questions. She basically said that while I should of been more supported at times, it was never going to be a great labour and she thinks that even if I'd transferred earlier it was always going to end in a section. It just may of taken 24 hours off the labour. Which would of been nice but hey ho.

On and I forgot to add - the consultant I saw at the debrief said that if a women had come in twice struggling with the pain - but was only, say, 3cm she would make sure that the position of the baby was identified and if it was OP then they would be admitted and given pain relief if they wanted.
So hopefully some hospitals are already a bit better with this position!

Oh and just one more thing! The consultant said that she didn't think there was that much that could be done to turn the baby with positions etc it was just luck. She mentioned ARM making it difficult for the baby to turn but you get to a point where you have to augment the labor somehow if it's been going on for ages.

The lady I spoke to at one2one said that there was things you could try to help them rotate - like squats, robozo sifting(sp?) and hip circles. She also said that you can try lots of pressure on the lower back and water injections to help with the pain.

I think the most helpful thing for women in any type of labor is to be treated with respect and compassion.

DD was OP, they didn't realise until after they had pumped me with syntocin because labour wasn't progressing (funny that), at which stage the contractions were so strong but not effective at all due to her position, eventually had an epidural which only took on one side (the anaesthetist tried a couple of times, but to no avail) - can remember a group of docs at the business end, one with forceps and thinking to myself "nope, they're not going anywhere" and pushing with every single cell of my body, and finally feeling her make her way down and out. I can also remember what people refer to the "ring of fire" - it was like heaven to me after the pain that had come before, the tear and stitches were a walk in the park as well!

Back to back with DS. Started on Wednesday, gave birth on Saturday. Agonising pain, only position that helped was standing with the small of my back pushed hard flat against a wall. Kept being fobbed off by midwives, as I wasn't dilating much. Got sent home, told I was in 'early labour' and it would get worse. Horrific pain at home, no sleep, constantly standing/walking. Back in again next day, left to it. Told to go and have a warm bath and had to call for a nurse to get me out as I couldn't move for the pain.

Waters broke Friday night, still not properly dilated, meconium/baby in distress so forced to lie on my back so they could put a monitor on him. Episiotomy/threatened forceps/lots of being told I wasn't trying to push enough.

I started life as a new mum having not slept for over 76 hours, and seriously traumatised after having no pain relief for the first 72 hours because midwifes told me I should wait until it 'got worse'. It was 'worse' all the way through.

I only found out he was back to back afterwards. I absolutely loved the emergency c - section I had with DD, it was so much easier/less painful both during and after!

DD (12 days old now) was back to back. I was induced at 41wks due to reduced movement, and she wasn't or hadn't been b2b, however anterior placenta here and it was something I'd been aware of.

First 24 hours on antenatal there was no mention of her being b2b. I was in bloody agony and kept being put on my back for monitoring; the rest of the time I was on my knees with the bed head up hanging over it. It was horrendous and I think I said on more than one occasion I just wanted to die... My back felt like it was being broken in half. Waters went at 2cm and that made it even worse. I'd been having BH every 2 ish minutes when I'd gone in for the reduced movement, and these basically carried on and turned into contractions getting closer together, so there was no break.

Once I was on delivery suite, they organised a mobile epidural for me with no argument (although I had to wait maybe an hour, I can't really remember how long, for the anaesthetist to come out of theatre) and MW examined me and said straight away she was b2b. I honestly can't fault them from the point I got onto delivery suite. Epidural was amazing, I was on constant monitoring so on my back but couldn't feel a thing. Went from 4cm to 9cm in 2 hours, and then stuck at 9 for about 5 hours or so. Her trace wasn't reassuring so I did end up lying on sides to help, but the staff kept me informed of everything but in such a calm way I never thought anything was really wrong. DD did turn, but not completely, drip to make it the last cm but once I started pushing the pain was back instantly and her heart beat was dropping with my contractions so ended up with forceps delivery. Apparently cord was tight round her neck and why she couldn't turn back completely, and I wouldn't have gotten her out on my own. But from the point I was on the delivery suite I absolutely can't fault the care or communication, I was in agony and it was recognised and dealt with. MWs on antenatal did their best but I guess there are policies in place that limit the pain relief available until you go over to DS.

I was induced. Two days in midwife mentioned OP based on CTG but it wasn't really taken seriously. I told everyone who examined me but it was dismissed.

Four days of stop start labour, 16 hours of active labour. Horrific tear. Nobody confirmed it until afterwards and I had no idea how dicey things were at the time.

My baby is drifting towards back-to-back. Discussed with midwife today and despite previously assuring me they were "very good" at spotting b2b labour in hospital, she now tells me there's nothing that can be done if baby is b2b in labour. I mentioned positions to help turn the baby in labour and she flapped a bit and agreed.

Why are midwives not more informed about this? I'm terrified of being fobbed off and in constant pain.

DC1 was B2B. The midwives realised straight away (I was on synto drip due to PE) and told me to try sitting on the loo for a while, which would turn her.

I did as they said and DD turned at some point. I pushed her out in 15 minutes. Minimal tear, but I did have a very bruised back where DH had been pressing on it to relieve the back contractions.

My DS is 17 now and if I had my time again I'd have had a caesarean. 3 days of agonising contractions. The hospital knew he was back to back but certainly never suggested any alternative positions. When he started to become distressed they did an emergency forceps and basically dragged him out. I've never fully recovered from that physically and he was badly bruised and swollen. He has mild SN and I have always wondered (but will never know) if it was because of that birth experience.

2 MWs, 2 obstetricians and some other people milling around the delivery room. At midnight I was 10cm dilated. At 6.34am they pulled DD out with the vacuum cup because I insisted I couldnt push anymore so it was either vacuum cup or c section. Only then did they realise she was back to back. 6 and a half hours of delivery. My labour was only 5!

Cupcakes, it was a relief having a cesarean after my first experience. I also wonder the same about my son - he has adhd/dyspraxia/hypermobility and was in distress for at least 5 hours.