3 years later, pregnant, and finally got my debrief. What questions shall I ask?!

[Crunchyside]

I have been waiting 3 years for a debrief since giving birth to DS1, it's only now that I'm pregnant that they have prioritised me for one.

The debrief will be with a consultant obstetrician and a senior midwife so I want to make sure I'm not wasting anyone's time and that I'm getting the most out of it - I need to ask the right questions!

Basically, my first labour was very long and painful. I went into our local midwife-led unit coping well but in a fair amount of pain - turns out was only a few centimeters dilated. I had been hoping to use the birthing pool. The midwife on duty grumpily told me that my blood pressure was too high and that I needed an ambulance transfer to the consultant-led unit 40 minutes drive away. I have always had low blood pressure so I'm convinced it was only high due to the stress of being in labour - I asked her if this might be the case for reassurance but she shook her head and told me no, it's a concern, you must be transferred. I became more stressed and the pain got worse. Having to lie down in the ambulance the pain really cranked up to the point that I was begging for an epidural on arrival. I had to wait several hours before I finally got it. When the anaesthetist was inserting it I kept feeling electrical pains down my leg. I yelped and asked for reassurance that it was normal, the anaesthetist refused to reassure me and kept re-iterating the 'disclaimer' spiel they take you through before medical procedures, it was as if he wanted to cover his own back if nerve damage happened. The more he refused to reassure me the more I panicked. Finally it worked and it was a massive relief. By the time the baby was born I'd been in labour for about 24 hours and the baby was delivered with forceps. I feel that the forceps damaged me internally, and I also feel that my episiotomy was very poorly perfomed as it had lots of knots in which wouldn't heal and ended up with a staff infection a week or so later.

I wonder if things would have gone more smoothly if I hadn't been under stress and made to be more anxious, so I am considering a home birth this time round - although that feels kind of insane considering I needed the epidural so badly the first time round. I would love another epidural but if they can't guarantee I'll get it when I need it, I wonder if I'm better off being at home without one, where at least I'll be in more control....!

So far I have thought of the following questions:

• Why were forceps chosen instead of less intrusive ventouse extraction?
• Is it typical to have to wait so long for an epidural or were they exceptionally busy that night?
• Is it normal that midwives and doctors don't reassure you when you are anxious during labour or panicking about something?
• Would it be safe for me to have a home birth this time round?

I just want to be able to make the right decisions this time round and I need to make sure I get the most out of this debrief... Can anyone give me some pointers?

That all sounds pretty miserable, I'm sorry to hear you had such a bad experience. You are certainly not wasting anyone's time with a debrief.

I think all of those questions are perfectly good ones! Some of them have an obvious answer - no, it certainly isn't normal not to reassure a panicking mother.

I'm not an anaesthetist, but I wonder if the tingling in your foot indicates that the needle tipped into your spinal column rather than remaining in the epidural space? That could be why it suddenly worked so well.

They may not have documented why forceps were chosen over Ventouse - contrary to what seems to be popular opinion, forceps are still commonly used in the U.K. and whilst they are more traumatic to your perineum, they have some advantages too (less traumatic to baby -although I know this is contested, but in my experience it's true - and more reliable). It wouldn't be routine for the doctor to record a defence of why they used forceps over Ventouse, beyond "that was what they felt was appropriate". I'm not saying this to defend/explain their use in your case, I just want you to be prepared for the fact that clear answers to such questions may not be forthcoming.

Finally, your labour is very likely to be shorter and easier this time round. The big question about home birth will I suspect revolve around your blood pressure. If it was mildly elevated but with no protein in your urine and explainable by stress, I hope they'd support a homebirth. If your BP was significantly elevated, including postnatally, and particularly if they gave you medication to bring it down, they're unlikely to be keen.

Home something in that helped

I didn't know they could give you a deal brief. I wish I had this with DC1. I couldn't understand why my contractions were fading off and I couldn't tell when to push.

Debrief* hope you get the answers you're after.

My labour with my second dc was a similar experience to yours. Staff just didnt answer my questions and didn't explain what was going on to me.
I was offered a debrief at the time, but couldn't face it. It still bothers me, but since I'm too scared to have dc3, I've decided to count my blessings with the two healthy dc I have.

Your questions sound good, and I would also opt for a home birth before ever going to a hospital again.

They sound like good questions OP.
It is normal to get the electric shock feeling in your legs with an epidural, it is normal to transfer out of MLU if you have high blood pressure even if it is stress related, it can be the case that you have to wait a while for an available anaesthetist if the unit is busy.. lots of theatre cases. Sorry you didn't feel you got reassurance from your midwife and any doctors. Debrief will be helpful for you and a homebirth sounds like a great idea

Thanks, I noted down some more ideas from this thread and I just got back from the debrief! It was so good. In the end a midwife couldn't attend so it was just the consultant but he went through my old labour notes with me really thoroughly and answered all my questions really well. It was very cathartic actually, and really helped "un-fog" my memories of the day because obviously they note down almost everything with exact times, I now know what order everything happened in and why!

So the high blood pressure it turns out was not just due to stress but was generally high throughout the labour even when I relaxed for 7 hours after being given the epidural. So it was definitely the right decision to transfer me to to the consultant led unit.

As DoctorMonty mentioned, it doesn't say specifically why the forceps were chosen over ventouse but it sounds like it was the right decision as the baby needed to come out fast (his heart rate had started dropping) and must've just been the doctors preference as apparently forceps offer more control.

The best bit of the debrief was hearing that they've restructured the staffing since I had DS1 and now there is a dedicated anaesthetist on the delivery suite and the aim is for them to arrive at your side within 30 minutes, if they can't get there they will actually call a consultant even if they're at home, to drive in and perform one! He said the chances of having to wait 3 hours for an epidural again are so low there would have to be a major incident happening at the hospital for that to be the case.

He also said a home birth would be a perfectly reasonable option that I can consider and it's totally my choice whether to deliver at home, at the MLU or at the consultant led unit. He said as it's my second birth the labour is likely to be a lot shorter and I'm low risk enough that all these options are open to me. Okay, so that still leaves me with a difficult choice to make but at least it'll be an informed choice now. I can discuss the ins and outs of home birth at my next midwife appointment hopefully.

He took my concerns about lack of reassurance very seriously and will pass on the feedback. Basically a lot of the negative feelings I have looking back on that labour would have been mitigated if the midwives and doctors involved simply had better bedside manner. It sounds like all the right clinical decisions were made but the communication was really lacking.

I feel so emotional I can't believe how therapeutic that debrief was, it answered questions I didn't even know I had. I'm so glad they scheduled it for me especially to have it with a consultant obstetrician who really knows what he's talking about. I'd definitely recommend it to anyone who has questions or anxiety about their first delivery.

That's good to hear that it was worthwhile and it sounds like it all went really well.

Wishing a safe and prompt arrival for your second. I love reading some of the home birth experiences on here. I'd love to do it myself.

Glad it went well for you. I had a kind of debrief whilst in labour for ds1 with a midwife and whatever the midwife in chg is called - totally unexpected but I was panicking that my labour was following same pattern as first one (11 yrs previous), so they spent nearly an hour going through all of my notes with me, explained stuff, understood why I didn't want certain things and although circumstances meant I couldn't have exactly what I wanted (e.g. A water birth) midwife went the extra miles to make me feel better - it made me feel a helluva lot better.

Thingywhatsit that's really good - it just shows what a difference good communication makes.

I am tempted by the home birth option partly because I'd be the centre of attention once the midwives arrive so it kind of feels like you're getting special superior care As opposed to being dumped in a hospital room for hours with no update and little support...!