Lulumama/doulas/midwives, could you help me with a few questions?

[nuttygirl]

I'm currently writing to my PCT regarding my recent birth and could do with the answers to a few questions so any help is v much appreciated.

1. Monitoring (following waters breaking, not yet in labour - did I have to be lying down?

1. Pethidine - at what stage should/can this be given (i.e. can it be given before established labour & is there a point at which it shouldn't be given as it is too close to the baby being born?) Also are there any official guidelines on this?

TIA

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Monitoring - you should be able to have intermittent monitoring with a handheld doppler which means you can be fully mobile, unless you have an epidural or are being induced with syntometrine in which case they usually want continuous monitoring which means the straps across the tummy and staying close to the monitor although even then you should be able to stand or sit on a birth ball.

Pethidine can't be given too close to the birth as it can affect baby's respiration (breathing) - usually given during active labour but not if you are getting close to pushing. Can make you feel very woozy/out of control, and once you have it, you basically have to let it wear off which takes a few hours, so usually other options would be considered first, such as gas and air.

Sorry just saw this was in relation to a birth you have already had - check NICE website for clinical gudelines, will find a ref for you later, just off to collect DD

Re the monitoring, my waters had broken at home and I had to go into hospital where they monitored me for 30-45mins with one of those belt monitors to check the baby was ok (ie not in distress)

Would it be normal for a mw to check how labour has progressed before giving pethidine?

Can pethidine be given before established labour?

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Couldn't find anything on the NICE website...maybe I'm a bit crap at using it though

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Thanks to you both. That's all really helpful.

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Yes, pethidine can be given before you're in established labour and many believe it can be very helpful in the latent phase (before established labour when you might be having contractions but not dilating) as it can allow you to rest and conserve your energy.

You don't have to be lying down/semi-recumbent for the CTG monitoring, although it can be difficult to get a good trace if you are.

Sounds like with the monitoring they were just trying to get a baseline to establish how baby was doing, and they would need at least 20-30 mins for this - as someone said it can be hard for them to get a trace if you are standing or sitting but they ought to try if you ask. Yes agree with giraffski that they ought to check progress before offering anything especially peth because it does carry quite serious risks for the baby if given too close to delivery. What was the outcome - I'm guessing fetal distress and emergency section?

Following the monitoring I was told I could go home. I asked about moving around because I was made to lie on a bed with only one pillow and had to move from being on my back to being on my side and the midwife was not at all pleasant about it.

My labour was very quick and I asked for pain relief, eventually (having practically screamed the hospital down as they didn't believe I was in labour) they agreed to give me pethidine. I had to go back to an antenatal ward for it (if I was in established labour then I was entitled to be in a delivery room and they shouldn't have forced me to crawl along the main thoroughfare of the delivery suite to an antenatal ward...I got halfway and was told to go back to a delivery suite - where I'd been for a bath - so that I didn't disturb someone sleeping in the antenatal ward)

I was given pethidine without being examined and about 5 mins later was ready to push. I was falling asleep between pushes. I refused stitches for my tear because I had no confidence in the midwife.

My baby has had to be FF as she was very sleepy (in fact she still sleeps a lot) and wouldn't take to bf.

Also, if I was 1-2cm dilated when I had my sweep is it possible to not be dilated at all when I had my internal exam at the hospital later the same day?

LOL ! what everyone else said , basically ! good to see you are going to get some answers!

if you were 1-2 cm at sweep, some midwife might consider that not dilated because 3cm plus is established labour?

some anecdotal evidence of cervix closing when a labouring woman is tense and feeling out of control

if pethidine given too close to birth, makes baby sleepy, as you know....there is something that can be given to counteract this i thought?

Thanks Lulu - didn't want to ask anything stupid in my letter!!!

You might find these guidelines on making a complaint useful here

You might also like this article on the use of pethidine - a little shot of something not so nice

Yes pethidine can affect the suck reflex. It is a narcotic and easily crosses the placenta. Babies can be given Narcan which is an antidote but it is usually only given if they don't breathe at all, not if they are just slow to start. I think the risks of pethidine are very much downplayed - not a nice drug at all, in my view.

The baby can be given naloxone (Narcan) but really only in cases where the pethidine has actually caused respiratory depression and the baby needs resuscitation on delivery. It would be unlikely to be given for a 'sleepy' baby as the side effects can be quite severe.

x-posts!

Snaf are you a midwife?

Not yet... but only 18 months to go [shit-scared emoticon]