Upset and angry, in need of advice please

[lilylilyrose]

I posted yesterday about a crap midwife appointment where my baby seemed to have 'unengaged' itself. Well my day got a whole lot worse after that...

I had a trace of glucose in my urine yesterday for the 2nd week running. This has happened before but I had the GT test and it came back clear.

I saw one of the midwives last night when I was at the hospital for a parentcraft class, and she asked if she could have a word with me. She took me to one side and explained that she wasn't happy about me having a homebirth any more, as the risk of blood sugar problems for the baby/shoulder dystocia was too high (my fundal height is 42cm, up 2cm from last week!)

I just sort of nodded and tried not to cry, thinking how shit it is that I've got to FULL TERM and all of a sudden my homebirth plans are scuppered. I don't know what to do.

I'm too scared to have my baby at home if the midwives aren't supportive, but at the same time I am in bits at the thought of having to go to the hopsital and all the associated risks of intervention etc. that it brings.

I spent last night crying and feeling so angry with myself - I really, really don't need this at 40+2, as I am sure being in such a bad place emotionaly is going to delay things even further.

I want to write myself a hospital birth plan but I don't know where to start. I'm completely at a loss here. Help!

lily - I really feel for you it must be such a blow at this late stage.

Just remember though, as long as your labour is progressing normally you can stay at home for as long as you need to before going into hospital.

I'm sure someone more knowledgable will have more practical advice about the best way to write your birth plan, but a hospital birth doesn't have to end in intervention.

Good luck and stay positive xx

I had 2 hospital births with minimal intervention even though one was induced early for pre-eclampsia. They did what they needed to do but pretty much left me alone.

With ds2, there was no intervention as I gave birth within minutes of arriving and didn't get to the delivery suite!

It must be dreadful to have your plans changed at such a late stage - but hospital birth does not have to be dreadful.

Good luck

Could your birth plan say: I intended to have a home birth therefore I would like minimal intervention so that it can be as near to a home birth as possible.

And tell everyone (or get your partner to if you are deep in the throes of labour) what you want when you get to the hospital.

meemar - thankyou. I told my MW that I want to stay at home for as long as I possibly can, and she's happy with that - at least I'm not being induced, so I get some degree of control over it!

popsycal - I'm trying to re-write my birth plan now, and I've added a note to say that I'd wanted a homebirth originally. Hoping that this will encourage whichever MWs are present to be sensitive to the fact that I won't be 100% happy.

Luckily my mum will be here for the birth, and I know I can rely on her to speak up for me

Good luck.

Just noticed your name....it is one of the girls' names I have at the top of my list should I ever have a girl. Just the one Lily though

you cannot be forced to go to hospital...speak to head of midwifery NOW

if your GT was clear, and you only have a trace of sugar, then unlikely you have GD.....

fundal height is not that accurate , nor is it a cast iron way to determine if your baby is going to have shoulder dystocia

get a second opinion now and look at homebirth.org.uk for your rights ,and AIMS

I agree completely with lulumama - it's your choice completely - you are entitled to have your baby however you feel comfortable. If you feel hospital is safer but don't want intervention then make it VERY clear - it's your body and NO-ONE has the right to tell you what to do. Stick to your guns!
But also remember to accept any advice given by the mw as she may be right. Good luck.

I measured big throughout DD's pregnancy and still had a homebirth despite having had a 10lb baby previously (DS1) and glucose intolerance with DS2. The size of the shoulders is what causes shoulder dystocia and can happen with 7lbers so fundal height is not a gauge for this. Get a second opinion.

OTOH, a hospital birth doesn't have to be horrible.

I'm going in to the day assessment unit on Monday to see a consultant and have another talk with the midwives - hopefully I'll be a bit better prepared than I was last night! I have a few questions about the whole shoulder dystocia issue etc, so I shall write a list of things to ask.

I know I am entitled to have my baby at home if it's what I want, but my confidence is really shaken and I don't know if I'd be relaxed enough. At the same time, hospital will have pretty much the same effect!

I think I will just have to see how I feel when labour starts. My new improved birth plan is nice and militant though - lots of underlining in red

My funda height measurement was 39 at T+16, she was 10lb 6oz - errrr don't think it means anything at all - I looked like I was carrying twins but they all kept telling me the baby wasn't going to be big.........

I was told repeatedly during the last months of my pg (by the head of community mwives) that I shouldn't have a homebirth because I had a big bump & the risk of shoulder distosia (sp?) was too great. A consultant I saw for my urine infections even started talking about it for no reason at all and even wrote on my notes in very big handwriting that a homebirth was too dangerous and I would be going against medical advice ... my mw at the time (the head of community mw's) was sat in the room & I think she had put him up to it....I went away saying I would think about it & then when I saw her next said I still wanted to have a homebirth...& she magically changed her tune & the pack was delvered etc.....I wonder if she was just testing my resolve tbh.....in the end I transferred for a completely different reason but DS was still born normally weighing only 8lb 9ozs...he was just very long in the torso - hence why my bump was so huge as he could only curl up so far!

Afaia TRUE shoulder dystocia is very rare and babies getting stuck is more to do with positioning and lack of support.

Big babies, if allowed to labour without intervention and given time to get into a good position, can then put good, equal pressure on the cervix aiding dilation. Changing positions can allow the pelvis to open more to let baby out. Upright positions (not sitting) allow the pelvis to open up to 28% more and at the point of delivery the Rhombus of Michaelis moves back giving you 2cm extra room. Optimal foetal Positioning allows your body to do what it instinctively knows how to do and also allows your baby to do what it knows it needs to do.

Labouring with your pelvis in front of your hips and your hips higher than your knees gives your baby the easist path out. If rest is required then lying on your left side and right knee up but foot on the bed will be OK.

If baby is having difficulty getting manoeuvred down then pelvic rocking, taking stairs sideways, leading up with the side that baby is putting pressure on and down with the free side first, or standing with foot on stool and knee opened out (the side which baby seems to be stuck) for three contractions and then change position again...

Listen to your body and feel where baby needs guidance. You can do this, I know you can, regain your confidence and state your intentions clearly!

i found that the more i dug my heels in about home birth the more the midwives were willing to do to make sure everything was ok. ask if you can have a scan re the shoulder thing. the worst they can say is no, if they say yes then at least you know for certain if that is a problem.

remember you can change your mind about where to give birth at any time if you are booked for home birth, not the case if you are booked for hospital. my mw said that if there is a problem mums often change their minds and transfer to hospital as they instinctively know if things arent going to plan. you can say you are sticking to hb plan and see what they suggest then turn up at hospital when labour starts if you feel like it.

notdragon is right that hospital doesnt have to be awful - ds3 in pool at hospital was wonderful experience, no intervention, exactly as i wanted

I am leaning more and more towards staying at home after all. I just hope I haven't messed up my chances by nodding and agreeing with the MW last night - surely she won't have wiped my name off the homebirth board already? It was only an informal discussion...

I've got some fantastic advice from here, and also from the HomebirthUK mailing list, so am feeling much more confident and ready to state my case. gringottsgoblin, I think if I dug my heels in, I would get the support, but I just need to try! Thankyou all

If you go into labour in the next day or two just phone up as you would and say you're having a homebirth, it really doesn't matter whether your name is on their list or not. Probably for your own peace of mind it's worth letting her know that you are still planning a homebirth (if that's what you decide) - that letter Angela suggested was great and as she said, a homebirth is well worth fighting for IMHO.

Hiya

DS3w was meant to be ahomebirth, after a bad experience of the local hospital (ds2 was born elsewhere in a fab unit)

I mentuioned in the birth plan (something I have always found useful even if others don't- I'm bad at making myself heard, so having it in writing helps) and asked for immediate discharge to a local birthing unit, or to home. I was home in 6 hours

Myr eason for change was out of my hands (local electrcity board cutting off electricity for work that week randomly- buggers) but it still upset me and I think I know how disappointed you feel. DS1's birth was appalinga nd put both our lives at risk. FWIW the unit ahd imporved massively and was much better for ds3.

Good luck

X

Oh am seeing GP Thursday to discuss new pg, will be looking for a homebith to go ahead thsi time LOL

Aw, Lily, it's horrible to have your plans scuppered at this stage and you have my sympathy. I was planning a home birth too, but because of the baby obstinately remaining breech, I'm transferring to hospital as there aren't community midwives skilled in breech deliveries in my area. I felt massively disappointed too.

But, am in a much better place now after working out what my next best option would be and speaking to the right people. I've found a very supportive midwife who is willing to help me labour in the midwife-led bit of the hospital rather than consultant-led (which seemed so much more austere and medicalised and unlikely to let me have the birth experience I wanted).

I'd suggest that you first find out whether research and other women's experiences support the idea that you can't labour at home - it sounds pretty much like supposition to me. I'd be inclined to find out what the scale is for measuring glucose levels and where you fit into it, and where the corrolation between that and you having a difficult labour is. Same for the shoulder dystocia. If you feel informed, you'll be able to decide more clearly. Maybe start another thread here on both of the factors cited for others' experiences? If you decide you want to pursue a home birth, you may be able to request an experienced midwife to attend you, with provisos where you/they think it's bailing out to hospital time. If you decide you won't be properly supported or feel confident with a home birth, then ask to speak to a senior midwife about how you can make a hospital birth a better experience for you.

Good luck - and let us know what you decide to do x

Hi there, I sympathise so much - it is horrible to feel forded into a birth you don't want. Last time I was planning a water birth in a hospital birth centre but because I had elevated blood pressure (pre-eclampsia repeatedly ruled out) I was forced to go on the medical labour ward - and guess what happenned? Yes that's right, I had a bloody shoulder dystocia and my baby had to be resusitated! He was fine eventually thankfully but it was a nightmare experience. Anyway, I would just like to say that I completely agree that my shoulder dystocia was due to lack of support and mismanagemnet of the birth - he was not particularly big (8 lb 3 oz) and I measured exactly the same as my week of pregnancy all the way through. I was standing all the way, labour was going really well and it was only when they made me (again I didnt realise I had a choice) get on the bed near the end to make it easier for them to monitor me (was on continuous monitoring due to the high BP)that it all went horribly wrong and he got badly stuck.

This time I would have loved a home birth but of course I was also told I would not be supported in this becasue of the previous shoulder dystocia! Bloody vicious circle. However, this time, I am at a different hospital and they have a better attitude and have agreed that I can have a non-medical birth (i.e no continuous monitoring) and can stay off the bed, they will just check the babies cescent a bit better (well at all, unlike last time) and I will have a senior mw with extra training present. I did have to have a bit of a strop and change consultant to get this concession, and am still dreading another hospital birth, but at least I won't be strapped to a bed. Last time I didn't really realise that I had options and could have insisted on the type of birth I wanted.

The other thing is that abviously this time they are looking for any signs of the baby being big because of the previous dystocia, GTT etc, and last week I got sent ofr a growth scan as my fundal height was 37cm at 35 weeks, and I did feel a bit bigger than last time, however, this scan showed the baby is absolutely average in all possible measurements so I am still on course for the non-interventionalist birth (hopefully). Maybe this is something you should ask for so they have some facts rather than just assuming the baby is too big?

Anyway, sorry for the essay, just wanted to let you know that there are other options you can still try. I found speaking to the supervisor of midwives very helpful.
Good luck.

I have just reread my message and feel that I should also point out the flipside - if there really is a significant risk of shoulder dystocia - and you need to get this properly establised first I would say, I think on balance it probably is a good idea to give birth in hospital. I don't want to worry you but it was very scary. My baby had been fine all the way but came out completely dark blue with an apgar score of 1 and didn't breathe for 8 mins. As I say he was fine thankfully and no oxygen deprivation or lasting effects but whether this is because the crash team were able to get to him so quickly i don't know?

I have had my 2 dds in the hospital (we lived in rented houses) - both times they where intervention free. Ultimatley they have your baby's best interest at heart and as long as you have a healthy baby surely that is what matters not where you give birth?

cazzybabs - why would living in rented mean you had your dds in hospital? We live in rented & I fully intend having my next baby at home - can't see how the landlord could stop me?

Yes, we are in a rented house too

can't see the link myself

Perhaps you'd like to point out to your midwife that NICE guidelines say that they should not test for glucose in your urine in pregancy as its physiologically normal for your glucose threshold to be lowered in pregnancy and by itself is not indicitive of a problem. I can probably find you a reference if you want.

Measuring 42cm at 40 weeks is not that large. Normally +2cm is seen as within normal limits. If your baby had disengaged then your fundal height measurement will have gone up. I bet if baby was engaged you'd be measuring a couple of cm smaller.

Totally agree with earlier post about position when giving birth can greatly reduce teh risk of shoulder dystocia.

Can't give you any advice on the shoulder dystocia thing - but fwiw I had +++ sugar in my urine the whole way through this pregnancy (right up to delivery), though my GTT was fine, plus low iron levels, yet I was still offered the chance to have a homebirth (though I preferred to be in hospital). I can't see any reason why a trace of sugar should be of any concern at all.

Good luck with it all