Midwives, Doulas please, your opinions....

[Klaw]

My HBAC client is 40+2 and was sent to the hospital today for a check up as baby's HR was too fast. Baby is no longer engaged either. Mum is distraught as she was hoping her deep pelvic pain was baby engaged and grinding!

At the hospital she was not scanned or given a CTG.

They used a Doppler again to hear HR, got confused as found hers first, racing away with white coat syndrome but did find baby's to be high.

Consultant recommended that, as bump was so big and she is fairly petite, baby is pretty big and her chances of VBAC are less than 50%. HB is now considered 'unsafe' for her. I forgot to ask if she managed to keep off the bed for the Doppler....

I went over her options with her i.e. elCS, careful induction (previous induction was horrendous experience which also traumatised her dh) with possibility of CS early rather than later if not going to plan, asking about Propess or Foley Catheter for cervical ripening, or waiting with Expectant Management and making decisions according to findings. I told her to listen to instinct and to consider how she would feel after the event of all her options.

I also suggsted she might like to ask to speak about her options at the hospital again, maybe insisting on CTG and scan and further explanation of her induction options in case she wants to take the chance...

I reminded her that she will make the best decision under the circumstances with the information available so not to feel that she would let anyone down. Baby's HR has really freaked her so I suggested 'talking' to baby, getting massive TLC from dh and resting while they consider all the options and make their decision.

I'm sad for her that she might lose her carefully planned HBAC, she's terrified of the hospital. What do you think of this situation?

Hi Klaw- sorry to hear about your client, she must be disappointed and worried .

Fistly, if she was sent to hospital for a fast HR, the hosp should really have done a CTG, especially as she had a previous c/s.
Remember that the normal FHR is 110-160, so even though a baseline of 155 seems really fast, its still at the upper levels of 'normal' and if it was listened to during an accelerative period, it can be a good deal faster.
It would be worth getting a scan to give an estimated fetal weight, and although this is not 100% accurate, it would give an indication of size compared to last time.

Induction is tricky with prev c/s also, cant use PGE, as it works to soften the scar as well as the cx, cant comment on the propess as I have never seen it used. I have however used Atad catheter and +/- gentle synto with prev c/s patients (just google it) with quite a bit of success. Again, dont know if your hospital has used this.

I suppose a lot depends on why she had her last c/s, was it for breech, failed IOL, CPD....etc?

If she dilated well but had fetal distress, there is no reason not to go for it, but if she did not dilate or baby did not descend, I would probably not push IOL too much, as it will be quite long, tramatic and low chance of success.

If the head is high, she is small and the baby is big, and she is likely to be traumatised by a lengthy IOL with probable CFM and epidural and a high chance of a c/s again at the end of it, I would probably advise her to go with an el C/S, which is much less traumatic for her, but she might well have feelings of guilt and disappointment due to this.

The alternative, of course, is to have a CTG and if it is ok then wait for labour to start as it doesnt really sound as if there is any desperate reason to do anything in a hurry, although it sounds like the hospital will try to talk her out of this option. Bear in mind that generally, obstetricians are not very supportive of HB in low risk women, let alone prev c/s, and this could just be a convenient excuse to get her into hospital.

Sorry that this is a bit rambling and long,and it is only my opinion. Whatever she decides to do, I hope it goes well for her.

has baby been engaged at all?

with her first , was that baby slow to engage, or high up.. hence c.s?

if so, and this baby is high, and big, then she might genuinely have CPD issues...

i would absolutely second the suggestion of scan, CTG and more talking with the hospital

at the end of the day , it is her birth and her decision, but she needs to be realisitc, about how things will play out. if she has happy to have TOL either home or hospital, then go for it..

Let us know how she gets on Klaw

Thanks for your replies.

She couldn't handle worry of baby's HR, I called and her mum answered, they went in this morning, with her in tears!

Baby boy, 9lb 9oz, both well and so worry over. Can't wait to go see them. Just wish that she'd been given a CTG yesterday so that she would have known if hr really was an issue...

Beginning to think I'm a jinx

oh lovely ! it is not you

i think she was frightened, but she made the best decision under the circs...she was not able to feel comfortable going for HBAC. and that is no reflection on you. it was not your decision, IFYSWIM, you gave her all the info and support and she made the right decision hopefully.

email me if you want....and re your last birth..if you want. take heart

sorry to hear that Klaw, but I had a feeling from what you said that she would not want to go through the mill again. At least she has a healthy baby and 9.9 is a good size, so she may have had a horrible IOL process and still ended up with a c/s. You know you did your best so dont feel bad.

Where I work, I help deliver 150-200 babies a year, and sometimes I have a run of women who have horrible labours, or end up with instrumental or c/s, and I think, like you, that Im jinxed, and its easy to start to doubt yourself,but on reflection, there is nothing that I would have done any different and so I put it down to the nature of childbirth. Then I have a run of lovely normal births, and I know that my run of crappy stuff is over.

You know that you have done your best, now you need something nice to restore the balance, and hopefully that will come with your next birth

Klaw

I'm no m/w or doula, I just wanted to say loudly IT'S NOT YOU!

I've seen & experienced the support you offer to people on this board & if you offer the same support to your clients (which I'm sure you will) you are a fabulous doula.

I'm sorry you've had two difficult deliveries on the trot, but as we all know birth doesn't always go to plan, no matter how much we want it to. I'm sure both your clients were glad they had you to support them through a difficult time.

fingers crossed your next client will have a nice "normal" delivery

{hugs}

Oh Betsyboop, now I'm in tears! That's so very kind of you to say!

Thank you to all of you, Lulu, Mintpurple too!

I've been a text buddy to 4 people on a rival board and they've all gone on to have a CS so you can understand why I, irrationally perhaps, am beginning to think it's me! So thank you for your kind words. I'm looking forward to a 'good' birth to restore my confidence tho!

As I'm new to this I have decided that when I take on new clients for the forseeable I will probably not deal with any that would use that same hospital, which is on the outer limits of my area. I will need to be more experienced before taking them on again!

Am waiting to speak to my mentor about this.

Thanks ladies, you are wonderful!

Chin up Claw I have noticed from my expereince CS seem to come in waves and can blow your confidence. Please remember every birth story is different and we must leave it where it belongs with that mother and baby. The mother made her own choice and that is what is important. Talking it though is the best thing for you so speak to your mentor. There will be another beautiful birth experience that will bring you back to being positive. You not 'jinxed' I will have to send the birth angel to shower you with love. Cyber hugs