Trying to understand- dilated but "not in labour"?

[stripey1]

I am looking forward to a birth review some time in the next month or two, after a long labour which ended up with baby being rotated with forceps in theatre. I'm glad baby is here safe, but have questions, one thing is I'm struggling to understand about how "established labour" relates to my experience and I wondered if anyone here could explain?

I went to hospital with painful frequent contractions, was only 2cm dilated but allowed to stay on antenatal ward. Contractions slowed to every 8-9 minutes but very painful. Staff kept suggesting I go home as "not in labour", no-one examined me for over 24 hours til I had a meltdown with the pain and they discovered I was 7cm and sent me to labour ward for a cascade of interventions. My question is, what was going on in those 24+ hours? Was I in "active"/"established" labour, so could have gone to birth unit and had partner present and better pain relief? Or does the contractions being less frequent than average mean that I wasn't? Naively I would think that if you're having big enough contractions to dilate that far, you would deserve to have good pain relief and a birth partner present? I know I need to ask this at birth review, but it is bugging me now and I wondered if anyone in the know could please shed some light on this for me? And is this dilating with infrequent contractions a known scenario that is meant to be managed in a certain way, or am I some kind of freak? Thank you.

Labour is typically diagnosed when you're having at least 3 contractions in 10 minutes and the cervix has dilated to at least 4cm.

So you could theoretically have a baby without ever being in labour, if your contractions are less often?

4cm is the magic number for the NHS, for whatever reason. The contractions don't seem to be considered relevant except for before 4cm.

Thank you, so does that mean that at whatever time I reached 4cm I could have had birth partner and gas + air, if only we'd known the dilation?

Yes, that would usually be the policy of most units.

I had the same issue with my last birth going from 1cm to 7cm in about an hour when I'd been stuck at 1cm for hours and hours. Was your baby back to back? Apparently that can cause that kind of progression.

Thank you. Two days in a dr checked, said she was back to back in awkward position and we were going to theatre straight away, but I have no idea what position she was in for the first two days, I think someone said ROA early on but I guess they could have been wrong? It's frustrating not knowing when or how quickly the dilation happened between 2 and 7 cm for me.

If you’re having pain, you should have access to pain relief. It’s really that simple. Doesn’t matter how regular they are, how dilated you are. If you’re not managing with the pain as it is, you should be offered pain relief that helps. I assume your partner wasn’t with you due to being on an antenatal ward and that’s restricted due to COVID, but there’s no reason why you shouldn’t have access to entonox or an injection if the pain is extreme. We wouldn’t leave someone in awful pain because their gallstones are only small or their appendix is only a bit inflamed.

Units can move you to the labour ward when they deem fit. They could have moved you at any point if you needed pain relief and they couldn’t provide it in the antenatal ward. The fact that your contractions slowed does suggest you weren’t in active labour at that time, but you were having contractions Ana were in pain. No, people don’t have babies without having at least 4 contractions in 10 mins, but sometimes active labour can be less than an hour after days or even weeks of contractions.

That might be something that the debrief can help you with? Unless they didn't check you between those times so they didn't know either.

I felt very much like this - did something weird happen, is my body broken, nobody else's birth story seems to be like mine. Once I started reading about back to back labours, everything made a lot more sense.

Babies can move even during labour, so the position early on isn't necessarily as relevant as the position at the point everything cascaded.

Tammy, thank you, it is really helpful to hear that.

Bertie thank you, yes it seems we had a similar experience. I will ask more at the debrief but I think a lot will stay a mystery as I wasn't examined for those 24h as far as I recall. I don't want to be a pain in the butt to the staff as I know they are busy and short staffed, but I really want to take the opportunity to find out what I can, I'm curious if things could have turned out any differently or not, though of course we are where we are and having baby here safe is the important thing. I'm sure I got off lightly compared to many women's experiences and outcomes.

@stripey1

Thank you, so does that mean that at whatever time I reached 4cm I could have had birth partner and gas + air, if only we'd known the dilation?

You can have gas and air as soon as you request it and you are entitled to it.

I was 2cm but having contractions every minute and a half, lasting a minute and screaming in pain (due to baby's position it turned out) and they gave me gas and air in triage because I was scaring other women with my noise!

Ouch that sounds intense Chanel05! Thank you.

I had irregular contractions, and neither time was I believed to be in active labour before being examined. Those exams put me at 10cm with my first and 7cm with my second. I've no idea how they were positioned. The first time was after a monitor failed to pick up regular contractions, so it wasn't just a case of miscommunication. Luckily the midwife decided to check me after I told her the feel of the contractions had changed. Not so luckily I only mentioned it after she gave me a shot of pethadin but oh well, we made it through.

Gosh GrumpyG so it sounds like you pretty much did childbirth without being "in labour" according to the textbooks. I'm glad you still got pain relief along the way, although the timing wasn't great. And this happened for both your labours...so maybe I had better be prepared for a similar experience if we ever have another pregnancy.

I am a doula and I have attended births where the contractions never got to the stage of being regular, sustained and frequent and yet they dilated and pushed their babies out.

To me it sound bad that you were not checked in 24 hours. I had a case where triage told me not in labour as 'not in enough pain' and only a few cm dilated should go home for another day or two ... Less than 20 mins later baby arriving in a lift that same nurse freaking out. So I believe the policy is tell you to go home those who know having baby wont go.

My second was what the midwife called a spurious labour. Contractions were 11min or so apart. At 4cm and refusing to go home I was admitted to the antenatal ward for the night and told I'd be checked in the morning thou was given a tens machine to help with the pain ( fuck all use that was) 3 contractions later I thought I needed to poo. I then realised baby was coming! I was 10 cm and rushed to delivery without even a wiff of.gas.and air at that stage.
So it can be far from the text book labour.

PS. that is not to state that they were not in labour, what I observed was labour and it sounds like you experienced labour too.

Position of the baby can have a big impact on how labour progresses.

Ha! Nobody ever thinks I’m in labour. Midwives never believe me- and when I’m examined I seem to slow down. The result is I’ve had three babies, in hospital, without pain relief, because I ‘wasn’t in established labour’.

Each time midwives have seemed shocked. I don’t really mind because, ultimately I had the babies safely! Also, I think it made me feel less pain (weirdly), because I assumed they were correct (I know, I know) so psychologically braced myself for things to get worse- and then, of course, they didn’t.

I don’t really have any thoughts for you, OP. It’s just I wouldn’t ever say giving birth was fun. I imagine it’s been an absolute nightmare during COVID. I hope you get some resolution.

ChateauxMargot thanks. It made me think, oh it would have been nice to have a doula there, with all that experience and able to inform and advocate. Then I realised they wouldn't have let you in anyway, as I wasn't in labour!

853ax yes maybe that's the policy, it's an odd one though! Maybe they explained at the time why they weren't examining me and I've forgotten, some parts are a blur now.

Swashbucklecheer that sounds terrifying! Curious horse, i like your positive thinking! Thank you both, it's nice to know I'm not the only one who didn't follow the textbook.

Stripy had your waters gone? They get extremely reluctant to check at that point due to infection risk, but it's pretty tough luck for those of us who don't follow the textbook.
I was induced the first time so I did do the whole dilating bit by myself in the antenatal ward, trying not to wake the other woman and getting fobbed off with paracetamol for ages by the midwives.The pethadine itself was great, but the timing was awful as I couldn't push properly afterwards and ended up with ventouse delivery after over 2 hours of pushing.
I hope the debriefing helps you, I didn't have one and sometimes wish I'd pushed for it.

Hi Glumy, (sorry I got your username wrong before). No my waters were still intact when I finally went to labour ward.

That sounds a nightmare having to try not to wake someone, at least I had a single room on antenatal.
I hadn't realised pethidine affected pushing, there's a lot of serious disadvantages to all the decent pain relief isn't there.

I can't remember who or why but someone offered me a review at some point and I jumped at it.

I’d be more interested in why they used rotational forceps instead of offering a c section if I was you.

I was similar in the sense that DS was back to back & no contractions were showing on the monitor. The midwives refused me an epidural as I wasn’t “far enough” advanced & I had to beg three different midwives for three hours to give me something more than just codeine.

When I finally got gas & air, I said I needed to push and “suddenly” I was fully dilated. DS then took another four hours to arrive because I mentally shut down after basically being told for hours that I wasn’t contracting blah blah.

The more I think about it, it was awful having to labour on the antenatal ward with only a thin curtain between me and other women. Being told to keep it down, that I wouldn’t be moved for hours and that there were three or four women ahead of me who would all be moved to the labour ward before me.

With my next child, I’m definitely requesting an epidural, may ask for a planned C Section or go private. It was awful not being believed.

I am a midwife and also someone who (prior to becoming a midwife) with my first baby went from 1cm to a baby in my arms in less than 2 hours.

My thoughts on you not being examined on the antenatal ward are that if you were 2cm when you were last examined and not much had changed with your contractions or behaviour there would be no indication to examine you. If you straight out asked me to examine you then after explaining the risks of repeated examinations, the potential of accidently breaking your waters ect I would do so if you consented but I would not offer an examination unless you showed signs of progression due to the associated risks and potential interventions that may follow. It sounds like once your behaviour did change that is when you were examined.

It is difficult as we are taught by 'textbook' labours, of course we know that not every woman is textbook so a lot of the time judgement, intuition and experience comes into play but typically a first time mother will not progress unless regular contractions lasting a significant amount of time and painful enough not to be able to talk through.

BUT....

I know what it is like. My first baby I was induced. I went from laughing and joking to the exorcist in around 30 minutes. I needed to push. I was declined gas and air as 'I wasn't in labour' and shouted at that my baby was back to back and it was his position that made me want to push (back to back). In the end they offered an epidural to stop me involuntary pushing, I agreed as I thought I was failing! The anesthetist took one look at me and told them to examine me prior to the epidural, they wouldn't as my waters had gone and said was an infection risk. He escalated it and they examined me....his head was nearly out. He was born 16 minutes later and actually born back to back and it was around 2 hours from my 1cm examination and about an hour and a half after the 1st contraction (and I needed to push for an hour of that time).

Midwifery is a work of art. It really is. Science and biology can only tell you so much about a womens labouring body.

Ask whatever questions you need to at the review, but just be prepared they may not have the answers you are looking for!

Hopefully time will have you come to terms with what happened, tbh 7 years later and now a midwife I am still traumatised by mine even though everyone tells me I am so lucky to have such a quick birth, I didn't feel it. You can feel however you feel about YOUR birth. How you felt can't be compared to how it was observed or to anyone else's. What you felt was traumatising, to someone else it may have been lovely. I see what I perceive to he horrific births all the time (I work usually on labour ward) but the woman is over the moon and others I think were beautiful perfect births and the woman is traumatised.

Anyway, enough of my ramblings! Hope the birth review and some time come to heal you.

Congratulations and enjoy your little one!