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.

Yes similar happened to me and I had forceps too. No pain relief offered till last minute and only got it as I had a note on my file that due to a health issue I was to be kept as pain free as possible to avoid complications. My file was ignored for the most part and I was in agony for hours and hours then suddenly going from 2 to 9cm apparently. I don’t think so I think I was in Labour the entire time as I was in that much pain they openly said they couldn’t examine me properly. It was an induction and early due to pre eclampsia so maybe if I hadn’t had that baby would have moved to a better position naturally but for me, the contractions were relentless I hadn’t really breaks from them. In my debrief they apologised for not reading the file, or listening to me when I tried to explain. Due again in may so here’s hoping it’s second time lucky!

Thanks fur sharing @00deed1988.

Midwifery is indeed a work of art. Protocols and schedules should be guidelines not instructions. The minimum should be that women are listened to and supported.

Childbirth is a major life changing event. For some it is magical, for some it is traumatic.

No one should ever be told that they are 'lucky' to have whatever birth they had. We should listen to their stories and honour their narrative.

Helenahandbasket CS was the back up plan which everything was ready for, but they tried the forceps first and luckily it worked and we are ok.

Maverick it sounds like you had a horrible time on the shared ward without pain relief and being told you weren't contracting. I hope you get a better experience next time.

00deed1988 thank you that is so helpful to hear both sides from your experience. I wish I had known to ask for an exam. Thanks for your understanding as well, you sound like a good midwife. It sounds like you had a tough experience in childbirth and I'm glad the anaesthetist twigged you needed examining. Yes I get there aren't always answers, tbh talking here has been a big help already. Thank you.

Yummymummy thanks for sharing your experience. I'm sorry you went through so much without pain relief and I wish you all the best for your next birth in May.

ChateauxMargot that all sounds right. I think mine was overall magical in that baby arrived safe but at times also upsetting.

Are they meant to offer a debrief, or only if you request one? I've never heard of this, I think it would have helped me. I've had 2 premature babies and have lots of unanswered questions. It too late now as they are 5 and 7, but it would be good to know to recommend to others.
Both times they said I wasn't in labour and I was. I wondered why they never tried to stop my first from coming as I was only 30+3 and my waters didn't break for about 6 hours. Maybe because they thought I wasn't in labour?
With my 2nd they told me my labour wasn't progressing so they were going to put me on a ward, I was crying in agony and they told me I could only have paracetamol and were taking the gas&air off me. I had a strop and went to the loo as the woman was telling me to calm down, and thought I was going to push him out on the toilet. I screamed for my husband, they just about managed to get me onto a bed before I pushed him out!
Sorry for jumping on your thread, I just wish I had answers
I hope it helps you get some answers

Heartofglass I'm not sure if it is a new thing and under what circumstances they offer it. Different places seem to call it birth debrief or review or reflections and some say it's a midwife some a Dr that does it but basically they get your notes so you can go through what happened and ask questions. I'm sorry you didn't get the chance to do that, it sounds like you had stressful birth experiences.

Sorry that you didn't have your birth partner or pain relief @stripey1 that's really really crap! I was in 'inactive ' labour for 26 hours and only got to 4cm I was contracting every 2 mins it was hell I begged for a c section at this point

Ouch MrsSunshine, that sounds like you had a horrible time.

To be fair I did have partner and better pain relief for the second part, it would just have been nice to have them before 7cm.

Of course it would! And you should of had @stripey1

I had a similar experience to you but not in covid times. I had been in early labour since 4am that morning, had my 40 week appt at 10am and was told I was 2cm. I was ok and using TENS and paracetamol at home. By about 10pm I was exhausted as the pain had really ramped up and was no longer manageable and so I hadn't slept since the 4hrs I got the night before. I called labour ward in tears and they warned me they didn't think I sounded like I was in active labour so might be sent home but they told me to come in to be examined anyway and at the least they would give me some codeine. We went in to the MLU, I was told I was 3cm, I was given codeine, which I promptly vomited up and had a lot of vomiting so they gave me an antiemetic. They did a CTG and told me I actually had to give birth on labour ward instead as I had a growth scan booked for the next day due to concerns that my DC may have been small for gestational age so that made me high risk. My community midwife had not said this to me so that was a shock. As the hospital were aware of my mental health history they did give me options, they were either 1) go home, 2) stay on MLU with DH for now but with no pain relief or care 'as if you were at home' until active labour at which point I'd be moved to delivery suite, 3) be put on syntocinon drip to speed up labour. I was in worse pain now and vomiting a lot so opted to stay in the MLU. I didn't question the lack of pain relief offered. After about 5 hours and DH attempting 3 times to get a midwife to come and see to me I was finally rexamined and found to be 8cm, so I did most my labour without pain relief, which was not what I wanted/planned and it was awful and traumatic. I was only offered pain relief at that point, though denied the epidural I requested being told I wouldn't be able to sit still enough for siting. I also ended up having an assisted delivery without adequate pain relief as my diamorphine had worn off and I couldn't tolerate G&A so that was severely painful as was my stitching because for whatever reason the local anaesthetic was ineffective. I have birth trauma and it was all due to lack of pain relief. If my pain had been managed the experience would have been totally different.

@Heartofglass12345

Are they meant to offer a debrief, or only if you request one? I've never heard of this, I think it would have helped me. I've had 2 premature babies and have lots of unanswered questions. It too late now as they are 5 and 7, but it would be good to know to recommend to others. Both times they said I wasn't in labour and I was. I wondered why they never tried to stop my first from coming as I was only 30+3 and my waters didn't break for about 6 hours. Maybe because they thought I wasn't in labour? With my 2nd they told me my labour wasn't progressing so they were going to put me on a ward, I was crying in agony and they told me I could only have paracetamol and were taking the gas&air off me. I had a strop and went to the loo as the woman was telling me to calm down, and thought I was going to push him out on the toilet. I screamed for my husband, they just about managed to get me onto a bed before I pushed him out! Sorry for jumping on your thread, I just wish I had answers I hope it helps you get some answers

I’m so sorry you’ve had those experiences 💐

As far as I know there are no time limits on requesting a debrief because the nature of it means many women struggle to ask for a long time x

Google your hospital and “birth reflections” they should have a page and contacts for requesting one xx

@MeadowHay that sounds truly terrifying why is this allowed to happen

Ouch Meadowhay, that sounds awful having to go through the labour, and the assisted delivery, and the stitching, all without the pain relief you needed. I'm sorry you had such a traumatic experience.

They defo did allow for it years ago, because I was told about it when I had DS1 who is 13 this year.

But it always used to be that you had to ask for it, it wouldn't be offered automatically. I heard about it through antenatal classes.

I’m so worried about what stopping partners being around for ‘early’ labour means for women.

It leaves women without an advocate at a very vulnerable time.

What I mean is the notes should still exist so no reason why you couldn't request if you want to :)

@PinkPlantCase I think it's pretty barbaric ?! But I also thing during covid and the rules about birth partner who let's face it 99.9% of the time is likely the dad and likely living with the mum denied to be with them and she hurried out 30/60minutes after birth. It's a joke

I had similar.

2nd child so knew how things went. Had contractions for hours, recognised all the signs, got to the magic contractions number in 10 mins, went to hospital, was examined and told I was only 2 cm and not in labour and not allowed on to labour ward. Only to come back when I am and the pain goes 'next level'.

Go home hang around for a couple of hours with contractions thinking, ' I really AM IN labour, finally order a taxi back to hospital and standing up to walk to the door my waters break. Get to hospital, walk straight to ward labour ward (remembered where it was from first baby and slip in due to a guy coming out of the locked doors) and go straight to the nurses and say I am about to give birth. Get on bed and ask to be examined. Much faffing about, 20 mins later I am finally examined and I am fully dilated and told to push. Baby born 20 mins later.

Its the not listening that annoyed me. I should have been allowed to stay in the hospital and labour for those few hours in peace instead going back and forward.

Ouch Torches yes, surely you should have been allowed to stay in.

Unfortunately this happened to me in December.

My waters broke at 36 weeks, but on examination my cervix was closed and I was admitted to the antenatal ward for observation and induction that evening if I didn’t go into labour spontaneously. Fortunately 2 weeks before I gave birth, my hospital changed the rules allowing my husband to be present during “early labour”.

I went into labour spontaneously later that day and the midwife didn’t believe me. I was refused a second examination 12 hours after being examined, even though my contractions were every three minutes and too painful to talk through. I was only given codydramol for the pain, it did nothing. I wasn’t given gas and air. I did have a tens machine I brought with me, which did help for an hour or so.

By the time they finally agreed to examine me, 3 hours after I went into labour and 15 hours after being examined, I was screaming as the pain was so bad, and I was 8cm dilated. I gave birth an hour and a half later.

@00deed1988 do you think that you are more likely to believe women than other midwives, having been been through the same experience? Also, what are your thoughts on being refused examination and pain relief?

In my case my baby was higher risk due to prematurity (36 weeks). I was told I should have my baby on the delivery suite (rather than birth centre) as it was higher risk. I had an abnormal CTG that morning before I went into labour, as well as during 2nd stage of labour once I was finally moved over to the delivery suite.

Fortunately my son was born healthy, however if he had become distressed during the 3 hour period I was in labour and not being monitored, the outcome could have been very different. I understand the infection risk with repeated unnecessary examinations, but surely leaving a high risk woman in labour on the antenatal ward not being monitored for three hours is dangerous too?

I wonder if anyone is trying to research and develop a way of examining the dilation of the cervix without risk of introducing infection?

Which also makes me wonder why cervical examinations are not done with a flexible tube and a scope?

Yes interesting @ChateauMargaux as they only give you 24 hours to get into active labours after waters going but then some babies are born not in their waters and are fine ?!

@ChateauMargaux there’s this thing called the purple line: bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-10-54

It’s a shame more research isn’t done into this and other alternative methods of assessing dilation and labour progression.

Dsttc that sounds outrageous that they didn't believe you were in labour even with such frequent contractions. I'm glad your son was healthy but sorry you went through all that without pain relief.