Delayed 2nd stage

[MeadowHay]

I'm pregnant with my second and found my first birth traumatic, it still has an ongoing effect on my mental health despite some therapy and a birth reflection. I found I consistently received different explanations for what happened to me, for example the midwife at my birth reflection told me from viewing my notes that they had only 'let' me push for around 30mins as they were concerned my baby might have been small for gestational age (based purely off the last two fundal height measurements) and that baby's CTG showed they were in distress so that's why they wanted to do an instrumental quickly and it was so urgent that will have been why I wasn't offered epidural at that point despite that being in my birth plan.

I've finally requested a copy of my notes and have been left even more confused. The reason for instrumental in my notes is delayed 2nd stage of labour, not foetal distress. I can also see that the CTG up until the point of beginning the instrumental really doesn't look significant - no significant variable or late decelerrations, and baby's heartrate was fine throughout. It was only when they began the delivery did my baby suddenly briefly become tachy and then with each pull massively reduced heart rate. I can also see that there was a 2hr interval between me beginning pushing and the instrumental beginning!

My main query about all this though is why does it matter whether someone has a delayed 2nd stage of labour anyway? I've tried to research this and I can't find any evidence of the risks that aren't actually related to operative delivery itself ? Why do doctors recommend intervention in these cases?

So sorry you had a traumatic delivery.
In all honesty I think they wanted to speed up the delivery for reasons perhaps not medical.

I was always told they don’t like you to push for more than two hours as it’s hard on you and the baby. When I got to the two hour mark with my DD, they suggested forceps but lucky she was born shortly afterwards. Were you pushing for 2 hours or 30mins? Seems very confusing.

What does 'hard on you and the baby' actually mean though? I can't find any research showing adverse outcomes for a long second stage?

Yes it is confusing - I checked my notes and I was pushing for 2hrs before they fitted the ventouse cap to commence delivery. However initially I was reviewed by a doctor after pushing for only 40 mins who advised commencing instrumental in a further 20 mins (so after roughly 1hr of pushing). But this wasn't done as the midwife documented she felt I was doing well then and making progress so it wasn't needed and ultimately wasn't done for another hour.

My main query about all this though is why does it matter whether someone has a delayed 2nd stage of labour anyway? I've tried to research this and I can't find any evidence of the risks that aren't actually related to operative delivery itself confused? Why do doctors recommend intervention in these cases?

Here is a nice summary of the research on length of second stage: evidencebasedbirth.com/prolonged-second-stage-of-labor/

What position were you pushing in OP? Were you able to move around or were you lay on your back?

Thanks for the link - a bit upsetting for me as it seems the risks only seem to significantly rise after the 3hr mark really and not the 2nd hour. There was also a concern that my baby may have been small for gestational age and that I was exhausted too so it wasn't solely the time period that the doctors wanted to do the instrumental for. However I'm not sure why a bit extra long pushing would have been more risky for my DC even if they had been small given the CTG was fine. As for exhaustion - I do remember feeling exhausted definitely, I had a very long labour and felt like the involuntary, natural urge to push was getting less as time went on and it was becoming more forced and I was distressed. I just wonder whether there could have been other options for dealing with that though like more encouragement, support, maybe even a short phase where I just tried to rest rather than focused on forceful pushing and perhaps that would have calmed me down enough to get back to it more effectively after a bit. Obviously this is all just conjecture and I appreciate I could have been left 3 hrs and still ended up in an instrumental but the research posted above suggests up to 3/4 of women would deliver vaginally unassisted after 3hrs even if they hadn't by 2hrs.

I was pushing in a few different positions. Initially on my left side (my choice), then on left side with my right leg up in lithotomy ('left lateral') which I was encouraged to do by the midwife. Then later semi-recumbent (my choice), then all fours (again my choice), then I was encouraged to go back to semi-recumbent by the midwife on the basis that my pushing on all fours had been less effective than when I was semi-recumbent before (how would they know that?). Then eventually that's when I had the instrumental after that.

Hard on you as it's physically demanding to push and can be utterly exhausting. It's not something you could do for hours and hours.

It can also be hard on the baby as they can get tired too. While it's normal for the heart rate to dip briefly during a contraction, they monitor the baby to watch out for signs of fetal distress. I note they say there was no signs of fetal distress in your case but perhaps it becomes more likely after two hours of pushing.

I presume they were acting on the side of caution with the safety of both of you in mind.

Every birth really is different and history is unlikely to repeat itself. Is there someone at the hospital you can talk to about your birth plan with this baby?

I had a traumatic birth with my second child and I've been anxious during this pregnancy. I spoke to a really lovely midwife though who wrote a personalised care plan for me and it's really helped me to relax.