Was Birth Plan a factor in our baby?s death?

[rzl]

We went to an ?active birth? workshop where we were told us that a woman knows instinctively how to labour and should never be coached to ?push? through her contractions as this will upset her natural body rhythm. The teacher was quite evangelical about this so we put it in our birth plan.
She also said that our birth plan should include a point that pain relief should not be offered until asked for, because when in labour you are likely to take anything that is offered without thinking.

I am now wondering if these directions contributed to the situation that lead to the death of our baby?

Our baby died twelve days after he was born; he had been starved of oxygen around the time of his birth which severely damaged his brain.

My wife started her labour at a midwife-led birthing unit but was transferred to hospital after twelve hours due to lack of progress. However, by the time she arrived at the hospital (by ambulance) her waters had broken and she was pushing fast.

My wife had laboured actively through the night using only TENS for pain relief. By the time she had been transferred to the hospital she was tired and exhausted and just needed someone to take control and tell her what to do.
Unfortunately, the midwife did not seem confident enough to take control of the situation while my wife was confused and directionless.

The midwife didn?t instructed dw to ?push? but maybe she tried to, in a roundabout way by saying ?breathe through it? as the contractions came. But dw was floundering, in pain and shouting for a c-section ?get the scissors now!!!?
The midwife didn?t offer pain relief but started filling up the pool which is when it all went horribly wrong. (I have discussed this elsewhere at www.mumsnet.com/Talk/1365/411674)

Our birth plan didn?t state that we wanted a water birth but perhaps the mv thought it would be in keeping with the ?natural birth? style of the plan.

Since that terrible day my dw feels that holding out rigidly for a ?natural birth? is foolhardy and if we have another baby she wants it to be by c-section.

Oh rzl I am so so sorry. I can't comment on your situation, but want you to know that I am thinking of you and your dw.

Oh i'm so sorry

I dont have any answers. But, I find it unlikely that your birth plan was the problem.

Because if they ought to have known after you were taken to hospital in the first place that closer monitoring was required and this clearly wasnt done. If proper assessments were done regularly, the HCP's could have advised you accordingly at each point, instead of 'muddling' through.

If your wife changed her mind and asked for assistance then the least that should have occured was a consultant should have come to see you.

I remember your other thread. And I have to stress that you didn't write anything out of the ordinary on the birth plan - in fact it sounds very similar to mine.

It must be very hard for you and your wife to not only be coping with the loss of your baby but also in some way thinking it was down to the birth plan.

The birth plan you and your wife wrote did not cause the loss of your baby, please don't think it was in any way your fault.

I also can only say how sad I feel for you and echo what other posters have said previously. Birth is a very very risky time for babies and mum's. There seems to be very little to say that anyone was "at fault" not the birth plan, not the lack of FH monitoring, not your wife being exhausted etc. I think you will always have unanswerable questions, what if's etc. Perhaps even by the time your wife arrived at the hospital your baby already had suffered the oxgen deprevation.

Wishing you the very best in coming to terms with this enough to cope.

i posted on your other thread

i have to say IMO, nothing that you and your wife did, contributed to teh death of your baby. a lot of women aim for a natural birth, at home or in a birth centre or hospital. a lot of women do not want chemical pain relief, a lot like to use water as pain relief. nothing you wanted was at all out of the ordinary.

sounds like something catastrophic happened to the baby at some point before delivery and due the the MW not listening in or asking a second opinion re the FHR, delivery was not done quicker.

the shouting and floundering you describe that your wife was doing is not that out of the ordinary either

many women find as they near the end of the first stage and enter the second, taht they feel panicked and out of control. also, as the birth becomes more and more imminent, feelings of panic can escalate as the sensations become more intense.

your wife did nothing wrong at all, whatever happened to your baby was nothing to do with anything you did or did not do, but i imagine you cannot help reliving hte birth over and over to see if there is some clue to why it happened.

i hope you have both been offered some counselling after this terrible ordeal

I am terribly sorry for your loss. I can't imagine what you and your wife have been going through . Have you had the opportunity to speak to the hospital staff and other relevant people involved about the possible reasons for your baby's death? I couldn't possibly answer your questions in you OP, but I would say that a birth plan is always only a guide as to what the parents would like to happen. No right minded midwife, doctor etc should let a birth plan override the needs of mother and baby. Births rarely go 'according to plan', and any trained midwife would understand this.

I hope you can find the answers you are looking for, and that you and your wife can find some peace of mind.

did you say on your other thread there had been an investigation?

it is a positive that you are able to talk about another baby in the future.

once again, my condolences to you

Hi
I'm so sorry to hear what happened.

From what you have said there is absolutely no way this is you and your wife's fault. A birth plan such as your wife's doesn't say anything like please don't intervene or don't monitor my baby if it is in danger does it.

You need to seek some more answers (sorry I haven't read the other thread) from the hospital. I would definitely instruct a lawyer - there are people who specialise in births where a hospital has been negligent (not ambulance chasing types but serious, reputable lawyers).

I think you need to speak to someone with more experience of this so that you can get to the bottom of what happened. This won't change what happened but maybe it can help you stop blaming yourselves.

Have you spoken to anyone at the Birth Trauma Association?

hopefully the dodgy eyebrowed chancellor will have to leave office now...
not sure of his political ability but everytime dd (5) sees him on ch4 news before bed she has nightmares...
could just be coincidence of course...

so sorry so very sorry wrong thread
xxxxxxxxxxxxxx

I am so sorry to hear your story. A birthplan can never be blamed for what you have been through. I believe that ultimately the professionals are there to guide you through an experience which can be traumatic and of course is alien to you if you are first time parents. I had a very long, painful drawn out labour with ds2 and it was only due to the fact that mw's and docs were completely taking over at the end that meant a safe delivery for him.
My thoughts are with you and your wife.

rzl - cannot add anything. so very sorry for your and DW's loss.

I don't think that the birth plan lead directly to his death but that it perhaps influenced the way the midwife handled things and that she might otherwise have acted differently.

A consultant has reviewed the case and said "there are a number of actions which in retrospect might have been done differently" but he cannot be sure if they would have affected the outcome.

I know we will never know if a different course of action would have made a difference in the end but these questions continue to haunt us both terribly.

rzl, IMO if there are problems with a delivery it should not be influenced by a birth plan - the professionals should act in everybody's best interest whatever it says on a birth plan. If they feel that what is requested on the birthplan is not the best course of action, then they should ignore the birthplan, particularly in cases where the baby or mother are at risk.IMO as professionals, it is their responsibilty not yours. They are the experts not you. In my case - the doctor made it very clear what was going to happen and that is was going to happen whatever I or anyone else said. She was completely in control at a point when I was hysterical. If she had not not done that, we may not have had such a positive outcome. So please please don't blame your birth plan.

Please don't think it was your fault. My birthplan said similar things and in the end, after two hours of very difficult pushing (where I didn't know what I was doing) the consultant said I was not allowed to push any longer. They failed the ventouse attempts but managed finally with forceps. I was screaming and begging for an epidural top-up but they wouldn't give it to me as they said there was no time and they had to get the baby out. I am not blaming the medical staff in your situation as obviously I don't know all the details and childbirth is always a dangerous and tricky time for both mother and baby. But I do know that if hospital staff had adhered to my birthplan things would have gone horribly wrong. At the end of the day, they know more than you and your wife about medical matters. Birthplans are only general preferences and life or death decisions should always take priority. It is the hospital's responsibility (as far as I am aware) to guide you through these and keep you fully informed of any risks.

I am so sorry for your loss. Please son't blame yourselves. It is not your fault and may not be the doctors' either. But I am sure you are looking into the circumstances to try and find out what happened.

Hi rzl - I am so very sorry to hear of your loss

As a midwife, I can honestly say that I see birthplans like yours all the time, and if things are starting to go pearshaped, the birthplan does go out the window. Occasionally, some people insist on sticking to a particular point in the plan, and even with discussion, will not change their minds, and I have seen babies suffer because of this, however, if you have been flexible, the plan should have in no way jeapardised your babys wellbeing.

Looking through your previous topic, and this one, I feel that there are areas where your care might not be completely appropriate to your situation, for example, after a transfer from the birth centre, you should have been reviewed at least by the registrar on labour ward, also probably should have had a CTG, which may have picked up a problem, and in your case, I have to wonder if the pool was the most appropriate place for your wife, with only intermittent monitoring.

With no disrespect meant, we are only hearing things from your perspective also, and if you are (most likely) in a state of shock as your wife is so distressed etc, it is easy to lose objectivity as you are so closely involved, so the documented notes may give a clearer indication of the midwifes intentions and reasoning behind what she did.

I certainly think you need more of an answer than the consultant saying that things could have been done differenly, and I feel that you should set up a meeting to speak to the delivery suite manager or the consultant midwife, as they know the correct protocols and procedures to follow in a transfer to l/w from b/c and can advise you about what was, or was not, done correctly. One way to go about this is to go through the PALS office, (patients advocate and liason service) who will 'be on your side' in this matter. You can ask to be put through to them by calling the hospital. IME, they do add significant clout to any investigation.

You also need to get a copy of your notes, and make it clear that you will take legal action if you feel that this process is not completely transparent.

Good luck, and again my thoughts are with you and your wife.

RZL so sorry for your loss

FWIW your wife's birth plan sounds very similar to mine, and ime the midwives generally have a look at it at the start of the process, to get an idea of what you want to do, but certainly do not use it as a hard-and-fast guide to what happens in your labour. So please do not blame yourselves for what has happened.

I hope you get some answers for this awful situation.

rzl - How very sad. I am so sorry.

I think Fio and MintPurple have made very good contributions.

Every midwife knows that a birth plan is a preferred course of action if possible^ and barring complication. You transferrd as advised, and it sounds as if care in the hospital was less than it should have been given the need to transfer.

Birth puts us into an arena where so many thngs are out of our power or control, from the physical aspects of giving birth as a badly designed human, to the strength and health of the baby, to the trust we are forced to put in the experts who care for us, to the simple bad luck that means that some babies will not make it, no matter what.

I am so sorry that you had the worst outcome - but it doesn't mean that anything you could have done could have changed things.

I want to reiterate what others have already said about how you couldn't possibly have known what would happen. It is the doctors who failed you.

Please don't blame yourselves for the failings of the NHS.

Sadly this is not the first story of this kind I have read on mumsnet. And sadder yet it's probably not the last.

I do completely understand your wife's desire for a c-section. Who would ever want to trust the NHS to get it right next time when the price you paid for trusting them was your child's life?

I'm very sorry to hear of the loss of your son.

It's entirely common, unfortunately, to go through a phase of blaming oneself - I know I did when I lost my son.

Have you contacted an orginization such as SANDS where you and your wife can discus these feelings with experts?

I know at present the grief is overwhelming but hope you and youe wife find the strength to get through this together.