Getting labour complications 'diagnosed' years after the fact

[ThisTaupeZebra]

Back in 2018, had a long labour, with a variety of complications that cropped up that were never explained to me. Or at least were described as discreet and not linked as part of a 'bigger picture'. I was never offered a birth reflections session as officially, my birth was 'not traumatic' (though I had flashbacks for months afterwards nobody asked me about) and anyway, I couldn't face going back to the hospital and giving the midwives another opportunity to gaslight me.

I now have reason to believe I had an undiagnosed obstructed labour, partly as I was recently diagnosed with endometriosis, and it is part of the puzzle that fits. It is of course not the only piece of the puzzle that fits, but I don't want to bore you with the details, just explain why this realisation is coming so late.

Has anybody ever sought a diagnosis of a labour complication that was not made while they were in labour?

It is partly for health reasons: understanding whether or not what I suspected happened to me, happened to me, could potentially impact future health and decisions I make around it. It is also for validation, as it was basically implied I was an overreacting first time mother when I highlighted the various reasons I thought something was wrong, and my distress was laughed and scoffed at.

And then somethings did go wrong, and it was all treated like a bit of an insignificant mystery. With an attitude of well birth is risky/unpredictable etc...

Sorry you have had this horrible experience. You could request your maternity notes by making a formal subject access request to your hospital's medical record department. This would enable to see what has been documented- make sure you ask for the full notes including antenatal and postnatal to give you the whole picture. PALS can usually help you get the request to the right department if it isn't easy to find contact details for them online.

Did you ask for a ‘birth reflections session’ or did you tell your GP about the flashbacks? I found it very helpful to speak with my GP after my traumatic birth - I did request it and was given a longer appointment but this was within a few weeks of the birth.
Get a copy of the notes, see your GP then decide what else you may need.

Why do you think it was undiagnosed? If your labour went on longer than those times we give, then it woukd be automatically classed as obstructed. Perhaps they didn't tell you that. But every time a doctor was involved in suggesting an intervention or making a plan, that was because your labour was obstructed basically. It was "failing to progress".

Because I was told I had a long latent labour because I didn't dilate for ages, which was used to deny me pain relief for about 24h. I wasn't convinced at the time, and now I am even less convinced.

Okay.

So, I'll tell you what we changed to in our hospital in about 2016.

Basically, a lot of women reported what you are reporting. They weren't admitted or offered effective pain relief until we declared them in active labour (4cm dilated, soft cervix, regular, strong contractions). There are numerous issues with that method of admission to labour ward/121 care. You've experienced them yourself.

Before, someone would need to attend 3 times for assessment before we admitted them, declared it a too long latent phase, and offered them augmentation of labour by breaking waters, the gel or having the hormone drip depending on where they were at.

After the change, if you come in for assessment and you are not in active labour, we offer you the choice to stay in and be augmented. We offer an informed choice because see, anything we do to augment raises risk of fetal distress, infection and you're more likely to end up with an assisted or surgical birth.

This offers women more choice but there is one choice that is rarely on the table in the latent phase, which is to come in and not have augmentation but have 121 care. So a midwife supporting you in those early stages of labour. We did change that a bit. Now, if circumstances allow, we can admit a spontanous labourer to the antenatal ward where they can have pethidine and/or entenox. The number of babies born in the antenatal ward has risen as a result...

The latent phase is a tricky one. It might be perfectly normal for it to last this long in some women. We need to create environments where they know what to expect and can have individualised support through it.

Another interesting thing is that tell women to take a bath and some paracetemol in the latent phase. Paracetemol inhibits prostaglandin that progress labour and there is some evidence that entering water too soon in labour can slow things down. We might be prolonging this stage with our advice

@Squishedpassenger there are two separate issues here though, the inappropriate withholding of pain relief, and the various complications that were eventually detected. Are you a midwife or a doctor?

Midwife.

As I said, it is tricky. For instance, something that has happened since we started admitting latent phase labourers in the antenatal ward is that a woman came in with prolonged latent phase, had pethidine, and overnight everything stopped. She went home that day to await events but people weren't happy about the idea of her having opiates and then leaving. I'm not sure there is a rationale for their unhappiness but it is certainly unfamiliar.

She did come back again within 24hrs with reduced fetal movements and then was induced.

We have to ration rooms and beds, even for women in labour. How to do that effectively is complicated.

The other thing with a long latent phase is sometimes it leads to a shorter active phase. Other times the labour continues to progress very slowly. Does this mean that it was always a prolonged, obstructed labour or was there still a clear latent phase before an active phase? It's hard to say without hindsight.

We are all force fed this idea of a wonderful natural birth which is just basically lies in my opinion.
My birth gave me PTSD and I never had any more children. Neither could I go back and demand an explanation. I wanted nothing more to do with any of them. Its 42 years later and Im still not over it.