Mears is doing a bit of research on women who have long early labour phase

[mears]

I am looking at developing a research question for women who had long phase of early labour. I am sure that applies to many of you out there and I am hoping you will share your experiences.

I am focusing on what your experience was when getting to hospital and being told that you were not in active labour and what your views are about your experience. Initial questions are

1. What made you contact the hospital - to ask advice or ask for admission?

2. What was response from midwife on telephone

3. When did you go in - was it your decision or the midwife's on phone

4. What were your options when told you were not in active labour

5. How did you feel about it

6. How long did pre/early labour last

7. When did you go into actual labour

8. Did you go into labour yourself or did the midwife inetrvene such as break the waters to get things going

9. What type of pain relief did you have

10. What was the type of delivery you actually had

11. Looking back on your experience, what would you like to have done differently

Those are some initial thoughts about questions for women. Some of you may be able to suggest others.

I am trying to get a feel of how to approach it. Any help will be gratefully receives as ever, mears.

I think that this applies to me, but I was in hospital for the duration anyway (pre eclampsia), so I'm not sure if my responses would be relevant

thanks for you response happyberries. You have highlighted that I should have been more clear in that I am looking at normal, healthy, low risk pregnancies resulting in spontaneous labour after 37 weeks.

mears that sounds like my 2nd pg

i help if you like

btw im not stalking you!

1. to ask for admission

2. the first two times she said, no, the third she said yes

3. the midwife's decision

4. to go home and have a capax/bath. i was only 2 cm dilated, but I would definitely be having DS within 24 hours

5. a bit gutted really - it was about 3 in the morning, and given I was going to be back shortly anyway, I would rather have just stayed

6. about 18 hours - 4 p.m. Sunday to 10 a.m. Monday

7. mid morning the next day

8. I went into labour myself

9. I had tens machine, gas & air and 2 X diamorphine

10. ventouse and episiotomy - DS was distressed and then nearly escaped ventouse as was about to push him out, but then they saw the cord round his neck

11. i was exhausted by pre-labour so don't think I could have managed on g & a, so probably gone for epidural instead of diamorphine. I didn't realise that the diamorphine would dope me up and render me bedbound anyway - I still had fluffy visions of an active birth approach. also diamorphine ground my contractions to a halt, DS became a little distressed, so they had to break my waters (meconium in the waters) and put me on a syntocin drip (and transfer me to consultant led unit)

Can you explain for me what is the difference between "pre-labour" "early labour" and "active labour"? Thanks!

In 7. is 'actual' labour the same as 'active' labour?

OK, that counts me out!

Said offspring is now 8! Ohmygawd!

ive been told im in early labour since last wed and still nothing yet will help if u want

My labour was like this.

1. To see if I should go in, I'd had a show contractions which increaded then went again.

2. Wait till contractions came steadily for x amount of time.

3. After a few days (monday night) I went in as I just couldn't take it anymore, it was my decision.

4. Stay there alone or go back home

5. Gutted!

6. From saturday - tuesday!

7. Tuesday evening - was sent home tuesday afternoon in agony, was back home for 1 hour before had to call ambulance to go back and when got there was into active labour.

8. Myself, did have waters broken though.

9. Early on, none, this was awful, once in active labour gas & air and pethidine x 2.

10. Normal

11. Nothing I could have done differently, wish the staff had listened to me alittle more though. Perhaps if I'd gone back home with dp when they said, I wouldn't have been left alone and got hysterical.

1. My waters broke

2. Come in, we'll check you over

3. Hers

4. Told I had to go to large, non-local hospital to be induced, was 14 days overdue however!

5. Not happy, but had no choice

6. It took about 30 hours for me to start dilating, they started the syntocin drip after 24 hours.

7. I was getting all the pains but nothing was happening, so i don't know!

8. Had pessary and a container and a half of that drip by the time it was all over.

9. Had gas and air at first for about 6 hours, but she gave me an internal and NOTHING had happened, so I had an epidural on her aadvice. glad I did too.

10. Had a vaginal delivery, no forceps or venteuse. Tore half a cm.

11. I wish I had tried to breastfeed. Nothing about the labour, didn't feel I had any options left so just did what I was told.

I was very disappointed to be packed off to the shower on my own an hour after labour, and that "breakfast" was one slice of toast afer nothing for 2 days! Food was completely inadequate anyway.

Was not happy to be berated by the midwife halfway into labour about not going to antenatal "classes"! I thought by then, it was too late to worry about that sort of thing, so why upset a woman in labour.

And I hated being called "Mrs X" and "mummy". Felt I should have worn a name badge. But I digress.....

1. What made you contact the hospital - to ask advice or ask for admission?

advice/request for assessment - i was booked for a homebirth

2. What was response from midwife on telephone -

you are not in labour/your contractions are not of the right duration/interval/you wouldn't be able to talk to me if you are in labour/do not put on your tens machine because you are not in labour. this is with pains 2mins apart btw.

3. When did you go in - was it your decision or the midwife's on phone

multiple shows during the day now bright red blood - agreed with mw on phone to go to hosp. however, dh and i had previously agreed to lie to mws on phone to tell them whatever they wanted to hear in order to get an assessment after 22hrs.

4. What were your options when told you were not in active labour

no options discussed or explanations offered.

5. How did you feel about it

angry, stressed, afraid, mistrustful.

6. How long did pre/early labour last

24hrs approx - hard for me to tell, there wasn't much difference for me between pre/early labour and the "real" thing.

7. When did you go into actual labour

see above

8. Did you go into labour yourself or did the midwife inetrvene such as break the waters to get things going

myself, eventually.

9. What type of pain relief did you have

gas and air, epidural(s) - think i must have had a spinal block at the end not sure totally out of it by then.

10. What was the type of delivery you actually had

vaginal assisted by ventouse.

11. Looking back on your experience, what would you like to have done differently

would have got independent mws for assured continuity of care and ability to assess me in early labour - and this is what i did subsequently with dd.

mears - i think q 11 should read what would you like the mws to have done differently?

• come out and assess me to confirm early labour
• advise on positions to adopt or other comfort measures
• explain what was going on
• not be so absolutely wedded to "cookie cutter" definitions of the ideal interval between and duration of contractions - i have now given birth to 2 babies vaginally without meeting those all important criteria! so technically i have delivered 2 babies vaginally without being in labour at all according to my first lot of mws!

hth and good luck.

1. I had a bleed and some back ache at 39 wks so phoned the labour ward Friday 2pm.

2. The response was good! Basically it was get yourself down here and we'll check you out.

3. as above

4. She asked me if I wanted an internal to see if I was dilating. I said YES! Afterwards she said I was 2-3cm, but not contracting. She did a membrane sweep and told me to go for a walk around the shops. She said that I'd most likely be back in that night.

5. I was delighted!!! Felt like the end was nearing!!

6. 2 DAYS (!) later I got much worse backache and phoned the labour ward again... same response, but was told they wouldn't send me home again. Was 4cm, but still not really contracting. That was 6pm Sunday.

7. Labour kinda started when my waters were ruptured by the mw at 10pm on Sunday, I was still 4cm.

8. After having my membranes ruptured I had slightly stronger contractions and was 7cm by 2am Monday morning. But it was a BRUTAL internal by a Doctor which really kicked it off. Internal 2am, dd born at 3.10am.

9. Had Entonox until that horrible internal. Then asked for half a dose of diamorphine, got three quarters of a dose 30 mins before dd popped out!

10. Had a SVD.

11. I wouldn't have gone in so early and I wouldn't have had the diamorphine. I managed so long without it and it just made me really sleepy and sickly after the birth!

So in summary it took me from Friday afternoon until 10pm Sunday night to go from 2 to 4 cm!!

This was me with my third child. I had a long prelabour with my fourth child too and didn't make the same mistake again.

1. to ask for advice (had had contractions 10 minutes apart for 12 hours)

2.They asked me to come in, and told me that I would probably be able to come home again

3. I went in then (5pm, about 12 hours after contractions started, but they were irregular, very mild etc etc and I knew I wasn't in active labour, just wondered what to do)

4. The doctor left me no choice - he told me I had to stay in, even though I wasn't in active labour as my previous labour had been very quick

5. I was really really upset - I wanted to go home.

6. That lasted another 8 hours (until about 1am).

7. 1am

8. Went into labour myself

9. Gas and air

10. Vaginal - normal - born at 3.50am

11. I wouldn't phone the hospital or go in when I wasn't in active labour - I really wanted to avoid being in labour in hospital, it was a grim experience with frequent internal examinations, and a rubbish midwife. I was only in about an hour and a half before my next baby was born - in active labour throughout.

Good question bossykate - will make that an additional one.

12. What would you have midwives to have done differently.

Yes I would like to hear your experience nailpolish.

If anyone would like to share info but not online please feel free to CAT me.

Thanks for such a quick response - you never let me down

1. My waters broke.

2. Come in immediately, even though I wasn't having any contractions.

3. I did not challenge the need to come in immediately - I went straight away.

4. I was told to stay in the hospital. Wasn't given the optioni of going home.

5. I was worried about having to be induced if I didn't go into labour spontaneously. However I started having mild contractions fairly soon after arriving at hospital, so I spent the time doing yoga and jumping up and down trying to speed things along. With the benefit of hindsight, this was a bad idea as I rather tired myself out before labour had properly started.

6. Contractions began to be quite painful by mid-afternoon (waters had broken at about 6.30 a.m.) By about 7 p.m. I was finding the contractions very difficult to cope with. It might have been easier to have coped with them at home, I don't know. My dh was panicking and not really being much use (although he was doing his best). I am afraid I can't remember when I got to three cm dilated, but it was some time later that evening, I think at about 10 p.m. There were no available rooms in the delivery suite, I was still on the antenatal ward. The midwives were very busy, and one midwife in particular made me feel as if I was making a fuss about nothing. I felt very alone and unsupported.

7. As above, I think it was about 10 p.m. by the time I was 3 cm dilated.

8. I went into labour myself.

9. I had pethidine which I regretted afterwards. I think if I had felt happier/more supported in the pre-labour phase I might not have been so desperate to have pethidine and might have had more confidence that I could do it myself. But by the time I finally got a room in the delivery suite (which I think was about 11.30 p.m.) I was just insistent that I couldn't cope.

10. The delivery was okay although I was in the pushing stage for a long time. However when he was born he was blue and didnt' breathe and his heartrate was only 40 bpm and he scored only 1 on his five min apgars. Although I was being monitored, the midwives hadn't picked up on his distress before he was born. (For a lot of the time, there hadn't been a midwife in the room.)

No-one knew why this had happened but two years later when I was getting ready to have my second son the consultant midwife at the same hosptial said she believed it was caused by an extreme and unusual reaction to pethidine.

11. I would have liked to stay at home longer and have been more supported. If I had known then waht I know now, I would have hired a doula, but I rather naively thought that there would be a midwife to support me during labour, includiing the earlyu stages.

I would like to have been admitted, rather than sent home at 3 in the morning, but understand that the system/health considerations think you should be in the hospital as little time as possible.

I would also have liked to have been given more info as to possible side-effects of diamorphine - i.e. grinding labour to a halt. I was so tired that I forgot ante-natal class info about it.

1 - For advice, thought waters had broken. I was having strong contractions 5 minutes apart.

2 - Advised to stay home as long as comfortable (10 min drive to hospital) and then to ring back to tell them when I was on way in.

3 - Following morning. Had finally fallen asleep exhausted after 6 hrs, woke to no movements at all and panicked.

4 - Monitored, baby ok. Told not in active labour and sent home. No other option given.

5 - A bit daft. Was 2nd baby, felt I should know if I was in labour or not. Male doctor had laughed at me when I said waters had broken and told me not to be silly. He examined me, would have preferred midwife.

6 - 7.5 days, assuming I had started pre-labour at 1 above. Felt like Braxton Hicks all week along with low dragging pains and awful back ache. Agony.

7 & 8 - Called to hospital for induction, I was 10 days overdue by this stage. Found to be 3cm dilated. Midwife broke waters. Full on contractions 3 minutes apart started within 30 minutes of that.

9 - Occasional whiffs of gas and air

10 - Brilliant, was over very quickly (less than 3 hrs). No further intervention -previous birth was epi & ventouse. Baby delivered onto my tum and after cord was cut, we were left alone until he found his way up for a feed. Heaven

11 - Should have insisted on midwife examining me at point 4-5 above. Think if she had I would probably have had waters broken and had baby then instead of an agonising week later.

12 ? Midwifes, nothing, they were brilliant. It was shift change but first midwife stayed anyway to see it through to the end . Jnr Doctor at first examine on the other hand could have done with whole lot of better training. He wanted to examine me using a speculum, I tensed up and he gave it up as a bad job. On that basis he decided my waters hadn?t broken and I wasn?t in labour, instead of requesting a midwife to examine me.

1. I had 4 to 5 days of labour like pains every night. I contacted the hospital when the pains were every 2 minutes or so but as each contraction wasn't strong or long they told me to wait at home. I finally took myself in on the 5th night when I bled lots of fresh blood.

2. I just got dh to tell them I was coming now!

3. Mine, but I guess they would have told me to come in anyway because of the bleeding.

4. I wasn't given any options. I was put on the ward for 24+ hours. Contractions increasing so I did lots of standing and pacing, huffing and puffing. No pain relief at this stage. Kept all the other women awake!

5. Very neglected. There was monitoring of the baby's heartbeat and of the bleeding but none of how I was actually coping with the pain. Thank God for dh supporting me through the pains because they hurt like hell by that stage.

6. A week if you count from the first contractions! - but about 26 hours if you count from arriving at hospital to being taken down to the delivery suite (where I was found to be about 3cm dilated). Once there it took about 24 hours until delivery so they told me I couldn't have been in labour when I first arrived. I know I was!

7. That's up for debate.

8. Yes they broke my waters because things weren't progressing despite mega contractions

9. gas and air

10. Ventouse

11. More pain relief

1. I contacted the hospital initially because my waters had broken a week before and my show had been 4 days before that. I had been in hospital from the 27/2 to 4/3 for observation and tests as a result of waters breaking. I was discharged on 4/3 and advised to attend the hospital if labour started.

2. I was advised to go in.

3. I got some painful contractions from about 8.30pm on 5/3 but they werent regular so didnt contact them. They started becoming regular at about 1am but still about 9mins apart and bearable.

4. I was examined and told I was only 3cms dilated but would have to stay in hosp due to previous incident.

5. Quite relieved that something was actually happening.

6. My early labour lasted until about 9pm on 7/3.

7. Who knows?

8. I went into labour myself.

9. Initially a TENS machine for about 6 hours, til I had a bath, then the TENS machine broke and they didnt have a spare, so paracetamol (doesnt work) for about 24 hours then another TENS machine (no good at this stage for pain relief). When I went to labour ward and had pethidine which was horrid, then a snort of gas & air which also was horrid and then an epidural

10. Emergency caesarean

11. I would have not been so accepting of the way things were, I would have been much more demanding especially with regards to keeping me informed, and have insisted on a c/s earlier.

A lot of information I gained about my labour came after the event when I wrote a letter to the hospital (supported by my GP) ie. teh reason syntonocin wasnt given after they'd scanned me for my waters breaking because they thought the baby would get stuck!, I'd only reached 7cms dilation according to the chap who did the op despite having got me pushing for 4 hours etc.

I did get a letter of apology from the hospital on 4 counts regarding my labour management including the failure to provide me with antibiotics after my waters breaking due to my heart problem.

PS. I send you a CAT with my answers, hope it helps.

Reg question 12. I would have liked better communication between the shifts, as I was checked by 4 different midwives while in labour and they didn't seem to know what had happened before I came to their charge (for example that I have had long regular contractions every 3 minutes for almost 12 hrs without dilating). I would have liked that the midwife have notified the consultant sooner rather than having a go at me when meconium was present. I wish I have not seen 3 midwives having a heated discussion between them about what the midwife in charge was doing wrong in the time it took for the consultant and paediatrician to arrive.

Mears, I know you are a lovely and knowlodgeable midwife, if I ever get pregnant again, can you be mymidwife instead? pleeeaaasee!

I sent you a Cat.

1. contractions 5 mins apart, had been going on for 2 days

2. wait until 2 mins apart before coming in 3. mine because was in so much pain 4. was monitored and told go go home and to come back in 48 hrs if still not established to break waters 5. tired and a bit like they wanted me out of the way - they were very busy 6. 4 days 7. waters were broken after 4 days 8. had waters broken 9. everything! gas and air, then diamorphine then epidural (which didn't work). Baby was back to back and 9lb 13oz, actually labour was 13 hours 10. ventouse with episotomy performed in operating theatre in case they had to do emergency C/S 11. More supportive midwife and the same midwife throughout (had 3 different ones and the last one didn't even speak to me). More explained to me and to be listened to more. I 'knew' that I woulnd't be able to push him out but they just said keep trying. AFterwards the ob said "you would never have been able to push him out"!

I only had a long pre-labour with DD1....with all my others I was induced for various reasons!

1. What made you contact the hospital - to ask advice or ask for admission?

I was having contractions every 5mns and had been for 6hrs, so wanted advice on what should be doing.

2. What was response from midwife on telephone.

Luckily very good. Because of problems had during the pregnancy I had bulit up a good relationship and she knew my wishes well.

3. When did you go in - was it your decision or the midwife's on phone.

Both....She asked me what I wanted to do and she agreed.

4. What were your options when told you were not in active labour.

I had none. Because of the problems they wanted to keep a close eye on me, which meant being admitted.

5. How did you feel about it.

Ok, because I was nervous anyway by then.

6. How long did pre/early labour last.

From 3pm monday to 8am tuesday, so 17hrs.

7. When did you go into actual labour.

8am tuesday.

8. Did you go into labour yourself or did the midwife inetrvene such as break the waters to get things going.

My midwife swept my membranes which triggered decent contrations. DD was born at 3.24pm tuesday, so that meant 17hrs pre-labour and 7 1/2hrs active labour.

9. What type of pain relief did you have.

Gas n Air, Gas n Air, Gas n Air.....love that stuff!!!

10. What was the type of delivery you actually had.

Normal vaginal delivery.

11. Looking back on your experience, what would you like to have done differently.

Nothing....everything went so well I look back as that birth as my best. Would have loved each of my births to have gone so well!!!

1. What made you contact the hospital - to ask advice or ask for admission?

Contractions had been consistent for 4/5 hours and were 5 mins apart. I'd been experiencing small contractions for the two days prior and had very disturbed sleep.

2. What was response from midwife on telephone
   Come in but we're very busy.

3. When did you go in - was it your decision or the midwife's on phone.
   Our decision...went in at 0200

4. What were your options when told you were not in active labour
   No options...go home and wait.

5. How did you feel about it
   Frightened (partly a night time thing), a fraud, very put off by mano or midwife and the fact that no one showed any interest in us in the ward even when I was bent over in pain.

6. How long did pre/early labour last. Not sure when to count in...3 days in total but serious stuff 16 hours

7. When did you go into actual labour
   about 12 midday

8. Did you go into labour yourself or did the midwife inetrvene such as break the waters to get things going
   Midwife broke waters

9. What type of pain relief did you have
   TENS machine, Gas and Air...wanted more but was reassured it wouldn't get worse and then later (when it had) it was too late and would slow things down

10. What was the type of delivery you actually had
    Ventouse

11. Looking back on your experience, what would you like to have done differently

I'd have had pain relief...having had two days of pain on and off I was exhausted and couldn't deliver without intervention. Also feel that with an Epidural/Pethidine I'd have had more energy post birth. I was extremely traumatised and exhausted and really can't recall much of the first week of DS's life other than wanting to cry.

I wouldn't use TENS again because it didn't seem to work for me and was more an irritation than anything.

I'd seriously consider an independent MW because my first impression really scared me a lot. Ended up with two very nice MW's but would have liked someone I knew.

I'd go a different local hospital with individual rooms for new mums. The ward I was put on in the evening was fine but the night time staff were rude and ignorant. At one point, even in my exhaustion I nearly got out of bed to complain about the way a member of the team had spoken to another mother. In the daytime there were a queue of people wanting to help and advise but the damage had been done by then. Also lunch was served at a trolley where we all had to queue (which is tricky when you can't stand very well)...closest feeling to being in a womens prison I ever want to have.

am looking at developing a research question for women who had long phase of early labour. I am sure that applies to many of you out there and I am hoping you will share your experiences.

I am focusing on what your experience was when getting to hospital and being told that you were not in active labour and what your views are about your experience. Initial questions are

1. What made you contact the hospital - to ask advice or ask for admission?
   Bit of both really - had pink tinged discharge, thought waters were starting to go, bit concerned about pink as had had blood a week. Also was booked for section and I thought it was best to get there early for it.

2. What was response from midwife on telephone
   Told to go in.

3. When did you go in - was it your decision or the midwife's on phone
   As above!

4. What were your options when told you were not in active labour
   Told not to go home, but told to stay in (strongly advised). Felt very confused - just wanted my section. Couldn't understand why there were so interested in whether I was in labour r not - nobody seemed to be listening to me.
   Dh sent home.

5. How did you feel about it
   I was concerned, confused and worried.

6. How long did pre/early labour last
   I was in severe pain from about 2amish to 11am when I got my section. God knows how long it would have lasted. Was 2-3cm dilated at about 9am.

7. When did you go into actual labour
   God knows. They certainly didn't care enough to monitor me. See above for pain.

8. Did you go into labour yourself or did the midwife inetrvene such as break the waters to get things going
   No intervention except internal exam (unkind and uncaring) when I arrived.

9. What type of pain relief did you have
   Two f paracetamol. And a bloody useless bath.

10. What was the type of delivery you actually had
    Section

11. Looking back on your experience, what would you like to have done differently
    Book my section for 38 weeks so I wouldn't have had to endure it.
    Could I ask you a question please Mears. I always get the feeling you are a nice, caring and sympathetic person, but a lot of midwives clearly are not nice people. A lot of them seem to hate and despise women, especially women in pain. I am not the only person I know who thinks this. Do you think they start out as cruel and uncaring people or does exposure to pain make people more callous? Like violence on telly is supposed to desensitise people. I was truly, genuinely and lastingly shocked and traumatised by the midwives I had the misfortune to deal with - who left me alone, frightened and in a huge amount of pain. It wasn't just bloody dangerous - I'd had a previous section and my scar could have ruptured for all they knew or cared - it was tremendously upsetting and has definitely changed the way I trust people.

I think just a little care, sympathy and prompt attention would go a long way. Proper pain relief and a swift move to c-section if one is planned would be even better.

HTH, and would be grateful for your thoughts too.

Aloha, I am so sorry to read of women meeting uncaring, unsympathetic midwives. I certainly don't think that it is the norm but I think these midwives are probably uncaring people in the first place As with all jobs, there are bad apples. Personally I have only known a couple of midwives who I have felt were totally unsuitable for their jobs.

One of the reasons I am looking into this aspect of early labour is because it is such a difficult situation to manage in hospital.

Women want some kind of pain relief, we midwives can't justify giving strong medication because the woman is not in labour. Part of the problem I think is that women are not dealt with well when they do arrive at the hospital. It may not be that the midwife is horrible, it is that the woman feels let down because she isn't doing anything about the pain. I think that women who are reassured that a level of pain is normal prior to labour getting into full flow do better at home in their own surroundings. Keeping them in hospital increases their anxiety which in turn increases their pain.

A lot of women come into hospital far too early. That depends though on what antenatal preparation they have had. I feel terrible when I have to tell someone they are not in labour, but I can usually see that before I even do the examination. For most women, paracetamol and a bath gives some relief. For some it does not. Some women will refuse to try it initially and then are surprised when they do get some relief. Often in prelabour, the contractions ease and she can get some sleep.
Frequently I will be told that a woman is very distressed and needs to come to labour ward. When she does, the pain seems to ease and she can cope. I think that really is one of the key issues here is support. In labour ward they do not feel so abandoned. Women also have the worry that they will deliver before they get to hospital. Although that can happen, it is quite rare for first babies especially. However, the media shows women delivering babies after a pop of the waters and a few contractions (Coronation Street, Eastenders).
I believe that a number of the women we keep in would be better going home with reassurance that all is normal. Better advice regarding positions to ease the discomfort/pain would be useful. Drugs just are not the answer. Hearing what women think though is vitally important when trying to plan any service.