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.

1, 2 and 3. I didn't contact them - we just turned up! Had very small contractions all day, and then at approx 10pm on the Tuesday night they suddenly got much stronger and closer together - and I panicked.

4. Go home, or stay, take paracetamol and get in bath. I stayed and got in the bath for a couple of hours.

5. Gutted, tearful and already dreading what was in store, tbh.

6. Well, all in all about 24 hours.

7. I was told I was 3cms at about 11am on the Weds, so approx 12 hours after coming in, and was taken down to delivery suite.

8. Spontaneous onset but I also had ARM but tbh can't remember when. Also synto drip after I had been in active labour for a good few hours but again afraid I can't remember when exactly.

9. Entonox, epidural.

10. Vaginal delivery, 2nd degree tear.

11. I wish I hadn't panicked and gone in so early, but that was partly due to lack of support. Midwife care during labour and delivery was generally good (one fab midwife in particular), antenatal care ranged from non-existent to borderline abusive. If I was ever to do it again I would hire an IM and have a homebirth. It's all a bit of a blur really, and I'm quite sad about that - I would like to have remembered more.

I don't know about other people, but I never felt that anyone really said how painful labour was/could be. I'm sure it was done with the best of intentions, but I think I would have been better prepared psychologically if I'd known what to expect. I would be happy to answer the questions but I'm not sure if I count- I went into hospital because my waters broke and they told me to come right in. It was about 11 hours from then until ds was born, so I don't know if that's long enough to count?

With ds3 last August:

1. Friday 8am - had been having niggling contractions for a couple of days and a sweep 2 days before - woke up in morning with quite severe lower abdo pain and not sure what was going on (concerned as had very speedy delivery with ds2 - only just got to hospital in time)

2. On domino scheme so community midwife came to house - examination showed I was 4cm dilated - midwife said I would probably deliver that day and to keep dh home from work - no need to go in yet.

3. When I did go in, it was my decision.

4. No real option - just told to stay at home until contracting regularly.

5. A bit scared to stay at home because I knew how quickly things could suddenly happen from my experience with ds2 and ds1 and ds2 were at home - didn't want to give birth with them around.

6. From that Friday morning till early hours of Sunday morning.

7. Woke up with contractions every 7 minutes at 2.10am Sunday morning (having niggled away all day Friday and Saturday) and delivered at 4.45am.

8. Went into labour myself though had had several sweeps over the week.

9. Just a bit of gas and air at the end.

10. Vaginal delivery with no intervention.

11. Nothing - delivery was perfect, just hated the 'pre-labour' that really seemed to last from the Wednesday before I gave birth.

12. I would have liked the midwife to pay me some attention. to actually listen to me and to speak to me and to actively monitor me, not to be invisible throughout my active labour stage (although admittedly this was quite fast and I am quite stoical in labour) and then bugger off on a tea break - i had got to pushing stage and mw had disappeared - i was still on the ward and the only attention i got was from a woman on the next bed who asked me if I was ok. grrr. rant over.

12. Midwives were brilliant, perfect and were for all 3 of my labours - cannot fault them - had fabulous community midwives who I knew very well after 3 babes in 3.5 yrs!

Sorry Tamum - you don't count You have importantly highlighted however that I need to hone down my question to women with intact membranes and contractions

Glad to be of some help though, I guess I'm not the only one to have had to go straight in!

The reason being that most units induce women within a certain time frame when their waters break and don't let them go home again (so do though). That is despite the fact that you can be left safely up to 3 days before starting induction process.

Mears: Did you see my earlier post asking for a definition of each term?

A lot of my friends describe their labours as being long, but their notes say '5 hours' or something. So I don't think I understand all the different 'types' of labour. Can you clarify?

Sorry morning paper, missed your post.

I used more than one term because it is called different things. Prelabour, very early labour, hesitant labour and even spurious labour. I thought I'd use a couple because that might be the terminology used by the midwife. Active/actual labour is once the midwife has said, yes you are in labour. Problem is that diagnosis of labour is extremely difficult to define universally. I am looking for women's own perceptions of what labour felt like to them IYSWIM?

Realsied I didn't clarify that I am looking for the time that women thought they were in labour, but told they actually weren't. Often labour is counted from the first contraction but there is a prelabour phased where there are painful contractions present but the cervix is not dilating. It may actually be thinning (effacing) in preparation for the active stage when it starts to dilate. The active phase of labour starts when the cervix is effaced, diltaing in the presence of regular painful contractions. The forewaters also begin to bulge.

1. Rang for advice

2. Midwife said wait until contractions three mins apart. Later on got another midwife who said i could come in to put my mind at rest and she checked me over and then we went home.

3. Was actually already booked in for induction before contractions started, so we went in then as planned (contractions had been regular five mins from Saturday afternoon through to Tuesday evening, which is when we went in, but still nothing doing) and they let us stay on the ward the night before but wasn't actually induced.

4. Could have gone home instead of staying in.

5. Quite relieved to stay in - very tired and sure it would all happen asap (ha ha)

6. Sat pm to weds morning (?about 78 hours)

7. They broke my waters tues am and things started getting serious about lunchtime tues

8. Waters broken

9. epidural (offered as had syntocin drip)

10. ventouse

11. Stayed at home longer, let things happen naturally (but was 15 days overdue) maybe used a pool at home for relaxation, pain relief. but easy to say in hindsight

HTH

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

bit of both - i'd been having contractions for about 20hrs by then, were 5mins-ish apart but not v strong and didn't feel they were going anywhere. was a bit concerned about how baby was doing, esp as was 13/14 days overdue by then.

2. What was response from midwife on telephone
   "you don't sound like you're in labour"! was a bit as thought she meant it was just BHs!

3. When did you go in - was it your decision or the midwife's on phone
   was mine - i had an appt to be induced about 2hrs later anyway and wanted to be checked out before then. wasn't induced in the end as hindwaters broke when i put my shoes on to go to hosp.

4. What were your options when told you were not in active labour
   was told to go home and come back in 12hrs or earlier if i felt i needed to.

5. How did you feel about it
   a bit that was only 1cm dilated after all that time (24hrs+). hadn't really absorbed from NCT classes that this was poss. otherwise ok, pain wasn't toooo bad.

6. How long did pre/early labour last
   not sure when it changed to actual labour, but had been 36 hrs when i went in the second time.

7. When did you go into actual labour
   as above. turned out to be just short of the 12hrs from 1st hosp visit anyway.

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

9. What type of pain relief did you have
   was offered gas+air, but tried it and didn't like it. was told to have an epidural after about 6hrs of active labour cos i was having urges to push at only 6cm that wdn't go away, and also cos they wanted to put me on a syntocinon drip cos i had got stuck at 6cm for about 4hrs. was knackered by then, so i agreed.

10. What was the type of delivery you actually had
    c-section. i only got to 9cm after 17hrs active labour, inc about 8hrs syntocinon, and ds was getting tired. his head was v high (zero station) so wasn't time to wait around for it to descend.

11. Looking back on your experience, what would you like to have done differently
    i shd have taken a few paracetamol and gone back to bed at the start. i was so keen to avoid being induced + cascade of intervention etc that spent the whole labour (until the epidural) walking around and so was incredibly knackered by the end. and then had a c-section to recover from too!

I was actually v gutted to have the c-section as had been reading lots of sheila kitzinger, janet balaskas etc and was convinced i cd do it all with no pain relief. have since realised it's not a bloody competition, and you can't revise for childbirth as if it's an exam. grrr.

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

wd have been nice if i'd had one. when i went in the second time, the labour ward was overflowing and i got put in a side room off the postnatal ward. the ward midwives popped in to do VEs every so often, but me and DP felt v unsupported.
while the syntocinon drip was up i had a MW who said about 2 words to us the entire time - i was just praying for the end of her shift. the last MW was nice tho.

Thanks Mears that's interesting.

"spurious labour" - I bet a MAN invented THAT phrase!

1. What made you contact the hospital - to ask advice or ask for admission? Because wasn't sure what labour was like - started having "contractions" Saturday am, got progressively more painful and more regular, albeit only every 15 minutes so by Sunday morning was fed up and went in.

2. What was response from midwife on telephone. Not very helpful, but probably the best advice she could give - have a warm bath, try and get some rest etc. and come in when felt needed more advice.

3. When did you go in - was it your decision or the midwife's on phone. My decision, went in Sunday am.

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

5. How did you feel about it.Rather foolish for making a big deal over nothing.

6. How long did pre/early labour last. Finally went back in after long walks on Sunday on MOnday at 4am.

7. When did you go into actual labour. At 4am on MOnday morning (due date) was 2 - 3 cm.

8. Did you go into labour yourself or did the midwife inetrvene such as break the waters to get things going. Midwife did a sweep and said that would wait an hour or so to see if things began to kick off properly. Contractions got more painful quite quickly and Waters broke at about 8am.

9. What type of pain relief did you have. Entonox, pethidine, epdural Last 2 within about an hour of waters breaking as it HURT!

10. What was the type of delivery you actually had. Unassisted. 40mins 2nd stage.

11. Looking back on your experience, what would you like to have done differently. Just had the knowledge that labour really hurts. I thought I had a high pain threshold, boy was I wrong. If I'd known that the niggly period would last that long, I'd have tried to rest more. As it was, felt completely knackered after dd was born. Wish I'd stayed at home for longer and tried TENS and walked around more. But noone can tell you how it will be, not really, and on paper the labour looks pretty good- 7 and a half hours ish from established labour to delivery, no assistance for second stage. Tore badly, but blame epidural for that really. This time, I'll hopefully be at home for the whole shebang.

Hope this helps.

Question 6 - from Saturday 6am untilabout 6am on Monday = 48 hours. Not as long as others!

Mears - how long is long and are you interested in a Spanish perspective? (if 15 hours is a long pre labour that is)

1. Bona fide contracts from 4-9PM made me contact the hospital. The pain was already becoming quite severe.

2. She was on the fence. Her attitude was more like, 'Go if you feel the need.'

3. It was my decision to go.

4. Edinburgh Royal Infirmary cannot accommodate women in active labour. They normally send women home who aren't 2cm dilated. BUT, ERI is also more than 45 minutes away for much of Edinburgh's population. Since it was quiet on the ward, I was allowed to labour in the room used for ladies who've been induced w/gas and air.

5. It hurt very much, so I got a trolley with gas & air.

6. Contractions began at 4PM. It took till 4AM to go to 4cm.

7. I was 2cm at midnight, so considered in active labour then.

8. My membranes were swept when I first went in, at about 9PM.

9. Gas & Air, then an epidural at 6AM.

10. H-F forceps. Delivery at 4.05PM the next day.

11. Nothing. Baby had her hand up by here head. She was never in distress, and it was impossible for them to have known why she wasn't coming down until she didn't. I felt I was dealt with promptly and adequately.

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

My waters were leaking

2. What was response from midwife on telephone
   I was told I have to go to hospital to check if it was the waters.

3. When did you go in - was it your decision or the midwife's on phone
   Told no need to rush, so I got there 4 hours later and was told off for taking so long!

4. What were your options when told you were not in active labour
   They confirmed waters were leaking but no contractions.

5. How did you feel about it
   I was told I had to stay in hospital until baby was born. I just wanted it to be over quickly.

6. How long did pre/early labour last
   Mild contractions started 22 hours after waters started leaking. Had gel induction and as far as I was concerned, the contractions hurt.

7. When did you go into actual labour
   Was put on drip 31 hours after waters leaked.

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

9. What type of pain relief did you have
   Whole tank of gas and air, epidural topped up 3 times.

10. What was the type of delivery you actually had
    emergency c-section

11. Looking back on your experience, what would you like to have done differently
    I would have liked to have been told what was happening. Also at the time, I was mortified they let male students midwives in to watch blood being taken from baby's scalp. I had already said no but they obviously didn't listen.

Just like to add, the midwife that started off with me (I got through 3 in the end!) actually stayed 3 hours after her shift ended but then really had to go. She came and found me the next afternoon to see how it went, she was very sorry to hear I had to have a section. She was just so lovely.

Sorry, in response to no. 4, meant to say ERI has no facilities for women not in active labour. No well baby unit, either. And not enough beds so that mothers to be are routinely transported to Glasgow or Dundee to give birth.

Both my labours have had very long early stage (3 days and 2 days) - do you want both experiences? I also planned home births for both, but only achieved it for the second. Do you still want me?

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

Woke up feeling really weird and crampy - 3 days over due date - so, advice.

2. What was response from midwife on telephone
   Try paracetamol and a bath and ring us back if there is any change.

3. When did you go in - was it your decision or the midwife's on phone
   Woke up at 5 a.m. went in at sevenish that night - had had "contractions" for most of that day, by the evening I was getting edgy and tired. They said to come in.

4. What were your options when told you were not in active labour
   Both times (yes, I went in three times!) I was offered a place on the ante-natal ward, or I could go home, and the first time, they even suggested going for dinner and coming back later as they thought I would deliver that night.

5. How did you feel about it
   Fine, I saw two different mid-wives and a third for my actual delivery and they were all incredibly supportive.

6. How long did pre/early labour last
   5 a.m. Sunday morning until 8ish Monday evening.

7. When did you go into actual labour
   Not sure, what you exactly need here, I went back in 8ish the Monday night, still 3 cm dilated but this time in active labour (felt no different to me!), possibly head engaged(?), and he was born at 4 a.m. Tuesday morning.

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

9. What type of pain relief did you have
   Pethidine (twice) and gas and air

10. What was the type of delivery you actually had
    Vaginal, couple of stitches.

11. Looking back on your experience, what would you like to have done differently
    Nothing really. As it was my first labour, I felt so unsure about everything that even going home twice, having been given advice and seen by someone, who knew what they were doing, was what I needed.

12. What would you have liked the midwives to have done differently.
    Nothing. They couldn't have been more caring.

I was in agony with horrifyingly painful contractions, coming very regularly but all in my back and lower body and i was still told I wasn't in labour unless I had belly contractions. Ha bloody ha.
I think it is wrong just to say ' you aren't in labour' when you can clearly go from 'not in labour' to 'collapsing with pain and bleeding profusely' in an hour or so. Just saying 'you aren't in labour' gives a woman no idea of what is supposed to happen next. I think labour can't (or shouldn't) be defined so narrowly. I didn't even want to go into labour so couldn't understand why it seemed to important for me to meet these technical (and to me, spurious) criteria for labour anyway. Had I wanted a natural birth, this attitude would have been equally unhelpful, I think.
Also, for me, two paracetamol were about as useful as....a completely useless thing. Someone actually suggested I get some sleep - I actually feel tearful putting that down as it was SO stupid and callous. It was like suggesting to someone who was having their leg amputated without anaesthetic to 'try to get some kip'. Totally unrealistic. Insulting, almost. I really think that not meeting these artificial criteria for 'real' labour should not mean that women are denied adequate pain relief. I think pain relief should be offered when women are in pain, not when someone else says they are in labour.

1. What made you contact the hospital - to ask advice or ask for admission? - because I'd passed blood and wanted to know if that was the plug or not

2. What was response from midwife on telephone - told me to come in immediately- she said they wanted to check me out. She also told me that I could well be going home but it was better to be safe than sorry

3. When did you go in - was it your decision or the midwife's on phone - I went in straight away on the midwife's advice

4. What were your options when told you were not in active labour - because of the blood they said I could go to the labour ward for the night or I could stay in the delivery suite.

5. How did you feel about it - I was ok so long as dh could stay with me. Didn't want to go to labour ward as dh would have to go home

6. How long did pre/early labour last -17 hours

7. When did you go into actual labour - 3.55 saturday afternoon

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

9. What type of pain relief did you have - diamorphine, gas and air and epidural

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 - very happy with it all. Very nice staff at the hospital, very professional and caring