What are my choices next time,,,,,

[sillysow]

Hi all, could I have some guidance from you wise people

For my first labour I wanted a homebirth with minimal intervention. Rightly or wrongly my birth plan was never completed other than saying home. Having not had a child before I was not sure who was meant to complete it!
Anyhow, my midwife spotted GD two days before I went into labour, although it had been in my test results from two months before. As such they immediately made me high risk as opposed to low risk. I was put on the consultant led ward, and when I asked if I could go in the MLU it was refused.
Baby was also back to back, I had ketones in my wee at this point too (not entirely sure what that means).
I ended up with an assisted low forceps delivery, and then promptly lost 1000mls of blood.

As such, having had GD, PPH and an assisted delivery, what say will I likely have next time.....I'm guessing a home water birth is out of the window

I would just like to know what to expect before I make any decisions.

Many Thanks

You should have all options open to you, providing that everything is normal.If not you need to surrender for the health of your baby and yourself.

2nd deliveries are normally much easier.

I would speak to your healthcare team.

Thank you fidelma

I'm sorry you had such a rough time with your first .

To start with, I'm not a medical professional, but as far as I know ketones in your wee usually means you haven't eaten recently and your body is starting to use your fat deposits.

Do you know why you had a PPH? Was it a direct result of the forceps? I had a PPH after I tore through a vein, but as it was a tear rather than uterine it didn't give my MW any concern with planning a 2nd HB.

Re. the assisted delivery, every labour is different. As you say, your DC wasn't in the best position for labour and that almost certainly didn't help - if you have another you could focus a lot on optimal foetal positioning in the last few weeks to try and get the baby into a better place and reduce the chance of needing help. Plus, from what I know, assistance is usually required because the labour has become non-progressive - as long as you've got an observant MW (which you should have at a HB) it shouldn't be an emergency situation. I'd talk to them about it but, if it were me, I wouldn't see a previous forceps birth as a reason to labour in hospital next time unless I could be given a very strong reason why it was in the best interests of me and/or my baby.

Re. GD, that's probably the one I know least about. My understanding is that "GD" is a very broad brush and should be considered on a case by case basis. Did you come across the homebirth site? There's quite a bit of information there on all these issues, including GD, under "Can I have a homebirth if...?". IIRC one of the big concerns is that the baby will be larger and there is an increased risk of shoulder dystocia - SD is an obstetric emergency, but will be handled in almost exactly the same way whether you're at home or in hospital. I would want a detailed understanding of why hospital care would be considered more appropriate...

With all of them, your HCP's may recommend you have a hospital birth, but they cannot dictate your care unless you are mentally incompetent. How old is your DC? Have you been through your notes with a MW to discuss what happened and why (most hospitals offer some form of "birth afterthoughts" service where you can do this)? At the end of the day there are risks and benefits to any choice you make - you need to understand how likely the different possible outcomes are, so that you can make a informed choice of which set of risks you are happiest to take.

you really need to find out whether the bleeding was vaginal or placental, I had a PPH of 1600ml from site where placenta attaches, v helpful GP did some research for me and chances of bleeding next time are roughly 3 x more likely than average person.

If it was from a tear or cut it would be very bad luck to bleed again.

don't know if this helps?

p.s i was due to have a homebirth but labour was v long so transferred to hospital, things may have been much worse had i stayed at home.

Thanks for all your replies. I will try and find out what the cause of the blood loss was - would I be able to find out by calling the maternity unit?

I havent discussed any of the birth with any HCP as to be honest I would like to try to forget it! Obv it would be a good idea to talk it through, and I will try and pluck up the courage to do so - but who do I ask?

At the time I accepted it really well - but it was so vastly different to what I wanted that I am not sure that I would want to do it again.... dont get me wrong I was also greatful for the help I did receive, but I also hated being so so so out of control of the situation.

You should be able to organise a talk with a senior MW or a consultant (or team member there of) either through your GP or directly through the maternity unit. Its not the right thing for everyone so if it doesn't feel right for you then don't feel that you ought to, or that your have to do it now. But it does sound like it might help you to understand why things happened the way they did. If you do choose to go, make a list of questions you want to ask and points that you want to make. You can also get a copy of your notes (for which they can charge to cover admin costs), which might be another way you could get the information - if you want to do that then you need to write to the hospital (see here for more details). I'm not sure how easy it would be to get just one piece of information (where the blood loss came from) - but you could ask the hospital or ask for the notes to be sent to your GP and ask them to let you know.

I was very lucky with DD1's birth - even though she was 9lb 12 and breech she was a straight forward spontaneous HB with IMs that I knew and trusted. DD2's birth was different in nearly every possible way (induced hospital birth) and was, in many ways, the most traumatic experience I've ever been through. One of the things I was afraid of about a hospital birth was feeling that the situation was taken out of my control - but we felt confident enough to ask a lot of questions so that we understood exactly why they were recommending each and every course of action and we felt able to make an informed choice. 4 months on and there still aren't many changes I would wish to make to the care I received.

There are, of course, emergency situations that require immediate action - but they are few and far between and usually there is the time for a discussion (even if brief) of the pros and cons of any given recommendation. For us that meant that, even though we accepted pretty well everything they recommended, we understood why and felt that it was our choice to agree to it.

An acronym that we were given in ante-natal classes was to use your BRAINS:

What are the Benefits?
What are the Risks?
What are the Alternatives?
What does your Intuition tell you to do?
What happens if we do Nothing for now?
Smile!

I also found these phrases by Mary Cronk really useful for reminding myself that it was my decision what happened.

Sorry for another long winded message. I just feel its so unnecessary for women to come away from a birth feeling the way you do

Ask your GP, HCP about your previous birth experience worries, why these things may have happened, is there anything you can do this time round? Get informed especially about GD.
If you really want a home birth then go for it, if there are any problems your MW will get you to hospital. My last child was a home birth and absolutely the best birth experience I had, i've also supported home births as a doula and they are so much calmer than hospitals, in the end you have to decide what is the best way for you and your baby, what ever you decide you want to have a good birth with both of you healthy.
If you don't feel confident asking HCPs and your partner is also not able to question HCPs then do consider a doula, we are very good at being your advocate and keeping you on track with your birth plans translating medical speak etc. Good luck I hope you get what you want and all your questions answered.

My first was very similar to yours sillysow except for the GD (sorry, i don't even know what GD means ).

I went on to have a fantastic home water birth second time round. I hope you get the support and answers that you need.

Thanks very much everyone for your kind help I really appreciate it