Giving birth after a prem birth & stillbirth - What's it like?

[Dildals]

[I posted this last week on the prem birth section, but didn't get many replies and someone suggested to post it here. So here goes!]

Talk to me! What was your second birth like?

I had twins first time round who came at 29 weeks. I had PPROM at 28+6 and gave birth not too long after. Unfortunately the midwives on call at the time didn't fully appreciate I was actually in labour and therefore didn't monitor the twins (properly). Twin 1 didn't survive the contractions and descent through the birth canal, which is hard on such small babies. They did finally realise I was in labour when she was crowning ... :-)

As you can imagine I am viewing my second birth with some trepidation.

They always say that labour is easier/quicker next time round. Does that apply to prem births as well? I would assume not considering I gave birth to 1kg baby, rather than a whopping 3kg+ baby?

Although I always thought I would want to go for an ELCS second time round (to completely eliminate the risk of baby getting herself in to trouble) I am still strangely attracted to this peaceful empowering fuss free home birth. Am I crazy? I can imagine the actual process of giving birth might bring back a lot of anxiety inducing memories which are best left alone when you're trying to give birth. What did you do for your second birth?

Because it was twins first time round the consultants will probably point to that as the reason for prem labour and will not consider me particularly at risk for a second prem labour. (They didn't find any particular cause for my prem labour). What do you think of this? Can I expect to go term-ish this time? Where you offered any extra stuff? Steroids, progesterone? Because of the stillbirth I will be offered 3 extra scans, I do know that.

What did you do for support? I know I am going to need some support, mentally, to get through this pregnancy, and afterwards. I know the strength of emotions a pregnancy and birth evokes and I definitely need help managing those. I am not putting much faith in the midwives (most of them do a fab job btw). I can't get on to case load care because I don't want to give birth in my local hospital (King's) (for obvious reasons) and the other hospital that IS in my catchment area (St Thomas) does not have caseload care mws for my postcode. Argh. So I will be cared for by the normal mw antenatal clinic. My experience last time wasn't too great with them, ie you see a different one every time, they didn't actually have answers to my questions (my questions were about giving birth - this should have been within their realm of expertise!). I am considering perhaps hiring a doula. I have looked in to a private MW but that's simply too expensive. I have considered calling all the community midwives and begging them but I can't find any flippin phone numbers!!! Another reason I would like some extra care, postnatal, is that I have this strange idea that I don't know what to do with a term child (assuming we go term that is) and am worried that I won't be able to breastfeed. We had such fab care in NICU/SCBU, not that I want to go back, but I came home completely confident in how to take care of baby and relatively confident on the bf'ing bit. I know there are breastfeeding cafes but it's hard to get to those if you're recovering from a CS. Having a second child where there is 'one missing' will be a massively emotional process, which is another reason for getting some postnatal support - I don't want to get PND if can help it.

Anyway. Sorry for the mammoth post but would appreciate your thoughts and experiences.

x

Firstly I'm very sorry that your baby died and in such awful circumstances. I was not in same situation as you but I had PPROM + prem birth followed by PPROM + late MC followed by live almost term birth.
Term birth was shorter than first birth but more painful possibly due to the sheer terror. I was constantly terrified throughout the birth that he would die. What made the difference was supportive care from the midwife. Make sure that you have the SANDS teardrop stickers all over your notes. I had a letter from the bereavement midwife to be read by the labour ward midwives explaining my anxiety.
Throughout the pregnancy I had an extremely high level of care from one midwife who gave me access to consultant whenever I needed to. This I believe was partly due to mistakes that were made during my previous pregnancy. I went back to the same hospital - better the devil you know and all that, and they did know me by then. Bereavement midwife also acted as liaison with the hospital. This is a level of care that I think you also deserve. Please ask if there is a bereavement midwife at your hospital that you could have a chat with.
I had scans fortnightly and then monthly. Cervical length scans (you can ask for this, incompetent cervix is a possible cause of PPROM) and growth scans later. Were your twins a good size for dates?
If there is no bereavement midwife you could ask to be referred to perinatal mental health team, you are at high risk for PND and could do with counselling antenatally (I had weekly counselling to counteract anxiety of pregnancy). Unfortunately I did get PND but got help very quickly.

BTW breastfeeding a term child is totally better - you don't have to force boob in mouth, wake up, take clothes off and tickle feet to force feed, express to keep supply up...they just want to feed and you already know how to feed them. The only thing is with all my subsequent children I have panicked that they are not feeding enough or gaining enough, you have to be aware of that prem baby force feeding mindset and fight it.

Thanks junior, sorry to hear about your history. Sounds like a rough ride.

That is a good suggestion, to contact the bereavement midwife, I will do that. It might make sense to ask for a referral to a perinatal mental health team regardless.

They were small babies for their dates, one kg, so 2 pounds.

That's interesting to hear about your term birth. That's what I thought as well, that the anxiety would not help the zen birthing process!

Junior I just had my 12wk scan and got roped in for the INSIGHT study, which looks at predictive markers in preterm labour. I also got referred to the prem labour clinic. My cervical length will be checked every 2 weeks, swabs for all sorts of stuff and fibronectin tests. So it sounds like a fairly comprehensive care pathway to make sure it doesn't happen again. This has put my mind to rest a little.

I also asked whether second time labour would be easier and the honest answer was 'we don't know' but the fact that the cervix can dilate sufficiently apparently is a good sign.

Good to hear about breastfeeding a term baby. I CAN'T wait for a baby that actually WANTS to eat! :-)

This is fantastic news, I am so glad you will receive such a good level of care. I had a couple of fetal fibronectin tests done in my last pregnancy and found it extremely reassuring when they said no labour for at least next two weeks. The swabs will presumably make sure there is no infection which could travel up and cause waters to break.

My cervical length was checked weekly then fortnightly. It did dip a little bit but then stayed fairly constant so again this was reassuring. Although you may do what I did and start looking up average cervical length for each gestation.... anything above 2.5cm is good and these days they aren't even that worried if it drops to 2cm.

Here's to an uneventful pregnancy in which you are treated like the duchess of cambridge

I will to that!

Hi. I can’t possibly know what you went through but I had twins at 27+6. Went into labour at 27+4, waters never went (born in their sacs), never had the urge to push. Both 1kg too, no identified cause for prem labour. Both were OK after quite a long stint in NICU/SCBU. Didn’t actually deliver at my local hospital (ended up at St Marys in Manchester which is/ was a regional centre for prem babies) which was about 30 miles from home at the time. Post natal care was amazing, so when I got pregnant for the 2nd time, I elected to have all my care (antenatal and then to deliver) at St Marys (we’d moved in between but it still wasn’t my local hospital). I pushed for consultant led care right from the start – did see midwives but had regular appointments (can’t remember exactly when) with consultant. I think I was classed as low risk pregnancy wise (they said it was “probably a twin thing” so as this was only one, I wasn’t high risk) but I think they could see how anxious I was and the midwife was quite understanding. I think it’s a really good idea about the bereavement midwfe. I found that I was OK in the early stages, I got quite distressed about 25 weeks and didn’t leave the house for a couple of weeks around my previous delivery date (other than for work). I also pressed for monthly swabs (for my peace of mind).

As for the delivery – I think only you know how you will fee. For me, I don’t think my twins would be here if I had delivered anywhere else than St Marys so I wouldn’t have contemplated a home delivery in a million years. That’s just me though – the hospital environment was a comfort rather than a cause of distress.

Number 3 arrived at 39+6. She was 7lb 14.5 oz and I was in labour for about 2 hours (it had been 19 hours with the twins). All of the things that I thought would be easy weren’t (breastfeeding – I had expressed for about 4 weeks with the twins as they were fed via an NG tube before they were fed, but b/f for a year after that - whereas 2nd time around, I found it really painful not expressing, waiting for her to feed, sobbing with the pain) and she was clingy. The twins were never clingy because they’d gone straight into incubators then went into moses baskets etc. She would not be put down at all for about 10 weeks (slept on us, had to carry her). I also doubted myself not having that constant support / reassurance that you get from having babies on SCBU. But that all faded quite quickly and everything was good in the end.

Good luck and best wishes.

Getting prem babies home does have its advantages!

I cannot fault the neonatal care we received at King's, at all. As soon as there is an emergency King's (and St Thomas) are exceptional. It's just that they could do a bit better preventing things becoming emergencies.

I think my preoccupation with a home birth is more caused by the fact that, absolutely, unequivocally, I DO NOT want to labour in hospital. The association with what happened there before is too strong and my baby died basically due to midwife error so it's either ELCS or a home birth for me. But that's just my particular circumstances/hang ups.

Getting from 26 to 30 weeks will definitely be a difficult time ...

I had my booking in appt yesterday and we agreed that I will only see one MW. She is also going to try and get me in to caseload care, although there are no guarantees. She's also booked me in to see the consultant already, because I don't want to fret about mode of delivery for 3 months!