Due June 2022 (thread eight)

[Annabell1]

New Thread.

Also got given a load of baby stuff this weekend by a friend. Now have a massive travel system and
car seat, a foldable next-to-me style cot and a huge high chair. Also a steriliser and perfect prep. Would never have bought all this high end stuff myself!!

On the names, DH and I have a list of names we like, which is good. But whenever I ask someone from his family or any of our Egyptian/ Arabic speaking friends what names they like / recommend they always suggest Adam "because it works in both languages." For some reason I find this really annoying. I want us to choose a name that we like and is meaningful to us, not just the most obvious thing that "works". The names we have are meaningful and "work" across languages too, so this is totally a non-issue but I find it really grating.

Also, is anyone else thinking of asking about a maternal request caesarean? I'm really not keen on the risk of severe tearing and incontinence / later life prolapse. I also have some trauma history that means I really want to avoid a forceps/instrumental delivery and I don't think it's realistic to say that I just won't consent to forceps - in an emergency it might be the only option.

I've got a discussion call with the obstetric consultant scheduled, but I don't know how that conversation is likely to go!

@invisibledragon Good luck. I may need a C anyway but will probably request one if not. There are some good threads about it and what to ask, eg what the risk of 3-4 degree tear, emergency sections or other intervention would be for you (age range etc) if you had a natural birth, and whether the section stats they provide include emergency sections which tend to have more complications. Then you can properly weigh up likely scenarios.

There was another really good question that I've forgotten. Drat.

Let us know how it goes

@AlbatrossSociety @fpeg @PeeAche very jealous of all your new places! We moved into the current 2-bed flat before the pregnancyness started and very early on in pandemic - in retrospect we would have moved a little out of London and into something bigger. At the time we were 'using' London more and we thought commute would still be important...

I may suggest 'Pelvic Girdle Pain' to my family as an alternative - they'll probably prefer it :D

Just got back from Whooping cough vaccine - which also includes tetanus and something else - nice little booster for all sorts of things! Feel fine atm, hopefully the aspirin I'm taking anyway will settle any bad side effects..

Also EVERYONE is annoying me today.

Morning ladies. Thanks for all your kind words about my damn cervix! My midwife was really good and chased down my consultant yesterday. Like the private doctor, she thinks the first (NHS) measurement was incorrect. However they haven’t offered to get me it to monitor or recheck, just told me that the measurement from Tuesday’s private scan is normal, ignore the first one, but to be alert for cramping, leaking fluid etc.

So looks like I now have to wait another 12 days until a recheck with the private doctor. It’s gonna be a looooong 12 days of knicker watch let me tell you. I’m also really sad because my mum is coming next week whilst hubby is in Spain with work and i don’t feel like I can be excited about this pregnancy anymore until I know LO is safe up there and not going to make a far too early appearance. I’ll probably bow out of this thread for the next few days for the same reason. So hope everyone stays well x

That's understandable. We'll be thinking of you, and looking forward to hopefully good news in a couple of weeks. Take it easy. X

@InvisibleDragon I’m sorry to say that you’re right about the forceps consent - I said I did not consent to it, but in the end I did because at that stage it would have been riskier for both me and the baby to have an EMCS - it would have involved pushing her back up the birth canal. The team who looked after us were brilliant and it was completely my decision in the end - but it became apparent that I had been very naive thinking you can just say no to forceps. Also, it wasn’t the forceps that did the damage to me - I’d already torn from the ventouse, which is meant to be the “gentler” option. The forceps was just one last tug and she said she would only try a gentle pull. For the ventouse I had two people pulling me back in the table as they tried to pull the baby out!

@InvisibleDragon I wasn’t trying to scare you by the way - you seem to be very realistic and know things I wish I knew. I was assured even at NCT that you could opt for an EMCS at any point over forceps, even if very late on. Well, yes you can in theory, but you could be taking a big risk for both baby and yourself. I thought I was so well informed pre birth, but turns out I wasn’t.

@EarlGreywithLemon @InvisibleDragon reading with interest. I know you can't really predict these things and in the moment you just do what you have to but I really don't want any kind of intervention - no sweeps, no pessaries, and definitely no ventouse or forceps. Reading around it just seems like once you have one thing it begins to cascade and you're more likely to have an EMCS which I definitely want to avoid - I'd rather cut to the chase and have an MRC. But on the other hand if everything seems normal (baby in right position etc.) a VB seems to be the best option in terms of recovery?

I don't really know what to do/ the questions to ask/ conversations to have with my midwife. Because of my anterior placenta apparently it's more likely that baby will be back to back which can result in a more challenging birth which makes me want an MRC. I just don't know! I've had abdominal surgery before and know it's no walk in the park re: recovery but sounds a lot better than recovery from huge tears/episiotomy etc! Just wish someone could magically know a right thing to do and tell me!

@mrkb you might be able to get stats for the likelihood of an unassisted delivery for your situation (age, baby position?) Which could help? I don't know how far they break them down. Has anyone got any more intel?

Joining those of you on the sex bans !! 😂 had 24 week midwife appt this morning who confirmed no nookie. Had to break the news to DP who is gutted as he’s already been patiently waiting since early 1st trimester due to all the issues we had. I’ve told him he’s going to have to go solo for a while.

On a positive note, heard little one’s heartbeat 😍 which was at 144bpm which is supposedly in the good range. Countdown until next milestone at 28 weeks begins now

@mrkb I found this paper really helpful at laying out the risks. It's from 2020 and it had data from hundreds of thousands of births in England, so the stats seem quite robust:
www.bmj.com/content/371/bmj.m3377/

What shocked me was that 43% of first time mums had a "complicated" delivery even in the low-risk category. They defined "complicated" as severe tears, instrumental delivery, EMCS, low apgar score and a couple of other things. In the supplementary info they have a breakdown of what that 43% was and it's mostly tearing, EMCS and instrumental delivery.

It's a very clearly written paper and they are very up front about all the different categories and outcomes (although you have to look at the supplementary info for the really fine detail).

For me, those figures are really high. I think a lot of stats are presented across all births, not just first time births, which masks the high risk in the first delivery.

For severe tears I think the big risk factors (from other papers not this one) are a large baby, back to back or breech labour, the baby being overdue, instrumental delivery and (maybe) an epidural.

It's not as simple as just refusing all interventions though, because you end up swapping one risk factor (epidural) for another (later, larger baby). And then possibly adding the epidural back on top of labor doesn't begin spontaneously.

Although I'm technically in the low-risk category, my baby is tracking quite big (90th centile), he's currently back to back and I'm not far off 35. To me, all those things make me really hesitant to play the numbers game. If I could guarantee a non-complex birth I would be happy but the odds aren't much better than tossing a coin!

Finally had the anomaly scan today; all looks normal according to the sonographer. She didn't give me any measurements - might be a good thing because I'd research each one. Got a nice picture of the head, but most of the time I couldn't make out what I was looking at even when the sonographer pointed things out. Still, I was happy enough to know I was looking at the baby. Going with mid-wife led care from now on so I guess I won't see any more scans

@invisibledragon brilliant - that's exactly what I've been looking for. I wish this type of data was more accessible!

@RoseValleyRambles Glad you found it helpful! Most of the key info is in table 4 (partially shown in my attached screenshot).

@EarlGreywithLemon yes exactly. If my baby got stuck in the birth canal and the doctor said they need to deliver now because he's in distress, of course I would consent to forceps. But for me, the thought of being in that situation and having to accept something that I know I will find frightening and traumatic, as well as likely to permanently injure my body in ways that will also affect my mental health ... Well, I'd prefer not to put myself in a situation where that's a reasonably probable outcome!

@mrkb it’s such a tricky one, I know what you mean. Ultimately I’m afraid no one can guarantee it one way or another - it’s down to what position the baby is in on the day. I know people who had inductions with epidurals which were straightforward and with no tears - their baby was in the right position. I also know people who had an anterior placenta and their baby was not back to back. Our daughter was- my placenta was posterior. And she wasn’t particularly large (50th centile). I know that’s not an answer - but I have so much sympathy with your dilemma

@RubyRoss what a beautiful picture of your baby!xxx ❤️

I didn’t realise having an anterior placenta may cause a back to back issue. I’m planning a water birth and don’t want an epidural. I don’t particularly mind other drugs if I feel I need them, hoping gas and air but it’s never straight forward. My moms birth to me wasn’t great. She had pethodine too late and I came out high. They had my mom prepped for a C as I was face first but ended up being too late, I was coming out the wrong way regardless. They also tried to induce a couple of times and nothing happened, I was just too damn stubborn apparently.
Hope mine can be straight forward as can be but my main goal is just to get the baby out safe and alive. 😬 you’d think after millions of years we’d have evolved to perfect labour and make it easy. 🤦‍♀️

@RoseValleyRambles @InvisibleDragon @EarlGreywithLemon thanks for your replies! Thank link looks so helpful and I had no idea the risks were actually that high. Will definitely be spending some time reading the full study. No one mentioned what centile my baby is in at the 20 week scan - I was sent away with a piece of paper with a series of charts so assume I can find out on there? I'm also not too far off 35 either so know that even though I don't feel ancient my body isn't a medical spring chicken! My mum had me at 27, was induced 3 weeks early, had an epidural and apparently it was a breeze but obviously all births are different!

@Vimto1991 water birth is my ideal plan too! Basically I want my ideal birth or I want an MRC and want to avoid anything in between if I can haha. Best laid plans I'm sure...

Does anyone know if we have another scan between now and the big day? Also feeling quite envious of everyone's 24 week midwife appointments. Mine only does 28 weeks which I know isn't far off now but I feel like I've suddenly got so many questions! Strongly considering booking a private scan towards the end if not as I think it will help me make some clearer decisions based on baby's position.

@Vimto1991 yeah the position you give birth in and the warm ness of the water really does look like a better labour set up, also looks a lot calmer when I saw a video of the hospitals room with the bath in. They have diffusers and light dimmers. Just hope the room is free!!

My midwife appointment is 1st March so around 26 weeks! I don’t believe there is another scan unless the midwife is concerned about the size or perhaps position of baby.
I considered another private as I’d like a 4d scan, but I’m starting to read too many ultrasound scans can be harmful, not sure what anyone else has read? So far I’ve had four scans. Two private, two NHS. (One private was to check baby was okay after car crash as NHS didn’t want to check!)

@vimto1991 We're planning on a 4d scan too, and asked sonographer at our 20wk if there were any risks or issues. She said it was fine, which is reassuring. Given we're in for monthly growth scans already, I assume one more ultrasound won't hurt.

@InvisibleDragon yep - she was in an awkward position (back to back and then half turned) and there was no way she was coming out on her own. Then she started getting distressed and I got some bleeding. The registrar said afterwards she thought I was having a placental abruption. So was I going to put her in danger and have her pushed back up and then have a c Section? Of course not, I wanted her out right away. And good thing I did too because I then had a massive haemorrhage- not sure what would have happened if we waited around.
Weirdly it wasn’t traumatic at all though, and I think that was down to the team - I can’t tell you how lovely and reassuring they were. When we were in theatre everyone looked so calm and in control, like a well oiled machine and they were so nice and friendly I just couldn’t panic. It really felt like “they’ve our backs here, they know what they’re doing and it will be fine”. I had also had an epidural and had rested so felt calm and in control myself. The recovery wasn’t pretty, I won’t lie. But I actually look back on the birth with fondness rather than distress.

Hi all! Had my 20 week scan and baby is looking fantastic 😍😍 After all my worries she looks happy and moving a lot!! Sonographer was lively explaining everything she was looking at and she even let us record a short video 😍😍 I'm totally in love!

@RoseValleyRambles @mrkb @EarlGreywithLemon This was the paper I was reading about risks for severe tearing. This is a big cohort study of first time mums, so the data is very high quality, although it was done in Sweden so risks might not translate directly to the NHS:
bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-017-1251-6

The key finding from the abstract is this:
The risk of severe perineal laceration increases with duration until the third hour of second stage of labor. Instrumental delivery is the most significant risk factor for severe lacerations, followed by duration of second stage of labor, fetal size and occiput posterior fetal position.

Occiput posterior position is with the baby's eyes looking up - so back to back labour.