Giving birth after a premature birth

[Dildals]

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

Thanks for the response annbag.

I'll move this to the multiples board and see whether I get more of a response there!!

Annbag 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. Thought maybe that would put your mind at 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.

They lie. All hospitals lie.

I had ds at 32+6 so I'm a high risk of another prem.

At 32+2 I went into labour this time, and they stopped it. I had steroids. And a positive fetal fibronectin test.

I have polyhydramnios which increases prem labour risk. I also have GBS.

I'm now only a few weeks off term and I'm NOT HAPPY! I want this baby out

To summarise, I wouldn't worry. Chances are you'll have an entirely normal pregnancy.

My first was born at 33wks following PROM. I was ill so it was put down to that, but to be on the safe side for my second I had cervical length monitored from 20 to 24 weeks (it got longer) and steroids at 32 weeks.

I thought I'd be really stressed about having another prem birth but actually as it was totally out of my hands I ended up not thinking about that and stressing about giving birth instead. My second was born at 38weeks, and it was a far faster and easier labour than the first despite her being much heavier.

With my third pregnancy my planned care was the same and i assumed i'd go near if not to term, but baby had other ideas - PROM followed by my quickest and easiest (physically not mentally!) labour at 30. Who knows what's going on with my body!

I look back and cherish the time directly after my seconds birth, being able to hold her and take her straight home. To a degree i had to just get on with it because of the focus on no. 1, and with 2 being bigger and stronger I worried much less about her being warm enough, feeding etc.

I did ask for some extra midwife visits in the first week for reassurance as I had no proper experience of caring for a newborn, and they were great.

Mine were all single births and I have never been through the trauma of losing a baby, so cannot imagine how you are feeling, but I hope this helps.

So sorry you lost twin 1, and I hope twin 2 is now doing well.

I had PPROM at 34 weeks, went into labour and DD was born shortly after. I spoke to a consultant who reviewed my hospital notes. He believed the most likely explanation is an infection of some kind weakening the amniotic sac (because there were no contractions or cervical opening until a few hours after the PPROM). Apparently this is just "something that happens sometimes" and no more likely to happen to me again than anyone else.

As regards antenatal care: Glad you've been referred to the prem surveillance clinic. It's unique to St Thomas's I believe, so lucky that you are there!

Easier/quicker birth: I don't know yet! (I'm 34+4 with DC2...) Birth was fairly quick and easy with DD, for me at least - was rather rough on DD though. I have heard that, counterintuitively, bigger babies can actually be easier to push out because they have more force and momentum iyswim.

I understand wanting the "fantasy" home natural birth. I strongly felt that I wanted to go to the MLU with DC2 (not an option now as I have gestational diabetes). I think it's part of trying to get over DD's birth - which was not nearly as bad as your experience of course - this idea that I will have a "normal" birth and a "normal" newborn so I'll get that experience I never had with DD. However, what I've realised is that very few women get the "fantasy" natural birth anyway. So whilst it might be something to hope for, bear in mind there are a lot of reasons that you might not get it... Also, would you be able to relax and enjoy a home birth, or would it just make you more anxious? Maybe aim for the MLU as a mid way option?

Postnatal care: I know what you mean about not knowing what to do with a "normal" baby! But, you're not starting from scratch as you have looked after a baby, plus there are a zillion books about "normal" babies and friends who've had them and can advise... I tend to think that having coped (just) with a prem (who was also a difficult feeder and sleeper) I must be able to cope with a term baby... surely...

Emotional support: I think it's really personal to you what would help you most. I wonder if SANDS might have any ideas? Or as a pp suggested, the MN bereavement board.

I'm so very sorry for the loss of your baby - absolutely awful that the midwives didn't monitor the twins properly.

My first pregnancy was twin girls, born very prematurely weighing under two pounds each. Sadly, like you, I lost one of daughters. She survived birth but passed away whilst being treated in the NICU.

Glad that your cervical length is going to be checked and that you are on the INSIGHT study. I was also told that the twin pregnancy was likely the reason that I went into labour prematurely but, on closer inspection, it turns out I have an short cervix. I was treated with progesterone.

I have had two children, both born at term, since the twins. I identify with a lot of what you have written in your first post, down to considering an ELCS (I really didn't trust my body after the twins) and I also felt that I would not know what to do with a term baby. My surviving twin was in NICU for four months and came home on oxygen. I felt very well prepared to look after her as had a lot of time to 'learn.'

My second labour was about the same length as with the twins but much slightly more painful. I think this may have been partly because I had an induction at 38 weeks and didn't seem to have any breaks between contractions. DS1 also had a massive, 100th centile head although he was not a huge baby, only 8lb 11. Third labour also very quick, so quick that I inadvertently had a home birth.

I think you might do well to hire a doula if it isn't prohibitively expensive? I found a few of the midwives quite unkind and it might be nicer to have one person with you throughout who knows that this process might be particularly difficult for you emotionally. The midwives were quite snappy with me when I panicked and told me off for getting upset - which didn't help. Surprisingly.

Didn't have any of these problems after DD3 as the amazing ambulance staff and lovely community midwife fixed me up and I didn't have to go near the hospital (which I have a bit of love-hate relationship with!)

Holding DS in my arms immediately after his birth remains one of the very, very happiest memories of my life Unbelievable that this big, fat bouncing baby was really mine after my poorly tiny girls.

I found quite a lot of support online via infant loss support groups. Real life support I found a bit harder to come by. The health visitor might be useful? I wonder if an organisation like the La Leche League might be able to send a volunteer to help you with breastfeeding if you are finding it difficult to get out and about. Both my term babies were very keen feeders so I was lucky there.

I've heard that thing about prem babies being more difficult births too... from a midwife if I remember correctly!

For me, there was definitely that element of my body having done it before making it easier, and me recognising what was happening at each stage. I was fortunate as they were all head down and in nice positions coming out, I know not all babies are so helpful!

I opted for midwife unit - obstetric unit was next door if I needed transferring. I didn't fancy an ambulance journey in the throes of labour. I worried how I'd cope without the reassurance of the monitors after such a medical birth, but I as she was bigger I could feel her moving between contractions, and to be honest my only thought was getting the baby out to stop the pain!

For me, the feeling of isolation, panic and lowness I felt after no 1 hasn't been repeated with either subsequent birth. I think being aware of my emotions and the possibility of feeling low helped. My situation is very different to yours though. Wishing you all the best for pregnancy, birth and beyond.

minipie You're right about lots of women not actually getting that 'fantasy' home birth. I guess it is more a fantasy than anything else. I fretted so much about mode of delivery first time round and afterwards realised that it really didn't matter much how you deliver them, as long as they're delivered safely. But now, being pregnant again, I seem to have trouble taking my own advice!

I would only consider a home birth if I can get case load care. I would absolutely unequivocally NOT do it if I just get some random MW to rock up at my door. I need to develop a bond and an understanding with this MW. Understandably I don't want to end up with some dud MW again! That's also my problem with MLU. I DO NOT want a hospital birth (which is how I end up with the home birth idea, by default), I cannot bear the thought of labouring in hospital. So if I cannot get case load care I will ask my consultant if I can have an ELCS. It's a big step to get comfortable with the risk of a home birth, meaning, I would want to know everything about how they plan to monitor baby and make sure it comes out alive. You are right though, if I would end up being transferred to hospital for whatever reason, I would find that really hard.

I am going to go to a SANDS meeting locally, there is a special Pregnancy after Loss group. I also left a message with the King's bereavement MWs if I could have a chat about how to get the right support in place (and they know the St Thomas bereavement MW too).

Re postnatal care - there's quite a few options. If I have an ELCS I will be in hospital for a little bit anyway. There's doulas and independent MWs that do postnatal care too and of course lactation consultants. My friend had a lovely doula and the cost of a doula is a lot lower than an independent MW, I would have to have a chat with her whether she thinks she can offer what I need. I am not sure whether the midwives in London have capacity to do extra visits. Either way, it seems I will be able to throw money at the problem if needs be.

Whistling Your story made me cry, although that's not hard to achieve nowadays. Coming home after 4 months on oxygen, they must have been super prem. Being in NICU for a considerable amount of time makes you know too much iykwim. Also understand your love-hate relationship with the hospital. It's like a black hole that sucks all the energy towards itself. I am often surprised it's actually still there and hasn't imploded.

It's funny isn't it, how sometimes you can get better support online, from people you don't know, then from the people that are your real life friends. Especially on baby loss I think because it is still such a taboo topic. I literally had friends avoiding me … it was awful … no one wants to be confronted with 'what could happen'.

How did you feel about your term newborn related to your mini-girl? I am sort of thinking I would feel guilty in a way, although I am not sure that's the right emotion. She's still so small for her age and had such a rough start and then to have a sibling who's in rude health … it just seems unfair if that makes sense?

Anyway - I had my booking in appt today and arranged that at least I will only have to see the MW, not a different one every time. She's also going to try to get me on to case load care, she suggested that herself immediately. She's also referred me immediately to my obstetrician to discuss birthing options, because I don't want to fret about this for 3 months!

Thanks for all the kind words and advice.

Dildals Didn't mean to make you cry Think I spent most of my subsequent pregnancy on the verge of tears!

Glad that your booking in appt went well - I think it is really nice not to have to see a different MW every time. I started to dread going over the whole story every time I saw someone new.

The contrast between my term babies and my minis I have found very painful at times. I remember, very keenly, thinking 'THIS is what they could have had, what I could have had with them' after my son was born. It was just so starkly different, he could breathe on his own, I could hold him close, cuddle him and feed him. Same with my third girl and I had the advantage of being able to hop back into my own bed shortly after! It just brings it all home how horribly different a very premature birth is.

It did stir up strong emotions, definitely a strange sense of injustice. Some guilt as you say. Bitter regret. I do try not to dwell on it but it is hard not to note the differences when you have had experiences at opposite ends of the scale.

Poor old mini. She really did have it tough as she was super prem, all the time in hospital and issues that she struggles with even now, years down the line. Was quite hard when her younger brother's speech became clearer than hers

That's OK. As I said it's not hard to achieve these days! Like you said, I am spending most days on the verge of tears.

I can imagine ...

Sounds like I have to prepare myself for some strong emotions ...