Home Birthers & Hopefuls!

[chuck]

I hate everything about my last labour and birth and I thought I was well informed.

I got the classic cascade of intervention ending in an EMCS even though baby was never in distress...all because I wasn't running to their timetable.

Got to 41 weeks - had a sweep

Went into labour - baby not ready is back to back

Go to birth centre - make maybe 1/2cm progress in 8 hours transferred to hospital made the mistake of getting pethadine to ease the journey - slowed everything down.

Ignored in hospital for hours - am exhausted but told not to eat just in case.

Given a drip - asked for epi to get some rest (STOOPID alert why didnt i get on all fours?!)

Many hours later I'm 9.5cm, no manual removal of the lip offered, just turn up the drip do another hour...same again so off to theatre because it's gone midnight.

I look back at it and think what a dumb ass I was! Why wasn't I given any advice on turning the baby? Why did I ask for the4 pethadine and then the epi?

I really feel bad about it still, the guilt is overwhelming sometimes. Then I just feel angry at the hospital for being so horrible.

 

[PeanutBean]

Chuck. I totally get where you're coming from. I feel the same self-blame alternating with blaming the hospital. Here's mine:

Waters went at 1am after no sleep the night before from coughing all night, contractions start almost right away
3am went to hospital to get checked as baby not moving much
9am MW visit, get informed I'll have to go to hospital at 18 hours for antibiotics - no pressure there then
3pm - take a homeopathic remedy and contractions suddenly pick up, I begin to feel a MW should be with me so we call
New MW arrives (the only one I ever didn't like from my aquanatal classes) with trainee; immediately does an internal against recommendation because she thinks my waters went at 1pm and that I must be progressing fast, 3cm dilated.
Yesterday I found out she spent the next two hours trying to dissuade DH from filling the pool and was clearly VERY negative about my homebirth
Told my time is up, MW leaves about 6pm and I get to hospital about 8pm
Into the pool, and on to the antibiotics
My mum is angry that we are left alone too much and the pool water is too cold making me ill; I get a sudden change in contractions that is very intense so they tell me to push. I'm all "how?!". After a bit of pushing to no avail they get me out and find I am STILL 3cm!
They now persuade me to take pethidine and lie down, I succumb and contractions die back to the paltry one every 5 mins. Time passes as I fall in and out of sleep between contractions.
6am they come to put me on syntocinon for non-progression and persuade me to take an epidural as the contractions can be bad on the drip and I'm shattered. I agree.
Epi only works on my legs, no anaesthetist available to move/remove it ever.
AT 10am I am finally dilated but entirely broken. I simply can't push. I am paralysed in both legs and can't feel my pelvic floor and in total agony from the contractions whilst I am stuck on my back. After half an hour I beg for a ventouse and get the inevitable episiotomy.

I highlighted what I consider to be their errors in red and mine in blue.

I spent a year feeling useless and broken and no-one quite seemed to get why I cared. In the second year I've been thinking more about the experience and began to draw conclusions about mismanagement. I then read the birthing made easy book a few weeks ago which I felt confirmed all my suspicions and have now gained new knowledge about the antibiotics.

 

[Jenniflower]

I just want to give you a hug chuck . Thank you so much though for sharing your story and experience with all of us. As you were all saying it's crazy just how misinformed, even when you think you've done you research, women are going into labour. It makes me so angry that the medical staff just seem to take advantage of women in labour while they're in such a vulnerable state. They should be more supportive!

PeanutBean: All your research you're doing is amazing! I keep learning new things every time you post! I'm glad you're feeling a bit more comfortable and confident in having your home birth even with the GBS. When will you be having a talk with your midwife about this?

Just wanted to add about the waters breaking, I know it's different with GBS and all. But my midwife informed me during my home visit that if my waters break it's their normal procedure to bring me in after 48 hours. I just had a big shocked look on my face when she said so as I always hear of places only doing the 24 hours. I told her I was very comfortable with that. Just to give you more insight that there are places out there that have 48 hours as their rule of thumb. (Now why they're decent on waters breaking, and stupid on weeks of gestation is beyond me )

 

[PeanutBean]

I was already working on the waters breaking thing, someone on here was 72 hours so I PMd and she told me it was the hospital policy! I was going to use that to defend my case but now I will just go for the antibiotics at home, given the positive swab.

The thing is there are sooooo many things that can go not to plan one way or another that it's just not possible to be prepared for all of them, or at least certainly not your first. I had researched about meds and active birthing etc and the MWs here are great so I had a lot of faith in my homebirth experience. My downfall was that though I was open minded about needing to go into hospital (before the birth) I knew nothing about the waters issue and I also couldn't have been prepared for the way I would feel. Nor did I realise the pressure to keep to their time rather than my own. I am sure had I been left alone I would've laboured and been tired and probably slept a bit and managed to deliver myself at home.

You hit the nail on the head jenni, we are so vulnerable. And half the time we don't even know how it could've been better, how the medics could've acted differently but didn't want to be inconvenienced. We walk away thankful for the help, thinking gosh, 40 years ago I or the baby might've died! When really 40 years ago we probably would have had an entirely normal birth at home. It makes me so bloody angry!

 

[snagglepat]

Just to add to the waters thing, when I was in hospital on Wednesday with the query on my waters having gone I was told their policy was to wait 48-72 hours before intervening. This was before they established mine hadn't but my immediate response was, oh good, another 24 hours! I'd have leapt off the bed and left there and then if we hadn't already agreed what we were doing with our IM. As it happened, it was after 2pm and their last 'induction slot' is at 3pm and it was booked so whatever happened they wouldn't have had me in to start an induction until the next day (as if I'd have agreed to that anyway if baby and I were showing no signs of infection).

So yeah, it's daft. But the fact that every hospital has a different policy just goes to prove that no-one really knows what best practice is. The NICE guidelines are the best we have to go on and the last time I checked they were still at 96 hours.

Gina. x

 

[Bournefree]

oh ladies thank you for sharing
It's so sad when really you needed comfort, reasurance, support and help to relax. You are not to blame and shouldn't feel any guilt!!! You are right, you are very vunerable.

It really makes me quite upset to hear how you feel about it all

 

[chuck]

Thing is what I said there isnt the half of it...there were so many other little things...the OB not ever having seen the NICE guidelines for how to treat a woman in labour, having to ask to have my cathetar emptied, them breaking my epi, being force to do another hour with drip turned up, only getting maybe 20 minutes with hubby in recovery before going to ward alone, not being told when baby was out...all sorts.

 

[Jenniflower]

Thing is what I said there isnt the half of it...there were so many other little things...the OB not ever having seen the NICE guidelines for how to treat a woman in labour, having to ask to have my cathetar emptied, them breaking my epi, being force to do another hour with drip turned up, only getting maybe 20 minutes with hubby in recovery before going to ward alone, not being told when baby was out...all sorts.

Interesting about the OB never even seeing the NICE guidelines. I think that's horrible! Makes me want to print them out now and attach to my birth plan.

 

[PeanutBean]

Thing is what I said there isnt the half of it...there were so many other little things...the OB not ever having seen the NICE guidelines for how to treat a woman in labour, having to ask to have my cathetar emptied, them breaking my epi, being force to do another hour with drip turned up, only getting maybe 20 minutes with hubby in recovery before going to ward alone, not being told when baby was out...all sorts.

Blimey chuck. Did you make a complaint to patients thingemybob or the midwife supervisor?

 

[luna28]

The NICE guidelines are the best we have to go on and the last time I checked they were still at 96 hours.

Gina. x

Actually the NICE Guidelines reccommend induction of labour after 24 hours of rupture of membranes.

"Prelabour rupture of membranes at term
1.2.3.1
Women with prelabour rupture of membranes at term (at or over 37 weeks) should be offered a choice of induction of labour with vaginal PGE24 or expectant management.
1.2.3.2
Induction of labour is appropriate approximately 24 hours after prelabour rupture of the membranes at term"

https://www.nice.org.uk/nicemedia/live/12012/41256/41256.pdf

 

[snagglepat]

Thanks Luna. That's why I said 'last time I checked'. That was a few years ago when a client was going through a prolonged rupture and I was aware I hadn't checked recently.

It still applies that with hospitals having such varied protocols there really is no sense of what is and isn't best practice. A postcode lottery for amniotic fluid.

Gina. x

 

[nikki-lou25]

My waters broke at midnight and I was told that I had to have given birth by midnight the following night to be able to stay at home. Luckily he came at 10pm, not that I'd have gone without a fight. I know the policy is different all over the country, one of our buddy group for Dec had intervention after 18hours without GBS. I like Snagglepats use of postcode lottery for amniotic fluid - that is SO true.

 

[PeanutBean]

Thinking about those NICE guidelines, as they refer to induction presumably they are for women whose waters go but labour doesn't start. My labour started immediately and I was told I was in because of the infection risk. So GBS aside, I wonder what the guidelines are in that situation?

 

[MandaAnda]

Thinking about those NICE guidelines, as they refer to induction presumably they are for women whose waters go but labour doesn't start. My labour started immediately and I was told I was in because of the infection risk. So GBS aside, I wonder what the guidelines are in that situation?

If I were in the situation where my waters had broken but labour hadn't started, I would refuse all internals, as they could introduce the infection they're worried about. I'd be happy to monitor my temperature and let them listen to baby's heartbeat, but I personally don't think PROM alone is reason to induce.

AFAIK, the NICE Guidelines say that waters shouldn't be ruptured for more than 24 hours now (it was up to 96 hours before). Here's what the Home Birth site says. I'll have a look around to see if I can find the current guideline (page 14, although the rest is interesting as well).

PROM – care of the woman
Advise woman that:
● risk of serious neonatal infection is 1% rather than 0.5%
● 60% will go into labour within 24 hours
● induction of labour is appropriate after 24 hours
No antibiotics for woman or baby without signs of infection
If evidence of infection, prescribe full course of broad-spectrum antibiotics

BUT

Until induction or if the woman chooses expectant management
beyond 24 hours:
Do not offer lower vaginal swabs and maternal C-reactive protein
Advise the woman to record her temperature every 4 hours during
waking hours and to report immediately any change in the colour or
smell of her vaginal loss
Inform her that bathing or showering are not associated with an increase
in infection, but that having sexual intercourse may be
Assess fetal movement and heart rate at initial contact and then every
24 hours following membrane rupture while the woman is not in labour
Advise the woman to report immediately any decrease in fetal movements

You wouldn't want to swab because it introduces infection. A CRP is an infection marker.

ETA: Huh, just reading through some of the pregnancy and birth guidelines on NICE... How funny that, at 38 weeks, there are some things that should be discussed in light of the possibility of the pregnancy lasting over 41 weeks, one of them being expectant management. Hmmm, why do I feel that it's the woman that ends up bringing up this option and not the HCP?

 

[PeanutBean]

^ That's really interesting and shows my care was definitely wrong last time, not least if the NICE guidelines were 96 hours at the time! My mws said they wouldn't do internals. The one that did at 14 ish hours after was shit and misread my notes or something as she thought they'd only gone a couple of hours before and presumably thought I was progressing fast. I don't know. It's a mystery! God if I knew then what I know now I bet I wouldn't have been physically and mentally damaged 2 years on as I am now.

I'm refusing all internals this time anyway.

 

[MandaAnda]

I'll be refusing internals next time as well. My day shift m/w said I was 6-7cm 4 hours after ROM before handing over to the night m/w. The night m/w didn't see a need to do another, but the obstetric registrar came in a couple of hours later and asked to examine me because "one person's 6-7cm can be something else, and I examined her when she came in". I was at the stage where I didn't care and let her. She said to the midwife, in my earshot, that I was only about 4cm. I knew I could do it if I was 6-7cm, and the pronouncement of 4cm set me back so much mentally that I asked for an epidural. They put an IV line in, and I'm lucky that both anaesthetists were in theatre assisting with a crash c/s. When I was becoming very irritable about another hour later, my m/w asked if she could examine me one last time (agreed, as I was so sad with the way things were going downhill), and she said, "You're not going to get your epidural, I'm afraid... Because you're fully dilated." I think the night m/w trusted the day m/w, could see I was progressing well and didn't believe the doctor, which I think is why she did the last one.

I hope next time to stay at home. I won't be asking for sweeps because I'm worried that I may go "overdue" - if I do, I do and will just do expectant management. And no internals unless I ask for them.

 

[luna28]

The current NICE guideline reccommending induction post 24 hours came out in 2008.

 

[Amy_K]

I hope next time to stay at home. I won't be asking for sweeps because I'm worried that I may go "overdue" - if I do, I do and will just do expectant management. And no internals unless I ask for them.

What is expectant management?

 

[Mervs Mum]

Luna are you here just to bum everyone out??!!!

 

[PeanutBean]

^ lol Forrunately that bit didn't apply to me whenever the guidelines came out!