Why did my MW make me get out of the tub?

[RJones1204]

My first DD was born at the hospital (all the typical PITB interventions), DS was born at home. And now my latest addition was born at home, she is 3mths old now. We were looking forward to another uneventful home waterbirth. I LOVED my water birth with DS. Everything was straight forward, quick, and nothing dramatic happened. But with this birth my water broke in the tub and meconium came shooting out. My MW got all serious and said that I needed to get out ASAP. So in the middle of having to push I some how managed to get out of the tub and on my bed. DH practically pulled me up and out onto the bed. It was the hardest thing I have ever done in my entire life, was managing to get on my bed. OMGosh I thought I was gonna die:
So anyhow it took about 20-30mins of pushing and LO arrived. Bright eyed and bushy tailed. They suctioned her pretty vigorously to suck any meconium she might have breathed in. My placenta wasn't coming out and it took awhile to get things moving. I was bleeding pretty badly and so they gave to pit to get the placenta out. It was fine and came out in one piece. But the blood was pretty shocking. So finally DD and I were settled. After the birth it was determined that the meconium wasn't that thick/ clumpy cause it just dispersed into the water and blended in.
Anyhow I was reading on a BBC birth group that one mama passed meconium and delivered her baby herself her MW never said anything about the meconium. Why was mine worried? I am a little disapointed that maybe I went through something that I didnt need to go through. Obviously I would have gotten out of the pool after the birth cause of the bleeding. But was it really necessary for me to get out with the meconium?

[OTMomma]

I think you'd have to ask your midwife to know exactly what she thought at the time- however, I think the concern of a baby who has aspirated mecconium having trouble breathing or needing other emergency help is greater, and its easier to do that on the bed- not worrying if the cord is long enough, baby is in the tub etc. In most cases, baby is probably fine, and we can all guess after the fact, but I would guess your midwife was being cautious, which I would want for me and my baby.

[nashvillemidwife]

What did your midwife say when you asked her?

Babies who are in distress may make gasping motions as they are being born and can inhale water. I would have probably told you to get out too. It's great that your baby was fine, but better safe than sorry. A lot of midwives aren't aware of this risk, so it could be that your friend's midwife didn't know better, or that her circumstances were much different.

[isabellamirac]

the birth center where i had my son had clear amniotic fluid as a pre-rec for waterbirth - reasons as PP described

[erin_brycesmom]

I'm sorry mama! I'm not an expert but I don't think there is a reason to get out simply because of the presense of meconium at the end like that. I would ask your MW why. I wouldn't assume a baby was in distress simply because of meconium as a baby is coming out. But then again, I would question your MW as to why they suctioned when your baby was bright eyed and bushy tailed. That doesn't sound evidence based either. I had mec when my water broke as well and I continued to labor and birth in the tub. My MWs did not ask me to get out nor did they suction the baby since he was vigorous.

eta - I just googled a bit and found that the consensus seems to be that mild and moderate meconium is perfectly fine for waterbirth but severe meconium is a reason to get out. I would consider Barbara Harper to be the leading expert on waterbirthing and she states that meconium used to be thought of as a reason to get out but not anymore. She states the same thing as above - mild and moderate mec is ok and perhaps even better to birth in the water, severe mec is a reason to get out.

[TheRobinsons]

My thoughts are also that mec is an indicator that bub is in distress, and bubs in distress can try to breathe as they are born, over-riding their usual reflex to not breathe until they are out of the water - so bub may have been at risk of drowning.

I am sad that you didn't get the waterbirth you dreamed of. I think it must be so hard for midwives, who are human to get it right all the time when we look back on their actions with hindsight. Especially when this is all happening while you are very distracted and in transition - and hardly ready for a conversation about the risks and benefits of continuing in the water.

My second midwife had a little panic with my blood loss after my waterbirth and asked me to get out of the tub. I was a bit disappointed at the time (because my blood loss was fine) but it must be a difficult line to tread between being cautious and being negligent.

Congratulations on your new baby. Hope everything else is going well.

[nashvillemidwife]

Originally Posted by erin_brycesmom

I'm sorry mama! I'm not an expert but I don't think there is a reason to get out simply because of the presense of meconium at the end like that...
eta - I just googled a bit and found that the consensus seems to be that mild and moderate meconium is perfectly fine for waterbirth but severe meconium is a reason to get out...

I don't really think it's fair for us to be second-guessing the clinical judgment of the OP's midwife based on the limited information we have. It doesn't really matter what Barbara Harper says or what you google on the internet when you're the one there at that particular moment whose decisions are responsible for the life of that particular baby. Hindsight is 20/20. It's great that the baby came out "bright eyed and bushy tailed" but you can't know that's going to be the case. It's also difficult to assess how heavy meconium is when water breaks in water. She says it "came shooting out", and to be able to see that in the birth pool is a red flag that this baby might be better served to be birthed in air.

[Maggi315]

I agree with the other midwives, it's hard to be a monday morning quarterback. But I think that the midwife seems to have acted appropriately. Part of midwifery is the "art" and trusting instinct. If this midwife wasn't happy with the amount of mec and felt the mom needed out, then I would think that's a legitimate reason. Even if it turns out maybe she didn't, midwives have to be able to go with our gut a little bit. If midwives can't do that during the birth, then you might as well have a hospital birth. You have to trust that your midwife is doing the right thing in the moment. I agree with Nashvillemidwife, you can google all you want, but in the heat of the moment decisions are made and the midwife sounds like she saw some red flags and decided to be conservative. And that's totally appropriate.

If someone had mec during push out, I would serioulsy consider getting mom out. I can't see in the water with mec, so how do I know baby is doing ok? How do I know if baby needs any help? Mec isn't always something to be worried about, but it is something that needs to be respected and dealt with appropriately. it sounds like that's exactly what your midwife did.

[erin_brycesmom]

I think the OP's questions are fair. I don't think it's fair for us to say that the evidence doesn't matter because MWs are responsible for a baby's life. The evidence matters even more precisely because the MW is responsible for the baby's life. Based on the information the OP provided (after the birth it was determined that the mec was not that thick), I think it's reasonable to form the opinion that it was not necessary to get out of the tub. Barbara Harper is an excellent source for the safety of waterbirth.
Personally, I applaud the OP for processing her birth and questioning what happened.

[xelakann]

Really? You really think nashvillemidwife is saying it is "ok to ignore evidence and practice out of fear". Come on. :

I agree she should ask her midwife instead of MDC... it is probably Dr. Google and MDC that is causing the OP to question the decision of her midwife in the first place.

Which questioning is fine, but go to the source.

[Maggi315]

no one said that evidence or research base is to be ignored. What we said is that it is difficult to know what was going through the midwives' mind. Maybe she saw things the op didn't. Maybe she didn't like the color of the mec, there is a big difference between "old" mec and fresh mec.

And no one said the OP shouldn't be processing her birth. But it is very hard to second guess another midwives' actions without hearing her side. I would recommend talking with her about it and asking her what happened and why.


And in my opinion, it is precisely because I am responsible for that baby's birth and life that I might have to make decisions that are not popular, and I might not even have time to explain them...and I might have to make a judgement call...it's not the kind of job we can go look up stuff in a book or the internet, but rather have to perform based BOTH on research and instinct.

[erin_brycesmom]

Like I said, I don't think it's fair to say that the evidence doesn't matter because a MW is responsible for a baby's life. In addition, I have already suggested asking her MW. I haven't, nor will I, comment on what was potentially going on in the MWs mind at that time. My responses have only been answers the question the OP asked.

[nashvillemidwife]

Originally Posted by erin_brycesmom

I'm sorry mama! I'm not an expert but I don't think there is a reason to get out simply because of the presense of meconium at the end like that. I would ask your MW why. I wouldn't assume a baby was in distress simply because of meconium as a baby is coming out. But then again, I would question your MW as to why they suctioned when your baby was bright eyed and bushy tailed. That doesn't sound evidence based either.

This comment sounds like you are expressing a formed opinion that the midwife's decisions were not evidenced based.

[georgia]

I am a little disapointed that maybe I went through something that I didnt need to go through. Obviously I would have gotten out of the pool after the birth cause of the bleeding. But was it really necessary for me to get out with the meconium?

I can totally understand the disappointment! I would definitely ask your midwife and process it with her if you've not. IME, it's so interesting to hear the mw's POV about a birth. Totally different perspective! So much is situational, IME, and I would imagine there are many factors that could have lead her to her suggestion that you exit the water immediately. She was probably erring on the side of caution, which, IMO, isn't a bad thing

[Epona]

Originally Posted by georgia

I can totally understand the disappointment! I would definitely ask your midwife and process it with her if you've not. IME, it's so interesting to hear the mw's POV about a birth. Totally different perspective! So much is situational, IME, and I would imagine there are many factors that could have lead her to her suggestion that you exit the water immediately. She was probably erring on the side of caution, which, IMO, isn't a bad thing

Originally Posted by RJones1204

and meconium came shooting out.

This does not sound non-alarming to me. It sounds like it would raise red flags for most people. "and meconium came shooting out." does not sound like a little bit. It's fantastic that your baby was bright-eyed and bushy tailed, but that has no bearing on precautions taken before people could see that she was bright-eyed and bushy tailed. And suctioning her was a fair decision. Meconium aspiration is no laughing matter. If meconium did indeed come shooting out, then your midwife certainly was doing what was thought best for our baby at the time.

[erin_brycesmom]

Originally Posted by nashvillemidwife

This comment sounds like you are expressing a formed opinion that the midwife's decisions were not evidenced based.

Yes, of course! That is not evidence based. And?

[Maggi315]

I think the problem is your are basing your opinion on the midwives' actions without fulling understanding why the midwife did what she did, how she decided on that, and trying to say whether it is evidence based or not. Barbara Harper is a great resource, but even she will tell you that evidence based practice is necessary in a responsible practice, but in the end it comes down to the midwife's decision based on what she is seeing AT THE TIME. And in this case, heavy mec that is shooting out is something that would concern every midwife out there, including water birth proponents.

it sounds like you might have an axe to grind, but this isn't the place for that, the OP asked for our opinions, you have a right to give your opinion, and so does the administrator, and so do the midwives. And then leave it at that....not sure what point you are trying to make? That your opinion means more than anyone elses here? That's not true, no matter how much googling you have done, it's just not....and I don't see how it is helpful to the OP who is asking for a variety of opinons and got that...that's why you had your post edited, because it's not helpful or accurate...

[erin_brycesmom]

I think the problem is that I'm the only one that is answering the OP's actual question. The rest of the responses are given as if the question was "did my MW make the right choice at the time?" If she had asked that, I wouldn't have had an opinion. She provided more information than *JUST* what happened AT THE TIME. She also gave info about afterwards such as saying what was determined AFTER the birth regarding the severity of the mec. Whether the decision was best at the time is totally different than asking whether it ended up being "necessary" in the end. There are plenty of choices I've made that I feel were best at the time even if they didn't end up being "necessary" in the end. I've only responded more than once because others have addressed what I wrote. Frankly, I think it's completely bizarre that my having an opinion has caused such a stir.

[nashvillemidwife]

Originally Posted by erin_brycesmom

I think the problem is that I'm the only one that is answering the OP's actual question.

Actually, you're the only one not answering the OP's question. Everyone else is saying "because of the meconium!" and you're responding with "but google says that's not evidence-based!"

[Maggi315]

Having an opinion is NOT the problem, having an opinion that you think is better than anyone elses because you googled it is....actually, the question is WHY did the midwife do what she did...and we all gave some scenarios and some reasons,

-because of heavy mec
-because it came shooting out
-because she felt uncomfortable and wanted to see how the baby would do and can't see in heavy mec

and so on...

that is absolutely answering her questions to the best of our ability without being there....

Georgia gave some support and expressed empathy for her situation and disappointment....

you, on the other hand, answered with" well, according to a google study, she shouldn't have done that"....which doesn't answer her question, WHY...does it?

Not particularly helpful that you didn't give her reasons WHY the midwife might have done what she did at the time...you just came on and said she shouldn't have done it at all...that is NOT answering her question....

I think it's sad because she wanted some reasons why this happened, and wanted some support for her disappointment, which is a very real feeling after not getting the kind of birth you want...I try to make sure all of my clients understand that they may not get that birth they have in their head so they understand that birth is a fluid process and things can happen and change in a moments notice...but it's still disappointing when you want it to happen a certain way and it doesn't....and it's good to process it and ask questions, no one is saying she shouldn't, or shouldn't be allowed to question her midwife, just one person,and that is going to do nothing but stir the pot and not be helpful at all....sad....