I-Can('t find an answer)

[sgmom]

What I want to know is, is what happened to me last time was necessary? And what do I do if it happens again?

I've been searching the net like mad and I can't find the information I'm looking for, nor can I find any really good books or atricles on vbacs and what is and isn't necessary (hospital intervention).

Here's how my labor went (the short version). I had a midwife (same midwife this time) with a hospital labor.

13 days past my due date.
12:20 pm my water broke (meconium).
2-3cm dilated, fully effaced (was like this for several weeks before labor).
-2 station (lots of internal exams between now and birth).
Midwife is sleeping (5 births in 3 days) so her partner told me to go to the hospital because of the mec.
Immediately hooked up to electronic monitoring (forced to stay in bed). Contractions are close together (I forget how close), but I felt nothing.
7-8 hours later, moved to a labor room (private - lovely!) induced with oxytocin. The levels were raised every 30 minutes until the max limit was reached. From induction to epidural was spent mostly sitting and bouncing on the ball. Hurt way too much to walk.
Midwife showed up a couple hours later.
Some several (maybe 6?) hours after that, I was talked into an epidural (went to bed, slept a little, didn't do any walking or ball bouncing).
Low grade fever (later to be discovered I had amniochromiotitis)
Monitoring then changed to internal, due to the belly thing not staying put.
Fully dilated (there's a hard spot on cervical lip). +1 station.
3 hours of pushing in bed, on the squat bar.
+2 station
Sleep for 2-3 hours.
2 more hours of pushing (this time on my back). Still +2
Ultrasound to see what was going on with baby. Posterior.
30 more minutes of pushing (on my back).
2:30 pm (26 hours later), c-section.

I'm sure I missed some details, but those are the biggies.

Looking back, I can see how a lot of this could have been prevented (no internal exams, more walking and upright positions, no electronic monitoring, etc), but what do I do if I'm late and my water breaks with Mec again? Was my induction REALLY necessary? Could I have avoided a c-section by maybe pushing in a different position, or refusing the epidural?

I really need to know how to avoid this happening again, but I can't seem to find the answers to my questions online...

Sorry this is so long... thanks for any advice you have to offer.

[kltroy]

I hate to be the bearer of bad news, but you will likely never know whether it was "necessary" or not. With all medical decisions you are playing the odds. Your MW can probably tell you if you ask, the answers to some of your questions. Such as, what are the odds of the baby having a problem if water breaks before labor starts and there's meconium? How are those odds changed if you induce versus letting labor play out naturally? What are the odds that your infection was due to repeated internal exams versus would have occurred anyway? What was accomplished with those exams and were any treatment decisions made based on their results? Sometimes internal exams are useful in gaging progress, especially if a decision to intervene hinges on how far along you are. Other times it's just curiosity.

What I'm trying to say is that you're right, there are some things that you could have done differently and they may or may not have changed the outcome. Being 13 days past EDD and having meconium puts you into a difficult situation because the odds start out worse than they would be if you were closer to EDD and with no meconium. This means that they are more likely to intervene more agressively because of the greater potential for problems.

It does sound like your MW gave you LOTS of time and different positions to push in - certainly more so than many that I know of. If you feel ok about it, I would have a sit-down with her and go through the birth and the decision points along the way and see what the alternatives were, so that you know next time. The thing is, you all (MW included) probably made the best choices that you knew to make at the time, given the information you had at the time. That's all we can really ever do - we're only human and we cannot predict alternate outcomes. Best of luck healing and making your peace with your birth. I know it can be tough.

[sgmom]

Originally Posted by kltroy

It does sound like your MW gave you LOTS of time and different positions to push in - certainly more so than many that I know of.

My midwife was dead tired by the time she arrived and because I had a doula, I pretty much let her do her paperwork and allowed my doula to help me through labor. Unfortunately though, she was a friend of my husbands, and I think I was only her second birth so she had little experience to help me. On top of that, she didn't really give me the kind of help that I wanted. So she was much more helpful with keeping my husband busy, than she was with me.

As for positions, I didn't really try any other than dropping the foot of the bed (semi squat) and ended up on my back because I was told that I push more effectively that way. Not that I could tell... I hated being on my back and was MUCH more comfortable in a squat, but I figured that she could tell by looking so on my back I went.

My doula did tell me that I should get on all fours, but by that time I was beyond exhausted and the idea of moving sounded just awful.

I know that I might not have been able to change the outcome, but if something similar might happen with this birth, I'd like to have a better idea of what my options were.

I think everyone involved was just tired and was trying to convince me to take the easy way out (surgery), just so it would be done with. The entire experience left me feeling quite empty.

Certainly not like I had given birth (because when you think about it, I didn't). The whole thing was VERY medical.

[cocoanib]

Wow Mama, that's quite a birth with lot's of turn of events.
I'm no help as this is my first. I hope you are able to figure out what will work better for you, your next time around.

[cathicog]

I don't know about others, but one of the first things i talk about with moms in labor(before labor, really) is optimal fetal positioning, and avoiding posterior babies. This can usually be detected late in pg, before labor starts. One of the frustrating things (to me) about hospital birth, is they don't check the baby's position, to ascertain that the baby is anterior, before giving pit, breaking water, etc...The midwife might have checked and noted it, but by what is written here, doesn't sound like it....It is extremely important if the baby is not anterior, to get him that way, if you can. it saves mom and baby hours of frustration and many times, can avoid surgery. I have had 2 babies posterior when labor began, and because I was at home, and could move around, got both of them flipped to anterior before transition. Your best bet to avoid future surgery, might be a VBAC at home... Most all hb midwives I know check the baby's position and get him turned round before labor starts...makes it a lot faster and easier on both mom and baby... Much of furniture today encourages a reclining position and that is the very thing to avoid during pg...Jean Sutton has an excellent book called Optimal Fetal Positioning, you might want to read before next time. Sorry you went thru such a long hard labor...

[womenswisdom]

My c/s story is similar to yours except I was induced with AROM which caused a persistent posterior position and after 4 hours pushing in every conceivable position I had a c/s. Anyways, it was really healing to me to talk to the midwife afterward (took me about 4.5 yrs though) and discuss what happened and express my disappointment and sadness. Also, the next birth I chose to stay home with a midwife who felt comfortable doing a manual rotation from posterior to anterior if it came to that, which I didn't even know was an option with my first. I was able to labor in the water and move into whatever position I needed to and my second rotated alllll the way from LOA to posterior and then to anterior. I also got lots of chiropractic care in my second pregnancy to help make sure everything was lined up correctly to be sure my body would not be "in the way" if baby needed to move during labor. I know how hard it is to feel like you came so close and then had a c/s. It sucks. You might never know for sure whether your c/s was necessary but you can still look at what happened during your first labor and choose to do some things differently this time so that you know you're giving yourself the best possible chance for a vbac. Good luck to you!

[sgmom]

Originally Posted by cathicog

I don't know about others, but one of the first things i talk about with moms in labor(before labor, really) is optimal fetal positioning, and avoiding posterior babies. This can usually be detected late in pg, before labor starts. One of the frustrating things (to me) about hospital birth, is they don't check the baby's position, to ascertain that the baby is anterior, before giving pit, breaking water, etc...The midwife might have checked and noted it, but by what is written here, doesn't sound like it....It is extremely important if the baby is not anterior, to get him that way, if you can. it saves mom and baby hours of frustration and many times, can avoid surgery. I have had 2 babies posterior when labor began, and because I was at home, and could move around, got both of them flipped to anterior before transition. Your best bet to avoid future surgery, might be a VBAC at home... Most all hb midwives I know check the baby's position and get him turned round before labor starts...makes it a lot faster and easier on both mom and baby... Much of furniture today encourages a reclining position and that is the very thing to avoid during pg...Jean Sutton has an excellent book called Optimal Fetal Positioning, you might want to read before next time. Sorry you went thru such a long hard labor...

Are you a doula? Or a midwife? This is some amazing information. Thank you so much for posting this.

Throughout all the exams, my midwife was showing me how to feel where all the parts were (shoulder, spine, etc), and we were sure that the baby was anterior. It's possible that she flipped during the labor (especially considering how much time was spent on my back or side), but I can't help but wonder if she was posterior the whole time. I was convinced I was pregnant with twins for the longest time (even after the ultrasound, I thought the second baby was hiding LOL). My daughter was one active baby!

As for our furniture, it's very difficult to sit upright on our couches (they do recline, and they've got quite a deep seat with a slightly slanted back). Even sleeping I ALWAYS end up on my back and have to reposition multiple times throughout the night. Because of this, I spent a LOT of time leaning over the exercise ball, but you can only do so much. One of my biggest fears with this baby, is another OP. So if there's anything I need to do now to prevent that from happening, or do I wait until the last couple weeks... I really need to know.

I know I've got another 4 months to go, but I'm kind of in a panic. I don't want to learn something in the last month that I should have been doing right now.

OT (or maybe not), I ordered the book Hypnobirthing by Marie Mongan last night. I'm sure I'll be fine when it comes right down to it, but I'm really hoping this book helps. I had a horrible time relaxing during my last birth (so much for birth plans!). I need all the info I can get!

[MsBlack]

Seems to me there were a couple of 'presenting factors' that basically led to all the rest:

labor starting so 'late' (by med ppl's standards) which tends to crank up perception of risk and the pushing of medical intervention

labor starting with mec-stained water --also tends to crank up perception of risk

Tired midwife...you ended up accomodating *her*, instead of her being 'all there' for *you*.

I'm not clear from your story though--were you planning a homebirth or a hospital birth?

It would be interesting to know as a factor in everything about your first birth.

Also--you say that you are using the same mw now....apparently you like her and did not particularly blame her for events of last time. That is all good--but the one thing that stands out for me is '5 births in 3 days'. That would not be so much for an OB, maybe--because OBs don't spend all that much time with their clients anyway, there would be time to rest between births! But we do tend to expect more time from midwives during labor--isn't that personal time/personal touch a big reason ppl hire mws in the first place? Not sure in your case of course--just stating a generality.

So, if that generality fits for you, if you want a mw partly because of expecting more of her time and attention, then I am wondering if she is the best choice if she is still doing so many births. Of course, maybe she only had 6 births on her calendar for that month, and they all happened to occur in the same week! This could happen--luckily it doesn't happen all the time. It also matters if she does homebirth or just hospital birth of course--because a homebirth mw has to spend some of her time travelling, as opposed to a mw who simply goes to one place to meet pregnant/laboring women. So a hospital mw might reasonably take on more clients than a homebirth mw--but for a homebirth mw, 5 births in 3 days sounds like she might be taking on way too many clients to be able to be there for them.

well, this is a ramble, sorry--if I were you I'd want to explore with the mw about the # of births she averages each month (whether home or hospital based) and whether or not she has the kind of time for you that you may want from your mw.

Otherwise--there is nothing about your first birth that seems like it would necessarily repeat. However, it is probably important that you become as informed and active in all decisions as possible, and make sure your care provider is a 100% good match for you and your birth plans.

good luck!

[GOPLawyer]

nak

I agree w/ MsBlack. What you said about the MW really jumped out at me. From what you said, she may not be the right fit for you. Did you choose her b/c of the friend status? That's a lot of births in a short period. It may be a fluke or she may be overscheduling.

Did she discuss the interventions w/ you before you agreed to them? I ask b/c you said you were talked into them.

JMO but I am wary of MWs who do internals as a standard protocol. Further, I also think that a seasoned MW who is best for a VBAC.

[sgmom]

Originally Posted by MsBlack

Tired midwife...you ended up accomodating *her*, instead of her being 'all there' for *you*.

I'm not clear from your story though--were you planning a homebirth or a hospital birth?

My midwife went to bed 30 minutes before my water broke, after being awake for nearly 3 days straight. It was her partner that was with me for the first half of my labor. Mine was great, once she arrived.

I was planning (hoping) for a homebirth, and we had already discussed what might happen incase of a situation like this, so when her partner phoned me back (when she is unavailable, she turns her cell phone off -so I can leave a message incase of non-importance- and forwards her pager to her partner. The pager is "incase of emergency") I knew what was going to happen.

The 5 births in 3 days was caused by them all being either early or late, and one having a complicated twin birth. 4 were from the same month. Once was early (due the following month - my daughter was born on the 24th).

I absolutely trust her, or I would not have gone with her again. We've agreed to discuss the "what went wrong and how to prevent it" during our next visit in Feb, but my reason for writing here, is because I don't really know what questions I should be asking, and I want to be better informed before I discuss anything with her. Perhaps I should just tell her what I want and trust that she will do whatever is necessary to make that happen?

It was my doula that I will not be attending this time. My midwife was awesome. But 5 births in 3 days, twins with complications, then my unexpected long labor (also filled with surprises)... I don't blame her for ANY of it. Although I do wish that she had respected my "no request medical intervention" request a little more, so I can't help but wonder... WAS it all necessary?

Edit: By the time she showed up, most of the intervention was done by her partner (whom is no longer her partner). By then, a lot of what we COULD have done, was out of her control.

[cathicog]

CPM candidate, doula, midwife apprentice
But I read constantly...
Ms Black, excellent points, and ones that I had missed. Wish you lived closer- I would LOVE to learn from you!

[kathan12904]

I've got to chime in about the mw in this situation. For her to not have advised you about an op baby seems almost negligent. Baby position would account for your late starting labor as well as the baby not coming down. I also cannot believe that she wasn't there for you earlier. I can empathize with being worn down after a lot of births but she should have had a back up or assistant there with you if she truly could not perform her job. From your story, she came in over ten hours after your water broke. That's not her being exhausted and needing time to refuel to be there for you, thats her not prioritizing you in her schedule. Even after 3 days, who needs ten hours of recovery? And if she truly did need that long, then her client load is too large.

[thehappydeer]

You may appreciate this reading list.

http://www.childbirthinternational.c...g/cesarean.htm

[sgmom]

Originally Posted by kathan12904

I also cannot believe that she wasn't there for you earlier. I can empathize with being worn down after a lot of births but she should have had a back up or assistant there with you if she truly could not perform her job. From your story, she came in over ten hours after your water broke. That's not her being exhausted and needing time to refuel to be there for you, thats her not prioritizing you in her schedule. Even after 3 days, who needs ten hours of recovery? And if she truly did need that long, then her client load is too large.

Her partner was with me the entire time, and didn't notify her until after she woke up when she called to check her messages. I don't blame her one bit. She had no idea I was in labor. Perhaps this is one of the reasons why they are no longer partners?

[sgmom]

Originally Posted by thehappydeer

You may appreciate this reading list.

http://www.childbirthinternational.c...g/cesarean.htm

Way ahead of you, but thanks for the link!