Sister midwives, I need some support

[jengacnm]

Here on MDC, someone suggested interviewing a midwife by asking abut her last three births. My last three experienced virtually the same scenario: rupture of membranes prior to labor, likely caused by a malposition; mom doing a great job of laboring in every position in the book; eventually going to the hospital for pitocin and an epidural (sometimes one before the other-two went to the hospital for pain relief first, then got pit), and ending in a c section after making it to complete and pushing. ALL of them were in hard labor for more than 24 hours. One was OP, one was brow presentation, and one was OP AND brow. My partner was involved to some degree in two of them-either starting or finishing.

Fortunately, since I have hospital priviliges, I was able to follow them and continue caring for them. One was a planned hospital birth anyway. Nevertheless, my soul is feeling flayed wide open, and I'm losing trust in birth and myself.

This morning I left a labor in tears when my partner took over. Not prelabor rupture, but a primip who took 12 hours to get from 3 cms to 6, then her contractions putzed out to every ten minutes. We'd tried homeopathics, nipple stimulation, feeding, watering, resting. At the moment (another 12 hours later) she's in the hospital with pit and an epidural; my partner was going to call me to first assist if she needed a c section-and I haven't heard anything.

I need reassurance that we all have bad luck streaks, and that I will someday again attend a brisk, no nonsense labor. What has me panicked is that my next FIVE clients over the next month are primips. Not a single multip in the mix.

:

TIA....

[mwherbs]

and the next ones should be butter all butter

[1stimestar]

Oh honey, the odds are with you now. You paid your birth karma dues so the next ones should be smoother. When I have a streak of difficult births (I'm a doula) I always try to LOOK FORWARD to my next few as almost always, they are easier. Good luck and hang in there.

[JanetF]

I think we all see the odd streak of things and it's ok to notice but it's also ok to let yourself feel the fear then move on. If you don't do VEs and you don't time labour you won't need to transfer for pitocin and caesareans after only 24 hours of labour. Just my opinion, of course.

It is important for all careproviders to be nurtured, to nurture themselves and always remember that birth is much bigger than all of us. Mamas will birth in their own sweet time, you can afford to relax and just be with woman and you may find those transports no longer "need" to happen. My last labour was three days so it's a good thing no one was giving me VEs and timing me. I'd have been sliced and diced for sure. Birth doesn't need to be "brisk" it just needs to be left alone to happen. How much less stressful for all concerned, hey? I hope you get some time to regroup before going back to supporting birthing women.

[olive&pimiento]

So sorry you're having this string of difficult births. I think that OP presentations are one of the most challenging things to deal with in midwifery. It is so hard to see a mom go through so much pain with so little progress. I'm sure these women were very lucky to have your caring support through these difficult births. Keep your chin up, everyone goes through runs. Heck, I'm still a student and I've been through a them a couple of times already!

[DoomaYula]

I'm not a midwife but I send you big hugs.

My twins vaginal birth (anterior vertex and feet-first breech) was way nicer and easier than my OP singleton. No ROM til I was complete and felt the urge to push, and they were both out within about 15 min.

My OP singleton was a very long painful labor, which started with PROM and ctx didn't start for about 8h.

Here's a thought -- maybe this is a sign about the importance of talking with your clients about optimal fetal positioning? seeing a chiro? spinningbabies.com? etc etc etc.

[blissful_maia]

Originally Posted by mwherbs

and the next ones should be butter all butter

This is what I was going to say! Sending you good wishes for a lovely home birth of a precipitous multip next time!

[mwherbs]

and you probably have the brow presentations out of the way for the rest of your career -- since the 80's I have only seen 2 one came out face presentation and one actually was born brow-- the incidence is about 1 in a 1000-- and from more recent studies it looks like there is less conversion to face than in the past- for brow in is about 44% are born vaginally-- and in low resource areas is a cause of uterine rupture-- so all in all I think you have been doing ok

[BeckiCNM]

I had a stretch like that last summer too... PROM, malpositioning and c/s galore. The nurses were starting to joke about my "black cloud".

Hugs and some good vibes to you...

[Jane]

I sometimes think that there is a larger process in place. I don't think there's much you could do to cause those scenarios, but perhaps you offered something by your presence at the births. Sometimes the things that "happen" to you are not about you.

[mothercat]

Oh jengacnm,
I've had this happen twice in the last 6 months, runs of three transports, including my first baby transport in 10 years. I've also posted looking for someone to tell me it wasn't my fault. So, here is mine to you "It isn't your fault."
For me I would like to think that when a birth goes really well, I was intuitive enough to tell the mom everything she needed to know to be sure the baby was in the best possible position and that the mom had cleared all the emotional and psychological stuff she needed to to have a perfect birth. Sorry, I'm just not that good
There are at least three people involved in every birth: mom, midwife, and baby. As much as we would like to think we influence the mom and provide a good birthing space, we can't control what the baby does-cords get wrapped where they shouldn't, they grow too short or too long, babies have their own personalities and some show that in their positioning even before birth.

It also has little to do with how patient you may have been. When the mom and you know that what you are doing isn't working, or she is in so much pain, as in OP, sometimes the judicious use of IV, pain meds, and epidural may be the things that get her a vaginal birth rather than a C/sec. Sometimes it doesn't. But, it is still not your fault.

It may take a few days or weeks, but pretty soon you will find yourself thinking less about the "what went wrong" and more about how to help the next mom. Sometimes it is just doing prenatals or postpartum visits where one of your clients mention how much you have helped her. Like any sort of grief, it does get better with time. It is grief, because you wanted her to have the ideal birth as much as she wanted it. It is not a reflection on your skills as a midwife.

[homemademomma]

nak
my group had 3 in a row transfer for ftp in 2nd stage- 2 c/s and one vacuum. then a horrible s. dystocia, with a transfer for mom and baby (observation for babe and 3rd degree lac repair repair for mom). then 2 transfers for loooong latent first stage, then a 33 wk placental abruption, and then a pp transfer for a lg hematoma. all in about 2 weeks.

and then, a long string of butter births.

[jengacnm]

Thanks everyone!!

Wow, you guys are great!

JanetF, I hear what you're saying-but there is a big difference between 24 hours of being there and 24 hours of active labor support and little progress. And of the three, two of them went to the hospital by choice, for pain relief.

YumaDoula, you are so right! I have vowed to tell all of my women about spinningbabies.com (the website is a bit cluttered and disorganized, but GOOD info in it) and to suggest chiropractic.

mwherbs, thanks for the stats reminder. I also had my first fourth degree about two months ago, and my backup doc said it might be my last.

To all who remind me that it's not about me-my head knows that, and overall I've gotten pretty good at releasing responsibility for outcomes. I just feel depleted and I'm afraid of carrying my fear to my upcoming births. The degree of relief I felt when reading "It's not your fault" says that SOME part of me must feel responsible, even though my HEAD says I couldn't have done much differently.

And a postscript-the labor I left in tears yesterday? She had her baby at 1 am today, sixteen hours after I left her at 6-7 cms, hospital, pit, epidural. Thickthickthick meconium, apgars 1, 3, and 9. I do believe the universe protects us from bad outcomes at home by making it clear that a transfer is in order.

I'm going to get a massage sometime in the next few days.

Big hugs to all of you!!!!
Jennifer

[jengacnm]

[QUOTE=homemademomma;8560262]nak
my group had 3 in a row transfer for ftp in 2nd stage- 2 c/s and one vacuum. then a horrible s. dystocia, with a transfer for mom and baby (observation for babe and 3rd degree lac repair repair for mom). then 2 transfers for loooong latent first stage, then a 33 wk placental abruption, and then a pp transfer for a lg hematoma. all in about 2 weeks. QUOTE]

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[Avena]

Keep up the important work dear sister! hang in there it will be easier

Love to you!:

[specialdelivery]

I recently participated in my very first planned vaginal birth that ended in a c-section birth (I'm a doula). I can definitely relate to how you are feeling. I agree with pp that you've paid your dues and you should have some "butter" births coming your way soon. To process my experience, I have been looking back at my favorite birth stories and it has definitely restored my faith in the birthing process. Continue to nurture yourself & enjoy your massage!

[mothercat]

restoring faith in birth

I think it was last year when Ina May was presenting at the MMA conference, I had the opportunity to talk with her and asked the question about faith in birth when there has been an unexpected bad outcome or just really unplanned circumstances where we thought we did everything right.

She replied that she has had those days and there are times when she just has to get up in the morning and make herself believe it is still true, that as Harriet Hartigan says, "Birth is as safe as life gets."
It's nice to know that midwives with far more experience than I, have had their faith shaken and continue to believe.