Your opinion on how to handle this? re: our homebirth/c-section - Mothering Forums

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#1 of 7 Old 11-06-2006, 08:13 PM - Thread Starter
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WARNING: Long post, sorry!

We started out with every intention of having a healthy homebirth. I laboured for 16 hours at home. Starting at about the 10th hour, I was at 7 cm and I didn't progress at all over the next six hours. My water broke with about 5 hours to go and it was obvious that there was meconium when I was labouring (as discharge) and when I would use the washroom (peeing) and wipe. We notified our midwife and she saw it herself throughout the labour but didn't seem at all concerned that there was meconium and that it might affect the baby.

Finally, at 8 pm, I decided that the pain was too much, I was too tired & b/c I wasn't progressing past 7 cm I wanted to go to the hospital. I was frustrated that I was giving up my homebirth but I figured I could still deliver vaginally with some help at the hospital from some Pitocin and painkillers (in whatever form we decided). My midwife wanted to stay a little while longer at the house and see if homeopathic remedies would help me relax but I finally said I couldn't and wanted to go. I could only focus at that point on the pain and on how sad I was not to give birth at home.

When we arrived at the hospital, they immediately hooked me up to a electronic fetal monitoring system and discovered that the baby was having fetal distress. Her heartbeat was not responding after a contraction (it should increase and then come back down to normal). Also, upon a pelvic examination, we discovered the baby had turned and was now transverse (which apparently means a c-section b/c it is near impossible to birth a baby in the transverse position - sideways).

We were immediately scheduled for an emergency c-section and when Caleigh was born, she was not breathing on her own. She required some emergency help and later oxygen in order to keep her alive. After having an x-ray, it was determined that she had inhaled the meconium and it was clogging up her lungs (like oatmeal in her lungs). She was put onto antibiotics to avoid pneumonia and she ended up spending 9 days in the special care unit at the hospital.

Here is my concern. If we knew that there was meconium and our midwife knew there was meconium passed, would that not indicate a transfer to the hospital? We discovered the meconium at least 5 hours before we left for the hospital. And there was a lot that passed when I urinated. When it was brought to her attention she said that there wasn't anythign to be concerned about.

I'm not looking to "lay blame". I just need to know why it wasn't suggested or enforced that we go to the hospital earlier in the labour. Both the attending hospital midwife and the surgeon who did my c-section said that if it had been caught earlier, we could have had a much better outcome and possibly prevented such a long stay in the hospital. And she also said that had we been 10-15 minutes later in getting to the hospital, the outcome of Caleigh's health or ability to live would have been threatened.

My husband and I are very upset even though we're trying to focus on the fact that Caleigh is in fact, now healthy and thriving at home. And again, I'm not trying to look at just the negative - but when you put full trust in someone to deliver your baby at home in a healthy manner, it is now sinking in that maybe she should have done something about our labour earlier.

What do you think? Am I being overly emotional about this or do I have a right to really start asking questions about why this happened and whether or not it could have been prevented? I'm still in somewhat of a daze about the last 11 days but I just feel that the midwife should have done something or at least now taken responsibility. She says that it was my mother's intuition that saved Caleigh. I have a hard time with that considering she was aware of what was going on and after 16 hours of hard labour, I don't think it should be left up to me who wanted to go to a hospital b/c it hurt.

What do you think? Sorry so long, maybe I juts needed to get this off my chest/mind more than anything.
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#2 of 7 Old 11-06-2006, 09:29 PM
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I'm so sorry you are having to deal with this. It's interesting -- I too had the experience of having obvious thick meconium during labor. I was in a hospital and the midwife was very concerned and insisted on constant fetal monitoring, which I found very annoying. The labor was short (slightly under 5 hours total), and there were lots of folks standing by to make sure DS didn't breath in on his way out and all turned out well. But I realize from your story that what I found to be such an annoyance was actually a good precaution, and not just one of those unnecessary routine things. It sounds to me like what would be most useful for you is really just to figure out whether you want to use this midwife again (and since you're moving anyway is most likely not even a possibility). And maybe you can use this experience to screen your birth team better the second time around (if there is a second time). If all turned out well there's probably not much point in dwelling on what the midwife did wrong, especially for your own sanity. But I have to say, I find it strange that the midwife didn't know that the baby was transverse. I thought they are trained to figure that out pretty easily?
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#3 of 7 Old 11-07-2006, 01:32 AM
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Well--were you 'overdue' at all? I thought I remember meconium being more likely if 'overdue' and then it wouldn't have been as worrisome to the m/w. I would think that even a 'handsoff' m/w would've wanted to check you to see your progress and to feel baby's position and would've noticed the transverse baby--but the baby may have moved into that position right before you got to the hospital.

As for the hospital saying: "had we been 10-15 minutes later in getting to the hospital, the outcome of Caleigh's health or ability to live would have been threatened." I wouldn't even think of that--I am pretty sure that is what they say to most people in that situation--I mean really, how could they determine 10-15min vs 3-4 hrs! WHO really knows ya know?

I would talk to your hb m/w and address your concerns and ask what her 'hidden thoughts' were during the labor--just to get an open line of communication and so you can get some questions answered. Otherwise you may have those questions floating in your head forever!
My biggest question from dd's birth 4 yrs ago is WHY WAS I ON MY BACK FOR HOURS WITH BACK LABOR??????? How come no one suggested I get up, squat, SOMETHING?
I'll never know (oh, and I was FLAT on my back, not even an incline!)

Enjoy that sweet baby--get your questions answered--then look forward to a 'healing birth' next time!
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#4 of 7 Old 11-07-2006, 12:45 PM
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From what I have read deep suctioning can actually push meconium down into the lungs thereby causing more problems than fixing so if the hospital did that, then discovered there was some aspirated, that would make sense. I don't think meconium means a bad outcome at all. Many women have meconium in their water and baby is fine. Babies also move during labor and if it hadn't been for the heartrate decels I don't think a c-section would have definitely been warranted.

Just my 2 cents! Congrats on your little one!

~Lanie mom to Layne, Liam, Maren, Meridian, and Melora
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#5 of 7 Old 11-07-2006, 01:39 PM
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From what I've read mecomium isn't usually a problem. I have also read deep suctioning with meconium present can infact cause issues. I would not take what the Doctor/midwife said about 15 more minutes as the absolute truth. There really is no way of knowing if it's true or not.
I do think you have every right to be questioning right now.
I don't think your midwife was neglectful for not transfering for meconium w/o any other signs of distress. There is really no way of knowing if the outcome would have been better if you had transfered when the meconioum was first noticed. It's really just speculation on the hospital staffs part, IMO.
I hope you find the answers you are looking for and that you find peace with what happened!

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#6 of 7 Old 11-07-2006, 03:00 PM - Thread Starter
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Thanks laides. We did speak to the mw this morning - and we were very open to the discussion. You're all right, the meconium wasn't as much of an issue for a hospital transfer (even though it did pose a problem once we got there) however she did say that b/c I was so dehydrated throughout labour (I threw up multiple times - between 8-10 times) that my uterus probably wasn't contracting as well as it should. She admits that she should have suggested a hospital transfer at least an hour beforehand.

I think both my husband and I are just looking for answers to questions that might not even have answers. Obviously, things can go wrong adn there are always things that can come up unexpectedly. It's just so hard when it's your own daughter going through all of the painful exams/tests that make it hard to deal with. And no one (midwife, hospital staff) has been able to really give us a good answer.

Bottom line is that she is healthy and home now and we should be focusing on that. Our mw was very open with us and she wished that she would have at least explained how the meconium could have presented as a problem.

As for being transverse, the baby was vertex originally and most of the way through labour. When we arrived at the hospital, it was determined that she was transverse. Not really sure how it happened, but from what I understand - at that point you're basically looking at a c-section anyhow.

Thanks again for your advice. I think I just needed to get things off my chest last night.
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#7 of 7 Old 11-07-2006, 04:08 PM
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Andrea, I would feel concerned too. As it turns out, you followed your mothering instincts and that led you to the help you needed. What concerns me the most is not the meconium, but that the midwife did not pick up on the transverse position or the distress in the fetal heartrate. Also, meconium in those quantities (especially combined with the other signs) can be a red flag. In the end, it all comes down to following our spirits and our instincts - and we are ultimately responsible for that. You did wonderfully and saved your baby's life by listening to your heart. I don't think there is much more to say than that - however, I might not go with the same midwife in a future birth. Also, you should make sure that she knows what happened so that she is more careful with future births. I'm so glad that things turned out well in the end.

Mandi - Doula/Childbirth Educator, Loving my DH, DS, DD, DD, missing my three (last m/c 4/2010)
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