Saturday, 5 February 2011

An uniformed birthing ''choice''...

So one of the most asked questions at my antenatal at my antenatal class was ''have you completed your birth plan?''. This stands to reason when most Mums are attending these classes to learn all about giving birth, their choices, pain relief etc, really these classes were supposed to give us enough information to know how we wanted our experience of birth to be.

Ok, so part of the reason I was attending was to get time off work paid and get out of working a late night but I was still interested in my so-called choices and I also intended on having a discussion with my midwife about how I wanted my birth to go, in an ideal world that is.

So at week 34 during one of my checks with my midwife I mentioned that I would like to do a birth plan. She told me it takes a while to complete but would book me in for a double appointment at 37 weeks to discuss it then. She showed me the page in my notes which told me about different things to think about and then sent me on my way.

Between weeks 34 & 37 I did have another scan, this showed that baby was growing well & was estimated to be about 7lb at birth, just below the 50th centile. I was assured this was fantastic as many women with gestational diabetes have very large babies. I then saw the consultant after and he advised as baby did not seem 'abnormally' large then he did not feel he needed to perform an early induction.

I went along to my appointment at 37 weeks and was greeted by a trainee midwife, she told me my midwife was in the next room & was I ok with a student. I most certainly was not ok with a student to do my birth plan but as my midwife was in the room next door I agreed. I must admit I am a fairly non-confrontational person and I didn't want to hurt the trainees feelings, nor did I want to be the 'awkward patient'. I mentioned my birth plan and she looked at me blankly, unfortunately my midwife had not put it in the diary. she nipped next door had a quick conversation then confirmed that she could still do it & I was her very first birth plan. Great.

I told her I wanted the birthing pool for as long as I could handle it but if I found the pain too much then I would consider other forms of pain relief including an epidural but that was as a last resort. She nipped next door (by this time I was getting annoyed as why did my midwife just not come in and show her how it was done?!) and when she came back she told me that it was highly unlikely I would be allowed the birthing pool due to my diabetes they would want to continuously monitor me and that it was best to leave my options open and just put a note about the skin to skin contact & the fact hubby wants to cut the cord. I stared at her in disbelief, my midwife had just told her that & did not have the guts to come & tell me herself - how flaming cheeky!! I said that I really wanted a water birth as I had read how good it is & I had it recommended to me by a friend but she just looked embarrassed and said ''you never know, you may get a sympathetic midwife on the day who will honour your wishes''. I left the room, walked to my car & cried. It may sound dramatic but all the way through my pregnancy I had been told I was overweight, unhealthy, high risk etc etc and prodded, poked & tested for all sorts at every opportunity and now I was having all control taken away from me during the birth so they could prod, poke & monitor me more. The worse thing was I had tried so hard to eat healthily, exercise and improve my health, even the diabetes had not progressed at all & in fact the blood sugar level readings were healthy even when I ate something sweet, no insulin was needed & my blood pressure had not been affected. I just felt it was all so unjust!

The next appointment with the sonographer, diabetes team & consultant was at 39 weeks. This time the scan showed my baby was going to be about 9lb at birth (the measurements were taken when baby was breathing out for the ''worst case scenario''). The diabetes team asked what I had been eating, I told them lots of salad, veg, lean white meat & hardly any carbs or sweet things. I felt like they thought I was lying, they even made me do my bloods there and then, the reading was 4.2 which is very healthy especially since I had eaten toast for breakfast about an hour ago. It was petty but I felt triumphant at the fact they could not blame me for my baby allegedly gaining about 2lb in 4 weeks. They also weighed me & I was the same weight despite the fact I had eaten loads over Christmas, ha ha, that shut them up...

The consultant basically told me it was my choice, I could be induced in 3 days time or have a cesarean. He warned me induction made labour more painful & I had more chance of needing an emergency cesarean anyway but I still chose the induction, there was no way I was choosing to have a cesarean, the thought of being cut open terrified me more than birth. He told me to call my midwife to arrange to have a sweep the day before my induction was due.

My midwife was too busy so I was unable to have a sweep but on the day I was supposed to have a sweep I noticed I seemed to keep having damp undies. I called my midwife and she told me that my bladder was just getting weaker towards the end of pregnancy. This got slightly worse that evening so I called the labour ward, they told me my midwife was probably right & they would see me in the morning to induce me. I called the following morning but unfortunately they could not induce me as it was too busy. i mentioned again about the leaks and they reassured me it was normal, I told them I really did not feel I was suffering from a weak bladder but they said they would see me the following day. Grrrr! This was getting frustrating!

That night my husband & I went out for a nice meal & went home to get some sleep before the big day.

I phoned on the Saturday morning and was told I could come in - yay! i eagerly got to hospital complete with overnight bag & post birth bag. They came in, monitored baby for an hour then - sent me home!! She said baby was fine, I again told her about the wet knickers but she said it was fine & did not even examine me. We went into town, had some lunch, went home and then the hospital called. There had been a change in shift & now I could come in and definitely be induced. I went up there, was examined & told I was already 1.5cm, given a sweep and pessary was inserted. I told her about the leaks and she said that baby's head was low so if I went for a walk labour would probably progress fairly quick. We walked around the hospital grounds but at 11pm they decided to put me up on the Maternity ward and send my husband home.

The following day a different midwife examined me 24 hours following the attempted induction and said I was still only 1.5cm, the baby's head was very high & so the induction had failed. She told me I had to stay in hospital and then they would try again the following day once I had 24 hours rest. I was so frustrated, I just wanted to be at home, the room I was in had two ladies suffering from placenta previa and were up and down to the loo all night & calling the midwife to record the blood loss so sleep and rest were not an option. They were sympathetic to this and moved me to my own room. My husband went home at 9pm and I was left to watch telly & sleep.

11pm my waters went spontaneously - yay! the midwife came in and monitored me and within an hour my contractions were very painful and I was having 3 in 10 minutes. I called my husband and we all walked to delivery.

The midwife stayed with me until the midwife who was to deliver my baby arrived (she was on call so had to drive in) but the person in charge would not allow me the birth pool nor would she allow me to be examined until my midwife arrived. I was in a lot of pain so they let me have gas & air. The midwife arrived at 2pm, examined me and said I was 3cm but my cervix was ''paper thin'' so I would dilate quickly. I could no longer cope well with the pain. I was on the bed with the monitoring equipment strapped to me and I wanted to walk around but every time I tried they lost the baby's heartbeat so I had to stay where I was lying on the bed in the perfect position for them to monitor me. I ended up having Pethidine and when I was only getting 25 seconds apart between contractions I had an epidural. I then slept about 2 hours then woke up to be examined and was told I was 10cm. This was 8am. I was excited but also in pain as the epidural had worn off, they advised not to top it up as pushing is more effective without it.

However, although I was fully dilated, I was advised to wait a little while before pushing as they felt I may need assistance and the theatre was busy. In that time I started to shake and was given an IV of paracetamol. At 9am I was finally 'allowed' to push. I found this really hard work, I was on my back as they really wanted to monitor baby and every time they saw the head, it slipped back down, the midwife told me I needed to try and get baby round the bend. Then after an hour & a half the person in charge said I would need to have some 'help' I said I really did not want to have any assistance so they let me continue for another 3/4 of an hour (this took alot of negotiation on my part) and baby was born at 11:15am. She was placed on chest straight away and my husband immediately cut the cord. I tried to get baby to latch but she wouldn't so the midwife told me we would try once she is clothed and changed.

She weighed a petite 6lb 12oz, hardly a 9lb baby - how on earth did they get it so wrong? When I took the time to look back at my experience of pregnancy, labour and birth I had the following questions:

Did I really have Gestational Diabetes?
This link was very helpful in answering that & I would definitely think twice about having the OGTT (Oral Glucose Tolerance Test) again

Did I have a choice to be induced?
This is a tricky one, I would have had the choice but in the eyes of the medical profession I was high risk & inducing me before baby got too big eliminated some of those risks. However in hindsight, baby was not too big and the placenta was healthy there was probably no need for the induction so it was preventative but not actually needed.

Would I have been safe in the birthing pool to begin with?
The answer to this would have been yes if they had known baby was of average weight but due to the inaccuracy of the scan, the fact I am only 5ft, this is my first baby & I had been induced not many hospitals would have allowed it. In fact many hospitals do not allow water births for any women who is under consultant led care instead of midwife led care.

How accurate are scans to give an indication of babies weights?
This is interesting as In 1992 Chauhan, Lutton, Bailey, Guerrieri & Morrison In "Intrapartum clinical, sonographic, and parous patients' estimates of newborn birth weight" found that ultrasound was the least accurate of the three methods - yes even Mum had a better knowledge of how big her baby was. In addition the UK Government's CESDI (Confidental Enquiry Into Stillbirths & Deaths in Infancy) report stating that "the inaccuracy of ultrasound estimates have been well documented. Indeed, it is possible that estimating fetal weight by late ultrasound may do more harm than good by increasing intervention rates". Hmmm...that certainly raises some cause for concern.

Was there any need for continuous monitoring?
This for me is the biggest question, I really feel labour would have progressed faster and baby would have been born quicker if I was not laid down. I was told I had to be continuously monitored yet I feel that this contributed to my 3 1/4 hour stage 2 of labour. Here is an interesting article that really made me question the need

How important was that first breastfeed for a baby born to a Mum with GD?
In short very important I will blog about this again with more details of my daughters problems after the birth but here is an interesting link in the meantime So it probably was not the best idea to take baby off after just one try then?

Were my antenatal classes any good?
Yes of course they were, they told me basic facts & helped me to learn about pain relief, birth positions, breastfeeding (vaguely) and what to expect in hospital but they were in no way informative enough to let me make informed choices.

What worries me is just how little I was told about my 'choices' and just how much intervention could have complicated matters instead of making things safer they actually added more concern...