Feeds:
Posts
Comments

Posts Tagged ‘Induction of labour’

Over the last two weeks 3 of my women were due to give birth – at home.

A is a 30 year old who was having her first baby. She wanted a homebirth as she is frightened of hospitals.

B is a 31 year old, also having her first baby. B decided on a homebirth after having an entirely normal, ‘easy’ (her words) pregnancy.

C is a 34 year old, she already has a 2 year old who was born in hospital following ‘an awful experience’, with a cascade of intervention and a ‘control freak of a midwife’.

A’s story

At 41 weeks pregnant, with the birthing pool up and waiting in the sitting room, A had a stretch and sweep. The examination discovered that the cervix was central, effacing and 2 cms dilated with baby’s head -2 above the ischial spines. For a few hours afterwards A reported that she was feeling sightly uncomfortable, but then everything settled back down. 2 days later a second stretch and sweep was performed, with very similar findings except that the baby’s head had descended to the level of the spines. A was now 9 days past her due date, so a date was made for an induction of labour when she would be 40 weeks + 12 days.

At 11am on the scheduled day A, tearfully, made her way to the maternity unit. On admission a cardiotocograph (CTG) was performed to assess the wellbeing of baby. Once it was demonstrated that baby was doing okay a vaginal examination was performed, a Bishops Score estimated and a prostin pessary inserted, it was 1pm. Following a second CTG A went for a walk and tried to relax, nothing was happening. At 7pm the whole procedure was repeated, her partner and Mother stayed with her until 10pm and then left (hospital policy) to await a phonecall. By 2am A was experiencing regular contractions but was coping well using a TENs machine and wobbling on an activity ball. 6am saw A no longer coping with contractions, a vaginal examination discovered that the cervix was now 6ms dilated and baby’s head was now -1 below the ischial spines, an artificial rupture of membranes was performed and A as given pethidine.  At 10am a vaginal examination was performed, hospital guidelines indicate that 4 hourly vaginal examinations should be performed during induction of labour to assess progress, at this time the findings were the same as 4 hours previously. A was very upset by the lack of progress, despite regular contractions, and when told that the next move would be to start a syntocinon infusion she requested an epidural, after an hours wait for the anaesthetist, he was in theatre, an epidural was sited and then the synto was started. 3pm, a vaginal examination by a doctor estimated that the cervix was now 9cms dilated but he detected that baby was trying to come out with it’s back to Mum’s back, direct occipito-posterior, he also believed that baby’s head was not tucked down with it’s chin on it’s chest, instead it’s head was deflexed. He decided that baby was not going to succeed in being born vaginally and so A gave birth to her baby boy, weighing 8lbs 12ozs, by caesarian section.

B’s story   

41 weeks pregnant and the super, heated, filtering birthing pool had been inflated and filled for a week. A stretch and sweep was performed and the findings suggested that labour was not imminent, the cervix was posterior, long and only 1cm dilated, baby’s head was -3 above the spines. An induction was scheduled for 2 days later and all started as with A. The first prostin worked wonders though and 6 hours after it was inserted B was taken to labour ward to have her waters broken (ARM). Within the hour her contractions had started and her TENs was pulsing away, 5 hours later, after much marching, she gave birth to her son who weighed in at 8lbs 10z and 6 hours later they went home.

C’s story

At nearly 36 weeks I couldn’t be sure that baby was coming head first so A went to hospital for a scan, baby was head down so her homebirth was booked. 4 days later A experienced sharp pain in her uterus so self-referred to the maternity unit where they performed a CTG. The doctor who reviewed it felt that it was non-reactive and believed that baby was small-for-dates so, as a result of these two findings, suspected intra-uterine growth retardation (IUGR), an USS and doppler was arranged for 2 days later. C was on tenterhooks. The scan and doppler were performed, plus a repeat CTG, and all was reassuring, baby wasn’t huge but was estimated to currently weigh about 5lbs 8ozs. C was now 37 weeks pregnant, it was all systems go for a homebirth and so…..the pool was inflated.

2 days later and C experienced a few trickles of fluid.  A community midwife visited, performed a speculum examination to try and assess if her membranes had broken, they had, and a vaginal swab was taken to exclude the presence of infection. The following morning the on-call midwife contacted C, there were no contractions and the membranes had now been ruptured for nearly 24 hours so C was asked to make her way into the maternity unit for augmentation of labour by syntocinon infusion plus the administration of intravenous antibiotics as once the membranes have broken there is a risk of infection to the baby. C refused, but did agree to attend the hospital a have a CTG to check that baby was okay. The risk of prolonged rupture of membranes was explained to C, but she opted to return home and await events.

36 hours after her membranes had first started leaking C’s contractions started. She contacted the on-call midwife who came round to assess the situation. It was 4am and when C was examined the midwife found that the cervix was 2cms dilated and long, C was advised that labour was not yet established. The midwife stayed for an hour and, believing that C was only in early labour, went back to bed. C was finding the contractions difficult to cope with so had a warm bath. Within half an hour she decided that, if this was early labour and that there were still hours to go (as the midwife had told her), then there was no way she could do it without an epidural so she, her husband and their 2 year-old son set off for the hospital, 20 minutes away. Halfway there C realised that baby was coming, quickly and told her husband to pull over. He told her to hang on as they were nearly there, with that C felt the baby’s head being born so screamed at her other half to stop, NOW! He did, and their son, weighing 5lbs 7ozs, was born in a lay-by. An ambulance took C and baby to hospital for a quick check over, all was well, and 4 hours later they were driving back past the lay-by where baby entered the world.

Why write about these 3 births. Well, all were booked homebirths, but not one actually gave birth at home. None of the examinations before labour gave any indications of when, or if, labour might start. In fact the examination which appeared to give the most positive sign of readiness to labour was A, who ended up with a caesarian section. What does this show?  That there are no rules, patterns or predictive measures as far as labour and birth is concerned and that birthing pools are very popular!

Advertisements

Read Full Post »

Hello baby

 

Evie Louise arrived 31st October at 13.50hrs, weighing in at 7lbs 13ozs.

 

and here’s how it all went……………………………….

Her expedition into the outside world was encouraged yesterday at 12 noon when DIL had her first, and as it turned out, only prostin pessary. Before the pessary was inserted she and baby were monitored for half hour, ensuring that all was well before the stress of induction of labour. Following an internal examination, to assess if it would be possible to rupture the membranes without using prostin, the pessary was inserted high in the vagina, monitoring was then recommenced for an hour. At this point all was well so DIL was released from the monitor and encouraged to mobilise. At 3pm frequent ‘prostin’ pains started. They caused the uterus to contract, frequently, causing Mum and baby to become distressed. Monitoring was recommenced, increasing DIL’s distress as it made mobilizing more problematic. At 6pm a repeat internal examination was performed, there was no intention to repeat the prostin as would normally be the case if it were needed due to the intensity of the uterine activity. Unfortunately there was no change in the cervix, unsurprisingly DIL was disheartened and after that it was taking a huge amount of support and encouragement to cope with each contraction. By 10pm it was all too much, TEN’s was ineffective and so pharmaceutical pain-relief was offered in the form of pethidine, this was given by injection. The opiod helped her to relax for a couple of hours but after 3 hours she had used up all her, and our (!), reserves and was extremely distressed. Another internal examination was performed and……..hurrah, the cervix had opened enough for the membranes to be broken (ARM). For this to happen we had to transfer to delivery suite, and unfortunately there were no beds and we had to wait another hour and by the time there were beds DIL was demanding an epidural prior to the ARM. This was nearly a problem as there are restrictions upon the number of women with epidurals on labour ward, in the end the fact that I was there saved the day. Oh well, I do have my uses!

Once the epidural was sited, and working, all became super calm, the waters were broken and two hours later the syntocinon infusion was started. DIL and Son settled down for a well-earned sleep, whilst I kept watch, labour ward was super-busy so their midwife was caring for three women in labour, totally unacceptable but par for the course in today’s under-resourced maternity services.

When the day staff came on they had their own midwife so I decided to come home, have a power nap and return rejuvenated, or at least refreshed, just after the next scheduled examination at 11am. On the way home I nipped to the bakers and bought some sausage rolls for son’s lunch and some iced doughnuts for after the birth. At 9.30 I flopped into bed, and at 10. 30 I was awakened by son phoning to say that it was all systems go, DIL was going to start pushing at 11am. Thank heavens the roads were clear and there was a parking place at the hospital!

By 1pm it was starting to become obvious that baby was not going to make an entry into the world by just it’s Mummy’s efforts. So frustrating as it was so nearly there but, push as hard as she could, there was no further advancement, a Doc was asked to review. After much encouragement, and a very exacting assessment of how baby was lying, doc explained that baby was trying to come out without flexing her head, so a larger diameter is attempting to deliver, something which causes delay. Baby was, by now, becoming tired, after every contraction the heart-rate was dropping from a baseline of 130 beat per minute to 70, and staying down there for a minute, action was necessary, a ventouse was decided upon.

At 13.50, after one pull of the ventouse, baby was born with with her hand up by her cheek and and a real cone-head. Whilst the Doc was stitching DIL up she started to bleed, he estimated about 1 litre. The IV syntocinon was increased, bi-manual compression was used and ergometrine was given, the bleeding stopped quickly, and DIL appears to have tolerated the blood loss.

As you can imagine it was all quite emotional, I think that all of us had been keeping our angst’s under wraps and the wonderful arrival of Evie has released our feelings, the relief is palpable.

Photos tomorrow when I’ve had a long nights sleep.

Read Full Post »