Catherine Rennie shares her story of intervention after intervention
It is Valentine's Day when I discover I am pregnant. It is our second pregnancy. Our first ended just a few months ago with the sad loss of our baby, a missed miscarriage. We discovered the loss at fourteen weeks. My husband and I then spent two horrible nights and three anxious days in the labour ward after having attempts to induce labour and deliver our child. My labour never did start and our tiny boy was eventually delivered during an internal examination. I feel frightened and anxious about this new pregnancy. I hadn't expected to fall pregnant again so quickly. I discover that our baby's due date is exactly one year after we delivered our first wee boy.
I join a 'yoga for pregnancy' class, which is followed each week by tea and discussions about choices surrounding labour and birth. I listen week by week and begin to think about what I want. I know what I don't want. I don't want to relive the three days my husband and I spent on the labour ward a few months ago. My memory of that time is of feeling bewildered and frustrated. We had no idea what was happening, what to expect, or how long things might take. I felt anxious and vulnerable just waiting for something to happen. The ward was really busy, but we spent most of the days in the room without much contact from anyone. The midwives had lots of babies to deliver during those few days; we could hear their cries from time to time. I felt utterly helpless. I decide I need to feel more in control this time and from the research I have done I come to realise an important part of this is avoiding an induction if at all possible. My hope is that this will also help me avoid the need for other interventions such as forceps delivery or caesarean section which might be more likely to happen if my labour is induced. I get to my due date at 40 weeks and at my antenatal check-up the suggestion of induction is made. I tell my midwife that I want to avoid it. She doesn't ask why but seems happy enough to wait and see. I am happy and I feel prepared and ready.
I eventually reach 42 weeks and 1 day pregnant. Most women are encouraged to have their labour induced before they reach two weeks past their due date. Because I have decided I don't want my labour to be induced, I have an appointment at the day assessment unit at the hospital to monitor the baby's movement and the fluid levels in my uterus to make sure it is safe to continue waiting. On the morning of the appointment at about 3am I wake up with crampy pains. They are mild and happening every 30 minutes or so. I smile, turn over and manage to get a bit more sleep. I get up at 6am excited, happy and sure now that at last our baby is going to make an appearance and in his own time!
I ring my midwife who advises me to attend the day assessment unit despite the fact that my labour seems to be beginning. Once we arrive I meet a midwife who looks very sceptical and relatively uninterested as she hooks me up to a monitor. The midwife seems happy with the baby's movement but is evasive when I ask her about the cramps I am now experiencing at regular intervals. She assures me they are not contractions. My excitement begins to trickle away and I begin to doubt myself. The fluid levels are absolutely fine, bub's heartbeat, movements and size are perfect, I should be leaving here happy and reassured. Instead, the way I am being spoken to makes me feel like I am in the way, being ridiculous, wasting their time. No one wants to know why I don't want my labour to be induced; no one discusses the implications with me. I am simply told I must have the induction in the next couple of days.
Eventually, I offer to explain a little of my reasoning to the midwife. She softens towards me a little when I tell her my story. Now she seems happy to let me have another couple of days. She performs a membrane sweep for me and seems surprised to find I am two centimetres dilated and the baby's head is lower than she first thought. She still assures me, however, that I am not having contractions. She tells me she will make another appointment for further monitoring in two days' time but she needs to clear it with my consultant first.
We wait two hours in the corridor to see a consultant. Still experiencing the cramps, I am now having to stand up every time another wave hits me. When the consultant eventually rushes us back into the day assessment ward she seems to have little time. I feel like I am being spoken to as if I am a naughty child with no idea of the significance of my decision. I am lectured for five minutes about how I must have an induction, during which time she tells me that although the monitor might show everything is fine now, it's not very sensitive and there is nothing to say that everything will still be OK tomorrow. Later I wonder, what was the point in monitoring me at all if that is the case? Obviously baby's well being is THE most important thing to me so at the end of the lecture I don't feel I can reasonably say no. I am on the verge of tears as she writes out an appointment card with the details of the induction she has booked for me in two days' time.
By the time we reach the car to go home, the pains I have been told are not contractions are starting to really increase. My consolation is that I now really think I am in early labour and feel certain I will not need that appointment for induction after all. I try my best to relax and not begin to doubt myself. I need to put my trust in my body to do what it has been designed to do.
Looking back at my antenatal experiences, it is clear that pregnancy is an emotionally trying time as well as a physically trying one. It is so important to be able to build a relationship with your midwife throughout your antenatal care to try to foster some emotional support. It would have been a huge help to me to be able to spend some time talking things through with a midwife I knew and trusted. No one was able to give me the time to help me examine the pros and cons of induction.
When we eventually get home from the hospital appointment it is 3pm and the contractions have really started in earnest. I try to eat some lunch, check my hospital bag for the 10th time and relax, trying to prepare myself for the hours ahead. By 6pm I have my TENS machine working wonders for me and my relaxation CD on loop in my earphones and I am sitting flat on the floor with my eyes shut. I have been up and moving around with the contractions but it seems to make them all merge into one, I can't tell when they stop and start so I sit and concentrate. I am managing to stay calm and relaxed, but I can't manage to eat any tea.
When I go into hospital at about 9pm the midwife in triage seems surprised to find I am 6cm dilated and I get to go up to the labour ward. I have requested to use the pool and it's quiet enough that there is no wait so we head straight up. Eventually getting into the pool is lovely, just being able to have my considerable bulk supported by the water feels brilliant and I am able to really relax between contractions. Our midwife is lovely and mostly leaves us in peace just sitting quietly when she is in the room.
Eventually, at 7am the next morning, they decide that things are moving too slowly. I have still had a tiny rim of cervix left to dilate at the last two examinations. By this point I am thoroughly high on the gas and air and I am very weepy. I feel at my most vulnerable, like I have lost all control over the situation. I have lost confidence in my body and mentally I just hand control over. The doctor examines me and recommends a syntocinon drip to speed up my labour and I just meekly nod and agree even though I had really wanted to avoid this. My midwife is kind and has a quiet chat with me. She asks me to think about pain relief because the syntocinon will make my contractions stronger. I feel thoroughly beaten by this point so I just ask her what she thinks is best. She suggests an epidural. I agree to it and now I have the feeling of just allowing events to happen, being swept along.
Epidural in place and no longer high on the gas and air, I find myself lying on the bed being monitored while they try to insert a cannula into various of my veins. It is exactly the same experience with exactly the same view of the labour room that I had during my stay one year previously when we suffered the sad loss of our first baby boy. Thankfully, during my labour until now I had managed not to relive that experience. Now I am faced with it. The dim lighting and relaxing atmosphere have been replaced by bright lights, anxiety and the very sense of lack of control that I had wanted to avoid.
I can hear our baby's heartbeat on the monitor slowing and stopping with every contraction. My heart is in my mouth waiting for it to speed back up. The doctor looks anxious. I no longer have any pain or gas and air to think about during the contractions so all I focus on is that heartbeat. The decision is made to take me to theatre for a forceps delivery. From a lovely peaceful water birth to the bright lights and what seems like hundreds of people in the room.
My second gorgeous son is born at 9.51am 16 days after his due date. He weighs 8lbs 2oz and is the double of his Dad. He is taken into another room to be examined and his Dad goes with him. The doctor tells me they are going to give me an injection to deliver the placenta. I had really envisaged leaving this to happen naturally with lots of skin-to-skin with my baby, quietly getting to know him and letting him have his first feed. This is so far removed from what is actually happening. The surgeon then tugs and pulls for ages and I can hear that they are concerned and are struggling to deliver the placenta.
Eventually, my husband and son come back in, I get a little cuddle and then my husband sits next to me holding the baby. They start to stitch me up and this goes on for ages. I drift in and out of sleep and the time goes on and on. I start to get really worried about what has happened. Why is it taking so long to stitch me up? How badly am I damaged? I am so anxious about how long it is taking to repair me. The theatre staff start trying to hurry the surgeon, there is a caesarean section that needs to happen in the theatre.
Nearly two hours after the birth I am eventually wheeled out of theatre. After a forceps delivery and a really scary amount of time to stitch me I have lost 1500mls of blood and I'm to go to the High Dependency Unit. There is no room on the ward so we spend 30 minutes in the corridor. My husband and I were taught in our antenatal class that immediate skin-to-skin contact is vital for successfully establishing breastfeeding and that ideally this should be uninterrupted until the baby manages to have his first breastfeed. This fact floats to my mind two hours after his birth when I am eventually able to have a skin-to-skin cuddle with my son. The midwife helps me give him his first breastfeed right there in the hospital corridor. I am anxious that he won't want to feed but he roots around eagerly and feeds for a few minutes before falling asleep.
Once I'm in the ward itself the midwife in charge of the room seems very stressed and is flapping around. She keeps popping over and telling us she is going to get this or do that and then disappearing for hours, seemingly forgetting the important task she had told us about and leaving us worrying about it not being done. She tells me she needs to wash me down and put on compression stockings but first she must measure me. She goes to get a tape for this and doesn't come back. I am on a saline drip and monitors which keep losing contact and beeping angrily but no-one comes to check them.
I am absolutely starving. I haven't eaten for 22 hours. I know that we have cereal bars in our bag and I keep asking my husband to get them for me but he won't give me one. He wants to check it's OK for me to eat. I keep on at him, I am very spaced out on all the drugs in my system and I am getting more and more agitated. Eventually he manages to catch the midwife as she dashes past and asks her what is happening. 'What do you want to happen?' she snaps in return. I start to cry. 'Look, she's getting upset now,' she accuses him.
We are left again. My husband is absolutely exhausted so I persuade him to go home, shower and have something to eat. He goes and I am alone. The water is on the table miles away, I have a catheter in and I'm still numb from the waist down so I can't move to get it. I vaguely wonder what will happen if the baby cries. He is still sleeping peacefully in his crib.
Eventually the baby wakens and someone hands him to me and dashes off again. I am still numb, I have a drip in my left hand, wires for monitors sticking to my arms and a heart rate monitor clipped to my right hand. I am so nervous of holding this tiny baby and I can barely move him around. He is rooting around, looking for my breast but he's hard to manoeuvre there. I try but I don't know what to do. I know how well he did at his first feed so I know he can do it, I just need some help. He starts to cry. He is so tiny and red with angry-looking forceps marks. He looks so frustrated. He must be making a lot of noise as the midwife appears. I ask for help to latch him on but she seems to think I am trying to force him to feed. I don't understand it as he was clearly rooting around looking for milk. 'You'll put him off the breast all together if you force him,' she tells me. 'Just give him a skin-to-skin cuddle.' She places him directly on my chest and dashes off again. She must have been with me for all of two minutes. I drift off to sleep with the wee man cuddled up on my chest. I wake up and he is still there. It is boiling hot and we are both sweating. I am still quite numb and covered in wires. It occurs to me in my befuddled state that it is probably not very safe for my baby to be on top of me while I am asleep. I manage to manoeuvre him onto the bed beside me and drift in and out of my very woozy sleep.
Bubs is crying again. I try again to feed him but I'm having the same problem with the drip etc. He latches on briefly and then I struggle to support him and he comes off again. I try propping him up on cushions but without success. The midwife dashes past halfway up the ward and shouts over, 'that's a terrible position you know,' but does not come over to help or offer any suggestions. He gets more and more upset and cries louder and louder. I can barely move to soothe him and I have no idea what to do. The noise brings the midwife dashing past again. 'He's very red,' she says. 'He might be jaundiced. I'll need to go and get the doctor.' And off she goes again. 'Of course he's red,' I think, 'he's boiling and screaming, who wouldn't be red?' Needless to say, the doctor never arrives.
The shifts change and a new midwife is on. This one is a little calmer but just as stretched. Bubs is rooting again, and again I try to feed him but he's way too upset and I'm way too upset now. The new midwife comes over and is very forceful and tries to latch him on but he is screaming too much. She asks when he last fed. I know it was just before I came into the ward but I have no idea what time it is now or how long I've been here for. He is given some formula by syringe and he calms down and goes to sleep. two hours later she brings him to me again and tries to get him to latch onto my breast. He doesn't really wake up. She gives him more formula by syringe and writes on my feeding chart 'not interested in breast'.
Eventually we get out of the hell that is the HDU and moved up to the postnatal ward. My husband is back by this time and when we arrive it is nearly time for lights out and the Dads to go home. I feel sick at the thought of a whole night on my own here. I count the minutes until he comes back and get very little sleep. Bubs feeds once through the night, latches on with a little help and seems to feed. One night-time feed doesn't seem very much to me and he doesn't seem very interested. We were told in the antenatal classes that once a baby has been given formula his stomach swells and he loses interest in breastfeeding. I am losing confidence that we will ever manage to establish feeding.
My mental wellbeing is further knocked the following day when the wee man is sick and the paediatrician decides he needs to go into the neonatal ward as they are concerned it is bilious vomiting. He is taken away and I am in pieces. I feel awful, I have lost lots of blood, had very little sleep and very little to eat over the past two days and now they are taking my tiny baby away. I am very weepy. My husband and I go down with him. It is the first time I have been out of bed since the birth. The neonatal nurse and paediatrician talk to us when we arrive. Most of what they say washes over my head except for the fact that they are about to put a tube down our son's nose and take X-rays. They tell me he may get very distressed during this and that we might prefer not to be there while it happens. In any case I don't feel physically strong enough to stay and as my husband and I make our way back up to the postnatal ward I faint in the corridor.
The next two or three days are desperate. Bub's tests come back clear and they are happy that there is nothing wrong but they want to keep him in to monitor him. I am still desperate to breastfeed and I attempt to do so a couple of times in the neonatal ward but I don't feel strong enough to go down very often or for very long. I try and try to hand express with no success at all. I begin to feel more and more detached from our tiny boy and I feel guilty for not going down to see him frequently. I also feel I need my husband with me but I am so aware that I am keeping him away from the neonatal ward and our son's bedside by having him with me. I spend most of my time in tears. Everyone keeps telling me that it's normal to feel weepy due to my hormones, as if my hormones are the only reason I might be crying.
When our baby is four days old he eventually comes back up to the postnatal ward with me. I am elated to have him back. They have given me my own room and I have been given a blood transfusion. I am eventually starting to feel a bit stronger. I now begin the fight in earnest to establish breastfeeding. My milk seems to have eventually come in now that I'm much less anaemic. Each time I try to feed him I press the buzzer for help. I need all the reassurance I can get. This, however, seems to make things more difficult due to the huge variety of opinions and advice given by the numerous staff members I speak to, (midwives, care assistants, nursery nurses, ladies who bring the tea, students...) I have a different plan of action with every shift change, ranging from desperately trying to express for hours on end to watching one midwife bottlefeed my baby whilst being told I am too tired to feed him myself and I should just go to sleep. The staff in the postnatal ward are clearly very stretched. I really begin to feel like my constant questions and need for reassurance are a burden to them. It takes me another three days to even think about being able to go home. I have spent my first week as a mother feeling miserable and anxious, my confidence undermined with every staff changeover.
Looking back on my postnatal care in the hospital, I am struck by how drastically understaffed they are. The High Dependency ward is my biggest concern. It is a place where new families end up when they are very vulnerable both physically and emotionally. Surely the staff there need to be especially mindful of that. A few minutes when we first arrived to explain what was happening and reassure myself and my husband would have made all the difference. The need for proper breastfeeding support here is also huge. It is surely here that mums will need a bit more physical help and emotional support with this. The main issue on the postnatal ward is the lack of consistency throughout the different levels of staff. A consistency of advice from all the staff and I might have got home one or two days earlier.
AIMS Journal, 2019, Vol 31, No 4 Reviewed for AIMS by Jo Dagustun Mothership By Francesca Segal Chatto and Windus, 2019 288 pages £14.99 ISBN 978-1-78474-269-0 Find this…Read more
AIMS Journal, 2019, Vol 31, No 4 Reviewed for AIMS by Emma Mason Eleven Hours By Pamela Erens Published by Tin House Books 2016 ISBN 978-1941040294 176 pages Publisher's…Read more
AIMS Journal, 2019, Vol 31, No 4 Reviewed for AIMS by Clara Hubbard, age 12 The Breast Book: A puberty guide with a difference - it's the when, why and how of breasts By…Read more
Registration for the NICE Annual Conference 2020 will open on 22 January 2020. For more details and to register your interest, please visit http://www.niceconference.org.…Read more
The theme of IMUK's 2020 National Conference 2020 is The Science Behind The Art of Midwifery. Speakers to be announced and tickets will be released soon. Information is a…Read more
21-25 October 2020 The theme for this year's Midwifery Today conference is Birthing in Love: Everyone’s Right. Classes will include: Clinical sessions such as Hemorrhage,…Read more
The Royal College of Obstetricians and Gynaecologists (RCOG) recently launched a public consultation on two draft documents they have produced. Both documents were in the…Read more
AIMS has responded to the Hull Daily Mail's article entitled, " https://www.hulldailymail.co.uk/news/health/baby-born-bus-stop-shoelace-3571474 ". 26 November 2019 Dear E…Read more
The Nursing and Midwifery Council (NMC) plays a key role in the ongoing quality assurance and regulation of the maternity services and its staff. Effective and efficient…Read more