(I made my 100th post last time!)
So, Andy and I had a meeting with a local independent midwife (IM) on Monday to go over the hospital notes from Jack's birth. It wasn't quite as tough as I was expecting it to be, I think because we had read over them on our own already and got the worst of it out of the way. The IM, Debs, asked us to describe, from our perspective, what had happened. That was the tough bit and I did cry a bit towards the end.
Then she had a look through the written comments from my labour and studied it alongside the partogram so she could see what physiological signs were going on at the time. She came to much the same conclusions as we had, that we had an inexperienced MW on the day who should have been suggesting specific movements to encourage Jack to turn as soon as poor position was suspected (from the very first examination).
Also, artificial rupture of membranes (ARM) should not have been offered as Jack's heart rate was elevated at this time which the MWs attending on the day themselves said this suggested he was in distress, which they confirmed on breaking my waters and finding meconium. Debs, however, says that "thin meconium liquor" as described in my notes is not really of much concern and that ARM is known to cause foetal distress, so when his heart rate was up anyway it was a very poor idea. It is also known to make it more difficult for poorly positioned babies to turn into a better position. All in all it was an extremely inappropriate intervention to offer.
On the positive side, however, she thought that the MW at the hospital stretched her guidelines and protocols for us, albeit in a very medicalised way, she still piled the interventions on, but did not put any time pressures on us for well beyond what her superiors will have been advising. When Debs was in the NHS she said that she found it almost impossible to provide woman-centred care and when she did she was repremanded for it. The implication is that the hospital MW we had was probably in a bit of trouble for the leeway she gave us.
Another thing that she advised us of is that prolonged periods on the syntocinon drip can increase risk of uterine rupture, which is why it is ill-advised for VBACs. We were not advised of this risk at the time of being offered augmentation of labour, nor was it raised as a reason to come off the drip and go into theatre. I do feel that this was poor medical practice. The MW and consultant did not allow us to make an informed choice, they did not mention any risks. I do not believe that the onus should be on the client to request this information, though sadly it seems to be the case.
I feel like a weight has been lifted off my shoulders. My own thoughts about what happened have been confirmed by an experienced third party and although we can never know if things might have gone differently with another MW I can at least take comfort in the knowledge that my body did not fail me.
It was also great to meet someone who we may well hire next time, her fees are doable if we save a little each month, but as she is currently expecting her first baby we had better make sure we wait as long as we intend to!
So, Andy and I had a meeting with a local independent midwife (IM) on Monday to go over the hospital notes from Jack's birth. It wasn't quite as tough as I was expecting it to be, I think because we had read over them on our own already and got the worst of it out of the way. The IM, Debs, asked us to describe, from our perspective, what had happened. That was the tough bit and I did cry a bit towards the end.
Then she had a look through the written comments from my labour and studied it alongside the partogram so she could see what physiological signs were going on at the time. She came to much the same conclusions as we had, that we had an inexperienced MW on the day who should have been suggesting specific movements to encourage Jack to turn as soon as poor position was suspected (from the very first examination).
Also, artificial rupture of membranes (ARM) should not have been offered as Jack's heart rate was elevated at this time which the MWs attending on the day themselves said this suggested he was in distress, which they confirmed on breaking my waters and finding meconium. Debs, however, says that "thin meconium liquor" as described in my notes is not really of much concern and that ARM is known to cause foetal distress, so when his heart rate was up anyway it was a very poor idea. It is also known to make it more difficult for poorly positioned babies to turn into a better position. All in all it was an extremely inappropriate intervention to offer.
On the positive side, however, she thought that the MW at the hospital stretched her guidelines and protocols for us, albeit in a very medicalised way, she still piled the interventions on, but did not put any time pressures on us for well beyond what her superiors will have been advising. When Debs was in the NHS she said that she found it almost impossible to provide woman-centred care and when she did she was repremanded for it. The implication is that the hospital MW we had was probably in a bit of trouble for the leeway she gave us.
Another thing that she advised us of is that prolonged periods on the syntocinon drip can increase risk of uterine rupture, which is why it is ill-advised for VBACs. We were not advised of this risk at the time of being offered augmentation of labour, nor was it raised as a reason to come off the drip and go into theatre. I do feel that this was poor medical practice. The MW and consultant did not allow us to make an informed choice, they did not mention any risks. I do not believe that the onus should be on the client to request this information, though sadly it seems to be the case.
I feel like a weight has been lifted off my shoulders. My own thoughts about what happened have been confirmed by an experienced third party and although we can never know if things might have gone differently with another MW I can at least take comfort in the knowledge that my body did not fail me.
It was also great to meet someone who we may well hire next time, her fees are doable if we save a little each month, but as she is currently expecting her first baby we had better make sure we wait as long as we intend to!
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