• The Fit Midwife

Sunday Story Time.........

This week we have Abby's birth story with her second baby Martha. This being her second induction of labour she knew what was going to happen and was lucky enough to have a good lead midwife to discuss her options with.

It's really good to hear stories of midwives and doctors discussing options before a care plan is made. Shared decision making should be the only way!

"I went into hospital to get induced on the Monday morning. After discussions with the lead midwife we decided to start off with the cervical ripening balloon rather than the pessary. Although I had the pessary when induced with my first child and started having contractions within a couple of hours, we felt that the no drug option was better for a 37 week SGA (Small for Gestational Age) baby.

The balloon was inserted around 2pm that afternoon. We walked round the hospital, visited the new Costa cafe and even played a board game. However I started having cramps and soon couldn’t concentrate on the game. I had a decent nights sleep and was examined at 7am the next day and found to be 3cm so they broke my waters. Nothing happened over the next couple of hours so I was put on the hormone drip at 10.15 am.

We made the room dark etc and although I was happy to chat to the midwives who were monitoring me constantly it was fairly quiet in the room. Contractions started around 1.30pm and got progressively stronger albeit the drip had to be turned up to it’s maximum. I spent this time standing swaying from side to side and on my birthing ball. When I was checked at 4pm they found I was 4cm but my cervix was still very thick. For the next 4 hours I listened to the relaxation tracks from my hypnobirthing course and spent some of the time kneeling over the back of the bed.

Shifts changed and the night staff checked me at 8pm. She felt that the previous midwife was very generous with the 4cm and said I was more like 2-3cm however my cervix had almost completely thinned out. She also reported that she could feel a large bulging sack of waters and suspected that not all of my waters had been broken that morning and therefore it was likely that the hormone drip wasn’t actually doing much and it had been my own body that had got me to that stage.

The doctor then broke my waters which I used gas and air for. The hormone drip was turned down to its lowest and I returned to kneeling over the back of the bed using gas and air for each contraction. The next 2 hours went very quickly.

We think pushing started around 9.50pm and Martha was born suddenly at 10.28pm.

I was induced at 37 weeks as baby had dropped below the 10th centile and of course it was in baby’s best interest to do this I couldn’t help but feel disappointed that I hadn’t been able to go into labour naturally. Martha was a healthy 6lbs 3 and was actually born on the 30th centile. Overall, it was a much better experience than my first labour and I feel that I was much more in control and aware of what was happening. I put this down to being induced with the balloon rather than drugs and would recommended this method of induction to anyone else in the same position."

I loved this story for so many reasons (not just because she's a friend and it always makes me happy to see my friends have great experiences). But for the shared decision making. Abby advocating for herself and choosing her method of induction. The fact that her body really did all the hard work because the induction wasn't actually fully under way as first thought. And the fact that she highlights such a typical "second time around" lightning fast transition and pushing stage!

It is important to remember that Vaginal Examinations are pretty subjective, and Abby highlights this in her story. It is important that you have the same midwife examine you as much as possible in your labour, same fingers...... A great midwife will always give you one number. And if in doubt between two numbers she will always go with the lower one! Something I was taught in first year and it has stuck with me ever since!

Also because it raised such an important issue that bugs me in maternity practice here in the UAE. Many Doctors will prescribe a hormone drip for you even if your waters have not broken or been broken. This is completely fruitless. The membranes act as a cushion against the cervix, so your contractions are relentless but the result is less pressure applied (which is what makes the cervix thin out and open up). I am not sure what to liken it to. Actually I am..... You know that episode of friends where they where they wrap Joey's head in bubble wrap and punch him but he can't feel a thing..... (https://www.youtube.com/watch?v=W9vZILbLlek) Yep. It's like that! So if this happens, please question this decision!

I think it is important to note that the gorgeous Martha actually was delivered at a perfectly healthy weight! On the 30th centile. This is a perfect size for Abby. Most mums grow babies that fit them. However we are not perfect in obstetrics. We can only use the tools we have to predict potential outcomes. And if a baby appears to have static growth.... Well we can't afford to ignore that. It is important to remember that in maternity we do the best for you and your baby with what we have and what we already know! Which Abby rightly points out.

Thanks for sharing your experience with induction and the cervical ripening balloon. It can give women another option for induction (and iranother talking point for me too)

Me and Martha chilling in Pizza Express!

Nikki xxx

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