Firetop

Now that the trauma of birth is well behind us, and all the fellow NCT mums have had their babies, I think it’s safe to post a diary of events from the birth of Maria back in July. Prospective first-time parents across the country don’t really know what to expect so this might be a useful ‘difficult case’ guide. Of course I’m sure service levels vary dramatically from NHS Trust to Trust, and lots of births are plain sailing (apparently), I wish however that somebody had given me a detailed breakdown of a difficult birth so that I could have prepared myself for the eventuality. I also had no idea of how responsible I would need to be in a maternity culture where nobody takes charge.

Believe it or not I didn’t take notes at the time, but if you think you might not be able to remember everything then I suggest you take a pen. It was quite rare for any staff to bother to read the pink papers we carried around with us, instead they relied on asking me about progress. I found that the only person project managing the birth was me… because my wife had enough on her plate without taking notes of times and drug allocations. Here’s the breakdown bullet by bullet - and to think in generations gone by the husbands just sat outside and paced the floor:

Sunday July 1st
• 10:30: waters appear to be broken, hospital advise coming in to day unit.
• 12:30: arrive at empty day unit, baby and uterus monitor set up - heart rate around 140/150, some mild contractions.
• 13:00: two midwives perform examination, confirm waters gone and head not engaged.
• 14:00: registrar comes down and in a much less sensitive manor examines mother again with another examination, confirms waters gone.
• 15:00: sent for a walk as no chance of leaving - risk of infection with waters gone, need to wait for space on delivery ward (very busy need a gap).
• 16:30: taken by midwife number three to post natal ward to wait for space on delivery ward.
• 17:30: midwife number four thinks there could be some meconium leakage and inducement is needed urgently.
• 20:30: midwife number five takes mother to delivery suite.
• 21:00: midwife number six tell mother she isn’t in labour, waters probably haven’t gone and insinuates that we are wasting her time. In a condescending manor tells mother that ‘pregnancy isn’t comfortable dear’ and explains to us what Braxton Hicks contractions are (like we don’t know by now)
• 21:30: doctor performs third internal examination confirms waters gone and uses ultrasound to check position and volume of fluid. No sign of dangerous meconium though so no rush.
• 22:00: mother taken back to post natal ward but we take private room to make sure mother gets sleep before labour and avoids crying babies on ward in run up to tiring labour.
• 22:30: mother and father given tea and toast by lovely friendly midwife number seven.

Monday July 2nd
• 02:00: midwife number eight sets up monitor again because of stronger tightenings (small contractions) – goes on through night.
• 08:00: registrar number two and doctor number two felt womb, looked at monitor, head still not in position - induce with likely C-Section and advise trip to delivery suite this morning.
• 16:00: registrar number three arrives, ‘sorry you’re bored, we’re heaving on delivery ward, you won’t be going today’.

Tuesday July 3rd
• 02:00: midwife number nine occasionally checks babies heart because of stronger tightenings (small contractions) until 07:00.
• 08:00: Mother taken to delivery suite where nobody spoke to her apart from woman to give breakfast (whoops! later people can’t believe mother has eaten).
• 11:30: midwife number ten arrives with student and goes through vitamin K signatures (tells mother and father how NCT is generally wrong and anti-midwife).
• 11:45: doctor number three arrives, performs examination to feel baby’s head and gives go ahead to induce to make it engage.
• 12:00: student kindly gets mother a birthing ball and CD player.
• 12:30: drip attached and inducement commences, midwife number ten laughs at birthing plan and says no real movement on bed allowed as difficult. Student midwife says ‘after what I’ve seen here I wouldn’t ever have a baby’ (reassuring).
• 14:00: midwife number eleven comes on shift - best yet, friendly, informative and only too pleased to help mother sit on birthing ball or change positions on bed.
• 16:00: midwife number eleven performs fourth examination, discovers water not fully broken… breaks waters - something can now happen following past few hours of wasted induction and oxytocin upped to 14.4.
• 16:30: six contractions each ten minutes experienced so cuts oxytocin to 9.6 as risk of womb over stimulation and some low 80/90 baby heart rates dips not a good sign.
• 18:45: doctor number two came round, no head movement, no dilation, some concern about low heart rate dips (80/90) lowered oxytocin 4.6, suggested epidural in case c-section needed in two hours (and catheter).
• 19:00: midwife number twelve and senior student midwife number thirteen arrives and takes over duties and monitoring.
• 19:20: anaesthetist arrives to insert epidural, delivers local anaesthetic but doesn’t wait for numbing and inserts epidural with much excruciating pain, screaming and crying for mother.
• 20:45: doctor number four turned up and said ‘Lets triple the oxytocin back to 14.4 and get this baby out’ without reading any notes ‘Are you sure?’ father asks ‘We’ve seen a few more low heart rates and average is now only 120/130′. It’s fine she said, lets look again in three hours!
• 21:15: midwife number twelve notices that heart beat on baby has crashed (student in charge didn’t), emergency crash button pressed, oxytocin switched off
• 21:17: heart beat back as doctor number four attaches head monitor to baby and mother moved onto left side ‘yes I think it’s time for baby to come out now’ she finally says (you don’t say!)
• 21:50: beautiful baby girl delivered by c-section, healthy with slight inhalation of liquid which will come out over next few hours anyway.
• 22:30: Mother and baby leave operating theatre, mother still shaking from drugs, back to delivery room for observation post-op
• 22:35: midwife numbers 12,13 and 14 spend fifteen minutes trying to set up drip feed of oxytocin to stop internal bleeding risk ‘I can’t work these new ones’ they say whilst anxious father worries about the health of his very ill looking wife.
• 22:50: oxytocin put back on for mother to stimulate contractions and shut down uterus and stop bleeding.
• 23:00: Midwife number 12 makes some toast and tea for father, mother allowed to just sip water only.
• 00:00: Mother and baby taken back to post-natal ward, father asked to leave although mother still shaky and paralysed from the waist down.

Wednesday July 4th
• Throughout night mother makes frequent calls to midwives using call button to get them to pick up crying baby etc. as unable to reach or care for new child, midwives not very friendly or sensitive to situation or recent traumatic crash event. First mid wife of the day insists mother gets up to go the the toilet - wife faints in toilet. Post natal care goes on to be largely awful for following three to four days.

On the plus side we have a lovely daughter in tip top health, and of course not everybody is that lucky. However, you would imagine that there is a better way of managing the labour process than passing an expectant mother around from pillar to post. It was VERY evident that the maternity wards are massively under-resourced with pressures of increasing birth rates - including an apparently growing proportion of mothers who are not even able to speak English adding to the difficult job of being a midwife (as I was told).

Technorati Tags: hospitals, birth experience, midwives, labouring, c section, caesarean, flatline, emergeny crash, water broken

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