Valerie Gommon Midwife’s Blog

Archive for the ‘artificial rupture of membranes’ Category

This is a guest blog, written by one of my clients.

My name is Donna and I am a mother of three.  Two year old Grace and nine week old fraternal twin girls Olivia and Faith.

My husband Paul and I had always agreed that we didn’t want a big age gap between our children so when Grace was one year old, we decided to begin trying for baby number two.  I fell pregnant fairly quickly but unfortunately suffered a miscarriage at 5 weeks which was very upsetting.  After a few weeks we were ready to try again and as before, I fell pregnant within a couple of months.

I was very anxious during the first few weeks hoping that this time I would hold onto the baby.  At 12 weeks it was time for the scan.  I was feeling quite relaxed as the pregnancy was going well and I was feeling extremely sick which I thought was a good sign.

The last thing on my mind was the fact that I could be carrying twins.  When the ultrasonographer casually told us ‘oh, you have two in there’, we knew that our lives were going to change forever.  I didn’t know whether to laugh or cry – so I did both!  Everyone in the room was so excited for us but my husband and I were just stunned.  His face was a picture.  They told me that the reason why I had felt so sick was due to the additional hormone racing round my body. They also told us that the twins were fraternal and each had their own placenta and were in their own sac which is the safest type of twin pregnancy.

The first feeling I had once I had calmed down was that of being pregnant for the first time.  My pregnancy suddenly went from having a singleton baby and feeling confident that I had done this before so it will be ok, to all the anxieties of a first time pregnancy.

I knew that I had to do my research so as I could make some informed decisions about my pregnancy and birth.  When I told the ultrasonographer that I was planning a home birth, her reaction was ‘oh, you won’t be able to do that with twins’.  I had a fantastic pregnancy with Grace and had her at home in a birthing pool.  The thought of having to follow a medical route and have my babies in hospital filled me with dread.

As with my first pregnancy, I chose to take on an independent midwife.  This was my preference as I knew I would be less likely to end up with a hospital birth.  I made sure I looked after myself by eating well, getting plenty of rest (as much as Grace would allow me!) and exercised regularly.  I found swimming was great for keeping me fit and taking the weight off my bump.  I had regular scans to check on the twins’ development and position.  Throughout the pregnancy, Olivia (first born) remained head down and Faith was breech.  I knew that this wasn’t ideal but also knew after doing some research that as long as Olivia remained head down and although a little more risky, I could still safely deliver Faith as breech.  At 38 weeks I went for my final scan and to my surprise, Faith had done a full turn and was now head down along with Olivia.  The perfect combination for birth.

We had put together a birth plan that covered every eventuality if I needed to be transferred to hospital at any stage.  Two days after my last scan; my waters broke at 9.30pm when I was lying in bed.  I felt a pop and then a head drop down.  I walked into the bathroom and called downstairs for Paul saying ‘I think my waters have broken!’  He chased upstairs and I told him to call the midwife.  My contractions started almost immediately after my waters broke.  I spoke to my midwife and she told me to go back to bed as things may not start to happen until the morning and I would need my rest.  Olivia was not going to wait until morning.  I came downstairs and stood in the bathroom leaning over the toilet with my contractions coming fast and furious.  I tried the TENS machine but that didn’t really work for me.  Paul was in the dining room putting together the birthing pool which I got into as soon as it was ready.  The relief was immense.  I had heard that water was the most effective pain relief next to an epidural – I can well believe that.

I had four midwives looking after me and the babies and they all arrived at my house in time.  It was all happening so quickly and Olivia was born in the pool at 11.55pm.  She shot out and I heard her crying straight away.  I stood up and held my baby; I was elated and also amazed that my babies would have their own birthdays.  One of my midwives held my stomach to make sure that Faith fell and engaged in the right position.  We knew she was head down so we needed to make sure she stayed that way.  We decided to wait for my labour to progress naturally however, it slowed down.  I got out of the pool to walk around and see if I could get it started again.  Four hours passed and a decision was made to break the waters around Faith as the midwife discovered they were still intact.  As soon as the waters were broken, Faith was born on the sofa, again extremely quickly.

She cried straight away and the midwife placed her on me so as I could give her a cuddle and have skin to skin contact.  Another of the midwives was looking after Olivia.  Both my babies were born healthy and I couldn’t have been happier than I was just then.

The down side was that I now had to deliver the placentae.  I was so tired but knew I had to keep going.  One of my midwives helped to keep me relaxed with hypnobirthing techniques and control my breathing.  The placentae had fused together and were not budging.  With a combination of experience from my midwives and a hot towel placed across my stomach, the placenta moved and came away.  If it hadn’t been for the determination and skill of the team of midwives, I think I would have ended up in hospital with a retained placenta and that would have been disappointing after going through the entire birth at home.

So all was well.  I was in good health and although extremely tired, felt elated and proud that I had accomplished the birth I wanted.  My husband Paul was fantastic during and after the birth and I couldn’t have asked for a more supportive birthing partner.

A home birth is not for everyone and if there had been a health issue with either myself or my babies, I would have chosen hospital care.

I wanted to share my story so as other women can see that you do have choices during pregnancy even when you are having twins and you can make decisions that are right for you.  For more information about twin and multiple pregnancies visit www.tamba.org.uk

Donna has also set up a website which offers information about homebirth; she offers a free ebook at www.happyhomebirth.com

The first thing I should say is that Induction of labour is not an easy option and should, in my opinion, be avoided if at all possible.

There are many debates about when women should be induced – the NICE (National Institute of Health and Clinical Excellence) suggest that women should be OFFERED induction at between 41 and 42 weeks of pregnancy www.nice.org.uk/nicemedia/pdf/CG70quickrefguide.pdf

Of course there may be medical reasons for an induction, and these should carefully be discussed with your midwife and doctor, however there are also risks associated with induction, for example you are more likely to have a longer, more painful labour after an induction and you are more likely to need some help for example a ventouse or forceps delivery or a caesarean section.

If it is agreed that an induction is preferable, I would urge you to try “alternative” methods or induction before resorting to a surgical induction https://midwifevalerie.wordpress.com/2008/12/09/alternatives-t…ital-induction/

Although methods of induction vary slightly from area to area, the principles of a “surgical” induction will involve you going into the hospital where you will first be checked over (blood pressure, urinalysis, abdominal palpation), your baby’s heartbeat will then be monitored for a period of time to ensure that the baby is well and that it is safe to proceed with an induction.

You will then be assessed internally to ascertain the best and safest method to induce you.  If it is your first baby and you are not yet in labour it is likely that the doctor will prescribe a drug called “Prostin” which is inserted into your vagina to soften your cervix with the aim of starting labour.  (Prostin is an artificial preparation of the hormone prostaglandin which is naturally present and involved in the labour process.)

Your baby may well be monitored for a period after the insertion of prostin – we want to ensure that s/he suffers no adverse reaction to the drug, – the monitoring is performed by placing two elastic belts around your abdomen to hold a “transducer” (a plastic probe) onto your tummy to obtain a print-out of the baby’s heart pattern (this is just a glorified version of the sonicaid that the midwife uses antenatally to listen to your baby).

Once the midwife is reassured she will be happy for you to get up and perhaps go for a walk or go to the hospital restaurant – it is a good idea to eat as you will need lots of energy when you are in labour!  Some hospitals will also allow you to go home and wait for labour.

Prostin does not always work first time, indeed often women need two, three or sometimes more doses and these are usually repeated at 6 hourly intervals.

An alternative to prostin is to break your waters – this can only be done if your cervix has already started to open – this is more likely if this is not your first baby, or if you have had prostin which has started the process but not put you into labour.

Breaking the waters is not particularly painful, although it can be very uncomfortable.   The midwife or doctor will need to do an internal examination and will attempt to “pop” the bag of waters that your baby is inside.  We use a plastic hook and literally try to burst the balloon of water!

Very often after the waters have broken labour will naturally start within a couple of hours, so again we wait … you can go off for another walk (are you getting a sense of the timescale here … an induction can go on for several days, so don’t expect things to happen in a hurry!).

If at this point the woman still is not in labour we usually suggest giving her a drip with a drug called synotocinon which usually starts uterine contractions.  These contractions are frequently more painful than a natural labour and because we are giving a drug we will also need to continuously monitor the baby’s heartbeat meaning that you are somewhat constrained in your movements (you can still stand by the bed or sit in a chair though).

In a few cases despite all our best efforts none of this will work and we proceed to a caesarean section.

Despite my doom and gloom, many women who are induced successfully labour and go on to have a normal birth, but to give yourself the best chance of a normal birth think carefully about whether an induction is right for you.  The decision as to whether you are induced or not should be made by YOU, in consultation with your doctor and midwife, remember it is your body and your baby, you have the right not to be induced.  A normal pregnancy is defined as between 37 and 42 weeks – so you are not even overdue until you get passed 42 weeks!

More information can be found in “Induction – do I really need it?” available from www.aims.org.uk or as always I am very happy to speak to you info@3shiresmidwife.co.uk


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