I had been training to be a midwife since 2006. Halfway through my final year on my internship I found out I was pregnant. I was on a 13 hour shift on the gynae ward and took a test into the bathroom and lo and behold it was positive! I finished my shift with great difficulty.
Come the end of my internship I was 16 weeks pregnant. I did not seek employment. I felt the job was hard enough with out being pregnant and fair play to anyone who can do it longer but I was done. I was attending the DOMINO scheme in my teaching hospital as I was low risk apart from being overweight but I had my glucose tolerance test at 24 weeks and all was fine.
I did want to have a home birth and fully support women’s choices to do so. Something in my head however said I would be better in hospital for my first.
I did my end of year assignment on “the maternal consequences of active management of labour”. Little did I know I would fall into the classic “cascade of intervention” we see written about so much and my daughter would suffer an adverse outcome as a result of that.
It was at this point that I realised no matter how informed you are at this stage you are only as safe as the people taking care of you. Unfortunately the people taking care of me were as I had been many times, stressed out. I was getting very stressed out.
My labour started on a Monday, very slow irregular contractions. I did what I would tell a woman to do – stay at home, walk, stay relaxed, keep the lights low. By Wednesday night not much had changed and I’d not gotten much sleep as the contractions were so irregular. I kept thinking it was kicking off only to be proved wrong. I had the full support of my partner, family and friends around me during the day, but at night it was harder to handle. On Wednesday night I decided to go in to the hospital to get my dilation checked, thinking if I was 3cms (in active labour) I would be better off on the labour ward and the days of slow labour were doing something. I arrived had a trace of the baby’s heart done (which I knew wasn’t necessary but went along with so not to seem difficult). My dilation was checked and I was 1 cm fully effaced. I did not loose heart though as effacing is a big part of a first time mother’s labour. I was offered to be admitted for pain relief but I knew I’d be better off at home so home I went.
Thursday was spent drinking smoothies, bathing, bouncing on the birthing ball and getting lots of back rubs. Thursday night I was wearing out and went back to be checked again. I thought I must be doing something now even though the contractions were still very irregular. I was also listening to my body and wondering why it was all in my back and thinking that the baby must be occipital posterior (back to back).
On Thursday night I had the trace and my dilation was checked again. I was still 1cm fully effaced and so exhausted I accepted the invite to be admitted to the pre labour ward for pain relief in the hope of getting some rest. The pre labour ward was as I remembered from working there. Overcrowded and understaffed. I had another trace done to confirm fetal well being before pethidine could be given. All was well and I got the injection. It provided little relief. It was at this point that I realised no matter how informed you are at this stage you are only as safe as the people taking care of you. Unfortunately the people taking care of me were as I had been many times, stressed out. I was getting very stressed out. The midwife suggested I have a bath and if I had no relief from that they would give me more pethidine. The bath seemed to work until a contraction hit, it was the worst one yet. I yelled at my partner to get me out.
At this stage all I could do was stand and sway. My legs were giving out after days of this. I forced myself to lay down for another trace in order to receive more pain relief. I couldn’t stay lying down but held the CTG myself as I stood and swayed. I got more pethidine and asked for my dilation to be checked again. I was 3 cms. Hours had passed at this stage and I was beginning to get worried. There was no beds available on the labour ward.
At this stage I could hear the lady in the bed next to me sounding “pushy”. She was fully dilated. The midwives rushed in and the door was closed. In our little room separated only by a curtain she began to push. I told my partner he could leave as I saw the terror on his face. I was not scared as I was all too familiar with the sounds of birth. He decided to stay but I could tell he was freaked out by the whole thing and found myself reassuring him. Her baby was delivered safely thankfully and all was well with her.
At this stage I asked for the use of entonox (gas and air) as I knew I was in for a long wait and was contracting more frequently. It worked wonders for me and my partner and I even managed to have a bit of a laugh when my hand went numb and I panicked as I thought it was gone and he had to find it for me! Time lost all meaning to me but having received my notes since, I was 5 hours waiting on a bed on the labour ward.
I was put flat on my back in a position called McRoberts as the midwife was afraid her shoulders might get stuck and my partner had to hold my leg. With the next push he got to see his daughter being born.
The entonox began to lose its edge and I began thinking of the epidural. It was a hard decision as I had been hoping for a natural birth and knew the possible complications associated with this. When we eventually got to the labour ward I decided if I was 5 cms I would continue on the entonox. My dilation was checked and I crumpled when the midwife said I was still 3cms. I needed rest. I uttered the code word “banana” to my partner and he knew I really did want the epidural. It was sited and I could finally lie down. But I knew what was coming next. Syntocinon.
I was rechecked 2 hours later and was still 3cms so the syntocinon was started. My baby did not like this. Her heart rate started decelerating. A doctor came in and said in the most condescending tone I’ve ever heard “it’s looking like a section, isn’t it?”. My reply must have shocked him when I said “actually Dr. I would rather you took a fetal blood sample in order to see if the baby really is in distress by looking at the pH levels and the base excess”. My midwife spoke to him outside and after that his tune changed. The FBS was taken and the pH levels were within good levels so a plan was made that unless I was more dilated in one hour a section would be performed.
One hour later I was 5 cms and baby’s ph levels were lower but still within safe levels. We decided to wait one more hour as the baby’s heart rate still wasn’t great and re-assess then. While we were waiting I heard a familiar sound on the CTG. The baby was turning! On the next check I was 8 cms and again baby’s pH levels were slightly lower but still safe. The next plan was to be fully dilated in 30 minutes.
I was rechecked and thankfully I was 10 cms but baby really wasn’t happy at this stage. She was having prolonged late decelerations and she needed to be born asap. Her head was quite high at -1 station and with the epidural and being a first time mother I agreed the best was to have a trial forceps delivery in theatre. As I was getting prepped to go the doctor said sure you may as well start pushing now while we’re waiting. So I put my chin on my chest drew my legs back, as I’ve instructed so many women to do and gave an almighty push.
The midwife yelled at me to stop I thought what could be wrong now?! But it was because she was crowning after one push and she had no gloves on. The next push her head was delivered. I was put flat on my back in a position called McRoberts as the midwife was afraid her shoulders might get stuck and my partner had to hold my leg. With the next push he got to see his daughter being born.
She was taken to the side to the resusitaire as she passed meconium when she was born (pooped, can be a sign of oxygen deprivation). I could hear her screaming so I wasn’t worried. I had an actively managed 3rd stage and an intact perineum.
I was so delighted I had avoided most interventions I dreaded and pushed my baby out myself. I was on cloud 9. She was born on the Friday at 02.20 6lbs 11 oz. We had no name for her as of yet.
I went home at 14.00 the next day. We had many visitors to the house. I was breast feeding and she fed well that day. The next day I started to worry about her. She wouldn’t latch on and she was kicking one leg more than the other. My blood pressure was high and that evening the DOMINO midwives thought I had better go back in. I asked about her leg and they rang a paed in the hospital who said it was probably nothing. Seeing as I was going in I decided to bring her with me anyway.
It is such a shame this had to happen. I do not blame any individual who cared for us but I do blame the hospital system as a whole. What I would hope my personal story would do is serve to warn that even the most informed and prepared can fall into the mouth of the beast.
We were seen pretty much straight away. I knew that wasn’t good. Her leg twitching prompted her oxygen saturations to plummet below 60% when it happened. She was brought very quickly by incubator to NICU. The doctor said what I was thinking, seizures.
I was readmitted as my blood pressure was so high it needed medication. I was put in a private room, which I knew was also not good. When she was stabilised after a few hours we could go and see her. She was in her own room with her own neonatal nurse. The wires and tubes didn’t bother me so much, i knew what they were for, but my partner couldn’t handle it. He was freaking out and trying to be strong at the same time. I was too. The doctor came and explained that they really didn’t know why she was having these seizures and there were so many causes we could be a long time finding out. It was up to a week until she could have an MRI but in the meantime they would test for everything else. Had we any questions? My question was to the point “could she die from this?”. The answer didn’t help “yes but it’s unlikely.” We named her Chloe that night.
The next day I was inconsolable. There was a visiting ban in the hospital at the time so my partner and I were the only ones who could visit the NICU and we had to give updates to the family and friends keeping vigil in the lobby. It was awful. People didn’t understand, I couldn’t explain. She was intubated as the medication trying to control her seizures was depressing her breathing. This devastated everyone but I knew it was a necessary evil. It was like I was speaking a different language. I felt so alone though I had no end of support. All I could do was express for her for when she could eventually receive nutrition.
Days passed and tests came back negative. She was no longer seizing due to the medication. We were told we may never find the cause. I couldn’t cope with not knowing why. I did research on my phone ( I was still in the hospital with high blood pressure not surprisingly). When she was 6 days old she went for an MRI in another hospital.She was extubated but still on nasal oxygen. She was moved to a less serious part of the NICU and tube fed and eventually I could put her to the breast (though she was so medicated she hardly latched). I was home at this stage. After 10 days we went in to get the MRI results and take her home.
What we were told was not what the report the doctor had in his hand said. We were told lies that day and we still don’t know why. We were told she had a bleed on her brain. This meant she may have learning difficulties, cerebral palsy, and blindness. We didn’t know what we would be facing the second time we took our baby home from hospital.
Since then we have discovered through another doctor and from getting our birth notes what she actually had was an ischemic infarction (where an area of the brain has died usually due to oxygen deprivation). Further to that, the time it occured was a week before the MRI was taken, so birth.
Since all this we have been so lucky with our little girl. She has hemiplasia (weakness) of her right hand (picked up at 4 months). She has had physio and occupational therapy and early intervention seems to have done her the world of good. She is now 17 months and just like any healthy baby thankfully but she is still being watched very closely.
It is such a shame this had to happen. I do not blame any individual who cared for us but I do blame the hospital system as a whole. What I would hope my personal story would do is serve to warn that even the most informed and prepared can fall into the mouth of the beast. Next time I will be avoiding the beast all together and having a homebirth. I trust in my ability to birth now. If I could birth under the circumstances I was in ie. LEAST ideal I feel I can birth anywhere now! Though I’m not in any hurry.
We have consulted with solicitors when we were very angry and not sure what we were facing. Now we are happy with her progress and are happy to leave well enough alone. I have complained to the HSE about their staffing levels and lack of resources as I feel this is what caused my daughter’s condition.
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