Extra pressure

midwifemissy · #1 (**permalink**) 05-May-2008, 10:44

When caring for a lady in labour who has previous obstetric history of maybe a difficult delivery or neo natal death for example, how do/would you cope with the extra pressure this must bring to the delivery?

I have been wondering about this since I witnessed a delivery a week or so ago, I don't want to go into details here due to patient confidentiality, but the lady had a very sad obstetric history, and her and her partner were very anxious about this baby which is quite understandable.
But I am sure it must put the midwife under more pressure in these kind of circumstances, but it wasn't apparent from the way my mentor conducted the delivery.

Is this something you learn to do, or does it come naturally with experience?

I do intend on asking my mentor this question when I get chance, but just wanted to know what others think about it too?

Shoshana · #2 (**permalink**) 05-May-2008, 10:57

Me again!

- I'm not really stalking you around the threads missy!

Sometimes I feel a bit annoyed when people say "This is a very precious baby, due to xyz" - All babies are precious!

If you regard every delivery in the same way, I am sure that it helps when caring for women in the circustances that you describe. I don't think that I am anymore cautious with these women than any other woman. It won't help them if the midwife comes across as being anxious. It is your hope that this experience will in some small way help to heal the memories of what has happened before, so the more relaxed the atmosphere, the better.

You sometimes find that women with poor obstetric histories opt for an elective section, believing that this will be the safest option. - That is debatable, when you consider the increased risk to both the mother and baby following the birth.

midwifemissy · #3 (**permalink**) 05-May-2008, 11:07

Ha ha ha, no worries Shoshana, I value your replies too much to even think that lol.

I agree with that, every baby is special, and should be treated as such by everyone concerned with his or her care.

You make a good point again, I hadn't thought of it like that, and my mentor didn't act differently in any way with this lady than any other I have seen her care for, confident, calm and professional always.

I just hope that one day I can be the same way.

Yes, the increased risks with an elective section can outweigh the apparent benefits, and I think this needs to be fully discussed with the family before hand, then they can make informed choices about it.

Originally Posted by Shoshana

Me again! - I'm not really stalking you around the threads missy!

Sometimes I feel a bit annoyed when people say "This is a very precious baby, due to xyz" - All babies are precious!

If you regard every delivery in the same way, I am sure that it helps when caring for women in the circustances that you describe. I don't think that I am anymore cautious with these women than any other woman. It won't help them if the midwife comes across as being anxious. It is your hope that this experience will in some small way help to heal the memories of what has happened before, so the more relaxed the atmosphere, the better.

You sometimes find that women with poor obstetric histories opt for an elective section, believing that this will be the safest option. - That is debatable, when you consider the increased risk to both the mother and baby following the birth.

upsy daisy · #4 (**permalink**) 05-May-2008, 20:57

I'm not yet in that position but I remember feeling very anxious when giving birth 2nd time around after having had a Prem baby 1st time around (thankfully he is fine) - however from the other side of the coin, I remember my obstetric history being discussed whilst I was in labour....eg I could hear the medical staff saying that I was a multip but as my labour wasn't progressing well at all and I was struggling with the pushing stage...it was almost as though they were saying "well she's had a previous baby but he was premature"....it was almost as though they thought I hadn't laboured a full term baby and I was being treated as if it was my first baby....I was quite angry about that at the time but in so much distress and pain I wasn't really able to argue back

The point Shoshana makes is an excellent one - yes ALL babies are equally as important, irrespective of a woman's previous experiences/obstetric history and I think it's a sign of a fab midwife that can treat all births in the same calm/confident way
x

Dory · #5 (**permalink**) 05-May-2008, 21:45

I think you have to treat every woman on an individual basis, and that it also depends on the stage of labour that the woman is at when you become involved in her care.

If I start to look after a woman while she is still relatively early on in her labour, I will ask about her pregnancy and her previous experiences of birth, as this can often help me to provide better care for her in labour. I've often found that where a woman has had a previous traumatic experience, it relates to a particular aspect of her care - such as 'no-one told me what was going on' or 'no-one listened' or 'the room was suddenly full of people I didn't know and no-one told me why', which is easy to tackle sensitively - you'd be surprised how many people who are traumatised by a previous birth experience feel this way because of lack of information or lack of control, rather than because of what actually happened. It can also useful to talk about the labour when the woman has had a previous NND, because you are acknowledging her previous baby and previous experience, many women who experience a stillbirth report it hard to cope because people don't want to talk to them about it.

When I take over the care of a woman who is already is established labour, the time for long conversations is usually past, and I would care for the woman as any other labouring woman. I think if I was aware that someone had had a previous traumatic time, I would go out of my way to keep things as calm as possible, but I tend to do this anyway, with low lighting etc.

midwifemissy · #6 (**permalink**) 05-May-2008, 21:53

That's the way my mentor looks after the women she is caring for Dory, and I agree it does depend on the stage of labour she is at when you start to care for her.

Isn't it very sad that even today, women still say that they weren't told or informed about what was happening to them? What about them having informed choice, isn't this what we are supposed to be working to provide? I know sometimes things can happen very quickly and maybe time is limited and that can affect what happens.

Shoshana · #7 (**permalink**) 06-May-2008, 07:23

Originally Posted by midwifemissy

Isn't it very sad that even today, women still say that they weren't told or informed about what was happening to them? What about them having informed choice, isn't this what we are supposed to be working to provide? I know sometimes things can happen very quickly and maybe time is limited and that can affect what happens.

I know that this can happen. But, it could be that the woman doesn't remember all that was said. It's not unusual for the partner to say to the women, after the baby is born, x y & z happened and for the woman to have no recollection of this.

I really think women should have someone to turn to during the postnatal period, to debrief their labour. Sometimes this is done in hospital, maybe the day after the baby is born. But, in my opinion this is not enough. Women need time to reflect on what has happened and then to have their questions answered. If this were the case, they would enter any future pregnancies in a more positive way, rather than dreading the day they go into labour.

Edited to add:
I do Refresher Courses with the NCT. These are usually 4 evening sessions. Half of the time I have with the parents is taken up with debriefing their previous experience and unwrapping anxieties that have built up as a result of this experience.

midwifemissy · #8 (**permalink**) 06-May-2008, 09:16

A very good point Shoshana, I think I remember every detail of mine, but in reality I probably don't.

That would be a really good idea, and so helpful for the women, give them a chance to put things straight and in perspective. Those classes sound really good, and must be a very positive thing for the women.

Originally Posted by Shoshana

I know that this can happen. But, it could be that the woman doesn't remember all that was said. It's not unusual for the partner to say to the women, after the baby is born, x y & z happened and for the woman to have no recollection of this.

I really think women should have someone to turn to during the postnatal period, to debrief their labour. Sometimes this is done in hospital, maybe the day after the baby is born. But, in my opinion this is not enough. Women need time to reflect on what has happened and then to have their questions answered. If this were the case, they would enter any future pregnancies in a more positive way, rather than dreading the day they go into labour.

Edited to add:
I do Refresher Courses with the NCT. These are usually 4 evening sessions. Half of the time I have with the parents is taken up with debriefing their previous experience and unwrapping anxieties that have built up as a result of this experience.

Ani · #9 (**permalink**) 08-May-2008, 11:38

The first birth I saw - my sister had a baby girl - my mum said to me afterwards that I would probably remember more about it than my sister.
Sorry, bit off-topic!

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Extra pressure

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