So looking after a woman last night who I had met the previous night and we had sent her home in the end, she returned soon after we came on shift last night and was still in the latent phase of labour.

She did want to stay, so we kept her care low-risk, listened in every hour or so and did not VE her until much later on when we needed to make a plan of care, or basically whether to send her home or do something!

I had sent her home previously and had hoped to protect her from the inevitable cascade of intervention.

So at what point was she left this morning?

Epidural in situ, CTG continously monitoring, ARM'ed, 7-8 centimetres.

Now you all know I am all for normal and I was able to work and be involved in decisions that enabled us to try to keep it normal for longer (we got jip for it this am, but that's another story...)

So my point is, anyway... that in that situation it ending up with epidural was in the end the right thing to do, FH was fine , but starting to have the odd warning signs (some variable decels, rare, but there) Also fetus was direct OP and so the woman had lots of pain.

Yet another thing I learned from it was we can try to keep things normal (and whose to say it might of stayed that way if baby had been more in optimal position?)

but sometimes it can't and is that so bad?

I discussed an epidural at length with her, she was not keen, but she was suffering so much, had not slept at all in two days, neither had her partner.

It worked well, yes we then had to other things, but she was pain-free and got to sleep for an hour, so...it made them happier and calmer and the couple I first met returned!

so what do you think?

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I think that we can, and should do all we can to enable a woman to have as normal a birth as possible. But there are times when this just isn't going to happen for one reason or another.

A direct OP baby causes a lot of pain for the mum, she gets very little or no rest, becomes anxious, doesn't cope well as she is in so much pain, so sooner or later decisions have to be made in my opinion.

I think in the case you describe, an epidural, although not the choice the woman initially wanted was at that point the best option for her. She was able to relax, have some sleep, and feel in control again and this is so important for her to feel good about her labour and birth afterwards.

Just my opinion.

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Midwifemissy x

Student Midwife 2007
Student uni rep
Educational Resources Manager

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Of course medicalisation has it's place. Of course we all want it to be as natural as possible - but we also want it to be an empowering experience for our women - not traumatic - and at the end of the day certain medicalised proceedures save lives - without a doubt!

What do folk think about the use of syntometrine though? Is it almost done as standard in your hospital too? I don't get it! Not as standard at least - no there to me is a truely medicalised process!(thats me on my high horse - pardon my poop!)

I think we have a thread on this somewhere... ie active management of third stage.... will look later on

Suffice to say so far I have not seen one, I have seen women talked out of it a few times though, and it is based on research that usggests that postpartum bleeding is reduced with its use, however Wickham disagrees saying the higher amount is normal physiology. Tbh though I have not looked into it yet, it would be a good essay subject and one I should've chosen really....

Anyone else know good stuff on it?

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There's other research though that says whilst bleeding maybe reduced at the time - it'll often result in bleeding more - for longer after.... 'fraid I'm a bit rubbish at knowing who said that though!

Hahaha Holliep,
I am about to start an essay on this and have also heard of this research - but can I find the blooming thing? NO!
KS x

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Kentish Spitfire
Moderator, Student Services
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"It's better to be thought a fool - rather than proved a fool!"

Well please let me know if you do - I'll give a copy to every midwife but one I've seen practising so far! 'Are you alright with an injection to get the placenta out'?!?! Is that really informed consent?! Grrrg!

This is all I have ever heard midwives say, to my shame I have said the very same thing, as was said to me when I had my own children too.

The same with vitamin K

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Oh sorry - I didn't mean to sound like I was having a go!

It's just one of my little things! I will probably be doing it by the end of this placement! Really though anyway, when a women is in labour is probably not the best time to go into depth about the whys and hows - it's our trusts policy unfortunately to encourage the use of syntometrin. When I've been on community I've talked to my ladies about it and will do more so I'm sure on community in future. It's just my personal view - I'm really sorry...

Hey, no need to be sorry, love!

it's our trusts policy too, and I just say what the midwives do, pathetic, I know. And yeah between pushing I can't discuss Wickham's views!

Please do not feel sorry, I didn't feel that way at all, I know you weren't having a go, hun!!

I haven't really read into syntometrine yet (one of my tasks for the summer of 5780000000000000000000) so if you know any useful articles online please feel free to post any links you have?!

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