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Some comments and cases
from Sylvie Donna...
While researching normal birth, I came across quite a few real-life cases where
women reported that speech (usually from midwives or other care providers) had
influenced outcomes.
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Case study 1:
Elise - Antenatal reassurance
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}
Background:
}Primipara.
Footling breech. American in France.
}
}Situation:
}While attending
an antenatal appointment the pregnant woman asks the doctor if the baby's
position is a problem.
}
}Woman’s
report:
}“I
had searched out a local doctor who specialized in ‘Leboyer’ births and who
attended at a very small clinic. Once we knew that my daughter was breech, I
asked this doctor about the difficulty associated with breech birth, but he
responded that there really wasn’t any difficulty
at all, just that it was a ‘little more complicated’. His matter-of-fact,
no-fear response just reinforced my trust in my ability to birth easily.”
}Outcome
}(I asked ‘How did the birth go?’)
“GREAT! By the time we arrived at the clinic, I could feel my daughter’s
foot at the entrance of my vagina… As soon as I hopped up onto the exam table,
the resident midwife shouted in a very surprised voice (in French, of course),
‘But, Madame, you didn’t tell me this baby was breech!’
I replied: ‘But, Madame, you didn’t ask!’ By then she just had time to grab a
towel and hang onto my daughter as she came out in one quick contraction.”
Case study 2:
Jenny – Nocebo effect
}
Background:
}Age
33, 5’4”. Primipara, no health problems
}
}Situation:
}She's attending
a 'routine' scan at 20 weeks. She returns from the scan to speak to the
consultant…
}
}Consultant:
What’s your shoe size?
}Jenny:
Er… 6. Why?
}Consultant: You’re going to have a
section.
}Outcome:
}Jenny
doesn’t respond. Feels distressed and confused initially because she doesn’t
know what a ‘section’ is – although it sounds bad (associations with being
'sectioned', etc. meaning being psychologically ill)… and later because she’s
dreading it and afraid. She never sees that consultant again. She cries every
day for the rest of her pregnancy. “I was in a real state. Ask my sister.” She
goes two weeks overdue. She then goes into labour spontaneously. After labouring
unproductively for over 24 hours she (predictably perhaps?) has an emergency
in-labour caesarean. She believed the consultant. She blames her bad
outcome on the prediction. “That’s why I didn’t have any more children,” she
says. “It was such an awful experience.” (N.B. I chanced upon this case study
because I met this woman who kept on admiring my own three children, but
repeatedly saying "I've only had one and I definitely won't be having any more".
Initially, I felt sure there must be some other reason - finance, husband's
view, etc. - but she assured me it was because of this consultant's comment and
the fact that she therefore had a caesarean - in her opinion.)
Case study 3:
Frances – Failure to progress i
}
Background:
}Multip.
3rd baby.
Two previous SVD, excellent outcomes. Straightforward third pregnancy.
}
}Situation:
}Labour
starts suddenly but then doesn’t seem to be progressing as fast as the woman
expects.
}
}Woman’s
report:
}“I
tried getting into a warm bath, but this time the magic didn’t work. I kept
moving and visualising but unfortunately the midwife also kept talking and I
didn’t have the guts to ask her to keep quiet. I found it impossible to ‘let go’
while she chatted to me and I felt obliged to smile politely and respond between
contractions.”
}Outcome:
}Frances
had planned to invite a friend to attend the birth – but decides against it:
“Somehow I felt too observed already… After a while I could hear the panic in
the midwife’s voice… contractions seemed to have stopped. I felt very
frightened. So I pushed with all the
strength I could muster. No contraction, but I pushed my baby out. And the baby
came out screaming with annoyance at having been disturbed.”
Case study 4:
Nuala – Failure to progress ii
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}
Background:
}Multip.
Second birth. Attended by Michel Odent, so monitoring through ‘watchful
waiting’.
}
}Situation:
}Baby
is posterior lie. Nuala’s finding the contractions ‘challenging’.
}
}Woman’s
report:
}“Just
as I got to one level a new one opened up, demanding my full concentration.
Sounds became excruciatingly magnified as all my senses heightened. I shouted to
them in the kitchen to be quiet, even though my own sounds were louder and they
had only been whispering. Still, all complied with the unreasonable request…
‘Everything irritates me.’ … I heard the book pages flipping from the kitchen as
she studied.” It was all too noisy. The pages were like flapping sails to my
ears.”
}Outcome:
}Nuala
takes homeopathic remedy Nux Vomica and (for whatever reason) within an hour
goes from 5cm to 10cm dilation and gives birth – face-to-pubis delivery. Neonate
initially grey, with no muscle tone and making no sound. Michel Odent suctions
the baby’s nose and throat and the baby suddenly ‘wails’. Third stage proceeds
soon after. Intact perineum. Mother generally has a very positive evaluation of
the birth but afterwards is clearly still exasperated with the ‘noise’ she had
to put up with. Interestingly, this same woman had a visit from the police in
her second labour - taking place at home - because they thought a murder was
taking place in the house! Nuala explains: "Although the police wanted to see
me, to set their fears to rest, Michel reassured them that all was it should be
and that I was having a baby. They returned the next day to ascertain that a
baby really had been born with the PC declaring that the sound had been
'bloodcurdling' and the WPC resolved never to have a baby after what she had
heard! Yet Ciara's birth had been beautiful to me." Moral of the story: while
it's OK for the labouring woman to scream blue murder, everyone else must keep
their mouths shut and not even make the noise of turning pages in a book!
Case study 5:
Liz – Intrapartum fear and reassurance
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}
Background:
}Multip.
Previous caesarean. Trial of labour for VBAC – but the mother is aware the baby
is in the breech position. (Had tried ECV, moxabustion, as well as ‘bum-in-air’
positions. Baby still breech.)
}
}Situation:
}Liz
is labouring in hospital, as planned, with known midwife (Judith). Judith
informs Liz she is 10cm dilated and says the next part will be ‘very hard work’
and if Liz wants an epidural she can still have it.
}
}Woman’s
report:
}“Having
done so much already, I felt determined not to do this [i.e. have an epidural]
and risk the interventions that could follow. I told her I was scared of what
was to come. She said being scared would make it harder, so I decided not to be.
It seems incredible that you can decide not to be scared, but that is what I
seemed to do.”
}
Outcome:
}“Judith
said she could tell what sex the baby was (a quirk of having a breech). Then,
after a big push, I finally felt the baby moving through me. I was leaning over
the back of the chair when another push brought the baby’s bottom out. I shouted to Judith as I was scared the
baby would drop out onto the floor. The
obstetrician was now in the room. She, my midwife and partner all lifted me onto
the bed. This felt awful as it felt like the baby was being pushed back inside.
Judith said to me: “The more of this you can do yourself the better.” The next
contraction I gave a big push and the legs came out; the next brought the arms
and shoulders spinning out. Then there was what felt like a very long silent moment. I could see the
sunset through the big windows. I could
see the midwife and obstetrician looking at me. I wondered if they were worried,
if there was a time limit on this bit. I didn’t wait for a contraction but
decided to push with all my might, to get the baby’s head out as quickly as I could. Then she was in
my arms.”
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Case study 6:
'Sallie' – Intrapartum vagueness
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}
Background:
}Multip.
1st birth
SVD. Age for this second birth: 40.
}Fetal
position: LOA. According to monitoring through ‘watchful waiting’ labour
progressing well, with 'Sallie' leaning forward (vomiting, etc.)
}
}Situation:
}'Sallie'
asks for an enema.
}
}Woman’s
report:
}“Michel
put his head round the door. I looked up. Feeling panicky. Had been straining to
do a poo. Asked Michel for an enema.”
}Outcome:
}“Michel
nodded with a serious expression on his face, no smile. He immediately left the
room. I waited and waited. Suddenly I get up (off the toilet) and experience a
fetus ejection reflex.
}Newborn
cries after a few seconds (I and baby enjoying intense eye contact beforehand).
}I
bend over to pick up my new baby, put her to the breast immediately.
}Third
stage completed smoothly as I bend down to pick up my newborn. No PPH. Almost no
blood loss. Very alert and contented baby. Retrospectively, very positive
evaluation of Michel’s avoidance of using an enema, since he knew my preferences
for complete non-intervention. Fantastic feeling of physical and emotional
strength and empowerment.”
Case study 7:
‘Clare’ – Poor evaluation
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}
Background:
}Multip.
3rd baby.
Bleeding in all three pregnancies. Given steroids in all three pregnancies to
mature baby’s lungs.
}1st baby
SVD at term (with intrapartum ARM).
}2nd baby
induction at 37 weeks. Midwife ignores birth plan (and previous SVD) and keeps
offering pethidine.
}
}Situation:
}In
labour with 3rd baby
after induction at 37 weeks again.
}Midwife
denies ‘Clare’ is in labour, although 'Clare' claims she’s been having a ‘back
labour’ for a few days.
}
}Woman’s
report:
}“The
midwife agreed to my request for an examination because I was sure something was
going on! She found I was 3cm dilated and said ‘See! I told you that you’re not
in labour, you were 3cm when you came to the hospital a week ago!’ I pointed out
that I was not dilated at all when I had been admitted and that she should go
away and read my notes if she wanted to be sure.”
}Outcome:
}“The
doctor came to see me several times and was looking at the trace from the
continuous monitor; the contractions were not very strong so they started me on
the hormone drip. I was not sure if I wanted to go ahead, but the doctor
convinced me it was the best plan. I think this is the point where I really lost
control of this birth altogether. The doctor used the expression ‘We need to get
some dynamite behind this one!’ A midwife and student came to start the drip and
the midwife could not find a vein easily,
I do not like needles and this stressed me out even more. Eventually the student
who was actually a more experienced nurse was able to do the IV. The drip was
started and almost immediately I began to lose control of my ability to cope
with the pain. The midwife and student did not leave the room like I wanted them
to but I didn’t really ask them because I was using a lot of the gas and air and
couldn’t communicate what I wanted
properly…
“I lost track of time for a while and was dimly aware of other midwives and the
doctor coming and going, all I could really concentrate on was the sound of the
baby’s heart on the monitor which was turned up very loud because he was in
distress. The next thing I knew a midwife was clipping the monitor to the baby’s
scalp because I was moving around so much. She did not ask me if she could do
this, and was actually laughing when I asked her what she was doing. She made a
comment about me being ‘away with the fairies anyhow’. Very soon after that I
had the urge to push and just did it without telling anyone. They noticed I was
pushing and wanted to examine me first because I had only been at 8cm a couple
of minutes before when the scalp monitor was attached. I refused and just pushed
the baby out. I really had to concentrate to ignore everything going on around
me and actually the pushing phase was very easy.” (N.B. Although 'Clare's' life
has avoided placental abruption - which she didn't realise was a risk at all -
and she has another live, healthy baby, her evaluation of the birth afterwards
is extremely negative and she still feels very angry at the midwife and the way
she spoke to her while she was in labour.)
Case study 8:
‘Sarah’ – Dangerous follow-up
}
Background:
}Primip.
38 weeks pregnant. Straightforward pregnancy.
}
}Situation:
}Experiences
sudden severe abdominal pain and continuous bleeding for the first time at 38
weeks. Phones hospital midwives for advice.
}
}Woman’s
report:
}“I
told them I wanted to come in. They told me it was just early labour – that I
should just have a bath and relax. They said it’d be a long while yet.”
}Outcome:
}‘Sarah’
does as instructed. Blood in the bath. Severe abdominal pain continues. Husband
is so stressed out – “This can’t be right!” – that he just calls 999 and
ambulance takes ‘Sarah’ to A&E. No fetal heartbeat on arrival. ‘Sarah’ has an
emergency caesarean and the baby is stillborn.
}She
gets pregnant again a year later and is given the option of having: a) a
caesarean at 36 weeks (not 38?) or b) an induction at 38 weeks (ignoring the
risk of uterine rupture after use of synthetic oxytocics?). Most importantly,
'Sarah' does not realise that
a repeat occurrence of
bleeding might endanger her own life and she must get to any hospital
not just the one she’s registered at ASAP. I explain it to her. I’m not sure if
she believes me
because I’m not her midwife.
}
In conclusion... I would say that 'talking' antepartum, intrapartum or
postpartum is something we should take very seriously indeed. There's plenty
more on this topic in the book
Optimal Birth: What, Why & How.
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