The spin doctor

The dreaded pregnancy end symptoms.

We’ve all heard the stories of the woman who was in labour for four days, exhausted, kept ringing her midwife and kept being fobbed off and not allowed to go into the birth centre or the hospital.

I get clients having their second baby who have this story and the fault isn’t with the previous midwife, it’s just a completely normal process that maybe hasn’t been explained to them properly. Or they just didn’t understand it.

The uterus is spending that time of erratic, shorter contractions building up receptors to catch all that awesome oxytocin that makes it contract, the cervix is busy thinning so it can open up. For a second time mum the receptors are already there and the cervix will open as it thins - an altogether faster process.

So for a first time mum there is a point to these pregnancy end symptoms otherwise called latent labour but it’s bloody hard when you are in it. Especially if you don’t understand that it’s a normal process that can’t be sped up but IS serving a purpose. For most first time mums -even those that understand - it’s a bit of a mind f*#*

It’s especially disastrous if the women and her support crew engage. An example being niggles that start at 10pm, everyone’s awake, everyone’s excited, the bag is already in the car, great auntie Judy three times removed has been informed that the baby is coming. THE BABY IS FINALLY COMING EVERYONE!!! But at five am the irregular contractions disappear, by 7am hubby has left for work on no sleep, the woman catches a short nap before the phone rings and visitors arrive a few hours later. The same scenario happens the following night again. By which stage the woman is exhausted and thinks she can’t cope, she won’t have the energy for full on labour, the tired hubby hates seeing her in pain and also starts to have doubts... the family wants to know what her midwife is doing about it? Two nights of no sleep and the pressure is on the midwife to get the baby to come NOW!

Whereas if she expects this scenario to happen, knows it’s normal and is told more than once in late pregnancy to go to bed and ignore the contractions until they are regular and she can’t nap in between them any more, the chances of a successful labour are vastly increased.

This expectation to ignore till you can’t ignore, combined with being physically fit, eating and drinking regularly throughout the latent stage (that uterus has to run a marathon after all - what athlete does that without training and a whole load of protein bars?) is the best set up a woman can have to increase her chance of a birth without interventions.

So back to my current client, I visited her around lunchtime and spoke to her a couple of times this evening. Now I’m writing this at 1.25am in my driveway, (it’s too cold to get out of the car). I’ve just got home from her labour assessment. And besides I stupidly had a coffee on the way to her house, wanting to stay awake on the long drive and thinking I had a nights work ahead of me. So sleep is now doomed.

This client has the classic first time mum story: Irregular short contractions started the night before this one at 11pm (knowing this was normal she didn’t ring to let me know until the next morning - thank you very much! She’s definitely in my good books.) The contractions continued to be erratic throughout the day, I visited at lunchtime yesterday to assess at her request and my vaginal exam showed she was 2 cm dilated, but with irregular contractions. So not yet meeting the generally accepted definition of established labour - starting at 4cm dilation, with regular contractions (3-4 in a 10 minute period, each one lasting 60-90 seconds).

So tooled up with tricks to help her cope she was happy to continue at home, reminded this process often takes at least 24 hours until established labour starts. She was happy something was happening and excited.

Then at 8 pm she rang again with not a lot of change in style of contractions. She was a bit demoralised now. I recommended a feed, bath and bed - as often a good sleep does the trick. And I assumed I would now get to sleep until the small hours at least. At 8.45pm her hubby rings back saying her waters had broken, once again I discussed the signs of established labour, but sleep evaded me as the chances of getting rung again quickly were pretty high now!

So at midnight after a short doze the phone rings again. Please come! Sure, coffee made, 30 min drive completed and guard cat avoided, my client now looked much more in the labour zone. No longer talking through her contractions was a great sign. However the exam told me not a lot of change had happened. Still in latent labour. And no we can’t go in to the birth centre yet.

AND I HAVE HAD A COFFEE! When will I learn?

But back to the point at hand. This is a very hard discussion to have as a midwife with your client. But it’s a pretty common one. Yes you are working hard - yes you’ve been at it a long time, but no there hasn’t been significant change since I last checked. That’s pretty hard to spin. She’s no longer excited. She’s scared she doesn’t have the energy for this and that something is wrong.

So the same words are used again explaining the physiological process, a lot of encouragement is given, a homeopathic remedy to help, an acupuncture needle for optimal baby position, the shower is turned on... food arranged. The dad is bolstered up again and given his job of feeding her every 30 minutes and away I go. It’s her journey, she has to accept the process. She is much more likely to establish at home in her safe zone than at the birthcentre.

And as long as she is fully informed, understands that this is normal I hope that she is never one of those who think they were in labour for four days and were unsupported in that time. Yes she knows she had pregnancy end symptoms for a long time, but then hopefully her story says she established and their baby came to meet them a few hours after.

Bets on when I will be called back?

I’m going with 5am.

Bets on when I get back to sleep?

I’m going with 4.45am 🙄