Things for prospective mothers to think about(Contains scientific info on stillbirth)

angelfire9

Hannibal Smith wrote: »

If you have bleeds and stuff and require in patient care I would expect you would have a fair few scans. But for an average 'normal' pregnancy, you don't get your 12 week scan. The hospital don't want to know you before 12 weeks and even when it comes to the 12 week appointment it's only for booking your pregnancy, taking your history/bloods etc. As I say, I still haven't seen a doctor yet and i'm 14 weeks now.

That is ridiculous!
Honestly I thought Limerick (St. Munchin's was bad with its 1970's design and paintwork that belongs to the dark ages) but at least you get a proper dating scan & a check up scan around 27/28 weeks

Which maternity are you going to HS?

metrovelvet wrote: »

Are you sure about that?

I was offered the choice of catheter or bed pan post epidural on my first as I couldn't walk for 8 hours post labour so the insertion of a catheter is not indicative of kidney failure in the majority of maternity cases IMHO

Ayla

As I mentioned earlier, the hospital outreach/community clinic I attended didn't see us until week 20, and only then did they do what I can guess is the "book in" (i.e: put us in the computer & write the referral for the scan). The didn't do bloods until later again (maybe around week 30) although they did urine analysis each visit. The scans rarely occurred before week 22-24 (and I had to call the hospital directly for my second preg to even find out if they had received a referral...glad I did b/c I don't think they'd gotten any paperwork on me at all).

I'm in the northwest and attended Sligo General for my deliveries...while there the hospital staff was top class and I have no complaints at all with the care I (or both of my daughters) received. The lead-up to the deliveries could be improved upon however (by having a standardized schedule of care, etc).

Naineen

I can confirm the same practice for Galway - no scans, no real prenatal care before week 20. (I rant about this in the pregnancy thread as well). I am almost 12 weeks, and I feel extremely left alone and slightly scared and panicky with all this. For most people, pregnancy is one of the major milestones in life, everything changes, but here, noone really seems to care until very late into the pregnancy.

It is an absolute joke to think that you will not know until week 20 whether you may actually have an ectopic pregnancy, ababy in the right location, a heartbeat, anything....Also, the blood tests at week 20 are a touch late - what if I have no rubella antibodies? or that rhesus factor thing (sorry, forget the technical name)? Or anything else that should be checked before you actually go on with your prgenancy?

I had a sneaky 8 week scan in Germany because for my GP here I was only yet another annoying pregnant lady, another number, next. Over there, you see your GP every MONTH during your pregnancy. Not getting scans everytime unless necessary, but as a checkup and a heads-up!
Here? Nothing.

I am very very disillusioned with the care here. I am not saying you need to have a scan every 5 minutes, but a little more care before the 20 week mark would be appreciated.

Squiggler

By contrast with the hospital experience I had appointments with my Home Birth midwife every 4 weeks from the beginning. Each appointment my blood pressure was taken, urine was tested, bump was felt, fundal height measured, after a few appointments we started trying to find a heartbeat too. Each visit lasted at least an hour, frequently more, with plenty of time to ask questions, and lots of advice too.

If I had been relying only on my GP (the one who confirmed the pregnancy told me not to get excited until we'd got past 12 weeks) and the maternity hospital I'd have been pretty stressed about the whole thing from the beginning.

Even though I won't have the option of a home birth next pregnancy (I won't meet the nutso criteria anymore) I am going to try for at least home-based antenatal care.

Needless to say there is one maternity hospital I'll be avoiding like the plague! :rolleyes:

metrovelvet

Hannibal Smith wrote: »

If you have bleeds and stuff and require in patient care I would expect you would have a fair few scans. But for an average 'normal' pregnancy, you don't get your 12 week scan. The hospital don't want to know you before 12 weeks and even when it comes to the 12 week appointment it's only for booking your pregnancy, taking your history/bloods etc. As I say, I still haven't seen a doctor yet and i'm 14 weeks now.

As far as I know its pretty standard care in the western world to get a viability, dating and abnormality scan. Three scans for your normal pregnancy. I guess Ireland cant keep up with standard practise.

angelfire9

metrovelvet wrote: »

As far as I know its pretty standard care in the western world to get a viability, dating and abnormality scan. Three scans for your normal pregnancy. I guess Ireland cant keep up with standard practise.

I have never come across a viability scan unless there was maternal bleeding

As has been stated by both grindelwald & I Limerick do a minimum of 2 scans during pregnancy with more if required (I ended up with 4 in total on my last pregnancy)

I don't think its a case of "Ireland can't keep up with standard practice" but more a case that hospitals in Dublin are over extended & under funded and the other 2 hospitals mentioned Galway & Sligo are regional general hospitals who probably focus their funds mainly towards A&E and General surgery rather than maternity care

Orion

metrovelvet wrote: »

Are you sure about that?

Pretty damn sure - I was there too. And others have just given similar tales so I'd consider that well backed up now

holidaygirl

Standard of care seems to vary vastly! I was a public patient at a Regional Hospital, and had 4 scans at 8w, 15w, 29w & 38w at ante natal visits. First scan was extra as it was reassurance due to a previous mc. I was admitted with High bp and protein in my urine at 39 weeks and also had another scan there before ds was born. I cannot fault the care I received throughout my pregnancy. I started labour myself while I was been monitored every 4 hours to decide what they would do induce or give medication for bp.

Any how I started myself at 39 + 1 and got to 8cm but for various reason Ds ended up been delivered my emergency section at 39 +2.

As regards dates, I was temping, using opk's and tracking cm and I was very sure. So when I when to my gp and the hospital I actually adjusted my lmp date accordingly as otherwise there would have been a 10 day difference. The early scans tied in to my dates.

On-top of the hospital scans I also had 2 private scans done at 12w & 26w.

As regards gp mine was very thorough the whole way throughout my pregnancy and afterwards.

I am in the very early stage of pregnancy already 5w +6 and have been to my gp, he has the letter gone off for my first scan. He also want me back in 4 weeks time.

metrovelvet

metrovelvet wrote: »

Thats my point about intervention, once you bring in one you invite the 'cascade effect' of interventions.

I've seen this "cascade of interventions" hypothesis made several times on this forum.

I would like to refute it if I may with an analogy.

A few months ago I was changing the pedals on my bike. The old pedals had been on for a few years and were fairly firmly stuck in the crank arms. Got the left off ok but the right one just wasn't budging.

It was time for the first intervention...

I put a tube over the end of the spanner to get more leverage. I used all my might but it still wasn't budging.

Less conservative measures were required...

I got a lump hammer and used it to hit the end of the spanner in the hopes that the shock would break the bond between pedal and crank arm. No dice.

At this point I wrapped the whole thing up in a WD40 soaked rag overnight, so that the WD40 could work its way into the threads of the pedal and do its thing.

Tried again the next day with spanner, spanner + pipe, spanner + hammer but still no joy.

It was time for extreme measures.

Using a blow torch I heated the crank arm so that it would expand and loosen its grip on the pedal. The blowtorch was applied until the crankarm was red hot.

Again the pedal spanner was applied and... magic! Free at last, free at last thank god almighty that pedal is free at last!

Now I know drawing comparisons between this story and childbirth may seem very condescending, but bear with me.

Was there a "cascade of interventions" in the above case? Most certainly.

Was there a causal link between one intervention and the next? Certainly not.

I ended up using the blowtorch not because I had put a pipe over the end of the spanner, but because the pedal was really, really stuck.

I went from mild interventions, to moderate, to severe, until I found a way to get the pedal off.

In the same way, if a woman has a failed vacuum/forceps delivery, and ends up having a section, was it the former that lead to the latter? No. The intensity of intervention was stepped up until a way was found to deliver the baby safely.

Ayla

In the same way, if a woman has a failed vacuum/forceps delivery, and ends up having a section, was it the former that lead to the latter? No. The intensity of intervention was stepped up until a way was found to deliver the baby safely.

I think you know that most people here are not talking about "cascading interventions" that way. They're talking about when a miscalculation of dates leads to an induction, which can then lead to a number of complications that require (as you put it) more intense interventions.

GoerGirl

Deleted User wrote: »

In the same way, if a woman has a failed vacuum/forceps delivery, and ends up having a section, was it the former that lead to the latter? No. The intensity of intervention was stepped up until a way was found to deliver the baby safely.

James - I find your analogy and reference to elevated steps of intervention as a hypothesis as nothing short of shocking to be honest.

Every intervention poses a level of risk of requiring the next intervention.

Routine intervention leads to higher risk of requiring the next level of intervention.

Induction leads to epidural. Epidural leads to constricted mobility. Constricted mobility leads to slowing of decent. Slowing of decent leads to time constraints for labour and second stages. Time constraints leads to assisted delivery. Assisted delivery leads to episiotomy......

metrovelvet

Its more like looking at a plant and deciding its not ripe according to book schedule so you start interfering and end up nearly killing the plant.

And if you left it alone for a little while everything would have been fine.

Not saying this is the case all the time, but it was in my case and im sure in others.

We've been over this a million times.

Yes induction can lead to a higher rate of interventions.

Not inducing leads to higher rate of fetal death.

Also, not inducing can lead to macrosomia- which also increases the chance of intervention being necessary.

metrovelvet

metrovelvet wrote: »

Its more like looking at a plant and deciding its not ripe according to book schedule so you start interfering and end up nearly killing the plant.

And if you left it alone for a little while everything would have been fine.

Not saying this is the case all the time, but it was in my case and im sure in others.

Way, way too much emphasis is placed on anecdotal evidence in this forum.

Squiggler

Deleted User wrote: »

Way, way too much emphasis is placed on anecdotal evidence in this forum.

Oh, really?

I'm curious. What is your personal experience of maternity care in Ireland?

How did your pregnancy/labour/birth experience compare to that
of the other women posting on here?

GoerGirl

Deleted User wrote: »

We've been over this a million times.

Yes induction can lead to a higher rate of interventions.

Not inducing leads to higher rate of fetal death.

Also, not inducing can lead to macrosomia- which also increases the chance of intervention being necessary.

James - you have actually provided very little to this debate with the exception of reiterating the above sentiments over and over; ie. your conclusions which you expect women to accept.

If you have information and evidence of benefits/risks of induction vs non-induction then post it and let women draw their own conclusions - this is after all the cornerstone of informed consent.

Ayla

Deleted User wrote: »

We've been over this a million times.

Yes induction can lead to a higher rate of interventions.

Not inducing leads to higher rate of fetal death.

Also, not inducing can lead to macrosomia- which also increases the chance of intervention being necessary.

Yes, after 42 weeks, when the preg would be fully overdue, of course there's a risk (and not just of stillbirth but of other conditions as well). But I think your assertion that rates "skyrocket" after 40 weeks is a bit sensationalist. According to your original chart on your original post, the stillbirth rate is 0.5/1000 at 40 weeks and up to 0.8/1000 at 43 weeks. Not exactly a "skyrocket" in my opinion.

In this country where care is so varied based on location and specific medical professional involved, all women here has is antecdotes.

I think what's important is comparing the risk of induction (with the possibility for a "cascade of interventions" - all of which can have an effect on the mother & baby) against the risk of not inducing. It's a fine line and not to be too easily scoffed at from either side. That's why most everyone here is pushing for individual & personalised care.

GoerGirl

Deleted User wrote: »

We've been over this a million times.

Yes induction can lead to a higher rate of interventions.

Not inducing leads to higher rate of fetal death.

Also, not inducing can lead to macrosomia- which also increases the chance of intervention being necessary.

Just to reiterate my points:

1. Cotzia research showed to save 1 stillbirth you must induce 500 women

2. risks must be analysed comparatively (ie. risk of induction vs risk of non-induction)

3. stillbirth is too broad a definition to be useful in understanding what is happening and whether interventions are actually making a difference

Induction is being proposed as a way of avoiding only one of catagory of stillbirth, Intrauterine deaths with unknown causes. It seems reasonable that induction would reduce this number, however it may increase intrapartum deaths and babies who do not breath at birth, it may also increase perinatal deaths and cot deaths. We also need to know whether it increases or reduce morbidity for babies. We already know that it increases morbidity and mortality for women.

One study I've seen referenced recorded perinatal morbidity - brain and spinal injuries: 1 in 664 forceps, 1 in 860 vacuum and 1 in 907 caesarens babies with these types of injury.

With regards to fetal macrosomia - or "big baby" - there are a whole host of issues concerning the management of macrosomia & misdiagnosis of macrosomia by scanning inaccuracies - the later in pregnancy the higher the rate of inaccuracy. By the third trimester scans can be out as much as +/- 1 to 3 pounds either way

In addition, evidence has shown us that suspected "big baby" alone is not a reason to consider induction

Induction of Labor Versus Expectant Management in Macrosomia: A Randomized Study

Conclusion: In this prospective, randomized study, induction of labor for suspected macrosomia at term did not decrease the rate of cesarean delivery or reduce neonatal morbidity. Ultrasonic estimation of fetal weight between 4000 and 4500 g should not be considered an indication for induciton of labor.



http://journals.lww.com/greenjournal/Abstract/1997/06000/Induction_of_Labor_Versus_Expectant_Management_in.5.aspx

Hannibal Smith

Deleted User wrote: »

I've seen this "cascade of interventions" hypothesis made several times on this forum.

I would like to refute it if I may with an analogy.

A few months ago I was changing the pedals on my bike. The old pedals had been on for a few years and were fairly firmly stuck in the crank arms. Got the left off ok but the right one just wasn't budging.

It was time for the first intervention...

I put a tube over the end of the spanner to get more leverage. I used all my might but it still wasn't budging.

Less conservative measures were required...

I got a lump hammer and used it to hit the end of the spanner in the hopes that the shock would break the bond between pedal and crank arm. No dice.

At this point I wrapped the whole thing up in a WD40 soaked rag overnight, so that the WD40 could work its way into the threads of the pedal and do its thing.

Tried again the next day with spanner, spanner + pipe, spanner + hammer but still no joy.

It was time for extreme measures.

Using a blow torch I heated the crank arm so that it would expand and loosen its grip on the pedal. The blowtorch was applied until the crankarm was red hot.

Again the pedal spanner was applied and... magic! Free at last, free at last thank god almighty that pedal is free at last!

Now I know drawing comparisons between this story and childbirth may seem very condescending, but bear with me.

Was there a "cascade of interventions" in the above case? Most certainly.

Was there a causal link between one intervention and the next? Certainly not.

I ended up using the blowtorch not because I had put a pipe over the end of the spanner, but because the pedal was really, really stuck.

I went from mild interventions, to moderate, to severe, until I found a way to get the pedal off.

In the same way, if a woman has a failed vacuum/forceps delivery, and ends up having a section, was it the former that lead to the latter? No. The intensity of intervention was stepped up until a way was found to deliver the baby safely.

But why not use the blowtorch from the outset? If you knew that was a sure fire way of getting the pedal off, why not go straight to that? Because you wanted to take the pedal off causing the least amount of damage to the bike. At every stage of intervention you risked more and more damage to the bike, and with every step you took you faced the damage done at that stage, plus the damage which might be caused at the next step.

Don't get me wrong, I agree with most of your points and I understand the point you're making but I just find flaws in your example

The reason there is such emphasis on anecdotal evidence is because that's all we have None of us are professionals or experts but we're speaking from experience and to be fair a lot of the ladies in this thread have a huge understanding of what they went through, the reasons why they went through it and the risks involved.

Hannibal Smith

metrovelvet wrote: »

As far as I know its pretty standard care in the western world to get a viability, dating and abnormality scan. Three scans for your normal pregnancy. I guess Ireland cant keep up with standard practise.

I'll get my viability scan at 18 weeks I wonder what the outcome will be :eek::D

As I say though, I did have two cheeky scans because of a recent miscarriage and because of bleeding, but if it wasn't for that, I wouldn't have had any scan at all.

On my first pregnancy, I was kind of seen infrequently up to 20 weeks and then every 2 weeks (with hosp and gp intermittently) after that because of high bp. Maybe they're going to do the same this time

metrovelvet

Deleted User wrote: »

Way, way too much emphasis is placed on anecdotal evidence in this forum.

Well I like anectodal evidence. I like witnesses. I like oral history. I like the evidence from people who actually experienced something. Distanced empirical evidence doesnt always tell you the full story.

I hate how people undermine someone else's experience by calling it anecdotal, it doesnt make it unworthy of considerations.

metrovelvet

Hannibal Smith wrote: »

I'll get my viability scan at 18 weeks I wonder what the outcome will be :eek::D

As I say though, I did have two cheeky scans because of a recent miscarriage and because of bleeding, but if it wasn't for that, I wouldn't have had any scan at all.

On my first pregnancy, I was kind of seen infrequently up to 20 weeks and then every 2 weeks (with hosp and gp intermittently) after that because of high bp. Maybe they're going to do the same this time

You are getting a viability scan at 18 weeks? What joke. You are supposed to have your abnormality scan around 21 weeks. So are you getting another one three weeks later?

I wish I had come across this 'anecdotal' evidence when I was pregnant.

Hannibal Smith

metrovelvet wrote: »

You are getting a viability scan at 18 weeks? What joke. You are supposed to have your abnormality scan around 21 weeks. So are you getting another one three weeks later?

I wish I had come across this 'anecdotal' evidence when I was pregnant.

lol nope...the abnormality scan will be the end of June....so that will be *counts on fingers* oh it'll be 23 weeks...sorry I think I said 27 weeks yesterday, I miscounted so it's not that far off really It's just the 12 week scan at 18 weeks that annoys me.

SanFran07

Every Week Counts Campaign Raises Awareness About Dangers Of Electively Induced Labour


http://www.huffingtonpost.com/2011/05/06/labor-39-weeks-baby-dangerous_n_858613.html

Squiggler

Squiggler wrote: »

Oh, really?

I'm curious. What is your personal experience of maternity care in Ireland?

How did your pregnancy/labour/birth experience compare to that
of the other women posting on here?

Right, so males are not allowed have an opinion on obstetric issues regardless of the extent of their training/knowledge.

Sexism does work both ways.

SanFran07

James during your training did you get to facilitate any physiological births? Have you ever had an opportunity to observe a homebirth or waterbirth? Undisturbed birth can be pretty amazing to see especially if your training is focused on complications rather than normal.

Squiggler

Deleted User wrote: »

Right, so males are not allowed have an opinion on obstetric issues regardless of the extent of their training/knowledge.

Sexism does work both ways.

Those were separate questions.

Sexism?

I asked what your personal experiences are (open to either men or women) and the second question was in case you were female (can't always tell from a username) and happened to have had children.

You haven't answered the question about your personal experiences. You mention training/knowledge, but not what it is.

All of the women on here have some experience with pregnancy and childbirth, we've all done research and studied books. I know that Sanfran and many of the others have studied medical papers and research (as have I).

Just curious to know where you're coming from.

Orion

JamesL85: it was a valid question. If you've a problem with a post report it.

Squiggler: the user name is a good clue in this case.

Let's keep it civil folks.

Moonbeam

Deleted User wrote: »

Right, so males are not allowed have an opinion on obstetric issues regardless of the extent of their training/knowledge.

Sexism does work both ways.

I too would like to know what your training/knowledge on the subject is.

emmiou

I've been following this thread as like some of the posters I too have long infrequent cycles and despite being sure of my dates have been told on all 3 of my pregnancies that I am between 4 and 10 weeks ahead of my dates by junior doctors at initial booking visits - mostly due to their lack of skill with portable scanners and inaccurate measuring of BPD, thankfully this was corrected in each case as I'd had private dating/nuchal scans at 12 weeks on each and this was taken into consideration for the dating post anomaly scan at ~22 weeks.

I suspect the OP is probably a medical student with very little obstetric experience to date...Sorry if its a bit off topic but this thread reminds me of a scene from the film Good Will Hunting...

Clark (Scott Winters): I was just hoping you might give me some insight into the evolution of the market economy in the southern colonies. My contention is that prior to the Revolutionary War, the economic modalities, especially in the southern colonies, could most aptly be characterized as agrarian precapitalism...
Chuckie (Ben Affleck): Let me tell you something, all right...
Will: (interrupting) Of course that is your contention...
Clark: Hold on a second...
Will: You're a first year grad student. You just got finished reading some Marxian Historian, Pete Garrison probably. You're gonna' be convinced of that until next month when you get to James Lemon, then you're gonna' be talking about how the economies of Virginia and Pennsylvania were entrepreneurial and capitalist way back in 1740. That's gonna' last until next year, you're gonna' be in here regurgitating Gordon Wood, talking about ya know, the Pre-Revolutionary utopia and the capital forming effects of military mobilization.
Clark: Well, as a matter of fact I won't because Wood drastically underestimates the impact of social...
Will: (interrupting) Wood drastically... Wood drastically underestimates the impact of social distinctions predicated upon wealth, especially inherited wealth. You got that from Vickers. "Work in Essex County", page 98, right? Yeah, I read that too. Were you going to plagiarize the whole thing for us? Do you have any thoughts of your own on this matter? Or do you, is that you thing, you come into a bar, you read some obscure passage, and then pretend, you pawn it off as your own, as your own idea just to impress some girl and embarrass my friend? You see, the sad thing about a guy like you is that in 50 years, you're gonna start doing some thinking on your own...