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

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    #32
    [Deleted User]
    Posts: 1,427 ✭ [Deleted User]


    GoerGirl wrote: »
    Women Ireland do not have access to dating scans. Booking in appointments in Ireland range from 12 weeks to 20+wks in some units.

    Inaccuracies for fetals scanning is widely reported. The later in a pregnancy a woman is assessed, the higher the rate of inaccuracies. The rate with which a scan can vary is +/- 1 to 3lbs depending on when in pregnancy the scan takes place. With estimated gestation for EDD by scans, inaccuracies increase after the first trimester and become dependent on genetic/conditional factors

    Early scans are very accurate. It is a pity that some women have to wait so long for them that they are done when they are no longer as accurate.


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    #33
    GoerGirl
    Registered Users Posts: 94 ✭✭GoerGirl


    Deleted User wrote: »
    Ok thanks, didn't know that, where did you get that figure? (Not doubting its accuracy, just curious.)

    I agree it would be terrible to see obstetric practice take the same route it has in the U.S. (section first, ask questions later), but at the same time the evidence as regards post maturity is too strong to ignore, and while adopting policies aimed first and foremost at preventing postmaturity related stillbirths will result in some women having less than perfect experiences, it also saves lives.

    2008 Perinatal Stats - ESRI

    "The trend in delivery by caesarean section has increased from 20.4 per cent in 1999 to 26.7 per cent for total live births in 2008, (for total maternities 20.0 per cent in 1999 and 25.9 per cent in 2008)."


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    #34
    GoerGirl
    Registered Users Posts: 94 ✭✭GoerGirl


    apologies, misread post, (deleted)


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    #35
    CK2010
    Closed Accounts Posts: 543 ✭✭✭CK2010


    I found this thread very interesting.

    I kind of had the opposite to what most mothers do, I felt i should have been talked to more about being induced.

    I was overdue by 2 weeks. I went into labour the day before I was due to be induced (which would have been 15 days over).
    At 39 weeks they discussed induction if i was to go over 40 and then I remember having two check ups in those 2 weeks that i was overdue, one including a scan to check the fluid, and they kept saying vague statements like 'if you go over by too long will have to induce' they never difinitively said we'll induce you after X amount of days, which i thought was weird. eventually they set the date when i was 13 days over.

    i was actually relieved that they were showing signs of caring!

    I had not 'dropped' even when labour started, baby was still very high and it took 29 hours of painful contractions to drop first and then the actual labour. so maybe that had something to do with not being induced?

    After the birth the midwife commented on the placenta being 'ragged' but never went into detail. would you say theres some connection there?

    i think alot of mothers set their heart on the all natural birth,and i think thats all well and good but if a doctor feels you need some sort of assistance then they should accept that. obviously there are exceptions to that, and a woman knows her body and her baby, so if she genuinely feels its not right then she should speak up, but im talking about mothers who outright from the start are determined to do it all their way regardless of what they're told is best.

    i think it should be stressed that birth plans are more birth 'ideals'. that they are what you should consider the best case scenario but not necessarily what should be expected.


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    #36
    cynder
    Registered Users Posts: 4,128 ✭✭✭cynder


    My second son had a ragged placenta, he was born 5 weeks early, it means the placenta did not come away cleanly and you might need a d&c. my womb wasnt contracting down as normal and the PHN came evry day to check on me it was only on the 6th day that she was happy that no bit of placenta was left behind.


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    #37
    CK2010
    Closed Accounts Posts: 543 ✭✭✭CK2010


    grindelwald wrote: »
    My second son had a ragged placenta, he was born 5 weeks early, it means the placenta did not come away cleanly and you might need a d&c. my womb wasnt contracting down as normal and the PHN came evry day to check on me it was only on the 6th day that she was happy that no bit of placenta was left behind.

    thanks for that.
    this is what i thought too. that bits may have come apart from it.
    thing is, i was never checked or even told what it meant. and i was a sixteen year old child at the time so there wasnt a chance they assumed i knew. it was just said to me in passing and never mentioned again!


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    #38
    GoerGirl
    Registered Users Posts: 94 ✭✭GoerGirl


    Deleted User wrote: »
    the evidence as regards post maturity is too strong to ignore

    Could you cite your information?

    WHO define "prolonged pregnancy" as continuing after 42 weeks. ie term+14

    Cochrane says:
    A policy of labour induction after 41 completed weeks or later compared to awaiting spontaneous labour either indefinitely or at least one week is associated with fewer perinatal deaths. However, the absolute risk is extremely small. Women should be appropriately counselled on both the relative and absolute risks

    http://www2.cochrane.org/reviews/en/ab004945.html

    And when you look at the absolute risk of perinatal death its 0.03% for the induction group and 0.33% for the non-induction group. Less than 0.5% risk for inducing or not. Hardly too strong to ignore.....which is probably why best practice says non-medically indicated induction should be offered at term+14


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    #39
    cynder
    Registered Users Posts: 4,128 ✭✭✭cynder


    Ayla wrote: »
    James, I think everyone here will easily support any effort to deliver a healthy baby safely. But at what point can you definitively define "overdue?" If, in my cases, the preg isn't really overdue, there's a risk to mom & baby by delivering under unspontaneous conditions.

    Is it better to be safe than sorry!

    One minute baby is fine, next the baby is dead. Who is to tell when baby's heart is going to stop, it could easily stop the minute you leave the doctors from the check up.

    If science could predict when baby's heart is going to give in (or placenta stops working) then there would be no need for such interventions until medically necessary, again is it not better to be safe than sorry, to take action before an emergency arises.


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    #40
    [Deleted User]
    Posts: 1,427 ✭ [Deleted User]


    GoerGirl wrote: »
    Could you cite your information?

    WHO define "prolonged pregnancy" as continuing after 42 weeks. ie term+14

    Cochrane says:
    A policy of labour induction after 41 completed weeks or later compared to awaiting spontaneous labour either indefinitely or at least one week is associated with fewer perinatal deaths. However, the absolute risk is extremely small. Women should be appropriately counselled on both the relative and absolute risks

    http://www2.cochrane.org/reviews/en/ab004945.html

    And when you look at the absolute risk of perinatal death its 0.03% for the induction group and 0.33% for the non-induction group. Less than 0.5% risk for inducing or not. Hardly too strong to ignore.....which is probably why best practice says non-medically indicated induction should be offered at term+14

    Now we're getting into the difference between relative and absolute risk. Yes the absolute risk is small but going from the figures above the relative risk is 11x greater.


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    #41
    CK2010
    Closed Accounts Posts: 543 ✭✭✭CK2010


    grindelwald wrote: »
    Is it better to be safe than sorry!

    One minute baby is fine, next the baby is dead. Who is to tell when baby's heart is going to stop, it could easily stop the minute you leave the doctors from the check up.

    If science could predict when baby's heart is going to give in (or placenta stops working) then there would be no need for such interventions until medically necessary, again is it not better to be safe than sorry, to take action before an emergency arises.

    this, i think, is my stance on the issue.
    i think you're damned if you do, you're damned if you dont.

    sometimes the decision is the wrong decision, which is obviously heartbreaking, but if they werent to take action and the outcome was the same they'd still be to blame.
    and it'd be my understanding that if they were to induce they'd have more medical 'scope'(???) to help if anything went wrong than if baby was left in the womb and they couldnt give it medical attention. if that makes sense.


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    #42
    cynder
    Registered Users Posts: 4,128 ✭✭✭cynder


    GoerGirl wrote: »
    Could you cite your information?

    WHO define "prolonged pregnancy" as continuing after 42 weeks. ie term+14

    Cochrane says:
    A policy of labour induction after 41 completed weeks or later compared to awaiting spontaneous labour either indefinitely or at least one week is associated with fewer perinatal deaths. However, the absolute risk is extremely small. Women should be appropriately counselled on both the relative and absolute risks

    http://www2.cochrane.org/reviews/en/ab004945.html

    And when you look at the absolute risk of perinatal death its 0.03% for the induction group and 0.33% for the non-induction group. Less than 0.5% risk for inducing or not. Hardly too strong to ignore.....which is probably why best practice says non-medically indicated induction should be offered at term+14



    14 April 2011 - Some 2.6 million stillbirths occurred worldwide in 2009, according to the first comprehensive set of estimates published in a special series of The Lancet. Every day more than 7200 babies are stillborn — a death just when parents expect to welcome a new life — and 98% of them occur in low- and middle-income countries. Well-known interventions for improving maternal and newborn health would reduce the number of stillbirths too. Well-known interventions for women and babies would save stillbirths too

    The Series shows that the way to address the problem of stillbirth is to strengthen existing maternal, newborn, and child health programmes by focusing on key interventions, which also have benefits for mothers and newborns.
    According to an analysis to which WHO contributed in The Lancet Stillbirth Series, as many as 1.1 million stillbirths could be averted with universal coverage of the following interventions:




    Intervention Stillbirths averted


    Identification and induction for mothers with >41 weeks gestation 52000



    http://www.who.int/reproductivehealth/topics/maternal_perinatal/stillbirth/Press_release_stillbirths_2011/en/index.html


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    #43
    metrovelvet
    Closed Accounts Posts: 9,376 ✭✭✭metrovelvet


    I was two weeks overdue according to the experts, but looking back I think they got it way way way wrong and as a result I had every intervention imaginable and a baby born too early, my guess is as much as a month too early.


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    #44
    SanFran07
    Registered Users Posts: 230 ✭✭SanFran07


    GoerGirl wrote: »
    James, Ireland's Caesarean section rate is nearly 27% (26.7%).

    33% in one regional unit :(


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    #45
    SanFran07
    Registered Users Posts: 230 ✭✭SanFran07


    CK2010 wrote: »
    I found this thread very interesting.

    I kind of had the opposite to what most mothers do, I felt i should have been talked to more about being induced.

    I was overdue by 2 weeks. I went into labour the day before I was due to be induced (which would have been 15 days over).
    At 39 weeks they discussed induction if i was to go over 40 and then I remember having two check ups in those 2 weeks that i was overdue, one including a scan to check the fluid, and they kept saying vague statements like 'if you go over by too long will have to induce' they never difinitively said we'll induce you after X amount of days, which i thought was weird. eventually they set the date when i was 13 days over.

    i was actually relieved that they were showing signs of caring!

    I had not 'dropped' even when labour started, baby was still very high and it took 29 hours of painful contractions to drop first and then the actual labour. so maybe that had something to do with not being induced?

    After the birth the midwife commented on the placenta being 'ragged' but never went into detail. would you say theres some connection there?

    i think alot of mothers set their heart on the all natural birth,and i think thats all well and good but if a doctor feels you need some sort of assistance then they should accept that. obviously there are exceptions to that, and a woman knows her body and her baby, so if she genuinely feels its not right then she should speak up, but im talking about mothers who outright from the start are determined to do it all their way regardless of what they're told is best.

    i think it should be stressed that birth plans are more birth 'ideals'. that they are what you should consider the best case scenario but not necessarily what should be expected.

    Ragged placentas are also caused by 'mismanagement' of the 3rd stage of labour.....cord traction and the placenta being pulled out before it has completely separated (which can sometimes result in a serious bleed too as the uterus can't clamp down properly).


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    #46
    cynder
    Registered Users Posts: 4,128 ✭✭✭cynder


    metrovelvet wrote: »
    I was two weeks overdue according to the experts, but looking back I think they got it way way way wrong and as a result I had every intervention imaginable and a baby born too early, my guess is as much as a month too early.

    How far along were you when you did your pregnancy test? missed 1, 2, or 3 or more periods?

    That would give you a good idea when you were likely to have conceived and when baby would be due giving that average gestation for a human is 40 weeks. I know when i ovulate as I'm in that much pain i cant walk so all my dates have been spot on, suppose im one of the lucky ones..... even my guy who was 5 weeks early was perfect (plastered in vernix) and was let home at 26 hours old.

    Most people take the test 1 week after missed period.


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    #47
    cynder
    Registered Users Posts: 4,128 ✭✭✭cynder


    SanFran07 wrote: »
    33% in one regional unit :(

    wonder is they are pre planned, medically necessary or emergency sections?

    would seem that this would be a hospital for high risk pregnancies where intervention is needed.


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    #48
    Hannibal Smith
    Closed Accounts Posts: 3,893 ✭✭✭Hannibal Smith


    I agree with a lot of the sentiment in the opening post. I would place birth outcome over experience any day. I had a pretty eventful birth, but I really didn't care about my experience, the only thing I cared about was a healthy baby. Of course, I'm not saying mothers who want a positive experience don't want the same thing, but for me, I believe a negative or harsh birth experience I can get over. The loss of a baby, I very much doubt I could recover from.

    Whilst of course there are parts of childbirth that need to be address in this country, and there does seem to be a lot of reform with early transfer home schemes etc, but I think the area that needs to be addressed is miscarriage. When I had a miscarriage in November I went to Holles Street and was left sitting in a corridor like a leper for an hour and a half segregated from the other mums. It was like they were the 'A' students and i was the failure. After two scans I was told there was still bits of tissue there but they patted me on the head sent me packing with some antibiotics and told me to take a pregnancy test in a couple of weeks and it all should be gone by then. Like it was nothing. A little compassion would have been nice.


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    #49
    Cat Melodeon
    Registered Users Posts: 1,617 ✭✭✭Cat Melodeon


    On the topic of scans, if the equipment is not sensitive enough or if the staff is not well-trained enough to determine whether a fetus is alive or dead, as recent reports have shown is the case in at least one Irish hospital, then I do not have very much confidence in them being sensitive/skilled enough to determine fetal age accurately either.
    grindelwald wrote: »
    If that time limit were not in place they would be many more dead babies and many more grieving moms, they are not doing it for the fun of it they are concerned for both mother and babies safety.

    A the end of the day its the mothers choice, no one can force her to have an intervention.

    On your second point what about the babies right to life? you seem to be thinking of only the carrier and not the life inside!

    Grindelwald, I feel you are deliberately misconstruing what I am saying. I am not advocating for no interventions, only for more considered application of them and for women to be treated on a case by case basis, not for them to be treated as a homogenous group.

    No woman would deliberately put her child's life at risk, but why should she be encouraged/coerced to undergo interventions in situations where there is no clear evidence that it is necessary? Yes, err on the side of caution, but not to the extent that unnatural birth becomes the norm, as is fast becoming the case for first-time mothers.

    As to the second point, I'm not going to get into a right to life argument on here as that is a separate and extremely emotive issue, but for the record, I absolutely believe that the life of the mother has priority over that of the child. I do not believe that the mother has a right to refuse necessary interventions when that clearly endangers the baby's life however, I hope that distinction is clear.


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    #50
    metrovelvet
    Closed Accounts Posts: 9,376 ✭✭✭metrovelvet


    ...and while they may not be doing them for the fun of it...there are financial motivations..

    1.fear of litigation

    2. C sections in the US are 25K

    cat mel is right. Intervention is becoming more and more the norm. If my brother and I were born today, we would have both ended up as sections.


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    #51
    SanFran07
    Registered Users Posts: 230 ✭✭SanFran07


    grindelwald wrote: »
    wonder is they are pre planned, medically necessary or emergency sections?

    would seem that this would be a hospital for high risk pregnancies where intervention is needed.

    Kilkenny - a small regional hospital. In Lagan Valley unit in the North Dr Niamh McCabe was able to reduce the c-section rate from 22% to 14% with no increase in neonatal mortality.


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    #52
    cynder
    Registered Users Posts: 4,128 ✭✭✭cynder


    Cat Melodeon wrote: »
    I absolutely believe that the life of the mother has priority over that of the child..

    I say that sums it up and that why we have a difference of opinion.

    People who think like me will go ahead with any intervention and even die for the unborn child, where as people who think like the above will put themselves first.


    off to enjoy the weekend!


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    #53
    metrovelvet
    Closed Accounts Posts: 9,376 ✭✭✭metrovelvet


    grindelwald wrote: »
    I say that sums it up and that why we have a difference of opinion.

    People who think like me will go ahead with any intervention and even die for the unborn child, where as people who think like the above will put themselves first.


    off to enjoy the weekend!

    That's very unfair. Have you looked into studies on pnd and pn psychosis? Have you looked into how interventions affect the baby? Or the person caring for the baby [the mother]?

    If you died for your unborn child who would take care of your unborn child? Mine would have ended up in a New York City foster care program for the rest of his life, orphaned.

    And fyi, my interventions nearly cost BOTH of us our lives, where if I just sat tight and trusted my body and didnt let myself get bullied by the medical establishment, a lot of pain would have been saved for both me and my son.

    FFS.


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    #54
    cynder
    Registered Users Posts: 4,128 ✭✭✭cynder


    metrovelvet wrote: »
    That's very unfair. Have you looked into studies on pnd and pn psychosis? Have you looked into how interventions affect the baby? Or the person caring for the baby [the mother]?

    If you died for your unborn child who would take care of your unborn child? Mine would have ended up in a New York City foster care program for the rest of his life, orphaned.

    And fyi, my interventions nearly cost BOTH of us our lives, where if I just sat tight and trusted my body and didnt let myself get bullied by the medical establishment, a lot of pain would have been saved for both me and my son.

    FFS.

    Your both alive i take it, and who knows if you hadn't of gone ahead with the intervention your baby might have died the next the day inside your womb. If you hadn't of gone ahead with the intervention and your baby would have died how would you have felt? Who know how long it would have took you to go in to spontaneous labour.


    If i would have died my mother and/or my partner would have taken care of the baby, i took out a life insurance policy when i found out i was pregnant at 18 so that if anything did happen she would be left with a hugh sum of money. My mother even offered during the pregnancy to take the baby if it was disabled and i declined her offer, thankfully she wasnt.


    anyways im off to the beach with the kids, enjoy your weekend.


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    #55
    SanFran07
    Registered Users Posts: 230 ✭✭SanFran07


    Hannibal Smith wrote: »
    I agree with a lot of the sentiment in the opening post. I would place birth outcome over experience any day. I had a pretty eventful birth, but I really didn't care about my experience, the only thing I cared about was a healthy baby.

    Just to play devils advocate (and this isn't directed at you Hannibal).

    Whenever the value of a Mother's birth 'experience' comes up in a discussion these comments are usually directed at women who choose to have a natural birth or homebirth and it's implied that they have put the 'experience' ahead of their baby's wellbeing. They are risking their baby's life just to get a particular 'experience'. These Mothers choose to avoid non medically indicated interventions whether at home or hospital that could potentially negatively effect their baby's wellbeing but the mothers wellbeing and experience also.

    So lets apply the same logic to a Mother who wants an epidural.

    Isn't the mother who chooses an epidural also choosing a particular birth experience and an experience that puts their needs ahead of their baby's? It could be argued that a mother choosing to have an epidural is choosing to ignore well documented risks of epidural anestheisa and putting their baby at risk just to get a particular experience.... :confused:


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    #56
    miss_shadow
    Registered Users Posts: 1,446 ✭✭✭miss_shadow


    ...what a lovely thread to be reading while pregnant :)


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    #57
    cynder
    Registered Users Posts: 4,128 ✭✭✭cynder


    SanFran07 wrote: »
    Just to play devils advocate (and this isn't directed at you Hannibal).

    Whenever the value of a Mother's birth 'experience' comes up in a discussion these comments are usually directed at women who choose to have a natural birth or homebirth and it's implied that they have put the 'experience' ahead of their baby's wellbeing. They are risking their baby's life just to get a particular 'experience'. These Mothers choose to avoid non medically indicated interventions whether at home or hospital that could potentially negatively effect their baby's wellbeing but the mothers wellbeing and experience also.

    So lets apply the same logic to a Mother who wants an epidural.

    Isn't the mother who chooses an epidural also choosing a particular birth experience and an experience that puts their needs ahead of their baby's? It could be argued that a mother choosing to have an epidural is choosing to ignore well documented risks of epidural anestheisa and putting their baby at risk just to get a particular experience.... :confused:

    I was to to have an epidural after 20+ hours of labour i didnt want one, only after they broke my waters was i told i needed one. I eventually agreed. 4 hours later my abby was born 9lb 1oz and no forceps or vacuum ( a good few internal stitches) and im not a big lady. There is more rick to the mother having an epidural than there is to the unborn baby, if epidural is given and baby gets distressed an emergency c-section can be performed very quickly. The epidural it has more pros than cons and your monitored ( and baby is monitored) every second it is in. unlike going home and waiting for spontaneous labour (that might not happen until after the baby has died inside of you).


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    #58
    cynder
    Registered Users Posts: 4,128 ✭✭✭cynder


    metrovelvet wrote: »
    ...and while they may not be doing them for the fun of it...there are financial motivations..

    1.fear of litigation

    2. C sections in the US are 25K

    cat mel is right. Intervention is becoming more and more the norm. If my brother and I were born today, we would have both ended up as sections.


    Out of curiosity how much are they in Ireland? since its Ireland we are living in.


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    #59
    Mimikyu
    Registered Users Posts: 18,904 ✭✭✭✭Mimikyu


    This post has been deleted.


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    #60
    CK2010
    Closed Accounts Posts: 543 ✭✭✭CK2010


    grindelwald wrote: »
    I say that sums it up and that why we have a difference of opinion.

    People who think like me will go ahead with any intervention and even die for the unborn child, where as people who think like the above will put themselves first.


    off to enjoy the weekend!

    i think thats a little unfair tbh. and i usually agree with most of your posts so dont take this as an attack on you personally or anything, but if someone says they believe the mother should be put before the baby that does not automatically equate to them putting themselves first.

    in a medical sense i think i would say that the mother should probably be the first priority (even though im not entirely sure of my opinions tbh because lets face it its not something anyone wants to think in detail about) but thats not to say i wouldnt die for my child.

    nobody ever knows what will happen, not even doctors, for sure. doctors can advise what they think is best and its up to the mother to decide what she thinks is best for herself and her unborn child. thats all any mother can do. there is no right or wrong or black and white. and i dont think any mother on here would choose flippantly. and certainly no mother wants to risk her baby's life, whether its to save/benefit her own or not.

    also, people will form opinions on the issue based on their own experiences so its important to keep in mind that while one person has a horrible experience being induced, another person may have benefited from it, and vice versa, so just because it was an easy decision or the best one in hindsight, that may not be the case for someone else.


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    #61
    SanFran07
    Registered Users Posts: 230 ✭✭SanFran07


    grindelwald wrote: »
    I was to to have an epidural after 20+ hours of labour i didnt want one, only after they broke my waters was i told i needed one. I eventually agreed. 4 hours later my abby was born 9lb 1oz and no forceps or vacuum ( a good few internal stitches) and im not a big lady. There is more rick to the mother having an epidural than there is to the unborn baby, if epidural is given and baby gets distressed an emergency c-section can be performed very quickly. The epidural it has more pros than cons and your monitored ( and baby is monitored) every second it is in. unlike going home and waiting for spontaneous labour (that might not happen until after the baby has died inside of you).

    Grindelwald I don't know anything about your history but epidurals are rarely medically necessary. They have their place but the majority of women have epidurals for comfort (a better experience) even through they are advised of the pros/cons for Mum and baby. I'm just making the point that there seems to be a double standard here....

    Captain Morgan and other expectant Mums the title of the thread says 'stillbirth' so you have a fair idea of what is going to be discussed......I would avoid this particular thread like the plague if I was expecting.


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