Premature labour & monitoring/intervention

Alan? any other midwives?

I'm just thinking about Kayla's birth. I have no problem with how things panned out.. but I do recall wondering if because she was prem whether I could still say no to certain things like ARM. The fact she was early made me less likely to question it IYKWIM. OK.. yes, I know I can say no at any time.. I guess I just mean.. IS the baby at more risk during the birth than a full termer? Did I HAVE to be monitored? I think they wanted to hurry things along a bit because both DD & I had elevated heartrates.

I'd like to know what sort of things are ok to say no to during a prem birth should #3 be early as well (I'm thinking prem at around 33/34 weeks.. not a really really early prem labour).. and no.. not pregnant yet! haha.

Any thoughts?

oh and since I'm asking questions.. I was never offered pain relief (which was a good thing.. don't get me wrong haha.. had to tell the midwife off for bugging me about it when labouring with DS!) Was this because it was a prem labour too? Can you not have pain relief with a prem? Maybe it was a public/private thing.. the private hospital hounded me offering pain relief and the public didn't even mention it!

TIA!

With prem labours monitoring is usually continuous simply because a prem baby usually isn't as resilient as a full term bubba and are less likely to cope with stressful situations like labour or anything that might be happening during labour which makes it even more stressful (like a funny position or APH)

As for drugs in a prem labour I know where I work they rarely give pethidine as it can effect bubs respiratory effort after birth and with a prem thats already at a higher risk of having respiratory difficulties they don't want to administer anything that could further effect this possibility. Epidurals are fine as is gas.

As a midwife I don't often offer pain relief unless asked for although I do make suggestions and occassional highly recommend something if I think it is needed. But if the woman behaviour indicates she appears to me to be managing well then I leave her I don't mention anything about pain relief (unless asked of course) so perhaps because you were doing so well then it wasn't neccessary to offer (but we are all different)

Usually someone over 35weeks is treated exactly the same as a term pregnancy/labour (maybe a little more monitoring) until the birth and then a paediatrician will be present in case of problems relating to prematurity arises immediately at birth. Under this gestation (or with other problems known) then things are treated differently.

This is a really interesting thread Liz. I just got my notes from the hospital this week, so have been doing some reading :)

Public Hospital
Private Patient
Own OB
Public MW's
33 weeks 4 days

With DD it was such a quick labour, we got to Women's Assessment and went into an assessment room, then within minutes straight up to L & D, they didn't check bubs at that point, just based on my ctx being 3 min, once we got up there we were trying to get settled, then my OB came in, checked dialation and I was 7-8cm, they checks DD HB with a doppler, the first checks they did on us were @ 10:00pm, I was admitted at the hospital about 15min earlier, there were 3 checks on the HR, the first being 125BPM and the last being 90BPM and I know that at that point they did lose the HR, it was at that point that an episiotomy was done as there were two tears one large and bub still wasn't getting out, and due to the loss of HR, I believe that the EPI was critical. She was born @ 10:37pm, 37min after getting to L and D.

I got offered gas but nothing else, and I didn't want something in my mouth so refused, and seeing as I was 7-8cm on arrival and things were progressing very quickly, I believe nothing else was offered as there wouldn't be time for it to work. I do remember being offered gas at least twice during the labour.

Did you have a monitor on your belly the whole time? Perhaps you can ask if they use the doppler at specific intervals instead?

How fast was have your labours been, maybe that will also dictate a bit how the monitoring may need to happen.

Do you know the reason of Kyla's early arrival? I would guess perhaps that an ARM would be done to progress a labour that was not progressing and/or bub was getting more distressed. But if everthing was going along relatively well, then I can't see why it would be necessary.

Seeing as I progressed very quickly and we have a family history of it, which may end up being diagnosed with me in the coming weeks as an incompetent cervix, we know that I will progress very quickly when labour does start, but we are hoping that with the cervical suture, it will prevent the cervix from shortening and thinning earlier. Getting me to full term.

It may be worth speaking with your Dr to do a check on it during your pregnancy, to make sure that it isn't a reason for your early delivery.

Sorry I have probably written more questions than given answers, but I am slo really interested in where this thread goes :hug: