I Was Denied Pain Relief During Labour

Premature Rupture of Membranes (PROM) & Vaginal Birth After Caesarean Section (VBAC)

When I was pregnant with my second baby, I was planning a vaginal birth after a previous caesarean section. (VBAC). When my labour started, the first sign that I got was my waters breaking - premature rupture of membranes (PROM). I didn't lose my mucus plug, I didn't start with any period cramps, backache or Braxton Hicks. I just woke up in the middle of the night, went to the toilet and "splash", water came gushing out of me and continued to keep trickling out of me for the rest of the labour.

Instead of panicking and going straight to the hospital (like I'd been told to do, because I was having a VBAC), I just went back to bed and waited for the contractions to start. However, I woke up the morning and I was still not in any discomfort. I contacted the maternity ward in Leeds that morning, just to let them know that I thought my waters had broken and they told me to come down and they would check me over.

I steadily got myself ready, had a shower, sent my daughter to nursery, got some breakfast and then we set off to the maternity hospital. When I arrived at the maternity assessment centre, the midwife confirmed that my waters had broken and that I had less than 24 hours for labour to become established, otherwise they would be inducing me. This obviously didn't help any oxytocin that I was trying to increase and it only created a sense of anxiety and stress. I was now on "the clock". I did not want to be induced and I did not want any kind of intervention. All I wanted was to have a physiological, vaginal birth, with no intervention and as little pain relief as possible.

VBAC Birth Story

Why I Did Not Want To Be Induced

There were numerous reasons why I did not want to be induced.

1. I knew that an induced labour is very different to a spontaneous labour.

2. I knew that an induced labour is much more intense than a spontaneous labour and highly increases the need for stronger pain relief, such as an epidural.

3. I knew that an induced labour requires continuous monitoring and reduces the ability to be active and mobile.

4. I knew that an induced labour increases the risk of intervention e.g. foreceps, kiwi cup, caesarean section and vaginal examinations. Although you can deny vaginal examinations at any time.

5. I knew that an induced labour would increase the risk of me having a postpartum haemorrhage.

6. I knew that an induced labour would increase the stress levels in my baby and cause their heart rate to be more sporadic.

7. I knew that an induced labour would not give me the lovely euphoric hormones after birth, that a physiological birth would give me.

8. I knew that an induced labour would increase the risk of my previous caesarean section uterine scar from rupturing.

Induction of Labour and Time Limits After Spontaneous Rupture of Membranes

The midwife from the maternity assessment centre shortly moved me to the antenatal ward and put me in my own room. The midwife said that the midwife in charge of the antenatal ward would soon come and see me and she would check my blood pressure and observations etc. She said that she will also discuss with me the plan for my induction. Yet again, that word, "induction!" This caused me more anxiety again and I felt like time was ticking by. I did not know that I could decline induction of labour, I did not know that the risk of infection only increases by <1% 12-24 hours after the waters have broken and by 1-2% after 24 hours. I did not know that I could decline vaginal examinations and that vaginal examinations or internal monitoring can increase the risk of infection after the waters have broken. In fact after 24 hours if a woman's waters have broken, her risk of infection goes up from 1-2% with minimal or no examinations, to 5% if she has repeated vaginal examinations.

What I also didn't know, was that if a woman who had previously had a c-section and she has an induction of labour, where she is put on a drip of syntocinon. She is 2 to 3 times more likely to experience a ruptured uterus, compared to a spontaneous VBAC. The risk of the uterus rupturing during a spontaneous VBAC is 0.5% and the risk of the uterus rupturing after an induced VBAC is 1.5%. Looking at these statistics, the risk of infection after 24 hours (no vaginal examinations) is exactly the same as the risk of having an induced labour causing a ruptured uterus.

Induction Of Labour Rates In The UK Are Rising

Where Did the "24 hour clock" come from After Waters Have Broken?

"The concept of the 24-hour clock for Term PROM started in the 1950s and 1960s. Back then, babies were more likely to be stillborn or die with longer time periods between PROM and delivery." (Burchell 1964; Calkins 1952; Lanier et al. 1965; Taylor et al. 1961).

"With the rupture of membranes, the clock of infection starts to tick; from this point on isolation and protection of the foetus from external microorganisms virtually ceases…Fetal mortality, largely due to infection, increases with the time from rupture of membranes to the onset of labour” (Shubeck et al. 1966).

“One study found that as many as 50% of babies were stillborn or died after birth if their mother developed a fever or had other signs of infection with PROM” (Lanier et al. 1965).

"No wonder doctors were so afraid of long periods between the water breaking and birth! In some studies, taking more than 24 hours for the baby to be born led to death rates that were 2 or 3 times higher than babies who were born within 24 hours after PROM! However, it is important to understand the differences between how care was provided in the 1950s and 1960s and how care is provided today, many decades later." (Evidence Based Birth, 2025).

"One study mentioned that more than half of the participants were African American. At that time, most white doctors and white hospitals did not provide Black women with any prenatal care. Black women who did not have access to a Black midwife and were sometimes not given any medical help by white providers until many, many hours after their water had broken. Tragically, their chance of infection was five times greater than white patients who were provided with timely health care." (Lanier et al. 1965).

"One of the most important problems with the evidence on term PROM is related to Group B Strep (GBS). Most of the studies regarding term PROM and infection risks were carried out before people were screened and treated for Group B Strep. It is very common for pregnant people to carry Group B Strep bacteria in their digestive systems. The CDC reports that 25% of pregnant people will carry the Group B Strep bacteria in their vaginas or rectums. Carrying this type of bacteria puts you at higher risk for chorioamnionitis and puts newborns at higher risk for Group B Strep infection. Currently, most pregnant people in the UK are screened for GBS in the third trimester, and if they are positive for GBS, most will be offered IV antibiotics when labour begins." (Evidence Based Birth, 2025). Dr Sara Wickham explains Group B Strep in great detail and the evidence surrounding it. She has also written a book called "Group B Strep Explained."

"Screening and treatment for GBS did not happen in most of the studies that looked at induction versus waiting for labour with term PROM. So, the results from these studies probably inflate the risk of infection that a woman or newborn might experience if they had term PROM today." (Evidence Based birth, 2025).

"Many of the studies also found that antibiotic treatment was not popular during this time. This means that those patients who were at risk for infections or who had early symptoms of infection were not treated until their infections were quite severe. The maternal infections could then be passed on to the babies in utero. If doctors did use antibiotics, they were usually limited to only penicillin, which is not effective against some types of bacteria". (Evidence Based Birth, 2025).

"Another reason reported death rates were high was because some researchers did not separate term PROM from PPROM. In other words, they put all babies who were born after PROM in the same group whether or not they were born prematurely. Finally, most of the studies from the 1950s-1960s were based on retrospective chart reviews and this type of study can have problems with accuracy. Also, none of the researchers looked at how many vaginal exams were performed during labour, which is one of the most important risk factors for infection with premature rupture of membranes. (PROM). Today, we have access to better quality research about what happens when people wait for labour to start on its own or induce labour after term PROM." (Evidence Based Birth, 2025).

"Research shows that with proper care, waiting for up to 48-72 hours after the water breaks does not increase the risk of infection or death to babies who are born to those people who meet certain criteria. However, waiting up to 48 to 72 hours for labour to start, can mean that the woman may have a higher chance of experiencing infection themselves." (Hannah et al. 1996; Pintucci et al. 2014).

So in today's world, the “24-hour clock” rule is no longer valid.

You can read more about the risk of infection after the waters have broken (PROM), at Evidence Based Birth.

The Maternity System's Birth Plan Was To Induce My Labour

When the midwife in charge of the antenatal ward eventually came to see me during labour, she informed me that the plan would be to get me induced at midnight. I was not asked how I felt about this and I was not given any alternative options or informed about what the risk factors were if I did or didn't get induced. I was not given informed consent. It was quite clear that the maternity team had made the decision for me and they expected me to consent.

However, my determination to have a physiological birth kicked in. I did not want to be induced and soon those contractions arrived. Each hour that went by, they got longer and stronger. Whenever a midwife came and checked in on me, she asked me how the contractions were doing. I said that they were fairly regular and that I was doing fine. Yet again, she said "that's good, we'll be moving you to delivery suite soon and getting you hooked up to the drip and inducing that labour." Why did she not believe that I was already in established labour? I had not had any vaginal examinations (thankfully), but I was very calm and controlled.

I continued to trust my baby and my body and breathed my way through each contraction. As time went on, I was finding it very hard to talk through those contractions and I became more and more internal with each contraction. Soon, the intensity became too much and my tens machine was no longer able to manage the discomfort. I needed something a bit stronger and so I asked the midwife if I could have some gas and air. Her reply was...

"Oh sweetheart, you can't have gas and air until you are in established labour!" Don't worry though, we'll be getting you induced soon and you can have some gas and air then.

Can you imagine how I felt after hearing this? Why did she not believe that I was in labour? If she had spent more time observing my behaviour and not focusing so much on getting me induced, she'd have seen that my labour was very well established.

Pain Relief Rights During Labour

Just to be clear, it is your right to pain relief at any stage during labour and you should not be denied any form of pain management when you request it. Birth Rights says "if you ask for pain relief, or for your pain relief to be topped up, it should be given unless there are good reasons against providing it. For example, there may be a medical reason for refusing pain relief because it could cause you harm. This may be called a clinical contraindication."

Thankfully, soon after the midwife left the room, I felt an urge to push. No wonder the pain felt so intense. I was fully dilated and those contractions were at the strongest that they were going to get. I was so grateful that my hypnobirthing tools and techniques helped me to not only avoid being induced, keeping that positive mindset, remaining determined and strong, but to also help me to manage the discomfort that I was experiencing. Using my calm breathing techniques and visualisation got me through.

By the time I was rushed down the corridor to delivery suite, being told by the midwife "try not to push", my baby boy was almost here. I never did get that gas and air. To be honest when I was asking for the pain relief, I was in transition. Once I was through transition and onto the second stage, I just got on with it and focused all my energy on pushing my baby out.

It would have been nice to have had the opportunity to have some gas and air whilst in transition!

How Many People Will Go Into Labour Naturally After PROM, Without Being Induced?

"If people with PROM are not induced, around 45% will go into labour within 12 hours. (Shalev et al. 1995; Zlatnik 1992).

Between 77% and 95% will go into labour within 24 hours of their water breaking (Conway et al. 1984; Pintucci et al. 2014; Zlatnik 1992).

Some researchers have found that it may take longer for people giving birth for the first time to go into labour after their water breaks. One study found that 20% of people giving birth for the first time waited longer than 48 hours for contractions to begin after PROM, while only 7% of those who had given birth before took longer than 48 hours after PROM (Morales & Lazar 1986)." (Evidence Based Birth, 2025).

Hypnobirthing & Doula Support

If you are reading this and you are expecting a baby, then congratulations and I am so glad that you are here! My hypnobirthing courses can help you to prepare positively for your birth and feel calm, confident and in control. They will teach you about your birth rights during pregnancy, labour and birth and help you to make informed decisions, increasing your chances of having a positive birth experience.

Having my support as a doula during your birth will not only help you to feel more confident and supported, but it will benefit your birth partner too. It will help them to feel confident and supported and know that they have an expert on their side, guiding them and helping them to advocate for you if needed and allowing them to feel listened to and held.

To find out more visit www.babadoulaservices.co.uk

Julia x