Induction at 41 weeks on mental health grounds....

(20 Posts)
thunksheadontable Wed 30-May-12 23:23:06

I am massively uncertain at the moment. I have posted a bit in the last few months. I have perinatal OCD and am not on medication but under care of perinatal mental health team.

My anxiety has just SKY ROCKETED since hitting 37 weeks. I have done hypnobirthing and hired a pool and theoretically want a lovely calm waterbirth but I am finding it a struggle just to get through each day right now. I have constant unwelcome images of my son dying, of the baby dying, of me dying.. sometimes they are just flashing through my head like a montage. It is really difficult to live with. I had symptoms under control (I don't have OCD except in pregnancy and after birth) but they are just.. well... not now.

I want this beautiful birth etc but the CPN suggested thinking about an induction at term as I have on my birthplan I will take meds from the birth. I didn't have guts to in pregnancy.

I said I could see why it might be good to consider it at 41 weeks if Bishop's Score was favourable because for complex reasons I will have additional family support until I am exactly 42 weeks (23rd June) but I won't have this support after that time as my family fly back home on that date.. yet wouldn't receive a "normal" post-dates induction in time for them to provide childcare for my son, and I am really concerned at the impact on him of having had them around for two weeks and then have them leave and have him dumped on friends of ours we hardly even know without really being able to prepare him.

Before anyone suggests it, I can't afford a doula or a night nanny or any of those things.. if I have to go in for an induction at 42 weeks basically he has to go to our friend 40+ miles away who can't come to collect him and who are getting married the end of that week, so not ideal. No other options.

I feel totally stressed and anxious as it is.. but an induction has risks and I am scared of it, I want this lovely birth.. but went to 42 weeks last time.

I just wish this baby would come out! I am 38+4.

What should I do.. I can see why it has been suggested, I can see why it might be of benefit but it is up to me what to do. I just wish I knew what was really best. I am so worried that I will wait and wait and need an induction that scuppers my planned home waterbirth anyway but with the added complication of all these childcare issues.

Interested in opinions.

BreeVanDerTramp Wed 30-May-12 23:33:45

I am sorry you are going through this at what is such a stressful time.

I have had two inductions, one for medical reasons and the second for term + 14. They both went well, uncomplicated and lovely births - full inductions with syntocin.

DH works away and I am currently 35 weeks pregnant with DC3 and very stressed about him missing the birth, etc and would consider induction at term if offered.

From a mental health point of view it would allow you time to prepare for the birth, arrange child care and have extra help and rest after the birth which you will need, particularly while being established on meds.

Fingers crossed you won't need induction though, this one might be on time smile

oikopolis Thu 31-May-12 00:09:59

i would do the 41 week induction tbh.

it's best to let go of the fantasies and make a decision based on what's best for you and baby imo. and it sounds to me like you need the support after birth more than you need a perfect birth in and of itself iyswim.

thunksheadontable Thu 31-May-12 21:40:57

Oh I have no fantasies, believe me. There isn't a single option I've considered that doesn't leave me cold with fear for one reason or another so they're all much the same.

Have an appointment to discuss it with consultant tomorrow.. I am dreading it because I feel it is yet another appointment where I have to go and tell my sorry tale of woe. I find it really takes a lot out of me as you have to really focus on the negatives in a consultant appointment for them to get a picture...

I just wish I could make this sodding thing go away. Midwife thought baby was breech today too and it would be great it they would just book me in for a section, I don't care anymore, I just want this to be over. I need to take those meds now and move on and develop a relationship with this baby...

BreeVanDerTramp Fri 01-Jun-12 05:53:14

I am awake at the moment as also have midwife today and a bit anxious, looking forward to finding out which way baby is lying and wouldn't be devastated to find out its breech shh, don't tell anyone else that wink

Could you write everything down so that you don't have to repeat everything to 6 different people - just ask them to leave in your notes and then if thru have questions at least the basic info is there?

Good luck today smile

RickGhastley Fri 01-Jun-12 06:25:40

Hi thunk,

Im sorry you are having such a difficult time.

Induction sounds like a good plan so that you can have support after the birth, get on some meds and get the best care for your son.

Induction need not be a bad experience - I was induced with DS2 and it was a far far easier, shorter and more positive experience then when I waited for DS2 to come naturally!

Good luck for your appointment!

thunksheadontable Fri 01-Jun-12 18:45:35

Thanks! Bree, how was your m/w appointment?

My consultant appointment was horrendous. The clinic was very busy so I arrived at 10.10 for a 10.20 appointment to be eventually seen at 12.40. I was extremely nervous, got myself into an awful state by the end of the second hour's wait and was finding myself becoming tearful in the waiting area.

When I went into the room, I was seen by one of the reg's who just was AWFUL. She started the session by saying "ooh I've left you in here a while sweetheart" and continued to call me sweetheart throughout, almost at the end of everyt sentence despite looking a good 7-10 years younger than me.
I tried to explain and she just totally seemed to miss what I was saying.. it was fairly straightforward, I need support with taking meds and because dh is finding it tough to have to do everything etc etc but she kept fixating on the fact I was booked for a homebirth and wanted an induction.. I literally COULDN'T get across to her that I wanted a homebirth if I went before 41+0 but I need a week's cover at the other side of the birth. I didn't think it was so complicated.

Choice things said were:
I said I was deteriorating rapidly and she said: "yes but only psychologically, not medically, sweetheart"

She asked what my "ideal birth" was and I said that as someone with perinatal OCD, I didn't have any "ideal" other than to survive it and to have the baby survive it. She said "well all labour is hard going, that's just labour sweetheart" (despite the fact I have no real fear of pain, just a terrible outcome).

She said "we don't like to induce for non-medical reasons sweetheart and you are asking for something in a very grey area between maternal request which is not recommended and some psychological difficulties" (if psychiatric difficulties are so non-medical, how come I have a prescription for MEDICATION for them?)

She wrote in my notes I was experiencing some "difficulties with thinking about the birth and wanted an induction for childcare reasons"

Another colleague came in and I was crying and asked if I was okay and she said: "oh don't mind her, she's just a bit tearful, aren't you sweetheart?"

She also grilled me on why I would choose a homebirth when it was so unsafe if I am anxious hmm.

She advised against water for pain relief for "an anxious person like you".

She asked where my husband was and whether he was capable of caring for my child when I was in labour and what support had he in "dealing with me".

All of this before she went to the consultant to ask if she would consent to induction and consultant said yes without hesitation! But the reg person said to ring my midwife when I was 41+2 and ask her to ring hospital to see if there was a suitable date "sometime that week", which wasn't really what I had asked for as it really doesn't remove any uncertainty.

Anyway, I left and I was distraught. I felt so degraded by the whole situation and the way she spoke to me, like I was a small child who was asking for something I didn't realise was totally irrational, like the moon from the sky. I actually thought I was going to lose it there and then. I had a sudden vision of ending up in the Mother and Baby Unit totally out of it within hours, I can't begin to communicate how distressed I was. I phoned my husband to leave work and come and get me because I could barely speak and walked around the side of the building and just sobbed. It just was so demoralising to be spoken to like that, as though the fact I have a current mental health condition means everything I say is irrational and ridiculous when it's just not like that. I am distressed and my brain isn't working the way it shoud but I am not a gibbering idiot, I am still me.. just me with thoughts I can't currently control very well.

While waiting for my husband I suddenly thought, sod this, go in and ask for a complaint form. I am a Health Professional, I know how this goes.. people don't complain and people walk out of clinics like these distressed and so it continues.

So I did and the Team Manager of the Clinic came to speak to me and got the ACTUAL consultant to meet with me and I explained my concerns while she LISTENED and they booked an induction for me there and then, with an actual date and talked me through the process. Phew. I am so exhausted by it, but relieved that I know that there is a date now.

I really feel sorry for people who have ongoing mental health issues throughout their lives and have to try and explain it to health professionals who don't understand it when asking for support and in distress. I don't know how they do it tbh.

I hope I go into labour before that induction date still though!

BreeVanDerTramp Fri 01-Jun-12 20:39:24

Well done thshunk!

The reg sounds absolutely the pits, her use of 'sweetheart' is just a cover for 'I can't be arsed to remember your nsme' angry. You are fab for standing up for yourself though, I would have went to pieces! Obviously her psych rotation was a waste of time - cant actually believe she referred to your mental health problems as non clinical hmm

My appointment went well baby is 4/5 engaged do really hoping to avoid induction and have decided to seriously consider home birth, DH and I are going to research at weekend, fingers crossed for us both then!

EdgarAllenPimms Fri 01-Jun-12 20:43:42

seriously, have you looked into hiring a doula or Im to get you through this? you need more support and continuity than the NHs is going to provide.

this is your second baby and a homebirth is actually safer both for you and for the baby.

also having them with you through an induction would make it a less scary experience if it came to that.

EdgarAllenPimms Fri 01-Jun-12 20:44:29

presuming you are medically low-risk that is...

thunksheadontable Fri 01-Jun-12 21:12:41

Yeah I am medically as low risk as you can get. My bp has been a steady 120/80 throughout, pulse around 75, no infections.. nothing.. previous vaginal birth was induced for postmaturity but active labour 10 hours progressed well etc.

The issue with doula is cost. To get me here without cracking up I have been spending £80 a week on CBT and also did a hypnobirthing course.. so really hard to get money for a doula together though I appreciate what you're saying. Dh is normally amazing but he is really finding all of this stressful.

Consultant was very pro-home birth, said she fully supported it. She also was happy for me to change mind about induction if I feel able at the time or can arrange some additional support. I think if it comes to it I will go to induction with mindframe that if Bishop's Score lower than 8 I say give me another few days and try again at 40+10, say. This is when my waters broke last time so am hopeful this will increase chances for homebirth.

narmada Fri 01-Jun-12 22:43:22

You are amazing to stand your ground with the medicos. Well done you.

That registrar sounds absolutely terrible. I hope she gets a proper ticking off and some retraining. Some people have no idea about mental health issues, just no clue whatever. It's telling she didn't see it as a 'medica'l issue at all.

I really hope all will go well for you - you sound like a strong person to me even if you are done in by pregnancy.

PS I would def have a home birth if I ever had another one, which I won't but still....

thunksheadontable Sun 03-Jun-12 11:25:35

Thanks narmada. I hope so too.

Apart from anything, using the word "sweetheart" repeatedly to someone who is older than you really doesn't make for a productive discussion. I felt about two inches high before I even told her why I had come, when the shame I feel about having this condition can already cripple me.

I think that when some of these people think of "anxiety disorders" they imagine you are a "bit of a worrier" and almost a bit, well, I can't think of a good word but perhaps "simple". And I say that in the perjorative sense, the way some people think of people with mild learning difficulties, as though they have and should have no voice. They also discount the fact this stuff just happens and could easily happen to them when they are pregnant. I didn't ask for this crap and it hasn't eroded my mental faculties.

As Gnarls Barkeley put it, "it wasn't because I didn't know enough, I just knew too much".

WhatTheHellJustHappened Tue 05-Jun-12 08:56:08

Only in this Europe, especially this country do women have to beg for an induction despite being over 40 weeks. Maternal request is apparently not a good enough reason for anything is it?! We can't ask for a caesarian, we can't ask for inductions, we can't ask for home births (unless the Godlike doctor agrees).
BUT when the midwife/obstetrician thinks an intervention is necessary, god help us if we refuse it. I personally know two women who refused forceps but were completely ignored. One had a baby with a broken collar bone and the other has a colostomy bag.

40 weeks is full term. Research has shown that after 39 weeks elective inductions and caesarians are not unsafe (barring the usual risks that accompany an induction or surgery). Then WHY does the NHS treat women like infantile idiots and refuse them the right to make their own choices?!

I'm sick to death of this global epidemic of pregnant women being denied choices. We have to seek "permission" to make choices about our bodies.
Someday, our daughters and granddaughters will look back at these attitudes and be horrified.

WhatTheHellJustHappened Tue 05-Jun-12 09:05:57

EdgarAllenPimms

Is it possible for you to cite your sources? How do you say a home birth is safer for mum and baby? I know that it's safe for low risk women, but safer? I don't think that's always true at all.
Home birth comes with it's own risks and they're nothing to laugh about. This isn't to discourage home birth at all, just to make sure people know what they're doing.

The Birthplace study concluded that babies of first time mothers were four times more likely to have a problem if they gave birth at home compared with in hospital, and were more than twice as likely to have a problem in a free-standing midwife-led unit. They also concluded that the transfer rates were not as low as we would like to believe (and this wasn't just true for first time mothers). It also concluded that PPH, broken skulls and heamorrheage was more common in home births.
Naturally hospital births come with a higher risk of intervention, but I wouldn't categorically say home births are safer. I wouldn't say that at all.

thunksheadontable Tue 05-Jun-12 14:08:11

I think Edgar was saying it is safer to have a second birth at home.

My understanding is that as a second-timer it's not at all unlikely that I would get very limited monitoring in hospital and would be discouraged from coming to the hospital before contractions were 3 mins apart lasting 1 minute each, at which point for many second-timers it can actually be getting pretty late in the birth process. There are parking issues at the hospital and I have three friends in six months who have had babies "born before arrival" because of these guidelines and a further four who have been at hospital for between half an hour and an hour, literally getting to the delivery ward with 10-15 minutes to go. They encourage you to call earlier for a homebirth which suits me.

I think birth in this country isn't massively safe, full stop. There are major staffing issues and I think place of birth is only one small piece of a very complicated jigsaw. We all just have to weigh up our own risks.

I will be absolutely happy to transfer at the earliest possible opportunity but I am scared of having too much panic in early labour so I want either:
a) homebirth to reduce this by increasing my sense of control
b) induction so I know I won't be turned away from the hospital and am less likely to be refused drugs if I need them.

Neither option thrills me, to be honest... but I have to have some sense of control about this.

thunksheadontable Tue 05-Jun-12 14:10:04

Also I do think it's not that it's "safer" but "as safe as"... in the context of what I said above, unfortunately.

WhatTheHellJustHappened Tue 05-Jun-12 16:55:52

thinkshedontable

I see your point. I agree entirely that birth in this country is not safe sad
I'm curious about something though- do they really turn women away if the contractions aren't close together?!
This shocks me for two reasons-
1. What if a woman wants an epidural(which we know won't be given if she is ovet 7-8cms)?
2. My niece's birth comes to mind. My SIL' had her baby in Singapore and as soon as her contractions started she was admitted to the hospital. By the time she got to 4 cms, they realised that the baby was in distress because his heart kept stopping for prolonged intervals. ( Before someone starts off- no it wasn't continuous fetal monitoring. ) After a discussion with her, They performed an immediate CS and the baby still needed to resusscitation (sp?) and was quite poorly. How will they diagnose fetal distress in a timely manner if they don't admit women until delivery is imminent?!?!
What about cord prolapse which can happen even in early labour?! If the mother is home labouring alone how will these things be found out and dealt with?
Parking spaces is the most pathetic sodding excuse for putting lives at risk.
Oh and whatever happened to supporting women in labour. Argh, I'm soooo angry.

thunksheadontable Tue 05-Jun-12 18:29:16

I think, WTHJH, that turning you away is precisely to avoid epidural. The registrar even put "increased risk of epidural" on my notes with reference to induction. While epidural can increase other risks, surely it is not in and of itself a "risk" to have pain relief? Two of the women I know who went on to have unassisted births at home had been to the hospital when contractions were beween 4 and 6 mins apart lasting between one minute and 90 seconds and were sent home because it didn't meet the magic number.

The issue as I see it is what counts as "risk". I found it a tad concerning that the registrar I saw initially didn't realise that actually having an anxiety disorder increases obstetric, fetal and neonatal risk... but it does. I feel I have committed SO much to trying to reduce these risks.. paying for therapy, hypnobirthing, taking early mat leave, working on diet and exercise etc, being involved with a wide range of professionals.. and yet I still have to battle to have this thing taken seriously or to get any assurances that seem based in scientific fact rather than "oh you'll be fine because it's your second sweetheart".

BUT I should stop thinking about it because all this stuff maintains my anxiety so is not good!

skssr Wed 13-Aug-14 21:34:36

Hello Its me.

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