Possible to have a discussion with consultants becoming disempowered?

[BrassMonkey999]

Hello,

I would welcome any advice regarding our current pregnancy.

My wife is 36 weeks pregnant with our fourth child. This time around due to her age (40! Shock! Horror!) she has been under consultant-care throughout her pregnancy.

We have had a couple of issues with her consultant-care so far. We requested a change from her first consultant after he became unreasonably defensive after we asked some very straightforward questions about the decisions he had clearly already made for us (mostly about the necessity for Clexane), to the extent that he told us that we would have to follow his advice if we "didn't want to leave our children without a mother" and suggested instead we should do our own research of the clinical studies (we did - but that's another story).

Anyway, we've just met our second consultant at the 36 week scan. He says that our baby hasn't grown as much as he would have liked in last 3 weeks. Although all other indications are normal including the amount of fluid and the blood flow, he has suggested another scan in a week plus a cervix sweep. He said that, even if the results of those are normal, he is likely to suggest an induction soon afterwards.

We didn't feel we had much chance to discuss the issue of induction. Since the meeting we have struggled to understand why, if baby and mum are both healthy, we wouldn't just leave nature to take its course for a little longer.

The main issue though, is that the whole thing has left us feeling disempowered and feeling defensive. We want to enjoy the final few weeks with our bump and then have as normal a delivery as possible. We both work for the NHS and don't mind a degree of "medicalisation" of the pregnancy and birth process. However the latest consultant's "we'll soon have that thing whipped out of you" attitude has left us feeling pretty low.

Any advice you have would be welcome, especially on the issue of how to have a constructive two-way discussion with consultants and retain some control over the decisions being made about the pregnancy and birth.

Sorry for the long post. Hope you can help. Thank you.

[Namechangeaccount]

The first consultant was definitely rude but I'm not sure I understand your problem with the second? You can still have s vaginal birth with an induction so I'm not sure why that's an issue? If the baby isn't growing well then it's better for the baby to be born.

But I've had a difficult pregnancy and can't possibly imagine why anyone would want to be pregnant longer than necessary, maybe that's my bias...

[GoooRooo]

Do you have a particular objection to an induction? I'm 40 so I'm under a consultant too and I did a fair bit of reading around this. The rate of still births doubles for women of 40 years or older once they get past 39 weeks - for me that's good enough reason to be induced if I get that far.

If it's any comfort, I had an induction with my first baby and had no forceps or ventouse and had a normal, vaginal delivery.

In terms of dealing with consultants I've had a mixed bag. I find going to the appointments with a written list of questions is helpful as it makes sure I ask everything I want to. Also having reasons why you don't want to do something/do want to do something. I am going to refuse internal examinations this time and expect some push back on that at my next consultant appointment but I will be firm (but polite) about it.

[GoooRooo]

You might find this useful reading on induction in mothers over 40.

www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_34.pdf

[BrassMonkey999]

Thanks for your feedback.

We're in no rush to induce unless there's obvious risk of harm, and there isn't at the moment. Maybe we just interpret the risk figures differently, but even a doubling of the risk is still no more than 1 in 400 (table 2 of the RCOG paper you posted link to), and that's in the 41st week of pregnancy. We're in 36th.

However the paper also says there no evidence that induction is more likely to lead to C-section, which was one of our worries, so we need to weight this up too.

I think we're going to have a look at the scan results before we sit down with the consultant next week, and be clear in our own heads what we want before meeting the consultant.

Thanks again for your thoughts. You're much more helpful than dadsnet.

[Brummiegirl15]

I'm under consultant care as well, but for different reason to age, mine is recurrent mc.

What I've found with my consultant is by all means push back and challenge but you need to show that you know the risks of whatever it is you want to do (so not being induced, or have an elective etc etc), understand the risks and importantly understand the impact of those decisions.

So I've challenged my consultant on a few things and be able to say "I appreciate your points, however it is my understanding x, y, z" and it's almost been a lightheaded sparring debate if that makes sense?

If it helps I'm on clexane as well as my consultant admitted it is very much about the benefits outweighing the risks

[GoooRooo]

I am also on Clexane - but I have a history of DVT and terrible circulation so would rather have it than not and conceded that point with the consultant.

The thing is, they can't force you to do anything you don't want to do, but as Brummiegirl15 said you need to be really clear about why you do or don't want to do something - not only to get the consultant on side but also so that you feel very confident in your choices.

[ThatBloodyWoman]

I wish I'd challenged more on my 2nd birth.
I ended up with a c section I neither wanted nor thought was necessary.
I find that although I'm normally quite assertive I was completely submissive in what I found to be an intimidating environment.
I would do a lot of research and have a long long heart to heart with your wife on what her wishes are,various scenarios,and just how far she would like you to assert your decisions on her behalf if necessary.
Good luck xx

[LongDayAlready]

Am 42 and expecting DC4 though in a slightly different position in that it's all been fairly straightforward so I've just had one consultant appointment and have the next at 38 weeks where we have the induction conversation again. My consultant was pretty pragmatic and explained the risks (although I did point out that saying the risk of still birth doubles is fairly pointless when he can't tell me what from - thank you for clarifying that!) but did take on board my point that all of my other DC have been late (last one was 9 days over) and I'm not entirely convinced that the risks of induction are any better. Like your DW, there's the matter of looking after self/existing children to consider. We rather parked the conversation but he did indicate that daily monitoring would be a compromise - would yours consider that? At least then if there were any concerns, you could act on them immediately.

Best of luck!

[Brown76]

The booklet 'Inducing Labour: Making Informed Decisions' was very helpful, available here: www.aims.org.uk/. After reading it I felt on balance that I didn't want to have an induction as the risk of still birth while double, was still low in my case. A consultant friend actively wanted an induction at 40 weeks as she has seen all of the 'worst case scenarios'. It sounds like it is important to you for it to be your own decision and to understand everything, perhaps it might be worth speaking to the consultant or another professional again to understand the issues around the possible growth concerns before having another scan or a sweep?

[worriedmum100]

I'm also 36 weeks and under consultant care. I've not seen the same consultant twice which I've not been impressed with. I'm 39 years old.

I agree with you about feeling a bit powerless. I've been pretty much told to try a VBAC despite quite strong reservations. I'm expecting induction to come up at my appointment next week but my take on it is that if I go overdue I'd rather just have a section. I don't want to be induced or interfered with. I can't have the drip anyway so all they'd be able to do is the pessary and break my waters. I will let them try a sweep and that's it.

I agree with the pp who said it's helpful to take a list of questions written down. I've also written a birth plan which I'm going to take to discuss. It basically says that I will try a VBAC but have a very strong preference for a section if there is a lack of progress or any fetal distress at all. I don't want any measures used to try and speed things up. This is mainly because last time they flogged me for 6 hours and I dilated not one cm further before ending up with an EMCS. I've tried to discuss this plan with my consultant before and he was quite dismissive along the lines "it may not work out like that" I think the only way is to be polite but firm.