Should I be making a complaint? scar rupture after induction

[louisoscar]

Hi all

I've been a lurker on mn all through my pregnancy but never posted until now when I really would value some advice and opinions.

My dd is 11 days old and we've been home a week after a very difficult delivery. I was admitted with pre-eclampsia a day before my due date and it escalated rapidly over the next 24 hours. I was hooked up to allsorts including a magnesium sulphate drip and constant fetal and bp monitoring; all standard protocol for pre-eclampsia. The problem is I was also induced at the same time as I was on all this monitoring with a 'propess' (sp?) pessary which was new to my hospital (introduced just the day before- they seemed very excited about it). This was my 2nd DC after having ds 6 years ago by CS after failure to progress. The doctor I saw proudly told me that I was the 4th woman to be induced with this drug and the other 3 had all had their babies within 10 hours of insertion (nothing like other people's success to make you feel like a failure!)

At my 34 week appointment I was specifically told that I would be only given 1 pessary out of a possible 4 (old induction drug) due to my previous CS as a forceful labour could rupture my CS scar. 24 hours after the 'propess' was put in my labour did start with a vengeance. I have never felt so scared, overwhelmed and in total sheer agony. I was begging them to help me (unfortunately no anaesthetist available for hours) and when I finally did get an epidural I contracted in vain and stopped progressing at 6cms. I then ended up with a section anyway (all of this whilst on fluid restriction for PE too) and they told me that my old CS scar HAD started to rupture. I believe this was from the force of the labour and that I should never have been induced with that drug under those conditions. It just scares me that if I had then opted for a ocytocin drip to try for a 'natural' delivery that my uterus might well have ruptured....

Obviously this was all very traumatic and still quite raw but I just wonder if people think I should be complaining to the hospital about this induction or just let it go and be thankful my little one is here safe and sound.

Thanks for your opinions in advance

[MerryMingeWhingesAgain]

I am not a Dr. But I know that induction is not usually offered to people who have had a CS because it is well known to massively increase the risk of rupture. IMHO they should have gone straight to CS when the baby needed to be delivered more urgently.

Did they discuss the risks of induction with you?

RCOG guidelines that are very interesting

[Manchesterhistorygirl]

When I was pregnant with ds2 I was told that under no circumstance would chemical induction be an option. They would attempt to break my waters, but absolutely not induce any other ey because of rupture risk.

I realise the local if anecdote is not data, but that's my experience.

Glad your little one is here and well.

[QTPie]

I think it varies from hospital to hospital... The hospital that I had DS had a "non induction policy after previous CS", but some hospitals will.

We're you warned of risk of rupture if you were induced? We're you given a choice (ie induction or CS)? People should be warned of the risks and, in my opinion, offered a choice.

QT

[QTPie]

Oh and congratulations: despite the awful delivery, great that DD is here safe and soUnd :)

[PacificDogwood]

Congratulations !

I'd ask for a 'debrief' with the consultant under whose care you were, rather than go straight in there with a complaint.

There is a risk of scar rupture for any VBAC, it was one of the risks discussed with me in some detail. And I was told that they would not go anywhere near augmentation of labout with syntocynon, but procede to CS if needed.

I am not familiar with the pessary you mention and I think that would need clarification: was induction with it in the context of previous CS have been contraindicated? If so, was it a relative contraindication or absolute? Where those risks explained to you and did you give informed consent? I know that can be difficult when in the throws of labour and anxiety about what's going on.

I am glad you and your DD are ok, but I would certainly want to speak to my consultant when I felt ready for it.

[louisoscar]

Thanks for all your replies.

I agree that I should have been told the risks for uterine rupture with induction and I don't believe I was. My friend who trained as a doctor in the cz republic said they would never have allowed it there but the emphasis here is so much on reducing CS rates that they will let women try 'under the right conditions'. It was quite obvious though that this was not under ideal conditions and I'm really not sure why I was not being offered a CS straight away. There was a woman in the bed opposite in exactly the same situation so I know they didn't just make a 'mistake' with me, it is obviously hospital policy. They also would have let me try the syntocinin drip had i pushed for it and I dread to think what might have happened had I opted for that.

I think it will be a good idea to speak to a consultant about this as I have a feeling it is going to eat away at me...Part of it is just about being heard though and I feel better having my concerns validated on here.

Thanks

[MrsHoolie]

It depends from hospital to hospital and consultant to consultant.

One of my local hospitals flatly refuses inductions for vbac and the other offers the balloon thingy (is that the propess).

Did you have a vbac appointment with a midwife at any point?Thats when they should go over risks with you.

Sorry you had a scary experience. I have also had two EMCS and both for FTP!

[Kveta]

God, poor you :( great that your DD is here safely though.

Fwiw, the Czech republic has quite a different approach to all things childbirth (friends there are horrified that not only was my first child a forceps delivery, but that my second was too - forceps are not used over there to the best of my knowledge), so not sure a Czech Dr will know what current guidelines are in the UK.

That said, it is definitely worth following up the way that you have been treated, can you do a birth debrief with a midwife or consultant at your hospital?

[TheCrackFox]

I would ask for a debrief.

My sister and baby nearly died (all fine now) because some bright spark decided to speed up her VBAC - she had gone into labour naturally. If a uterine rupture occurs the consequences can be utterly horrific and they shouldn't be allowed to sweep near misses under the carpet.

[PacificDogwood]

Ah nuts, I just composed a very considered post full of amazing insight and then 'tinterweb (which is a bit wobbly in our house) fell down or something.

The gist was:
Go for a debrief with the most senior person available to you ie consultant if they were involved in your care of the head of midwifery.
Make sure your notes are available at said meeting.
Go with somebody - your DH, or sister/mother/friend to have another set of eyes and ears there.
Take a list of questions and take notes.

You will either:
Come away from that meeting feeling reassured that everything was done as it should have been done and you were one of the unlucky women who have a problem with scar rupture.
Come away from the meeting with more information and better 'ammunition' if you chose to take this further/make an official complaint.

You said it might niggle with you - don't let it. Have that meeting.

Good luck .

[bemybebe]

First of all congratulations! How wonderful that you and your baby are now safe and sound.

Secondly, I would ask the hospital for the meeting with the consultant. In writing. They should explain to you why did they take the decision they did. My very strong advice is do it when you are in the position to take the information in. Set up the meeting for a few weeks from now, when you are fully recovered and settled with your newborn.

Make sure they have your notes with them and ask to see the notes (take camera with you if you can). Take as many notes as you can, ask as many questions as you can and ask them to send you a proper letter after your meeting.

Should you feel you would like to take the matter further, you have plenty of time to act.

[atrcts]

I would think it is fair to write a complaint about your management. Common sense tells you that the extra effort of contracting through induction is much more stress to the body. If some hospitals have a policy to completely avoid it altogether ten a complaint will force them to review their policy and might save someone else from having to go through what you just did.

I hope you make a very speedy and full recovery so you can enjoy our new little arrival without the birth hanging over your head.