To insist on a Bishops score before agreeing to induction?

[JohnnyMcGrathSaysFuckOff]

Feeling a bit at sea.

I am expecting twins and recently we got told one wasn't growing properly and they might need to come out early, around 34w. Fine, not arguing as the last thing I want is a stillborn baby.

But the question is, how? The consultant is very old school and wants to do an inpatient induction with full epidural, me on my back, constant monitoring, no moving at all. I am terrified of this as due to previous assault I feel very panicky when immobilised on my back and also an instrumental delivery is about the worst thing I can imagine due to previous experiences. I do not think I can cope with constant flashbacks to assault during the birth.

So AIBU to request 1) a Bishops score to determine likelihood of successful induction and 2) no epidural before agreeing to induction?

I do not want an elcs but would rather that than instrumental delivery. AIBU or am I being That Patient?

My friend, who’s a midwife, did her dissertation on the rates of instrument delivery after an epidural and they were very high, higher for your first labour. I’d ask your own midwife in case things have changed but be prepared to not get the answer you want. FWIW I had an epidural and ventouse and didn’t even know they’d started the ventouse process. You won’t feel anything.

Is this your first delivery?

I've had 4 singletons, 4 inductions and the first 3 had an epidural not an instrument in sight.

However with twins I wonder how many occur with no instrumental delivery for either - can you find any stats for the UK and in particular your hospital?

I was induced and didn't require epidural or instruments but my shit pelvic floor muscles meant dd practically fell out of me you can ask for a second opinion surely?

In this instance I'd be demanding a c section, as it sounds like you could end up with exactly the traumatic delivery you don't want

To be honest if that is the approach they are keen on taking, and given your history, I would simply refuse induction at all and ask for CS.

It sounds extremely unlikely that you will be met half way on this and given the kind of support you require to have a non-traumatic birth. The message seems loud and clear. Bishop's score is really helpful, but once they have you there on the drip then you do run the risk of really not being listened to and being railroaded into a birth situation you are not happy with (on back, instrumental delivery if not progressing). Their approach and the lack of confidence it's already producing in you makes instrumental delivery more likely, not less!

I would rather 100% have an elective section than an instrumental delivery. The unknowns are SO much less potentially damaging - both physically and mentally. Yes, a straightforward natural birth is lots better. But I think you're already starting from a point that that is less likely with the twins factor. Take into account the consultant attitude and that's where I'd draw the line and not feel able to agree to induction on those terms.

They have health concerns and want to medicalise completely - fine, then you give me a section, you don't put my future mental and physical health in the 'let's give it a whirl' category.

Absolutely agree - ask for a planned section

I was induced, epidural and ended up with c section after failed forceps. I would never be induced again. Like you I was on my back under constant monitoring. Not the experience talked about at ante natal at all!

Oh and I had sections - emergency and elective. I would much rather have had natural births with low intervention. But I would much rather have had the sections than a high intervention and certainly instrumental natural birth. I thought this before I was pregnant: conversations with women I now know who had the latter have utterly convinced me that I made the right decision. I have no after effects from my sections. The same absolutely cannot be said of several folk I know who have had instrumental deliveries. Not all - but too many for me to ever take the chance if I did it again!

YANBU I would ask for a section.
Even if you were giving birth without induction you could end up flat on your back and instrument delivery. If you have PTSD and can't cope with that then surely the best thing to do would be to have an elcs for the sake of your mental health. I managed a person with PTSD in my last job it's very serious and you need to think about the fact that you have to look after newborn twins after this. I wouldn't risk my mental health like that. It could cause problems with you bonding with your baby etc if you have a full on panic attack while giving birth.
Giving birth is hard enough without worrying about all this.
I say this as someone who had two natural births. I would not take the risk.
If you ask for elcs you will know when it will happen and you can keep calm and in control because you will know exactly what they will be doing and when it will be over.

Forgot to say my Bishops Score was 0 with the first and 1 with the others (would have been 1 even if not pregnant!!)

I think I would booking for c section tbh.

Also, I think that a huge part of it all is the not knowing.

Your particular history would make this a particularly difficult part of the 'baby prep' I imagine.

So the certainty of a section would also take away that element.

There is also the intrusiveness element. I found this a very different thing in a section compared to earlier parts of labour when I had my emcs. I found that very hard and really did not like examinations, just the general THING of it. I imagine you'd be the same. The section stage felt very different - like having an operation, the intimacy element was removed. It was mentally much much easier.

Ask for a planned csection. I did with twins. Mainly due to the risk of CP being much higher with twins. With everything else going on just get them out quickly and safely.

I was induced, no epidural to start with, but contractions went from painful but bearable to agony and constant with no gap in a matter of minutes and they had to take the gas and air off me so the baby could get oxygen. I then had pethidine and then an epidural.

Hadn't been able to move around before that as if I twitched the bloody monitor moved and had to be readjusted.

If this is going to be as difficult for you as it sounds from your OP insist on a ceasarian. My experience of induction was bad and I know other people have different experiences, but you don't know which one you'll get. Previous trauma puts you at higher risk of birth trauma anyway so again, another reason to push for a ceasarian if you think it would protect your mental health.

I was induced at 34 weeks due to baby being in danger. It is completely different to a standard induction. My bishops score was unfavourable and it still was when they broke my waters following pessaries. I had given birth before which did help.

I did have to be constantly monitored once my waters were broken. The risks to a preemie, small baby are far higher than a term baby. The monitoring was to ensure my little girl was coping with the induction. Having laboured before it would be the last type of labour I’d choose but I wanted what was safest for her. I wasn’t able to eat in case they had to get her out quickly if she didn’t cope. I was sat up but did have to be still.

It is worth asking about your bishops score but expect it to say you aren’t favourable. I’d also ask about the position of the babies and if that favours a natural delivery. Unfortunately you can only weigh up the information and make an informed choice.

Talk to the midwife who will be supporting you with the induction. Mine worked with me to help me get into a position that worked for me and for them to be able to monitor. I’m sure they will work with you in the same way.

At one point it looked like my little girl would be too small and too poorly to manage a vaginal birth and I’d need a c section. The idea terrified me. An epidural or general anaesthetic were triggers for me in the same way that you have triggers. In the run up the idea was enough to cause panic but when it came to the actual decision time with the consultant none of it mattered or even crossed my mind. Just my little girl. I hope you find the same happens for you x

Not much advice, but I had an emergency c section, after a rubbish labour, and it really wasn’t that bad at all. Despite it being a difficult section for a multitude of reasons, my recovery was reasonably quick, and by 6 weeks I was totally ‘normal!’ I will be having a section for any future births, and I am so relieved!

Given your sensitive history, I would go for a section. Wishing you all the best.

I was induced with a Bishops score of 4. It was very slow and painful (Indeed traumatic and I don't use that word lightly) and ultimately instrumental.

For later deliveries I was absolutely clear that I would refuse induction with a score in single figures (guidelines by then were 8+) and probably full stop.

Yes a section is a serious procedure, but so is IOL.

Good luck.

I’ve had 2 38week inductions and didn’t need an epidural so I’d find out why they want to start you with an epidural. I was also able to be upright on the bed even with a drip in each hand.
Ultimately and given your history it’s your choice.

Thanks everyone for being so kind - MN at its best!!

So a major dripfeed is that I have given birth before, spontaneously and very quickly (75 min start to finish). Probably would have helped if I'd mentioned that in the OP!!

So my thinking is: if the Bishops score is really unfavourable and they're being mulish about the epidural, ask for elcs. But if the score is more favourable and/or there is some flex, try induction but with a gentleman's agreement that if it starts going pearshaped we cut straight to cs.

Does that sound feasible?

I was induced with my twins at 36w and ended up with an epidural, first one delivered fine, second one turned awkwardly so ended up with emergency cs. Recovery was v hard having done labour, pushed and then been sliced and diced. Had I known I would have opted for elective cs and been able to enjoy my newborns rather than being off my face on morphine just to be able to sit up.

I had an elective cs for last baby, home in 24hrs and a smooth recovery on paracetamol and ibuprofen. A not a really tough ride despite my fears.

Given your misgivings which won't help during labour plus the possibility of restricted movement and instrumental delivery I would opt for the cs and feel confident that you have some control over the choices. All that matters at the end of the day is healthy mum and healthy babies. Xxx

I am expecting a big baby (no reason, she just IS!) and I've told the consultant that I won't be induced unless my Bishop's Score is 9 or over and otherwise I want an ELCS. I said it fully prepared for a fight but he 100% agreed and said he would recommend the same. YANBU at all. Remember that it's your body and your decision and don't let them talk you into anything that makes you uncomfortable.

Oh and to answer some Qs -

It is not about being able to feel instruments, it's about being trapped in stirrups and people shoving things in me. It is too similar to what happened before.

The twins are both head down and long lie now (32w) and whilst they could move I am not sure they really have room to?

Obviously on the day I will make any sacrifices necessary but I just don't want to feel close to suicidal after birth, that's all...

Strawberry because "that's how twin mums give birth in this hospital".

It is based in NICE guidelines (CG129) but the NICE is way less prescriptive than the consultant.

A twin birth is nothing like a singleton birth. An epidural is done in case of instrument use or emergency section. They don't have to put many drugs down the epidural, just enough to check it is working. Successful second twin outcome used to be only about 90%, they do it for a good reason.
If you are uncomfortable with a highly assisted birth, do have a section. If your obstetrician is unhappy about a section, demand a different one (use PALS if necessary). You do not want to end up with one vaginally and one by section.

You need it in writing if you're hoping to get them to do a c section if it starts going pear shaped. A verbal agreement may not convince whoever is in charge at the time to give you a c section. Even in writing, you and your birthing partner may need to be very firm with them to get this for you.