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?

I understand your fear of an instrumental delivery triggering your past - I have the same feelings associated with a c section and found a c section made me feel like I'd been attacked and violated. I didn't expect that!
Not sure what I'd suggest - but how about asking if you can spend some time being monitored on a bed on your back, but knowing nothing is going to happen? So when it happens for real, that bit isn't as scary?

I think in your position you should ask for a C-section especially when it's twins. I don't think anybody can really predict how a birth will go.

Such a tough call!

I refused continual monitoring with my inductions, they weren't happy!!

If they check your Bishops Score you can then refuse induction... from memory they checked mine before starting inducing and with each extra peasant!

It is absolutely up to you whether you accept an epidural and you can certainly ask the bishops score and whether the midwife believes your cervix is favourable. As a p1 that does make a big difference to things. In your position I’d be asking if they thought I was favourable for induction on assessment of the cervix and make a decision then. As for the epidural I’d just decline until i decided one was beneficial to me.

I ended up with ptsd after a section.
You can choose some bits, and choose not to have others. You consent for each part on its own. So you can have monitoring, then ask for it to be removed fir five mins and give you a break. They have to do that.

Ask to discuss this with another consultant. If you’ve laboured quickly before that’s very much in your favour for twin one. With artificial hormones it should be fairly straightforward to get one baby delivered.

The unknown is the delivery of twin two and it’s only fair to say that this is when there might well be some internal examinations and manoeuvres to get twin two into the birth canal. This is why they like you to have an epidural running. At 34 weeks and already compromised in growth there will already be a low threashold for CS.

If you know you can not tolerate this then ask for an elective CS. I agree with pp that one vaginal delivery plus one CS is the worst of both worlds. If you request a CS I cannot imagine you meeting much resistance.

Is it your preference to try for a vaginal delivery?

The consultant's request for you to have an epidural prior to induction is likely to be so you can go straight for section should there be any concerns for the babies.

Have you discussed your previous trauma and your concerns? Absolutely ask for the bishops score. Ultimately this is your birth, your choices need to be respected.

Argh so much to think about!

MrsP I know why they do it, but in a real emergency they can surely do a GA? I have had GAs in the past and am a healthy weight, healthy BP etc.

HarryS that is kind of where I am heading.

It is so tough! I think I do need to discuss with MW.

Matilda there isn't another consultant really. The guy I am seeing is the hospital's lead on multiple births and wrote all the patient info. The others are all junior to him and say "Mr X says blah" and that is it. Mr X is very old school and refers to women who ask questions as "emotional ladies getting all wound up" and women who choose home birth (not for twins obvs) as "damn fools". Amongst other gems!

I would go for a CS. I was induced with my twins and ended up in theatre prepped for a CS when it was discovered that I was (finally) fully dilated and they were born by ventouse. If your concern is being trapped on your back then my experience is that will be unavoidable. I had two straps around my belly to monitor the babies and the slightest movement caused them to lose track of one or both. I was desperate to get up and walk around and the epidural hadn’t actually worked, but I still had to stay on the bed for monitoring. It was one of the most frustrating parts of the process.

Bangin yes I would like a vaginal birth if poss. I feel like I can probably do it but insisting from the on lying flat on my back isn't going to help! I just want to give my body a chance.

Have discussed previous trauma with a female dr there who was sympathetic but she is not in charge and it is very awkward talking about being raped to a guy in his late 50s who snaps orders at you ("I'll be inducing you on such a date" etc) and generally treats you like a slightly dim little girl. Argh again!

Give your babies the best chance, get booked in for a planned c section.

Honestly I think you would be better with the known elcs factor.
The thing is they agree stuff when you are in the consulting rooms and then they can go back on what's been agreed when you are in the room because they know better and you're not in a strong position to start telling people what you want.
I hope whatever you decide you have a safe and straightforward birth for your twins and I sincerely wish you all the best

To be honest, most hospitals insist on an epidural with a twin delivery since the risk of needing assisted delivery or an emergency section is higher.

At 28 weeks my scan showed twin 2's growth slowing but they didn't seem concerned. Same at 32 weeks. At 35+1 I felt very unwell and strange - my midwife convinced me to go and get checked out, they were born two hours later by emcs, as twin 2 was IUGR, not moving and had a static heart rate.

I completely understand what you're saying, I had similar fears and had been pushing for an elective cs for that reason. I know lots of twin mums now and I only know one that didn't have some sort of assisted delivery, cs or induction.

As I learned, with twins things can change and go south very quickly. I would speak to your consultant about what you can best cope with.

I had induction with all 3 of mine. None instrumental or with syntocin drip. My bishops score was '3 and I'm being reallly generous' with my first. She was delivered after a 4 hour labour that they didn't monitor because they didn't believe me that I was in labour. I really don' t think that the Bishops Score will tell you much, especially second time around.

And if there are any concerns about the growth of one or both babies, they will need constant monitoring I think - I mean, you don't have to consent but I think that would be a big risk.

I think there is something to be said for this consultant's attitude. He will have loads of experience. And let's face it his only wish is the outcome of a safe delivery of twins which I expect can be tricky. I don't think putting all these conditions in place is really that helpful. Personally I'd hand it over to them and go for the C-section. Surely it's the easiest option rather than refusing this and deciding that nearer the time like during the birth. I'd rather have everything cut and dried. But still everyone is different.

Not the bit about the dim little girl. that's cheeky.

Not sure if it helps but with my first I was induced at 41 wks. Just the pessary & nothing else. I went from having a low bishops score to baby coming out 5 hours later. I feel your pain as being on my back with baby back to back was awful. No time for epidural & barely got to the G&A. At one point I ripped off the belt strap & flung the entire thing across the room 🤭.

With DC2 I had some problems & I was referred to a consultant. At 38 wks we tried induction (which I pushed for). 3 pessarys later my score was still low & I just knew the baby wasn’t ready. I asked for a CS, you do have to push a bit depending on who happens to be on the ward. My consultant had already told me I could stop the induction process at any time & request a CS so I was confident in my request so to speak. They had to use a ventouse during a CS as baby was so far up so I think I made the right choice.

I would always choose VB & if I have another will try induction again. I don’t think I can go into labour by myself.

Smell, best chance of what? What an unhelpful post! In actual fact, at 34 weeks babies stand 'a better chance'of not having breathing difficulties if born vaginally.

OP you can ask for your bishops score, but what difference do you think it will make? Would you then opt for a section rather than induction? If you are veering that way then I would definitely give thought to requesting an elcs. If you are pushing and end up requiring an instrumental (there is a very real chance of fetal distress as preterm and growth restriction) then it may well be more risky to perform a section at that point than instrumental. It is such a tough call :-(

I know it's different but I really wanted a spontaneous Labour with #4 and discussed in depth with pro non-induction consultant. Despite everything being very favourable for me waiting past 42 weeks I didn't want my "ideal" birth put ahead of increased stillbirth risk.

With your situation as it is now the induction sounds far too risky in terms of your mental health/PTSD so I would look at it in terms of safest option re babies & MH and accept that having a VB isn't an option???

In your shoes I would seek a C section.

Can you ask to speak with the supervisor of midwives? In a different situation (very post dates HB) i found them incredably supportive. They took the time to listen & understand my fears & were able to discuss with the consultant leading to an agreement with the consultant i was happy with. Nothing to lose by speaking with them!
Good luck

MissDuke yes exactly. So only go ahead with induction if I had a decent Bishops. Right now I am 32+2 but carrying low, both cephalic and long lie, having some small shows. I sort of think in another 10-14 days my body might be gearing up - and if no, ask for elcs then?

Waddle they don't have SoMs anymore! But they do have the oddly named normality midwife who was lovely when I saw her before so I might email her if they do push induction at next appt......

MissDuke Best chance of being born safely and quickly. I have twins and vb with twins increases the risk of CP for T2.

And my T2 was still doing somersaults and changing position at 37 weeks.