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?

So many different experiences on here, I had an induction with ds2, no epidural and no instruments, just gas and air an he was 9.5lb.

How many weeks were you with your first and how heavy???

My whopper singletons were very cosy still at 42 weeks but by #4 it was clearly my normal!

The hospital can’t insist on anything, least of all an epidural. Supervisors of midwives no longer exist although most trusts should be able to give you access to a Professional Midwifery Advocate but they don’t have the same powers.

With respect to monitoring at 34 weeks it’s pretty essential due to prematurity however as ever it is your call. The main concern with twins is that twin 2 once their brother or sister is out rather than neatly sliding into their vacated spot instead decides to do cartwheels with their new found space and either get themselves into bother or a position that’s either incompatible with vaginal delivery (transverse) or one that makes it a bit more awkward (breech). Depends how comfortable you are with the unknown.

As for the comment about giving your babies the best chance there are of course pros and cons and it also depends on whether your hospital can provide transitional care on the wards as to whether your babies will need a stay on SCBU however CS is associated with more breathing difficulties with prematurity being an added significant risk factor. Good luck.

Random she was 38+4 and 6lbs 8oz. These two are reckoned to be about 3lbs 8oz each now though I know growth scans are v inaccurate.

Thanks Harry

At 32w I was told mine were 5lb and 4.5lb but when they were born at 35+1 they were actually 4.5 and 3.5lb. I almost had a GA because they struggled for 40 mins to get my spinal in, but I'm so glad they gave it another go because T2 was in a very bad state when they got him out and I worry about what would have happened if he was also anaesthetised.

It's so difficult when you have trauma / phobia around these things and I really didn't know what to do for the best so in a way it's good that it was taken out of my hands I suppose, but it obviously wasn't how you would want things to go (ended up with T2 in nicu for 2 months so it was all very tough, but they are doing well now).

JohnnyM no SOMs anymore my youngest isnt 3 yet & I'm out of date! Sorry!

I do think a senior (or normality!! ) midwife is still a good shot as they really can help with the lost in translation problem.

I put in my birth plan that I wanted an epidural before getting the drip if it came to that, and a section if it looked like assistance would be required.

I ended up getting the section after 2 days on propess because my cervix was still closed and there was no point breaking my waters because instruments would have been required. So they do use common sense and listen to you sometimes.

I think they are mad for considering anything other than a section for 34w twins.

Can I just say that whatever happened to you regarding your mention of the assault sounds horrendous, as hard as it is please make sure the consultant is aware of this so they 100% know to go straight to CS if needed when the time comes. Personally I'd go straight for an elective CS but it's your choice I guess, I just think the whole thing would be so calm that way but it's up to you.

So a virtual consensus on cs...... interesting! Thing is, they haven't offered me that. Just induction.

Hmmmmm!

I'm not an advocate of sections at all, but given your history and your current situation with your babies, I would suggest you at least consider on ELCS.

I had an induction very recently (3rd DC and just the one) and it went from niggles to full on labour and baby very quickly.

I don't know my bishops score, but I was 1cm, cervix was long and not favourable when we began. I had a 24 hour pessary and if that hadn't of worked then it would have been waters broken and / or drip. (I had baby 22h into pessary after 21h of niggles and a 1h labour)

It was the most hands off induction ever. I was only examined twice. Once when pessary went in and once when I was ripping my clothes off and declaring I wanted to push.

Baby was monitored every few hours but other than that I was allowed to walk about, even went out at one point etc...

Not sure if the pessary is an option for you OP? It can take longer and be less effective for a FTM and may not be feasible for twins?

Athens neonatologist was keen fir a vaginal delivery as it gives the baby the best chance. My baby was born at 23 weeks. No monitor used or needed.

Athens? It should read our

I think people imagine a cs is somehow safer for baby - but it isn't generally. In fact babies often have breathing difficulties with a CS, thus needing extra support.

@Crunchymum I think that would depend on how you react to the pessary. I had the pessary, then the gel and then an ARM and drip. Had to have the pessary removed early as I was hypersimulated but it didn't trigger labour, just left me trapped on a bed for hours being monitored while in a not insignificant amount of pain.

I have twins and between 29-35 weeks they had similar concerns re the growth of twin 1.

I had weekly scans and each week they would decide whether I would need to deliver early. I had the steroid shots to help babies' lungs. I assume you have already received these too. If not, insist you have them.

In the end at 35 weeks they decided twin 1 was small but otherwise healthy. I had an induction scheduled for 37+3 weeks (should have been 37 but induction bookings were full!!) but twin one had other ideas and my waters went at 36+5. She arrived vaginally but twin 2 got stuck and was delivered as a crash section.

Double check they are using the twin pregnancy growth projections.

What is the current estimated weight? As in if they arrived now how big do they think the babies will be.

Mine delivered at 4lb 4 and 5lb 5. They had a few days in scbu for help with feeding and blood sugars and we were in for 13 days in total.

Mini no they have not mentioned steroids yet! I did wonder about asking at last scan.

They reckon T1 is about 3lbs 5oz and T2 3lbs 10. Who knows how accurate that is.... but my bump is now bigger than with DD 6lbs 8oz ever was, and I have quite a small/compact bump for twins the MWs are always commenting on it and making me feel guilty about measuring small

Fuck that. I'd have an ecsec over that shit. I had very bad experience of hospital incompetence so had an ecsec. It was great and the staff were lovely, competent and it was over before I knew it.

I’m sorry you’re having to deal with this at this stage. I really didn’t want to have to have my twins at hospital at all, but instead of just telling me to shut up and stop being stupid, I was referred to a lovely consultant midwife who talked me through why it might be sensible to take advantage of medical science.
I did give birth in hospital, and I did finally accept internal monitoring - at which point I realised it was actually easier than the external monitoring. However, I did throw out one of the doctors because I felt he wasn’t listening to me.
In the end I delivered both with no pain relief sand no instruments, but Thing 2 was breech, so the fabulous consultant who turned up just in time reached her hand in and yanked the baby out.
My point is only that a) you should have an ELCS if that’s what you want and b) your consultant is not necessarily acting in your or even your babies’ best interests by being so doctrinaire. I hope you have someone by your side who is prepared to be your advocate.

For my first pregnancy I was offered either an induction under epidural or a planned section.

My Consultant told me that a very high number of epidural inductions end in either instrumental delivery or an emergency section and advised it was much safer and easier to have a planned section.

Oh it's much easier for the Drs! So they sell it as much safer. It isn't. A planned list can fit more women through the process.

At 34 weeks, particularly if you haven’t given birth before, your BS is likely to be very low. It doesn’t mean your body wouldn’t respond well to induction, but just that it’s not ready yet. (I’m an ex midwife)

I’d ask your community midwife to arrange an appointment with the head of midwifery or similar at your hospital to discuss options, considering your history and fears - unless you feel that your consultant is approachable and would listen to what you’re saying. Sometimes they can be a bit brusque and busy.

the expected gestational weight of a singleton at your gestation is 3lb 14/4lb 4 ish. So their estimated weight isn't that bad given you are carrying two.

I too had a small bump for dates. I never measured more than expected for a singleton pregnancy, mostly being smaller than I had with my two previous children. Of course this also meant I spent a lot of time being sent to DAU by the community MW.

If you are happy and babies are healthy, I would ask them to hold off induction.

For the PP who says you don't want a vaginal and c section delivery as well, that is exactly what I ended up with. It saved my twin son's life as his heart rate was dipping. But this could not have been predicted before I went into labour and delivered twin 1. He simply enjoyed the space he had left and turned.

The consultant did have her hand up me trying to turn him though so if you really do not want to have any instrumental or potential complications to delivery, from a mental health POV then insist on going straight to c section. What you don't want is to be dealing with two newborns and the associated trauma of intstrumental delivery/PTSD/PND if it can be avoided.

I didn't have twins but I had a single baby induced preterm (2nd baby after a super fast 1sr baby born naturally) Again I was highly recommended to have the epidural in before they started the induction, it was pretty much a case of have the epidural or we don't induce you today !
I had the epidural but it didn't work. Despite this I still had to lie on my back on the bed (this wasnt an issue for me and I was managing fine on the gas and air for pain relief but it sounds like it could be an issue for you)
I was under continuous monitoring of the baby and if I moved at all they would loose the trace.
I also found the threshold for intervention in a preterm birth is very low. As it was I don't know what my bishops score was before hand but I was already 3-4cm dilated (from an earlier spell at preterm labour which they managed to successfully stop progressing) so they were able to go straight in and break my waters and put the syntocin drip up. I was in labour for about 6 hours on the drip but when it came to pushing after 1 or 2 pushes her heart rate was dropping and there was a whole room filled with people....the conclusion they came to was if baby's head didn't move on the next push then it was straight to theatre for forceps they were already pretty much pushing me out the door on the bed and this was only my 3rd push. Thankfully she did move a little and it was very quick to get her out then but the doctor pretty much dragged out with his hands. I'm pretty sure had my pushing stage been a few minutes longer than the 10 or 15 mins it took it would most definetely have been an instrumental delivery
I wouldn't say my experience of induction was horrible and i wouldnt fear another induction but given your history and the fact it's twins I reckon based on my experience that if I was you I would probably opt for an elc. Hope It all goes well for you whatever you decide