to be brave and ask for an alternative to induction?

[Seasiderabbit]

I went into hospital yesterday (Sat 12th) at 40 weeks to be induced. I'm age 40 and the risk of stillbirth increases post due date. No other problems. This will be my second delivery. My first baby was an uncomplicated vaginal delivery. According to my records I'm due at the earliest on 16th Oct because we only had sex once on 23rd January. I'm no expert, but I don't think implantation could have happened before we had sex!

The midwife couldn't get the Propress induction pessary in yesterday because my cervix is closed and because I was distressed. The pain made me black out. It was traumatic even with gas and air and it went on for several minutes as she wrestled with my cervix! This all happened after the induction was postoned several times so I was already exhausted and anxious. I'm re-booked in for an induction on Monday 14th Oct at 6pm and terrified of this proceedure because it was so traumatic. I'm not afraid of pain and I don't mind smear tests but this pain was in a different league.

Does anyone know if there are any alternative pain relief options for inserting Propess? I took paracetamol and took gas and air but this wasn't enough.

If there's no other pain relief available, am I allowed to ask to meet a consultant tomorrow during the day to talk about my delivery options? I might rather have an elective c-section or expectant management than go through more painful attempts to get the Propess inserted over the course of many hours during the night which seems likely to happen again unless my cervix softens today and tomorrow. I feel like I need a plan!

Can anyone help me to be brave and avoid a potentially traumatic birth?

I don't have any advice about alternative pain relief when being induced, but just wanted to say that I agree with you about how painful the insertion of propess was. I felt the same when I was induced. Hope you get it sorted x

How about asking for daily monitoring until you are favourable? The risks only increase at a very small rate. If your placenta has good function (Doppler confirmed) then it’s probably reasonable to do a care plan for YOU as opposed to all 40 plus year old women.

Did you have a straightforward delivery last time?

Doppler is no use when checking the placenta. You need scans.

It was all a bit of a blur but I really didn't find the propess a problem at all? I disliked the feeling of peeing with it more than having it inserted.

Would the gel be an option?

Propess really shouldn't be that difficult to get in...it sits behind your cervix, not in it so it shouldn't matter that it is closed. I think if I were you, I would give it another go but ask for someone more experienced. Or as a pp said, ask for some monitoring and a few more days to see if things get going themselves.

You know they count from the first day of the cycle you got pregnant on? So as ovulation generally occurs around day 14 you’re technically already 2 weeks at that point.

Sorry posted too soon, I would ask to speak to the consultant so you understand the options regarding elective section etc.

@Crunchymum you’re confusing the habd held Doppler for listening to fetal heart beat with a different Doppler combined with conventional ultrasound used to measure blood flow in both directions through the placental vessels. Both between maternal blood circulation to placenta and between placenta and fetus. The latter is a way of measuring placental function. They normally check other markers of health in the fetus at the same time. Usual part of assessment when planning induction / CS based on risk to fetus (as opposed those inductions for maternal reasons).

You don't have to go along with what they tell you.

If you believe your due date is later then you are well within your rights to refuse induction until after this date.

Good luck x

Honestly I’d suck it up and do it. I’ve never known anyone have pain relief for the propess! Ask for someone else to try? It seems strange that it’s that bad for you. I wouldn’t go for a csec for that reason. However, if you really can’t, ask for a proper discussion, yes. I wouldn’t put it off personally but some people are happy to wait until they are longer overdue and refuse to be induced.

Propress is bloody awful! Or mine were anyway (had to redo several times). Could you ask for the balloon thingy or to go straight onto drip instead?

Can you try acupuncture to induce labour? I had a session on Wednesday 5pm and my waters broke about an hour later!

If your cervix is high and closed your induction is less likely to be successful.

Ad ask for another examination and if you’re still ‘unfavourable’ go to ELCS or wait if it’s safe.

How would you get a foley balloon into a closed cervix?!

Obviously you need to make your own informed choice but I decided to not be induced and had just increased monitoring and a few sweeps. I gave birth naturally and vaginally at 40+16. I would have changed my mind and been induced if the monitoring suggested I or the baby was in any danger.

Thanks everyone, I will ask to see the consultant tomorrow. I like the idea of asking for someone more experienced to do it. If it's going to hurt like hell, I want the process to actually have worked.

@MatiltaTheCat yes I had a straight forward-ish delivery last time. Waters broke at 39w1d, contractions started but then stopped so after 24 hours I was induced using a pessary (painful but manageable), then drip. Baby born vaginally after 12 hour labour. It was pretty good.

I know the Propess SHOULDN'T be painful but it was. I am happy to suck it up again if that's the only and safest way, but I'd like to explore other less barbaric options.

I think they have to be able to get into your cervix to break your waters before you can go on the drip. The Propess softens your cervix enough to get the hook in to break your waters. So I don't think I can go straight to the drip.

Does anyone know if you can have a short-acting or partial epidural? I'm wondering if I could have that while they insert the Propess.

Thanks for the morale support.

I’m the biggest baby in the world with pain and the Propess didn’t hurt at all which I think means your midwife was very inexperienced. I doubt you’d have the same issues with a consultant.

I had it put in when I was extremely unfavourable. Cervix high, hard, not at all dilated and baby was not even slightly engaged so similar circumstances to you.

If you’d feel best letting someone more experienced try with the propess then that’s probably the best option for you. But yes you are absolutely ‘allowed’ to refuse induction or request expectant managing instead or say you want to discuss ELCS. It’s your decision.

I had the process and it was uncomfortable but not painful- maybe she was just rough?

Thanks @Merryoldgoat, that's interesting and yes, it does sound like our circumstances are/were very similar.

Good news - I am seeing a consultant tomorrow morning at 10am to have the baby monitored and to talk through the options.

Well I’ve never heard of a propess pessary not being able to be inserted due to a closed cervix before. Like a pp said it doesn’t go through your cervix or into your cervix so it shouldn’t matter that your cervix is closed.

Remember you’re able to say no/stop at any point inc mid procedure. Maybe let them try again, your cervix May be lower down which will make it easier to find the posterior fornix, you may have a different midwife.....but if it’s all going the same you can say stop.

If it were me i would just ask for an elective section or straight to the drip rather than keep trying to get something up there. I feel your pain OP as I found the examinations and the midwives sticking what felt like their entire hands and arms up there WAY more painful than anything else. Soon as I was allowed an epidural that's what I did. Do what you feel is right.

@NicoAndTheNiners - I think the midwife actually said something about the angle or position of my cervix plus me tensing up rather than my cervix being closed. I was doing my best to lean in and relax and like I said, I'm fine with smears and was fine with the pessary insertion for my first labour. She tried it twice last night and had to give up both times. My notes say 'unfavourable cervix and unable to tolerate procedure.'

Personally I'd go for expectant management rather than induction. Provided there's no other risk factors, I see no reason why a care plan can't be put in place for you personally rather than based on averages of hundreds of other 40 year old women.
Add in that only 5% of babies are born on their due date and of the remaining 95%, 70% are born after their EDD, I don't have a lot of faith in interventionist treatment based on a mathematical formula.

Thanks @gallicgirl, I tend to agree. I'm looking forward to having a sensible discussion about the options tomorrow morning.

I found the pessary awful going in, I cried
Nothing more useful to ad sorry just wanted to let you know you're not alone in finding it horrific!
You don't have to do anything you don't want to. In the end I had an unplanned c section as I was exhausted and wasn't dilating, the thoughts of x number of days more in labor with more internal examinations was hideous. I was listened to and given the section.
Good luck