To be reluctant to agree to an induction in these circumstances? WWYD?

[TinyCIanger]

Am currently 36+1 weeks pg with DC2.

About a month ago at 31+4 I paid a visit to maternity triage on a Sunday evening because I’d been bleeding- not fresh blood but dark brown, but wanted to get it checked anyway. Whilst they were doing the speculum exam the midwife remarked that quite a lot of fluid was coming out- I mentioned that I’d been having the odd small trickle for a few days but not huge amounts, and I’d dismissed it as runny discharge (apologies if TMI).

Because of this the midwife concluded that my waters had gone early, and I was admitted for 48 hours as there was apparently a 60% chance that I would go into labour in that time. On my notes the volume of fluid that was lost was estimated to be 40-60 ml. I was given steroid shots to help boost baby’s lungs and put on a 10 day course of antibiotics.

Very early the next morning I was transferred to delivery as I’d been having tightenings, roughly 4 in 10 mins- by the time we actually got round to delivery it had settled down and in hindsight this was more than likely just BH. Otherwise it was an uneventful stay.

I had a scan later that day that showed there was still plenty of fluid around baby, and it’s looking to be a good size. Have been coming in to hospital for regular CTG checks which have all been fine, I’m taking my temperature twice a day which has never gone above 36.9°, bloods and urine have all been normal and baby is wriggling like an octopus so generally, everything seems to be going exactly as it should be.

However due to this suspected PROM (which I’m still dubious about) the “plan” is to induce labour at 37 weeks. The reason for this I’m told is because baby is considered full term at this point and the risk of developing an infection increases from 0.5% to 1-2%.

I really, really don’t want to be induced for several reasons.

I don’t want to force my body into labour, and force the baby out, before either of us are ready.

My birth with DS was rough- I tried for a water birth and was in the pool for a few hours (after waiting 12 very painful hours to progress from 3 to the all-important 4cms when they finally moved me to delivery), eventually after 21 hours of labour and at least 8 hours of agony I asked for an epidural but by that time I was fully dilated so it was no longer an option. 2 hours of pushing followed, but in the end DS was delivered by ventouse with me on my back, legs in stirrups and an episiotomy. Turns out he was back to back, which nobody realised until his head was out. So I was rather hoping for a slightly smoother experience this time around.

If it comes to needing the drip I know I’m going to need an epidural, so that again means no water birth, and an increased risk of birth injuries and instrumental delivery. I am preternaturally terrified of forceps so this prospect scares me shitless. Also increased risk of the whole thing ending in EMCS which means a longer, harder recovery and will impact more on my ability to take care of DS and baby.

DS (aged 2) will be staying with PILs when the time comes- inductions can take days and I really want to keep the time that I’m away from him to a minimum.

All these concerns aside- I just keep thinking this “PROM” happened a month ago and they’ve been happy to leave us be since then, and that aside everything seems to be progressing well. All the checks and tests and scans and whatnot have been fine, perfect in fact- and the amount of fluid lost seems so small, and the level of risk so low, that I’m wondering just how medically necessary an induction really is.

I’ve got a scan tomorrow and am meeting the obstetrician on Monday when the “plan” will be finalised, so I need to gather my thoughts around this- on one hand, I’m not a medical professional and part of me thinks I should just go along with whatever they say because obviously they know best, but then I keep thinking they’re suddenly leaping to being super cautious at 37 weeks after leaving us to it for a month and all these other doubts come into my head.

@whosaidtha

I'd also focus on why it is necessary. What are the risks of not having an induction on baby? On mother? How likely are these to happen? What would the risk factors be if we waited a week? Two weeks? Three weeks? How big is baby- how likely that they may need neo-natal care? How long would I need to stay in hospital post induction? What are the options for a c-section? What are the pros and cons of this? Don't focus too much on your fear of induction and forget to question why they are suggesting it in the first place. I hope baby comes safely.

Good questions and good advice.

You should also ask what staffing levels are like at the hospital and whether they've had to put inductions on hold at any point recently, whether they've had to redirect women in labour to different hospitals because the labour ward is at capacity, etc.

I know someone who was pressured into an induction at 37 weeks only to find that the antenatal ward was full of women who had been waiting days for their induction because of dangerously low staffing levels. Not exactly a calm reassuring environment to give birth. She ended up with an EMCS and a baby in NICU.

Obviously there are more positive stories on this thread. But try and find out the current situation in your maternity hospital before deciding. Maternity care is in crisis. I would never consent to an induction in the current situation. My preference would be to wait to go into labour naturally but if I decided the risks were too great i'd go for an ELCS.

Also see this, it's very helpful
www.aims.org.uk/information/item/making-decisions

With my friend's recent experience, what I found striking was that all the doctors were going on about induction as if it was the only option. Actually there were two other options: doing nothing (apart from monitoring) or ELCS. It would have been far more helpful if they had discussed the pros and cons of each option, to allow her to make a fully informed decision.

I second the advice to ask to talk to the consultant midwife. You might get a slightly different perspective to the consultant obstetrician's.

In my experience (although my children are admittedly older), you do not get induced unless there's very good reason.

I had three inductions. 37 weeks (pre-eclampsia), 40+1 (given previous history of pre-eclampsia & rising BP) & 38+2 (rising BP & odd liver function blood results).

With DC3 I had been in hospital for 2 weeks prior to the induction. They wouldn't induce until absolutely necessary.

@wigglerose

I would go for an elective section. I don't know why hospitals are so keen on the rigmarole of induction. Quicker recovery my arse if you end up having an emergency section any way or forceps/ventouse/episiotomy.

Agree with this absolutely

My (42 week) induction was 3 days of hell and an em section at the end of it with exhaustion and distress added to the mix

I was induced at 37 weeks (with my second) for different reasons so can't comment on your individual case. It wasn't my plan but I actually didn't have a plan, I always had the attitude that they knew more than me and I would have to trust them. They look me to labour suit and could already burst my waters. 2 hours after they burst them my baby was born. No drip, no epidural, no 16 hours in labour like first. I remember thinking if I ever did it again I would pick an induction over natural labour! So it's not always bad being induced!!

@CoffeeRunner

In my experience (although my children are admittedly older), you do not get induced unless there's very good reason.

I had three inductions. 37 weeks (pre-eclampsia), 40+1 (given previous history of pre-eclampsia & rising BP) & 38+2 (rising BP & odd liver function blood results).

With DC3 I had been in hospital for 2 weeks prior to the induction. They wouldn't induce until absolutely necessary.

When did you give birth to your children?

There has been a big increase in inductions in the last 10 years.

"induced method of onset [increased] from 21 per cent to 33 per cent in the period 2009-10 to 2019-20."

Do you think it's "absolutely necessary" to induce 1 in 3 labours?

I don't think it is, but I'm open to being persuaded otherwise. Preferably with reliable data rather than anecdote.

Sorry forgot to include the link
digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2019-20/deliveries---time-series

The NHS want you to follow their procedure which is to induce you at 37 weeks. They don't seem to have any give in their procedure to personalise care based on your birth preferences. I was in a somewhat compatible situation to you, although much later down the line. I opted for monitoring as I didn't want to be induced without any medical need.

They can check you for infections, they can check how much water you have, they can monitor you and baby to see if you are both healthy. You can ask them to explore these options with you.

Also, you don't need to finalise any plans on Monday if you need more time to think or need more information or more test results. It's your care and you can decide what the plan is and when it will be made.

Ask them which waters they think the leakage came from & can they scan to check?
Might offer a different plan depending on if it was hind or fore waters (I had no idea before pregnancy there were 2!)

I had failed induction with dd (11 days late by their dates, 19 by mine) and only 1 set of waters had broken and EMCS which was actually much easier than I thought

Ds was an ELCS at 39+5 and was also fine

Be strong and confident on Monday

I probably wouldn't either. I'd want them to keep track of signs of infection or other changes of course, but I think they push inductions because they are too blase about sections and don't weigh up the dangers for mum and baby properly.

I don't think it is, but I'm open to being persuaded otherwise. Preferably with reliable data rather than anecdote.

Good luck with that - evidenced based maternity care is a rare bird, IME.

Similar happened to me when pregnant with my son although he was earlier that 36w. When my waters broke early they did the steroid shot and tried to keep him in me for as long as possible, but infection set in and after he arrived he and I were both on IV Antibiotics for a week.

Sometimes forced labour could be a good thing as if I didn’t get induced when I did - there was a good chance he wouldn’t be here today

I struggle to understand why people would disagree and argue with medical professionals because they don’t want to do be induced and they want to have a dip in the pool etc..

Because HCP’s are not ALWAYS right or looking at pregnant women as individuals. As someone who was induced with NO MEDICAL NEED for it. coerced into it in the first place after refusing several times because they had no evidence, I assure you it is not on a bloody whim. Evidence-based care is what we are all supposed to get, not weighing pregnant women against other pregnant women when our bodies are not all the same. Thanks to the HCPs I had I have a special needs child and I am reminded every day of their actions and wish I had known what I knew now. All I asked for was evidence since all my tests came back normal yet they still pushed it because he “looked” big and told me I was killing my baby. I knew he wasn’t big because spoiler alert, I could feel him. He was head down but I would feel his toes brush the bottom edge of my rib cage, there were times I could feel one part of him and not the other and considering my belly was the size of a basketball and ultrasounds are known to be off, I found it hard to believe he was some massive baby and if he was why would they induce me. This massive baby wasn’t even 7lbs and since my husband and I are slender people of average heights who have been on the smaller end of averages are whole lives, it wasn’t surprising to us (nor anyone with eyesight). I even asked for my bishop score to be checked before they started induction and was told I needed to be induced first. Induction is not easy and if your body is not ready for it leads to interventions and issues for both mother and baby hence it is why it shouldn’t be recommended without evidence in the first place.

Evidence-based care is how doctors are supposed to work anyway. Why some think HCPs always know best and don’t make mistakes I struggle to understand. Everyone makes mistakes so why are HCPs somehow exempt when it has been proven countless times that they’re not.

@Wanderlust20

I agree, I feel they really push inductions on everyone! Most of my friends were induced and I used to find it so odd. Then when I got pregnant, I was horrified when, at my 38 week check up, they said that the following week they'd book an induction for me?! I had no complications, was a very easy pregnancy etc so I could not understand why they were jumping the gun. I'd already decided I was sticking to my guns and just letting my body do its thing but luckily baby came 2 days later anyway on his own!

I could have wrote this! Absolutely no complications throughout my pregnancy other than one quick trip to triage as I had reduced movement at about 34 weeks. At my 38 week appointment I was told if I hadn’t naturally gone into labour by 40 weeks I would be induced and a date was set there and then. I was naive as it was my first pregnancy and they said this was standard practice at my trust. I was stressing as I really wanted to avoid induction if possible. Two days later I went into labour naturally. Unfortunately it ended in an emergency theatre delivery and forceps but I was happy I didn’t have to be induced!

With my friend's recent experience, what I found striking was that all the doctors were going on about induction as if it was the only option. Actually there were two other options: doing nothing (apart from monitoring) or ELCS. It would have been far more helpful if they had discussed the pros and cons of each option, to allow her to make a fully informed decision.

This is how it has been for me to be honest. I said before, at no point has one single person brought up ELCS as an option, or indeed doing nothing- it’s almost been presented as a fait accompli “we are going to induce you at 37 weeks”. Nobody has gone through the risks or pros and cons with me, nobody has actually really discussed anything with me at all, and when I make it clear that I’m hesitant to go along with this plan they just talk of increased risk of infection as though it’s a near certainty (so I was astonished when I learned how very small this risk actually is) and make me feel like I’m wilfully putting my baby in mortal peril if I don’t agree to it.

Just as a side note, I was up and about a few hours after my c section and didn’t have any trouble looking after my 2 year old so if for any reason you do need a section it might not be as bad as you fear

This!! I had an elective section in July and was out of bed as soon at the cath was removed and had no issues walking about, looking after baby etc. Just keep taking the pain killers. I also had a 2 year old at home and had no issues looking after them when I got home.

Please opt for elective c section rather than induction. Recovery isn’t as terrible as I expected, but the impacts of induction aren’t always good for mum or baby. Please focus on getting the baby here safely, in whichever is the least risky way.

*I struggle to understand why people would disagree and argue with medical professionals because they don’t want to do be induced and they want to have a dip in the pool etc..

Some of the comments on here, you’d think they offer them for fun because they get paid per induction*

That's because it's incredibly common for medical professionals to try and decide how you'll give birth for you without listening to the patient. They don't get away with it in any other area of medicine but this. I believe they used to/maybe still do have targets on the number of caesarian births.

In my experience, i was pg with twins, one breech. I said i wanted an elcs and set out my reasons why - safer, more predictable, less traumatic as they would probably have had to manually turn one baby - sticking their hand up there and actually turning the baby. They said "we aren't going to talk about that until 37 weeks" and then wrote on my notes "aim for vaginal delivery".

Ended up with a pprom, steroids, the lot, talked into trying a vaginal birth and then ended with a crash c section under GA. I ended up with ptsd, anxiety and depression. A massive part of that was feeling helpless and not being listened to. So yeah .. i would never recommend any pregnant woman just blindly trust the doctors. They want to get as many women as possible trying a vaginal birth. But they seem to forget that in this country, women have the right to give birth , or attempt to, in the way they choose. If you don't want to be induced, just say no. Decide what risks you're happy with and tell them that's the course of action you consent to, whether that's induction at 38 weeks, elcs, or something else.

Trusting the doctors (every doctor i came across, actually) over my own very strong instinct for an elcs almost cost me my baby's life, so the op is totally right to be looking at her options and making her own decisions.

I wish i had known the phrase "i do not consent to..."

The thing that swung it for me with induction is that is has a higher chance of leading to instrumental intervention or emcs than if you go into labour yourself. I didn't want an emcs or forceps.

They consider a good birth any where all parties are alive at the end of it. Injuries aren't really their problem or so it seems.

@phoenixrosehere

I struggle to understand why people would disagree and argue with medical professionals because they don’t want to do be induced and they want to have a dip in the pool etc..

Because HCP’s are not ALWAYS right or looking at pregnant women as individuals. As someone who was induced with NO MEDICAL NEED for it. coerced into it in the first place after refusing several times because they had no evidence, I assure you it is not on a bloody whim. Evidence-based care is what we are all supposed to get, not weighing pregnant women against other pregnant women when our bodies are not all the same. Thanks to the HCPs I had I have a special needs child and I am reminded every day of their actions and wish I had known what I knew now. All I asked for was evidence since all my tests came back normal yet they still pushed it because he “looked” big and told me I was killing my baby. I knew he wasn’t big because spoiler alert, I could feel him. He was head down but I would feel his toes brush the bottom edge of my rib cage, there were times I could feel one part of him and not the other and considering my belly was the size of a basketball and ultrasounds are known to be off, I found it hard to believe he was some massive baby and if he was why would they induce me. This massive baby wasn’t even 7lbs and since my husband and I are slender people of average heights who have been on the smaller end of averages are whole lives, it wasn’t surprising to us (nor anyone with eyesight). I even asked for my bishop score to be checked before they started induction and was told I needed to be induced first. Induction is not easy and if your body is not ready for it leads to interventions and issues for both mother and baby hence it is why it shouldn’t be recommended without evidence in the first place.

Evidence-based care is how doctors are supposed to work anyway. Why some think HCPs always know best and don’t make mistakes I struggle to understand. Everyone makes mistakes so why are HCPs somehow exempt when it has been proven countless times that they’re not.

That’s your opinion and you’re quite entitled to it. Yes they do make mistakes and yes women should be able to ask questions, get reassurance etc but it’s ultimately about the safety of the baby, end of.

Im not really sure why your DS having special needs was due to being induced. Was that confirmed? Did they take responsibility? I’m sorry that your little one has a disability, but I don’t think you can put it down to being induced, unless they’ve they actively taken ownership of the consequences.

As a couple of posters have mentioned, infection and still birth are things that can and do happen.

Too add- perhaps yours was a tragic case and it was, as you say, preventable, but if a mother decides to use the wait and see approach, that can have catastrophic consequences also

@MrsGeralt

*I struggle to understand why people would disagree and argue with medical professionals because they don’t want to do be induced and they want to have a dip in the pool etc..

Some of the comments on here, you’d think they offer them for fun because they get paid per induction*

That's because it's incredibly common for medical professionals to try and decide how you'll give birth for you without listening to the patient. They don't get away with it in any other area of medicine but this. I believe they used to/maybe still do have targets on the number of caesarian births.

In my experience, i was pg with twins, one breech. I said i wanted an elcs and set out my reasons why - safer, more predictable, less traumatic as they would probably have had to manually turn one baby - sticking their hand up there and actually turning the baby. They said "we aren't going to talk about that until 37 weeks" and then wrote on my notes "aim for vaginal delivery".

Ended up with a pprom, steroids, the lot, talked into trying a vaginal birth and then ended with a crash c section under GA. I ended up with ptsd, anxiety and depression. A massive part of that was feeling helpless and not being listened to. So yeah .. i would never recommend any pregnant woman just blindly trust the doctors. They want to get as many women as possible trying a vaginal birth. But they seem to forget that in this country, women have the right to give birth , or attempt to, in the way they choose. If you don't want to be induced, just say no. Decide what risks you're happy with and tell them that's the course of action you consent to, whether that's induction at 38 weeks, elcs, or something else.

Trusting the doctors (every doctor i came across, actually) over my own very strong instinct for an elcs almost cost me my baby's life, so the op is totally right to be looking at her options and making her own decisions.

I wish i had known the phrase "i do not consent to..."

Yes but your situation is different. I would also have asked for a s-section in your shoes. I would also ask for a c-section in OP shoes.

What I was meaning in my OP, and I should have made it clear, is when people refuse to be induced and don’t want any intervention AT ALL.

They want everything to be natural and that decision can have catastrophic consequences.

@phoenixrosehere

I don’t think I made it clear so I apologise. I absolutely think you should have been allowed a c-section in your situation instead of being induced.

My first post was relating to those that want everything natural and refuse intervention at all

If I were in your situation I’d have an ELCS. Both my children were delivered this way and both were very positive experiences.

Whereas people’s experiences of induction, especially at 37 weeks, tend rarely to to be described in glowing terms!

I don’t think I made it clear so I apologise. I absolutely think you should have been allowed a c-section in your situation instead of being induced.

Why? Why should/would my only options have been an elcs or an induction if all my tests came back normal? That’s not only ridiculous but begs the question why not induce all women then? You know why because there has to be a necessary, proven need for it otherwise it is risky like any other medical procedure that is done on a person who does not need it.

My induction was ruled by the hospital it was not only unnecessary but no evidence or explanation why they pushed it. I asked for evidence for an induction and even when their tests came back normal, they still said it was necessary and I asked why cue stillbirth statistics. I was happy to come to the hospital and be monitored to my due date and beyond. I lived 10 minutes away and on mat leave so wouldn’t have been an issue. Nope. Never received an apology whatsoever. I did learn later that one of them was let go after numerous complaints and that they were giving seminars to doctors to respect women’s decisions and not force their decisions which is great but sad that this has to even be said or taught.

That’s your opinion and you’re quite entitled to it. Yes they do make mistakes and yes women should be able to ask questions, get reassurance etc but it’s ultimately about the safety of the baby, end of.

So the mother is what, an incubator then? Why is it not both mother and baby? Why is the baby worth more than the mother? How is the safety and well-being of the baby afterwards when the mother is traumatised, suffering with ptsd, anxiety, depression, and other issues that arise when women aren’t heard and having their choices taken away? It is usually the mother taking care of the baby afterwards so shouldn’t emphasis be on making sure both are safe not just the baby?