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.

I had prom but not until 38 weeks so it was straight to induction with the drip. I have always said that if I had an induction with the drip again I wouldn’t consent unless an epidural was given in parallel. If you do decide to proceed you can do it with more knowledge and control having been there the first time round.

I don’t know what I’d do in your shoes but I would probably go for the induction tbh. As I was past term, they wanted baby out within 48 hours. I’d imagine they’ve let you get to 37 weeks as balance of risk re prematurity and then will want the baby out sharpish.

@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.

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?

I actually apologised, as I thought you weren’t happy about being induced, but you would have been happy to have a c-section.

Judging by your response, you didn’t want any intervention at all and wanted to use the wait and see approach.

I find that it astonishing that you think they intervene just for the sake of it. I bet if they said ‘right if we don’t get this baby out right now, you could die’, you wouldn’t ignore them?! Yet when they advise you before it gets to that stage, you think you know best.

I’m all for choice but the whole wait and see regardless just blows my mind, when they’ve advised you the labour needs progressing.

Unless you are monitored 24/7 with an alarm attached to you, where it would notify doctors etc if there was an infection or baby wasn’t moving etc…. Then imo it wouldn’t be worth the risk.

Things can go wrong very fast and even if you went in every day to be checked, things can go wrong in the night. I don’t understand why anyone would be so against ANY intervention that they’d be willing to take the risk…..

I would ask for an elective section in this situation I think.

I mean this in the best, kindest, gentlest way, but I think it might be that a part of you is hoping that you'll get to have a 'better' birth than you did last time, and perhaps that you're hoping to have a positive birth of sorts? But it sounds like that's maybe not on the cards, so perhaps it would be good to pick the safest, least painful option at this point?

Well.

The plot thickens.

I’ve just had my 36 week scan and, in a ridiculously ironic twist, we have now gone from “we think your waters have gone early” to (drum roll please)… polyhydramnios. AKA too much fluid.

I mean. For fuck’s sake.

So they’ve taken bloods for GD and a TORCH screen (I had GD in my first pregnancy but HbA1c test at c. 28 weeks was normal).

So there’s more to discuss with the consultant on Monday but yeah… it looks like either way I’ll not be making it to 40 weeks!

I mentioned to the midwife taking my blood that I was considering ELCS, and she was clearly Team Induction- emphasising that it’s more likely to go smoothly because I’ve given birth before, and that CS is major surgery.

I did ask about meeting with a Consultant Midwife as well as the Obstetrician but was just told the Dr I’m meeting on Monday is one of the best around (which a cursory google seems to confirm).

I thought I'd already commented on this thread oops. I just wanted to say that I had an induction with DS2 because I had cholestasis, and it went swimmingly well albeit very quick - took awhile to kick off but I remember my waters breaking at 6.30, he was born at 7.17pm. No other intervention necessary, first degree tear. Bit of a different experience than with DS1 where I went into labour naturally, pushed for 4.5 hours when he got stuck, had an episiotomy due to foetal distress , the stitches then broke down and recovery was AWFUL.

I was induced at 39 weeks though. If I was in a similar position, I'd ask for increased monitoring until at least 38 weeks.

All the best whatever happens

Two inductions as overdue, no other reason. Pessaries inserted and started contractions very quickly. Fast (6 hrs and 4hrs) labours, a few stitches and two average sized healthy babies. I was very glad they were safely out.

You've got the weekend to decide which set of risks you're most happy with. Go in prepared to fight your own corner. It's your body, your choice. When i was pg the doctors wouldn't even talk to me about c sections. They're supposed to get informed consent. I think they like to compare an elcs against an easy straightforward vaginal birth following an uncomplicated pregnancy.

@TinyCIanger

Well.

The plot thickens.

I’ve just had my 36 week scan and, in a ridiculously ironic twist, we have now gone from “we think your waters have gone early” to (drum roll please)… polyhydramnios. AKA too much fluid.

I mean. For fuck’s sake.

So they’ve taken bloods for GD and a TORCH screen (I had GD in my first pregnancy but HbA1c test at c. 28 weeks was normal).

So there’s more to discuss with the consultant on Monday but yeah… it looks like either way I’ll not be making it to 40 weeks!

I mentioned to the midwife taking my blood that I was considering ELCS, and she was clearly Team Induction- emphasising that it’s more likely to go smoothly because I’ve given birth before, and that CS is major surgery.

I did ask about meeting with a Consultant Midwife as well as the Obstetrician but was just told the Dr I’m meeting on Monday is one of the best around (which a cursory google seems to confirm).

Fingers crossed it's not GD. You could always say that you won't consider consenting to an induction until you've spoken to the consultant midwife. See what the community midwife says too as they can sometimes be a bit better at listening than the hospital ones.

Please talk to everyone who knows your medical history....sadly my sil had a stillbirth as she didn't and it's why I demanded an induction for DD prior to term (she born vvvvv healthy)... No one one here can tell you what's right or not as they don't know your medical history. Please please talk to your midwife and doctor. They only ones you can advise what's right for you but good luck whatever you decide

You could always say that you won't consider consenting to an induction until you've spoken to the consultant midwife

Or maybe the actually consultant

Actual

Oh OP what a nightmare Big hugs. I had GD and DS's movements reduced a lot at 37 weeks and I had to go in for daily CTG monitoring. I don't recall this to be a great time frankly, I just wanted him to be out. The hospital said if there is a third instance of reduced movements that week they'd do a planned section there and then.

I agreed a planned section at my 36 week appointment due to GD and increased risk of stillbirth and my history of recurrent miscarriages before and oversensitivity to certain meds they use to induce you. If I were you I would 1000% go with planned section over induction for the safety of your baby and your ability to plan around it. My recovery was very good, I had an infected wound but no issues, just had to take antibiotics and that's it. Every single person I know had a far worse recovery after induction and certainly after EMCS.

Best of luck xx

Ask for an elective section.

Also my experience is an elective section and recovery is a walk in the park compared with an instrumental delivery + episiotomy. I have done both and they don’t remotely compare. I resent the “major surgery” description as a means of deterring women from a section.

@SWS17

Also my experience is an elective section and recovery is a walk in the park compared with an instrumental delivery + episiotomy. I have done both and they don’t remotely compare. I resent the “major surgery” description as a means of deterring women from a section.

But it is major surgery. And not calling it that doesn't change the fact that it is.

I think it’s more that they use the fact that it is major surgery to try and put you off- but the fact is that an induction may well end in major surgery anyway, and if it’s elective it’s at least calmer and safer for both baby and me than if say forceps end up getting involved during induced labour which could result in injuries for both of us… but they never tell you that stuff. They have only discussed induction as far as it ending a smooth, straightforward vaginal birth and “your body has been through childbirth before so it’s more likely to go well”. Well it didn’t bloody go well the first time did it?!

The thing is op, 2nd births generally DO go more smoothly than first, that is a fact. ELCS at 37 weeks would be a pretty bad idea unless there is a really strong medical need as you would greatly increase the likelyhood of your baby requiring special care. Yes of course induction can lead to EMCS but at least baby will have experienced some labour, which greatly reduces the risk of transient tachypnoea of the newborn. ELCS at 37 weeks would be pretty unusual which may be why it wasn't advised to you.

It is astonishing that no one thought to do an amnisure when they suspected PROM, to confirm either well. It seems ridiculous that they didn't to be honest. I don't know how on earth they expect you to make such a massive decision without that confirmation.

Unfortunately an HBA1c at 28 weeks is not a good way to screen for GD, an oGTT is the gold standard. Since you had GD in your first pregnancy, you really should have had diabetes monitoring even in the first trimester. It does seem a high chance you will have it again, unless you have reduced your BMI or otherwise greatly changed your lifestyle in the interim. My trust changed to the HBA1c for a short time during covid but soon changed back when the numbers of GD being picked up dropped by 75%. It really isn't an appropriate tool for diagnosing GD.

Fingers crossed you get the opportunity to have a long conversation with the right people and get all the answers that you need.

@PrivateHall

The thing is op, 2nd births generally DO go more smoothly than first, that is a fact. ELCS at 37 weeks would be a pretty bad idea unless there is a really strong medical need as you would greatly increase the likelyhood of your baby requiring special care. Yes of course induction can lead to EMCS but at least baby will have experienced some labour, which greatly reduces the risk of transient tachypnoea of the newborn. ELCS at 37 weeks would be pretty unusual which may be why it wasn't advised to you.

It is astonishing that no one thought to do an amnisure when they suspected PROM, to confirm either well. It seems ridiculous that they didn't to be honest. I don't know how on earth they expect you to make such a massive decision without that confirmation.

Unfortunately an HBA1c at 28 weeks is not a good way to screen for GD, an oGTT is the gold standard. Since you had GD in your first pregnancy, you really should have had diabetes monitoring even in the first trimester. It does seem a high chance you will have it again, unless you have reduced your BMI or otherwise greatly changed your lifestyle in the interim. My trust changed to the HBA1c for a short time during covid but soon changed back when the numbers of GD being picked up dropped by 75%. It really isn't an appropriate tool for diagnosing GD.

Fingers crossed you get the opportunity to have a long conversation with the right people and get all the answers that you need.

I don’t know what amnisure is, but I had a scan the day after the suspected PROM happened and they said there was still plenty of fluid there.

I had a GTT in my last pregnancy but they aren’t doing those this time around to reduce the number of people in the waiting room (covid). And I only barely had GD last time- the cut off was 7.7 and I was 7.8. The reason they did the GTT was because my Mum has type 2 diabetes, I am a size 8-10 and healthy BMI etc and had no other risk factors besides that.

@nodogz

Ask for an elective section. If medical advice is to get the baby out then get it out in the least distressing and predictable way.

I see people write this a lot on pregnancy threads but in my trust you've no hope in getting an ELCS unless it is absolutely medically necessary. They'll always push induction on you first. I know theoretically you're supposed to be able to have a section if you want one but it's definitely not the case where I am.

I agree with those who say err on the side of caution in terms of dates. The main thing is to make sure the baby is born safely, and avoid an emergency situation.

Medical professionals don't consider enough IMO the mental and physical health of the mother after a traumatic and prolonged delivery with lots of intervention, episiotomy etc, because her body was not ready. And then ending up in emergency caesarian anyway. You do what you think is best for you and baby, OP, and don't let them railroad you into a short term economically convenient decision.

I think inductions are barbaric. All this 'what's best for the baby' - what about the mother and her likelihood of damage from instrumental delivery? My induction ended in being rushed to theatre, episiotomy, 3rd degree tear and PPH. Luckily I recovered really well (apart from a mild inability to do star jumps).

My ELCS with my second was absolutely lovely.

Inductions aren't necessarily best for the baby either. The drugs and strong contractions impact the baby too.

I think what I’m leaning towards now, is to agree to the earlier stages of induction- sweep, pessary, gel, ARM- but if none of those things work I would prefer to go straight to c section rather than the drip with the need for epidural, non-stop monitoring, lack of mobility and all the extra instrumental/birth injury risks. Does that sound reasonable?

I think that sounds reasonable, OP. Nothing wrong with just doing the ELCS either. I would avoid the drip too if it was me.

I’d just go straight to the ELCS if I’m honest. If they think the baby needs to come out then I’d be going for the quickest way to make that happen.