To be peed off about how ‘high risk’ pregnant women are treated?

[Cuppasoupmonster]

Inspired by another thread.

My first birth was your typical very medicalised one - induction at 37 weeks (medical reasons I was happy with this), epidural which failed, nobody took the wire out of my back so I was told to stay lying down (in agony!) through some coached pushing and eventually forceps.

Pregnant again and had the conversation of doom with the obstetrician last week. They ‘will induce me at 37 weeks’, I will have ARM and then a 3 hour timer to make some progress because they ‘don’t want me clogging up a labour room’ (in those exact words). Little chance I’ll get to use a pool if I do go into labour after ARM because ‘there’s only 1 out of 12 rooms on labour ward’.

AIBU to feel pissed off? If I was low risk there would be no question of ‘progression timers’ or me ‘clogging up a room’. I understand I’m high risk and that rules out certain things, but AIBU to think we should at least be asked if we have any preferences and what can be done to support them?

In the meantime a FTM who has a much higher risk of Caesarian or instruments than I do as a STM is offered the full suite of options.

Just moaning really ☹️

You don't have to do anything. Don't let them bully you. Now is the time to do some of your own reading and have your own evidence/ argument against what they are telling you you have to do. Sara Wickham is a midwife who writes a lot on IOL and the evidence for/ against it.

Good luck x

I agree OP, I was deemed high risk as i had an IVF pregnancy as an older mother, they told me at my 1st appointment i would be induced at 37 weeks, luckily for me I met a couple of experienced Mums who told me to ask why, which lead me to do a lot of research on the matter and i refused to be induced and refused a sweep. Made worse by the fact I was due just before xmas so they were obviously trying to make sure I didnt go into labour over the weekend or xmas!

Thanks @jellybe

@Pegasushaswings That does sound like a flimsy reason! How did it go in the end?

Midwife here so hopefully I can answer some of your queries.

If you are high risk this time but don’t want to be induced at 37 weeks that’s entirely your choice but I’m guessing it’s been recommended for a clinical reason? If you don’t agree with it that’s your choice.

In high and low risk labours there is a ‘time progression’ as you call it, in that progress is monitored to ensure you and the baby are safe and your labour progresses within normal parameters.

I think the 3 hours you are referring to is most likely that they are saying they will do an ARM then wait 3 hours before starting you on the drip. This is because you’ve had a baby already and perhaps they are taking a conservative approach that you may progress in to labour without further intervention. Many hospitals don’t bother doing this and take a ‘let’s get on with it’ approach.

The reason why a water birth is not recommended is because you are being induced for a clinical reason which means that typically, your baby needs to be more closely monitored during labour and this should be through a ‘CTG’ This cannot be done in the pool.

You are within your rights to refuse all intervention and do whatever you like if you don’t agree with your healthcare professionals.

As others have said you do have choices. Following the Ockenden Report there’s a lot of emphasis on maternal choice and while some hospitals will make it difficult you are entitled to make informed decisions. You’re also able to choose what hospital Trust to use, so if you aren’t comfortable with the care being received currently, it might be worth looking at the CQC rating etc of others you can get to and seeing about delivering somewhere you feel more listened to.

Thanks @Secretsout no I am very happy to be induced, there’s good reason to do so.

The 3 hour thing wasn’t because I’m a second time mum, in fact I had it with my first baby. Regular contractions started, no checks to see how far along I was or anything, just ‘we don’t think you’re making progress so putting you on the drip’. I then reached 10cm in 6 hours so guessing I’d made a bit more progress initially than they thought 🥴

Can’t you have wireless monitoring in water or did I imagine it? Again, I wouldn’t put baby at risk so wouldn’t ask for a pool if they couldn’t be monitored, but believed this was possible.

No she doesn't have to do anything, but the doctors will have offered her the option for the safest birth for her and her baby. I'd rather listen to actual doctors who know my medical history and have scanned my baby than random YouTubers.

*just to add to that, they said they couldn’t tell I hadn’t made enough progress as ‘you would be in more pain than you are now’. Mind you I didn’t make a peep at 10cm with no pain relief so not sure that’s a great yard stick to go by… I think they just wanted to get things going and get me out the room, personally.

@Blocked ive never listened to anyone on YouTube and I’m certainly not a natural birth fanatic. What was your experience can I ask?

I ended up having an EMCS for an unrelated reason and the consultant said she was glad id said no to the induction (i hadnt seen a consultant before that) but overall i had an easy pregnancy so wasnt happy with the one size fits all birth plan.
good luck, it might be worth speaking to an independent birth consultant-i did and she was great.

Thanks Pegasus I’ll take a look. It’s frustrating that any questioning makes you look like a whale song birth fanatic, I’m not! I’m definitely happy to be induced and I wouldn’t do anything radical or that meant the baby couldn’t be fully monitored. But within the limits of what is sensible I would like to have some kind of agency other than ‘drip in, lie back, we’ll tell you when to push’.

@Blocked it would be irresponsible to believe what random YouTubers tell you. However, in some hospitals births are overly medicalised so mothers are subjected to increased interventions. Doctors are not infallible and there is nothing wrong with any woman doing her research and asking questions and making informed choices.

why are you considered high risk? I’m considered high risk for about 4 different reasons. I want a home birth so I’m doing my research. Most of my reasons, I feel comfortable rejecting the formal advice of a hospital birth because I feel that they apply because of the particular circumstances of my first birth (I had a womb infection which then resulted in induction, forceps, a lot of blood loss and pre eclampsia after birth). Also at risk of having a big baby, but my first was only 9lb 5 and I am tall and big boned so I didn’t feel this was excessive.

One reason though, too much amniotic fluid, which has recently come to light, is making me seriously question the safety of a home birth. I am going to wait for further scans and test results to make a decision. I did the same when I was pregnant with my first. They kept trying to induce me from 40 weeks but I kept refusing because I felt comfortable that the benefits (an intervention free labour) outweighed the risks. However when my blood pressure became raised, and infection markers showed up on my blood test, then I accepted that induction was the safest way to proceed.

i am lucky in that we have an amazing midwife led home birth team at my hospital who are great at giving impartial advice that tends to be more nuanced than the risk averse views of the consultant.

Basically I guess I am saying not all high risks are the same and knowing exactly why you are high risk and what that can involve is really important.

@Blocked Sara Wickham isn't a random on YouTube, well regarded in her field (my own midwife suggested looking at her when I was being advised to have an induction which I wasn't keen on due to past experience) and talks about the pros/con of IOL.

Plus, as others have pointed out doctors can push for the medicalised route more then is possibly needed as that is what they are comfortable with, when in fact a happy medium can be found between 'drip up, lie back and push when we say' and 'this is my whale song sound track I will be birthing outside in the woods'.

Nothing wrong with exploring your options and getting second opinions.

Also whale song lover I am not! I want a home birth mainly so I can get straight into bed and be brought a nice cup of tea and snuggle with my baby! And because the logic that women labour better in calm, quiet surroundings makes perfect sense.

Everyone is different but in your shoes I’d ask for a planned c section. It would take away all the time pressure and you could, ironically, feel a lot more in control.

It was the being told not consulted that got my back up. With my first I was told after a scan that she was inclined to not let me go home. I was told that my induction would that place the next day and I was told I would have the drip. I pointed out to the consultant that they needed my informed consent and that no one had explained any thing in anymore detail than we will put a drip in. I agreed to be induced, I had no issue with it as it was needed. I just don't appreciate being told what was going to be done to my body. I won't repeat what was said when the surgeon came in, held up a pair of forceps and announced "I'm just going to use these big spoons to help things along"

Perhaps but I’ve already had stitches in my bits and would rather not have them in 2 places! I’ve been given a 95% chance of a straightforward VB, I just want to try to make it a somewhat pleasant experience and not feel like I’m a nuisance and there to be hurried along.

I understand. I think you’d have more freedom if they weren’t so short on midwives and could give you one-to-one care (assuming you’re U.K./NHS)

@Msloverlover exactly, of course the baby’s wellbeing is the most important thing. But then I didn’t feel a stressful forceps delivery, gash to DD’s head from the forceps and then prolonged jaundice was great for DD either.

I will definitely be induced as recommended, have the baby in hospital and definitely be fully monitored. I would just like a little choice within these parameters. And of course any ‘plans’ will be subject to change if there is any medical reason to do so.

Ideally, I would like a water birth if monitoring is possible and the drip isn’t needed. If the drip is needed I would like an effective epidural before it goes in, and to be encouraged to move about in labour rather than being told to stay on the bed. I don’t think I’m asking for the world.

good luck and I hope you have a nice birth however it turns out xx

I was “high risk” just because it was IVF. I asked if I could be allowed to go one week overdue to see if I went into labour naturally. I didn’t as it happens and was induced after a week but the two pessaries didn’t work. Then they wanted to break my waters but I said no and asked at that point for a c section. They agreed. My thinking was that ideally I would have had a natural straight forward labour, but my next choice was a straight forward c section. I didn’t want a difficult vaginal birth in a theatre or forceps etc. and I just felt like my body wasn’t playing ball with the induction. I am happy with the choice I made and they did listen to me and took good care of me.

With my first I had ARM for induction as a result of reduced movements. I had one hour to make progress or I had to go on a drip and couldn’t use the birthing pool. Luckily with lots of bouncing I made the sufficient progress but three hours seems like a long time comparatively!

My circumstances were exactly the same (weirdly so) but I felt completely differently. Having had a very risky first birth with a tiny baby I was delighted to have a second birth with lots of monitoring. For me, any illusions I had about birth being an “experience” well and truly vanished - I just wanted a healthy baby.
Guess we’re all different!

Holy moly @fyn were you at term?

Comparatively low risk women who’s waters break have 24 hours for contractions to start, not even ‘progress to a sufficient level’. I wouldn’t wait 24 hours in any event, but if contractions start naturally I don’t think 6 hours to see how it goes is much to ask?

I was high risk and took an induction at 38 weeks. I think so few births actually end up in the MLU or the pool and so I kind of felt relieved that knowing I was having a medical birth meant that I wouldn’t “fail” at having a natural water birth, as I’ve seen and heard so many women say they feel after their plans go awry.

Just because a water birth is out, it doesn’t mean you won’t necessarily be encouraged to move around. Our trust were encouraging me to get in the shower (before the CTG was attached) walk around and the midwife was encouraging of me moving around (after the CTG was attached). I struggled to get into other positions but it was due to the cannula they’d put in my hand (it had taken 5 attempts to get one in and it was so uncomfortable).

Personally, I didn’t want to go on the drip and I’d have asked for a c-section at that point. They also didn’t think I was as far along. I know they said they would examine me less once my waters broke due to the risk of infection. So with ARM they might be reluctant to do an examination but I would talk to your midwife. Ideally they would examine you after 3 hours and see if you need the drip. If you do need the drip, I would ask for an epidural and say you won’t start the drip until one has been administered (and they’ve tested its effectiveness). It’s recommended you have an epidural before the drip anyway so I can’t see much objection on that. You also have the option to ask for a c-section if you don’t feel like doing the drip (I know you’ve said you’d prefer not to but in the moment, you might feel different). You’ll probably get more pushback on that one but you can still request it.