Refusing induction - any experiences

[lilysma]

Hi everyone, I'd be interested to hear about your views and experiences. I'm 41 wks today and my hind waters seem to have broken at some point in the night - have been trickling slightly ever since. I just went to the delivery assessment room and they 'confirmed' this - it didn't seem to be a very scientific assessment though - she looked at my pad and said 'it doesn't seem to be urine so we'll go with it being amniotic fluid' ! No internal exam or anything. They did the usual foetal monitoring which was fine and said they would plan to induce me at 7.30 tomorrow if active labour doesn't start in the meantime.

I had a sweep on Thursday morning and since then have had two nights of fairly mild, irregular contractions which eventually died off in the early morning, and have lost my mucous plug.

I said I don't really want to be induced at this stage as I'm planning a home birth and she said I could refuse and come in to be monitored instead. I'm inclined to refuse induction at this stage if nothing happens. It seems a bit extreme to wait only 24 hours before being induced and after a horrible first birth and post-natal period in hospital with DD I am paranoid about having to go through all that again? Has anyone got experience of this? I still want support from the midwives and don't want to get into an adversarial mode with them...

Never been in your situation, but i too am planning a home-birth, (33 weeks pg) and if in your situation, and everything seems fine, i too would not be going in for an induction.

Would try and get midwife to just check me (ie monitior baby, but NOTHING internal) for a while, and so long as all fine, wait a while longer....

while massaging with lavender and clary sage etc, nipple tweeking and going for walks and stuff and trying to encourage baby to come by herself.

Thanks nannyl. Just to update, I just spoke to the community midwife, who was much more negative than the hospital one re the remaining window for a homebirth. She said she'd be prepared to come out to attend me if labour starts tonight but after tomorrow morning I would not be able to have a homebirth because I would need IV anti-biotics to be given in hospital - i.e. I couldn't even have a waterbirth in hospital (my major preference) as I'd be on a drip .

I'm REALLY upset by this news and not sure how far I'll be able to challenge it, so if anyone can help I'd really appreciate it!

Oh God.

What a horrid situation to be in . Sounds like a complete nightmare. Dont know what to say really, but having spoken to a good friends who used an IM when her midwifes were basically only "letting" her have a hospital birth, her IM is adamant that, to an extent, so long as nothing is done internally, you are highly unlikely to get an infection anyway....

Could you call an IM and get their opinion? Is it too late for a IM?

I hope all goes well for you and keep us updated PLEEEEASE

Remember they CANT induce (or do anything internal) you if you dont consent..... you can listen to their advice but dont have to follow it.....

Get tweeking those nipples now!!!!!!!!!

The reason they don't give you an internal as it increases risk of infection - which is the reason they want to induce you. My waters broke 2am on Saturday and wasn't induced until 11am Monday without IV antibiotics (without any actually).

Everything should be fine and I would probably wait another 24 hours but to be honest after that i would be induced as I personally wouldn't want to risk the health of my baby (not saying it is at risk I am just saying what I would do).

Thanks everyone. I'm just struggling to reorient my expectations and plans for the birth, especially labouring in the pool, which was the only thing that helped last time . I don't want to do anything stupid or to endanger the baby but neither do I want to do things just to cover the hospital's back or make things convenient for them IYSWIM! I'm just going to try to relax tonight and see what happens and prepare for a good discussion with them tomorrow morning, keeping an open mind. If anyone can help with doing that it would be great. I will keep you updated!

They aren't suggesting you come in to protect themselves, it's to protect you and your baby. Your waters breaking means the protection between your baby and the germs in the outside world is gone. Me personally, I'd accept that I may end up being induced. However, for your sake I hope things get moving of their own accord overnight - good luck!

You can refuse induction still, you can refuse to go into hospital and you can refuse the IV antibiotics. Some hospitals have a policy of 96 hours between waters breaking and advised induction - it's all a matter of infection risk.

You can offer to continue to go in for monitoring, including temperature monitoring (which when raised can indicate the presence of infection) but you cannot be forced to undergo induction if you do not wish to - this means you can stay at home, and if you are at home you can still have a waterbirth.

NICE guidelines (Intrapartum care) state: 1.10.4
^Until the induction is commenced or if expectant management beyond 24 hours is chosen by the woman:
? lower vaginal swabs and maternal C-reactive protein should not be offered
? to detect any infection that may be developing women should be advised to record their temperature every 4 hours during waking hours and to report immediately any change in the colour or smell of their vaginal loss
? women should be informed that bathing or showering are not associated with an increase in infection, but that having sexual intercourse may be.^

Even the last point would suggest there would be absolutely no reason why you couldn't have a waterbirth at the hospital if you weren't induced - if a bath won't increase infection then I don't see how a waterbirth in a clinical environment would!

Sorry, meant to have the NICE guidelines in italics :(

Thanks flisspaps (love the name ). Very useful to know the NICE guidlelines and to have some hope of a waterbirth!

MrsBB I understand that there are risks but I am not always convinced that hospital protocols are evidence-based when it comes to preventing risk and there are also risks associated with induction (due to higher risks of intervention) so I would like to have a balanced view rather than just being told what to do with no real information about why. I do accept that I may end up being induced, it's just that the range of different protocols in different places suggest that there may not be a clear evidence base for how quickly that should be done...

I will ask lots of questions tomorrow!

how are things this morning?

(am hoping to not get a reply for a while because you are busy having a baby!!!!)

Good luck, hope all is going well for you

So sorry to hear you went through this - would be interested to know the outcome and hope that all is well with you and LO.

I am going through the exact same thing as of today - booked a homebirth (and bought a pool) and all been's fine until last night when I had wet knickers and then some light spotting overnight. Rang labour ward to advise and they suggested I pop into daycare for monitoring. Because there was a PV bleed, their protocol is to have Dr review. Dr came and took a swab from the cervix and felt fairly happy that it was my show but got a scan arranged to check all was well with baby. This showed everything was fine but that my liquor was low. They agreed this means my waters have gone and unless I go into labour naturally, I have to go back at 8am tomorrow for induction. In my mind this means another birth like my first strapped to a monitor throughout and unable to move about. I am absolutely devastated and really don't know what to do. From what's been said here already I assume because they did an internal I am now more vulnerable to infection so won't be able to self-monitor?

Any further advice anyone can offer would be greatly appreciated as I'm feeling very stressed and upset right now.

Many thanks!

Update - contractions started at 02.00 and have been gradually ramping up ever since - now around 4-5 mins apart and 1 min in duration. Called labour ward and homebirth midwife on call called me back and advised to call when 2-3 mins apart. All good I thought and was feeling quite positive. Went up for a shower and she called back to advise that as ROM has been more than 24 hours now, I have to go in for IV antibiotics and a hospital birth and there's no other option available. I argued that antibiotics were only effective if there was an infection and asked if there was an option for oral antibiotics but she said I'd need to speak to the dr when I go in.

So despite everything, due to waters breaking (and that seemingly being the only risk factor) I'm not going to get a home birth.

Is there ANYTHING at all I can do? Doesn't seem as though I'll even be able to labour at home. And what about discharging post-birth - I am not willing to stay in again and see my baby undergo all the tests (including lumbar puncture) that DD went through post-birth.

From feeling calm and positive overnight I now feel depressed, stressed and angry which I know is not the way to manage labour successfully.

Any advice at all is more than welcome.

So you have been offered antibiotics and a hospital birth but you don't have to accept them if you feel well informed on the risks/benefits on both sides and comfortable staying at home.

I've had several clients who have elected to decline antibiotics and carry on at home even when their labour wasn't establishing as well as yours.

If you don't want to go in you just have to get your partner/birth partner to call up and be like a broken record about you being aware of their policy but also aware that it's your right to stay at home and insist someone comes out.

If you've made this decision then I'd hide yourself away and not get involved in the discussion as there's nothing like this kind of stress for getting in the way of labour as you say. Lights down, something nice to smell, music and switch off your brain and get on with the labour.

Obviously the risk of infection does increase after 24 hrs (though it's still small) which is why they recommend going in. It may be that you're happy to agree to this. But if not then it's comforting to know that the recommendation of 24 hr cut off was reasonably recently introduced and some trusts/hospitals are much more flexible - especially if you're already in labour.

Hope this helps

Hope you're in happy labour by now !!!

Hope it's all going well. Remember the birth is just one day, a task to be done. And then you will have your baby. No need to fight, you may just have to accept that it's not going they way you hoped and just try to go with the flow and listen to the hospital - they do have more experience than you.
I was monitored with dd2 and just insisted on walking, couldn't get far but the cables were long enough to allow for some pacing! good luck.

Hope all is going well.

Remember you dont HAVE to do anything.
They can can ADVISE you, and its up to you as an adult to make your informed decision.

Id be calling (or getting partner to call) and TELLING them you are in labour, will not be coming to hospital and look forward to seeing midwife soon at your home. Repeat as above as often as necessary.

Good luck and keep us posted

Hi everyone, just to let you know that I did end up having labour induced a week ago. I didn't go into labour on my own by the appointment time so went in to discuss, asked lots of questions and they were actually very flexible and stressed that it was my choice but they would strongly recommend inducing labour within 72 hours of the waters breaking, and also agreed that I could use the birth pool in the midwife led unit if I went into labour after they applied the prostaglandin gels. I didn't have much sleep the night before and didn't feel that I was going to go into labour any time soon. I was concerned that I would just feel increasing pressure to 'get everything going' and would end up very tired and emotionally exhausted at the start of labour (I already was to be honest). So I decided to go for being induced.

Unfortunately the gels didn't work so I ended up on the syntocin (can't spell) drip and it took the highest dose to get me into regular contractions - my body really didn't want to go into labour! I ended up with almost the full intervention list - epidural after 8 hours and then forceps delivery after an hour of pushing. In the end though, the midwives looking after me were so fantastic that it wasn't a wholly negative experience - they encouraged and supported me to mobilise and worked around my bouncing and throwing myself around on the birth ball to keep the belts on. DS was calm throughout and born very peacefully. He is gorgeous and very healthy and how he was born matters a lot less than it seemed to beforehand. I only stayed in hospital for 24 hours and found it much more manageable than last time - just took DS into my bed and BF there all night - no-one stopped me!

Thanks for your advice and support though - I did need to feel that I had come to my own decision rather than being 'told' how it was going to be. And it took a lot to let go of my hopes for my second (and last!) birth. But now I have my lovely baby and the birth is only a beginning...

lilysma

What a lovely story. It seems that you have found it very positive even if it didnt quite go to your ideal plan.

Congrats on a healthy baby, and you are so right, that is what matters in the end

lilysma, congratulations on your baby boy.
For anyone still looking at this post, there is a great piece on deciding to induce after prelabour rupture of membranes here and another by the same midwife describing the process of induction here.

Thanks for all the advice and wishes. Went in and while it wasn't the birth I'd hoped for it was very hands off and only cfm towards the end but still able to change position. Did have a shot of pethidine when i needed a break but otherwise just g&a and tens. hips were the most painful - i assume from spd so would def have preferred water for the end but got through it - noisily! And no tears or grazes either. Also ironically had to have my waters broken as i wasn't progressing which made me a bit but too late to stress over. In all it hasn't been the nightmare cascade of intervention i was expecting but still sad it became a medical procedure and I'm still stuck in hospital again rather than at home with my family. But we're both fine which is the only outcome that matters.
Lilysma sorry you had a hard time of it too but glad you're both ok and you're remaining positive. enjoy these precious moments!

minicorrect

congratualtions to you too on a healthy baby

Minicorrect sorry that you too didn't manage to get the birth you were hoping for . But it sounds as though you did brilliantly and very glad to hear that you have a health baby . Hope you get home soon and enjoy your baby. I'm moving to the sleep page now and will no doubt be lurking there for the next year .

This happened to me twice. With ds2 my waters broke, nothing happened. Refused induction again and again. Very stressed. DS1 at PIL's. Felt like I was under pressure to deliver quickly. Finally in established labour, meconium in waters. Ambulance called, transfer to hospital. DS2 born 90 mins later 104 hours after ROM.

With ds3 same thing although had reluctantly booked hospital birth due to high bmi. Wanted to avoid pressure and stress so booked induction for 2 days later but requested be left in peace until then. Cervix long, nothing happens. Arrive in hospital no contractions but somehow 3cm dilated. Can go straight to drip but no bed on labour ward. Wait around all day, mild contractions. Bed available mid pm but no midwife. 8pm moved onto labour ward, established labour begins. Am 5cm so midwife lets me have a go at labouring for a couple of hours before drip. Baby born 2hours 14mins later 69 hours after ROM.

I found the run up to DS2's birth quite traumatic. With DS3 I felt very calm and in control. Because of all the hanging around I managed to get the delivery room I asked for (wanted DS2 and 3 to be born in the same room) and as luck would have it I got a midwife who I knew because she'd been at ds1's homebirth assessment when she was a student. Two very different births in the end and DS1 was a planned homebirth so that one was different again. I think their births reflect their personalities though. DS1 hates hospitals, DS2 has a passion for emergency vehicles and DS3 leaves things until the last minute!