Need some help re:induction and how I can go about refusing

[PreggoEggo]

I am down to be induced on saturday at +12, I am very unhappy with this and have voiced this with the mw. I've asked if I can go in at +14 and they have said no as they are fully booked. I asked what would happen in the event i went into labour naturally at +14 if there werent enough staff and was told it was a different ward so there would be midwives available.

I feel like I am being totally forced into this, and dont seem to have a leg to stand on. I dont know what to say to the mw, she keeps telling me 'they wont let you go that far', but it isnt their choice?? its mine. I know when i ovulated to conceive this baby and it puts my due date at today, not 10 days ago. But she said the scan of the baby is more accurate than the LMP. But im not going on the LMP, im going on the LH surge detected when we were ttc. ??

She said, if you're lucky they'll be fully booked on saturday and you wont have to go in then. It didnt even occur to me to ask what would happen in that situation, if all of a sudden a space would become available on the monday for me to be induced then.

I am going in this afternoon for 'the sweep of my life' as she put it. Which i am NOT looking forward to as earlier on the phone she didnt think a second sweep would do much, so am i just setting myself up for more pain after the sweep? After my last sweep I started getting minor contractions and got really excited, is this just going to fool me into a false sense of hope when this happens again?

Im so upset, Ive been in tears this afternoon. I hate feeling pressurized to have this baby, i know it will come when it's ready, my last one was 12 days late. I so want to have my home birth and dont want that taken away from me.

Need to get DD2 ready for nursery. hope someone can give me some pointers before i go in at 230 x

I'd be firm, tell them you KNOW your due date is today and that you'd consent to more frequent monitoring as a 'compromise'? I dread induction too and tend to brew my dc slightly longer than average, but after my induction with dc1 I never want to do it again. If all is healthy and they have no reason to suspect otherwise, they can't make you do anything.

Just phone up and say Saturday doesn't work for you now and you need to move it to Monday

They can't force you to have an induction, full stop, at all. Until the baby is born, you have rights, it doesn't. Of course in reality most mothers put their baby's needs before their own but if you are confident to keep going until +14 (or beyond) then you can. They may want to monitor you more, which most people would probably welcome at this stage, when it is harder to feel the baby moving (and you may want to pay more attention to the baby's movements). But there is no reason why you should be induced if you don't want to. Stand your ground.

Sorry or should I say your rights come before the baby's. Does that make sense?

The mw was just making me feel really guilty about it saying the placenta could come away, become calcified etc and obviously i want to put the baby's health first but I just feel like im talking to a brick wall.

They can't make you. But if you go over what is the "limit" in your area you will no longer be considered a low risk pregnancy (if you are classed as this at the moment). This means that when it comes to birth certain options such as midwife led units and water births will be denied to you. It will also potentially lead to greater monitoring during the birth process which may limit your mobility etc.

On the other hand an induction may just kick start things and you can go on to have a less medicalised birth.

Something to think about, or so I thought when the MW explained all this to me when I was thinking of refusing induction.

Btw, you can refuse sweeps too (I did), as far as I know there is no evidence they work unless you are about to go into labour anyway.

i didnt realise that by going over the 'limit' i would be considered higher risk :( i will bring that up this afternoon. i just wanted my last birth to be at home where i feel comfortable. I know you cant plan for these things to go the way you want, and i need to get my head around the fact that i might possibly not be able to have my home birth now. I still want to cry about it!

Have you looked at www.homebirth.org.uk/?
There is a section on there about going overdue www.homebirth.org.uk/overdue.htm

which might give you some idea about how to approach the MW etc if you want to refuse an induction (not just if you want a home birth).

This exact thing happened to me, I was induced before +14 as they had no space. Doing it again I would insist to go to +14 before induction unless there was a medical (not admin!) reason to do it early.

If it is important to you, stand your ground. SOrry I don't have time to look it up but try and get the offical guidleines so you know your rights.

(I had a lot of monitoring because of the induction btw plus various other stuff as a result of it). Say you will go in for daily checks, whatever, so it not you being difficult.

NICE guidelines here should help

Specifically:

If a woman chooses not to have induction of labour, her decision should be respected. Healthcare professionals should discuss the woman?s care with her from then on.

From 42 weeks, women who decline induction of labour should be offered increased antenatal monitoring consisting of at least twice-weekly cardiotocography and ultrasound estimation of maximum amniotic pool depth2.

I am not an expert by any means, but...

They cannot induce you without consent. They can say that there is an issue with inducing at +14 (i.e. no availability), but in that case it would be totally your choice whether to choose an earlier date, or wait longer (either for induction or to see what happened).

Ask to speak to a supervisor/senior midwife this afternoon. Explain your position regarding dates - i.e. it isn't just dates, it's evidence based that you are not yet past 40. Ask to discuss other options. If you do not want to be induced at +12 (or +2 by your dates) say so in no uncertain terms. If you would accept further monitoring or induction at a later point, explain that to.

In terms of whether you are considered 'higher risk' I can imagine that may be true if you fall outside of their protocols. It is one of the things that made me to decide to go for a homebirth. They can deny you use of the MLU or the pools in hospital based on their risk assessment. However, a homebirth is your risk assessment. They can advise, but they cannot 'tell' or 'let'.

No one can take your homebirth away from you. Circumstances may mean you decide not to have one. But it cannot be taken away.

There is something about the medical profession that makes many of us very very compliant. Imagine you were buying a car and the salesman was trying to sell you one you didn't like. How much easier would you find it to be assertive about your requirements? Try to channel that type of feeling - you are an adult, and you deserve to be treated as such!

I did exactly this - I refused induction at 40+12, and had to go in for monitoring (it's worth doing that just to play the game)
Monitoring is basically, they put you on a bed and strap elastics round you and measure the baby's heartbeat for half an hour.
It also measures their movements, and any contractions you might be having.

Nice guidelines say that you don't have to consider induction until day 14 over anyway, so please print that off and take it with you.

You will also have to see a doctor registrar, who may be nice or may be horrid.
Mine was horrid and i told her off for being mean to me.
(she basically ranted at me for 10 minutes about how i was going to kill my baby)

You will prob also have to see the senior midwife, who will explain induction.

You don't have to be induced - you can have a Vaginal exam with a view to having a membrane sweep.
I refused this to stat with, but in the end, agreed because it would have bought me another day - the monitoring is every day, and they nag you every day, so having the VE means they can leave you until the next day.
As it happens, when I had my VE on day 14 over, they saw I was 3cm dilated, so I don't know if I even had the sweep in the end (if you have the VE you don't have to have a sweep, but if you decide to have one, you should have it while her hands are up there)

I can't remember the next stage if a sweep doesn't work, I think it's a drip of syntocin?
then after that, it's the pessary.

I should imagine that the sweep should be enough for most women at 14days over.

Do read the NICE guidelines on refusal of induction, and induction generally, and tell the staff that you have made your decision based on this.

oh, yeah, I had a homebirth planned too - and they wanted to make me go in (which if you're induced, it's pretty hard to refuse to stay at the hospital)

I went into labour on the next day in the early hours (so day 15) and I had DD at home at midnight on day 16. (which screwed up my records - i kept saying "16 days technically - 1 minute earlier and she'd have been 15 days)

(and apparently, my dates were accurate by LMP, but everyone said that she didn't look 15 days overdue)

For induction, ususally pessary first (and they may try this more than once), then drip.

ah.
I'm sure the Midwife supervisor said there was something before pessary.
can't remember what though.

You've been given lots of fab information here, I'd especially recommend reading the homebirth website info, really great stuff on there. I refused induction until + 14 and could have continued to refuse. After + 14 I think they like to refer you to a consultant and have daily monitoring, not sure of the NICE guidelines this was just what my MW told me. Don't be pressured by your MW, she's obviously not listening properly if she thinks you're going by your LMP when in fact you are going by Estimated Ovulation which is pretty bloody accurate.

No one can make you do anything, stand your ground. Induction is a balancing act, for one your dates need to be right and then it's a case of doing it, if you need it, at the right time. I went through the same feelings and completely understand I cried over it so much and in the end I gave in but it felt the right time for me at +14 days. My induction wasn't successful, my baby was born 3 weeks ago at + 16 days via EMCS.

In regard to what you were saying about them being fully booked for inductions, they only tend to book as many as they can handle if the delivery suites are in use with women naturally in labour. Does that make sense? They are normally very careful not to overbook themselves. They won't book in a ton of inductions as they have to have space for women who are due and could come in in labour. So if you go into labour before you're induced, when they've told you they are fully booked for inductions, they will almost 100% have space for you. This is why they try and manage inductions and can get pushy about when suits them.

Agree with Crystal's link to the Homebirth websites useful stuff on being overdue, also the NICE guidelines. I understand your anxiety about being considered higher risk if you go past the generally-accepted limits for being 'overdue'. Have you considered other options, though? I am 32 weeks and told my midwife I was not having a sweep under any circumstances if I went overdue, but was equally reluctant to have an induction at 42 weeks, or whenever they start nagging - and she suggested a couple of sessions of acupuncture to help kickstart labour, as she's seen it have a fair amount of success.

just read my notes from my livebirth thread - it's pessary then breaking waters then drip.

It's a personal choice of course but I would be very concerned for my baby if I went that far over. I remember reading something a while back about the increased risks of still birth. I think that would scare me enough to just go and get induced!

My induction went, 2 doses of gel over 24hrs, got to 1.5cm dilated, then waters broken and drip at the same time. Apparently if it's not your first baby you can push for a couple of hours between waters breaking and having the drip.

Term is defined by the WHO as 37-42 weeks. So you are not overdue. Read all the info on "you can't have a HB because" page, memorise it and ask for expectant management as per NICE guidelines.

I'd be underwhelmed by the not enough midwives argument re timing of induction - wouldn't you rather be at home with 1 mw than sharing between a number of others in hospital anyway

Ploink from 42 weeks (maybe 43 weeks actually), when dates are accurate there is an increased risk of still birth but it is still marginal. This also has to be weighed up against the increased risks of complications due to all the medical interventions. I understand what you're saying, I felt similar, but the prospect of being induced is scary and sometimes medical professionals use things to scare women rather than actually give them the full information to make informed choices.

Here's a link to my thread about induction, have a read OP, there is a ton of induction information, I was Pixie04, xmasmummytobe and stillwaitingforbaby. inductionthread

I really don't understand why they book you in for an induction, without checking if it's really necessary.
Surely monitoring the baby (even scanning to check the amniotic pool) must be cheaper for the NHS than an induction?

If your midwife thinks your placenta might be coming away, then ask for a scan to check it. Much better to be sure than induce, when statistically, it is most likely just fine.