Distressed. Goalposts have been changed.

[ChineapplePunk]

Just found out today that I will be induced simply because of maternal age. I am 41 years old and currently 38 weeks + 5. Throughout this pregnancy I have been marked down for giving birth in the midwife led unit as I have no other risk factors. However was told by a consultant today that due to my age I should never have been given the option of the MLU.

This all kicked off from a check-up appointment with MW at my local surgery today. My blood pressure was higher than normal (it's usually quite low), and I made a passing comment that I wasn't as aware of fetal movements anymore, but that baby definitely WAS moving on a daily basis, and I was probably just more used to them by now so not paying as much attention to them. Anyway, she decided to send me up to the day care unit at local hosp to have some more BP measurements taken and some monitoring of baby's movements and heartbeat.

Bottom line is that everything was fine. My BP had started to come down (to be honest, I found the walk to the surgery today quite exhausting as bump now quite heavy, and I'm sure that's what had raised my BP), baby was moving around quite happily and heartbeat was healthy. I thought that would be it but then MW told me that the consultant would be round to see me in a few mins. When consultant saw me she stated that she would like to do a vaginal examination and perhaps a sweep today. I declined because I felt as if i was getting hit with all this new information and wanted to have a think. She told me that they would like to induce me next Monday when i will be 39 + 5 because research shows that placental function can be compromised in women my age and I really shouldn't go over 40 weeks. I understand that this is a 'risk", but after monitoring it's obvious that everything was fine. Now I'm booked in for a scan, vaginal examination, and membrane sweep for Friday. Just like that!

I am PO'd at being told all along that, all things being well, that I was a candidate for the MLU. In fact at my 12 week scan the MW phoned the CLU to confirm if my age meant that i would automatically have to go there, and they confirmed this was not the case and I could choose which unit I wanted to birth in. Seems like quite a big mistake to me, as consultant today led me to believe that my age left for no ambiguity whatsoever as to birthing in CLU. I still don't understand that considering everything is fine with baby that I automatically have to be induced so as not to go over due date?

Has anyone been in this position and declined induction in favour of expectant management? I am dreading giving birth now, as I feel that the whole cascade of intervention will probably come to fruition. :(

Remember this - they cannot make you do anything, period. It is your body, your baby and your birth - they can refuse to admit you to the MLU but they cannot force you into an induction you do not want.
It's terrible that they have left it so late for you to absorbe and make these decisions, I'd say make a formal complaint but it's hardly the point at this late stage. You need to make the best choice for you and your baby, are you confident enough to do some independant research to try to be as informed as you can be rather then just feeling like the consultant and hospital are railroading you into doing what they tell you?
It is important to ask yourself how you would feel if something went wrong, did you make the most informed choice you could as it is one you will have to stand by. I'm not trying to scare you, but you need to try to be as sure as you can about what you decide especially if you are going to try to do something different from what the consultant has suggested, which would be much bloody easier if you had seen them earlier, got to know them a little and they had included you in the process rather than treating you like an incubator on an assembly line

I'm going to do as much research as I can over the next few days and then ask to see a consultant again. I asked today if I would be seeing a consultant on Friday when they are planning to do all this and was told "No. It wouldn't be necessary"!!?? Really? I think it's bloody necessary considering the lead up to this.
I really feel like making a case for an ELCS if they feel the need to get the baby out so quickly. I mean, I don't fancy going through a forced labour that is statistically likely to end up in assisted delivery or EMCS anyway. I know I'm being pessimistic but this is how I feel. :(

First up. Don't panic.
Nothing has changed, you've just had a consultant forget that s/he needs to preface every sentence with "based on my training and experience, I recommend that you x, y, z"
You still get to say: "thank you for your advice, what about if we do x and then discuss from there"

Hospitals do need to book things in sometimes so that if circumstances mean a certain action is agreed on the personnel and equipment are available. It's easier to cancel an appt at short notice than make one.

So...go for the scan - the risk of placental failure isn't huge but the outcome is catastrophic if it's missed. Get the evidence and then take further decisions from there. You could agree to the VE on the basis that after that you will have a bishops score and a better idea of whether your body is gearing up for labour itself. Those two bits of info together can then be discussed further:

• baby fine, placenta fine, no action on cervix - maybe decline induction but go for further monitoring
• baby fine, but placenta looking a bit calcified, no action on cervix - more discussion on risks of failure needed and consider ELCS rather than induction if that feels better than failed induction + EMCS

Etc. you have lots of options still and IMHO you should take as much care and assessment as they'll offer, but hold off on making decisions either way til then.

As for the MLU v CLU issue. Does it really matter? Say you go into labour spontaneously and turn up to delivery suite. They'll assess you and admit you to wherever they deem best then. In both circs you can accept or decline VEs, continuous monitoring, walk around, stay off bed or climb on and chill out. It's up to you. If there are pools in MLU and not at CLU then turn up at MLU and say you want pool and see what happens. I bet the midwives will assess you and if everything looks normal and reassuring they'll show you to a room with a pool. After all, the consultants will be busy looking after the women who aren't progressing normally.

By the way, I've just had a similar appt, had growth scan then VE. We discovered that baby is growing fine, all on track and I'm walking around 2cm dilated and 1cm effaced. That info prompted a plan to have another ve and sweep in a few days and I feel about 200x happier and more relaxed about possibility of induction next week as I know body is starting on the right track now and likely to be successful. But if news had been different I'd be pushing strongly at delaying anything until body seemed more ready.

You've had a shock and I'm not suprised at your reaction, I think it's totally reasnoble that you feel you need to see the consultant again, just becasue it's routine to the consultant and they are happy with the plan they have made does not automatically follow that you are too - they just obviously don't realise that yet.
Try to think of it more as an assisted labour, it won't be forced if you've agreed to it - and unless you feel comfortable I'm not sure you should agree as you won't be in the right frame of mind to give birth if you feel like you are being assaulted. Do you have a birth partner, someone who could come to the consulation with you and help you to process all the information and help make the decision?

DH will be with me. He was today. Sorry, I meant "forced" labour as in forcing my body to do something it isn't ready to do.

Yes Lady, I am going to assess situ based on scan and Bishop's Score, this is the reason that I want to see consultant on Friday. BTW, they were pretty adamant that the MLU would not be an option for me. I was under the impression that they would simply read my notes and I would be hunted out of there? I was very keen on water birth as I have a bad back and know that the water is likely to make me far more mobile in terms of labour positions. All I can visualise now is being flat on my back with legs in stirrups and forceps being stuck up me as my baby is yanked violently into his new world. :(
I totally understand that things don't always go to plan, but feel as if I have been totally wrong-footed from the very beginning of pregnancy. Allowed myself to get my hopes up regarding things that were obviously never going to be an option.

Going to see if I can get some sleep now. Feeling tired and emotional. Thanks for the advice guys. It has made me feel a bit better. I feel quite assertive when I'm not actually in a medical environment. Wish I could stay that way when talking to MW or consultant :)

I don't know how your local hospital works but we have a separate MLU then at the hospital there is the consultant ward and a halfway house option of a midwife led ward - it's not as nice as the MLU but it is less medicalised than the consultant side. I'm hoping to be abel to agree to be induced and taken to the midwife led side - the consultants arn't far away and it's quite easy to transfer. There is no reason even with induction not to move around - even with monitoring you can labour in different positions, standing or on all fours for instance. Epidurals can be done in such a way as you can still move somewhat - and if you have a birth partner then once all these things have been talked about and you have a plan B then they will be abel to help make sure they happen for you - though you can still always change your mind :).
I'm sorry if I'm teaching you to suck eggs - but like I keep saying you've had a terrible shock and I understand how you are feeling but whatever the outcome it's unlikely to be as bad as worst case scenario.

Sleep well, hopefully it will all look better in the morning anyway

Hope you managed to get some rest & that this doesn't sound patronising, but did you tell consultant about phone call to confirm MLU wasn't an age issue at your earlier appt and ask for an explanation why it now is?

I only ask as I had a midwife visit yesterday & she kept highlighting how important it is to ask questions if ur not sure about anything as they can go into "autopilot" and forget you don't have their knowledge and experience. I suspect the same is even more true of consultants (i have a couple of friends who are hospital drs & know they can be quite dismissive of patients as they know best, despite being lovely people in rl!).

Also if you struggle to stick to your guns at appointments why not write down a list of questions or points you want to raise? My baby brain means I have lists all over the house at the moment, just can't retain anything for long enough, even really important stuff. At least that way you should be able to cover off all relevant points & not be fobbed off (make sure you push to speak to appropriate person though, maybe supervisor of midwives if consultant not available?)

Finally, although you may have to change plans induction doesn't necessarily mean a highly medicalised birth, there are positive experiences of induction on mn, so may be worth taking the time to find & read a few to get both viewpoints & hopefully put your mind at rest a little. Good luck :)

Well, things have changed again! My waters broke at 5 o'clock this morning. Called hospital and was asked to go in to confirm they had actually broken and it wasn't just leakage.

Was immediately submitted to triage for monitoring, at which point I explained what had happened yesterday. The MW/nurse who I saw said "Oh, would you rather be submitted to Midwife led unit?" I said, "Well, yes, but I didn't think that was an option anymore". She told me that she couldn't understand why my age alone should be a risk factor and I was sent up to MLU.

Once there, I saw the MW supervisor who asked about "the plan" the doctor who I saw in day care unit had written. The plan was scan, VE, and membrane sweep on Friday, and then induction on Monday if things hadn't kicked off. I explained that the senior consultant who was on call (who I didn't even see) had looked at my notes and was adamant that I would have to be induced. She explained that it would be quite difficult for her to override what the consultant had said without good reason, but that personally, she couldn't see any reason for me being refused entry to the MLU to birth baby. She examined me and confirmed that my waters had definitely broken, then wrote down some notes and sent me back down to CLU for CTG.

After 20 minutes of monitoring, another consultant came in looked at my trace and said he would be quite happy to let me go to MLU if I go into labour naturally within the next 24 hours. Basically, I have until 8.30 am tomorrow, at which point I will be augmented/induced because of risk of infection if labour hasn't started. I know I could play for a bit more time but I'm thinking hoping that since my waters have already went then induction may not be so bad. And at least at this point I've had time to get my head around it.

alwaysanauntie, Yip, I asked that question more than once and all i got was the broken record response of "well, that should never have happened and you should have always been down for CLU".

So it looks as if it depends on which consultant you see and what their opinion is at that time. Surely there must me some level of uniformity though? I do feel as if I have been caught between two camps for no good reason.

Here's hoping that I go before tomorrow morning. Have been getting little of and on surges, twinges, and niggles, but things seem to have tailed off again.

Get up and down the stairs or bouncing on a birthing ball then woman - don't know what to say about themixed up consultants but just go with the advice you want and quote it at the MLU if you go into labour naturally.

Glad you feel a bit more in control and prepared.

FX you meet your little one very very soon - do update please when you are back out and have a spare minute.

Will do! MW also told me today that baby is back-to-back, which is a bit of a bugger. Hopefully he'll get turning at some point. If not, looks like I'm in for the long haul.

"I feel quite assertive when I'm not actually in a medical environment."

God, I HATE the compliant, obedient eejit I become around HCPs :o

Fingers crossed for you, OP :)

It may be a bit late for giving room to turn - or maybe not, I don't really have a clue. What I do know is that going on all fours can help with that - gravity can help settle their bum down into your tummy rather than your back as well as them having loads of room to move. So lean forward right over while sitting on the bouncing ball or up and down stairs on all fours maybe - just don't knacker yourself for the labour performing all these acrobatics while heavily pregnant lol

Nipple stim is another thing that can help. Concerted stimulation though - breast pump is good, but if not, 10-15 mins each side can get things going. At least that's what I was told!

Haven't a bloody clue whether I am in early labour or not! I am getting constipation type waves about every 10 mins. They are painful but totally bearable. Also, can your mucous plug go after your waters have broken or is it usually the other way round?

Sounds like early labour. Plug can keep coming for hours pints of slime IME. Hope it all kicks off for you over the next few hours.

Sleep if you can, if things start to get going you will soon wake up, and labouring when you are knackered is especially hard work.

Is standard now to offer induction 24 hrs after waters break if not much happening, but it is an offer and you can choose to wait longer if you prefer but risk of infection increases. My waters went and I waited 3 days (it was 'allowed' then) but didn't start to dilate properly. Hoping you have a lovely baby tomorrow

I was joking about the aerobic workout but not about either getting on all fours or leaning forward while kneeling or sitting that really can help with positioning tbh if youare in labour if you can sleep, sleep, if you can't do what you feel you need to x

You don't necessarily need to be induced after 24h. I guess you can have antibiotics to prevent any infection and then wait a bit longer.

I would try to sleep or at least rest. You'll need your energy later on :)

Good luck!

PS: Just seen your last post was at midnight. Well, I guess by now you already have a baby :)

Just logging on to say hope everythings going well OP you're in my thoughts

Hi all, our little boy Jude William was born at 6.14 on 18/4/2012, so I guess I was in labour. :)

Everything happened super fast. Got to triage at 3.30 am. Was told I was 4-5 cm dilated. Was admitted to CLU - there was no time to argue. Was fully dilated by 6 am! I had a 4th degree tear and other little complications. :)

Have been in hosp for a few days. Now home and very excited.