What will happen if I refuse syntocinon for induction/augmentation?

[TravelHappy]

Hello. I'm trying to prepare for a meeting with my consultant next week and seeking advice. I am terrified of syntocinon because of bad experiences of friends and family. Also I have polyhydramnios (too much amniotic fluid) and I'm concerned that should I be unlucky and the syntocin over stimulate my uterus it would be particularly bad/damaging for me. I'm thinking about notifying the consultant and hospital in written form that I refuse to have syntocinon and would like them to make plans and inform me of the plans for what else they would do in a scenario where they would otherwise use it. Is this a sensible course of action? Has anyone else done something similar? I do realise that in some circumstances the alternative will be a c-section.

My friend refused induction drip in December (after failed pessaries etc) and was given a c section. She did have to weep and wail (and her notes outlined previous poor treatment by the hospital at her first birth) but ultimately it was the right decision for her and they did respect that.

I would do some research into risks and benefits so you can demonstrate clear understanding and decision making to the consultant.

Monniemae - many thanks for the advice. I've been doing research for a while now but now I'm trying to gather it all together so I can put it in a document to show the consultant. I feel that I'll get more attention that way as I'm not a "weep and wail" person at all (though I haven't been through labour yet!). Do you think giving them a written summary of how I feel about is a good idea or will I just get their backs up?

I'd make notes for you to refer to if you get tongue tied/think you might forget to say or ask something.

Less aggressive (I'm guessing you don't actually know that hospital will try to get you to agree to a drug you don't want yet) but will help you keep a clear head.

Then if consultant wants your notes they can ask for a copy - but otherwise you can just work out a plan together.

see this interests me too, as i have decided i will not be giving consent for any chemical induction/augmenting of labour after doing some reading up on the drugs used. im 34wks on wed and have appt on thur morning, not sure if its a consultant one or just with the midwife though.

GingerJulep - I think you are right that I need to make notes for the conversation itself. I'm sure that the hospital are as keen as I am for me to have a natural birth without the need for these drugs. I don't however want to be in a situation at 3am where I'm being "told" by a midwife or doctor that I "need" syntocinon as the labour isn't progressing and that there isn't any other option. That's why I have an inkling that giving them my views or lack of consent for this written down will trigger a proper conversation and plan rather than "we won't give you anthing you don't want or need" kind of conversation I've had to date which hasn't given me any comfort really.

wispa what did your research find on syntocinon? I'd be interested to know.

Sorry I forgot to check thread. Friend isn't a weep and wail person either, but her consultant - who had said OF COURSE you can refuse sytntocinon if it comes to it and have c section - hadn't actually written this in her notes. So when it came to it (massively overdue, failed pessaries etc) the doctor on duty tried to get her to agree, plus she had a v painful vaginal examination at same time so discovered she could after all become a weeping, wailing woman in times of need...Then she got the c section.

Fwiw, I too am adamant I do not want a syntocinon drip for several reasons. Obviously I'll privately keep an open mind in case I feel different in stalled labour or overdue, but I feel informed enough to make an educated refusal of induction should I go overdue. You do have the right to do that.

It is hard though. I just had a consultant appt about something else, armed with notes and research, and in the end in the face of them assuming I knew nothing and was naive about childbirth the most I could manage was a timid "erm but what about this risk" - they just waved everything away. And I'm usually self-confident enough to make my case! I think I'll find it easier to stand up for myself when the time comes (hope I'm not proved horribly wrong)

monniemae - thanks for the clarification. I know exactly what you mean about not managing to get your point across in meetings with the consultant. I've been in the same place! That is why I had the idea of writing down and signing that I refuse syntocinon - not because I don't trust them to follow my wishes, but because I think it could force them to have a proper conversation with me about what would happen without using it.

I keep using the word "them" because every time I see a consultant there is more than one doctor there - I think they are shadowed by trainees or registrars. It can make it feel less like a conversation and more like them telling me what is what and I find it a bit off putting. Hmmm. I need to find my backbone!

Dildas - I've done quite a bit of research on syntocinon and found that it is relatively contraindicated for women with polyhydramnios as the uterus is already over extended and with low blood pressure. I have both (pressure in the 80s/50s). Relatively contraindicated means that the doctors need to weigh up the risks and benefits as there is an increased risk of an adverse reaction (uterine hyperstimulation and shock in the case of poly and low bp). I was already dubious about it after reading news articles then medical papers on the incidence of medical malpractice awards in the UK,US and Sweden that involve syntocinon. To be fair these centre on its misuse but it was interesting that one hospital in the US decided to limit its use to very few cases and saw their malpractice costs fall by a huge factor. The alternative to using it is to let labour progress naturally or if that is not an option I'm not sure but I think the only other alternative is a cs.

I have my consultant appointment on Tuesday. I'll provide and update after. Hopefully I'll manage to push hard enough to get some real answers!

Definately write down your thoughts when you see a consultant, make sure the consultant is in clinic they day you have the appt & not away, as a more junior doctor will not be helpful in this situation, and get whatever conclusion/ plan you & consultant come to written in your hand held notes.
Remember you always have a choice, so you can say no even on the labour ward.
The syntocinon should only be used once waters have been broken so it should and never before, and it is used safely with people of your condition but its entirely your choice and not obstetricians.
Btw, Clary sage sometimes is used for contractions in some hosps.

Hi mamamidwife. Thank you for your advice. My consultant appointment is tomorrow and if I don't actually have him and there is a junior doctor instead I'll ask for a meeting specifically on this. So if we agree what should happen in certain cirucumstances and he writes it in my notes then it will be followed in the labour ward? I'm quite confused about who's role it is to decide what should happen (or be stongly recommended to me) while I'm on the ward. It would be great to have someone designated to me ahead of time - but given no one knows when they will labour and the challenges of the NHS I think that is a pipe dream!
I'm interested in what you said about Clary sage. Is that something I could bring in with me if they don't try it as standard? I'll add it to my "things to discuss" list for tomorrow.

As long as there is a plan in your notes everyone should respect it but they might just need a gentle reminder about your wishes.
It is unlikely you will have a designated mw ahead if time for labour, although that's a nice idea
Clary sage is often used as a uterine stimulant but I doubt obstetricians give much credence to the idea, but it's an alternative, some essential oil used in a carrier oil for massage, I have seen it used with good results but maybe you want to see an aromatherapist?
Another option is raspberry leaf tea as it improve uterine tone? Again you may want to research this though in relation to the poly.
The other thing you may want to think about is the other uses of syntocinon as it is a first line treatment for haemorrhage and highly recommended, and you may want to use it in this situation,
Sorry more food for thought! Good luck for your appointment and I hope you see a consultant!

When I was a week overdue with DD3, the consultant was very pushy about trying to railroad me into an induction. On the advice of my midwife, I wrote an advance directive stating that I refused consent for any IV to be inserted or syntocin to be administered under any circumstances, and I put right at the front of my notes. The consultant did his damnedest to get me to change my mind, but admitted there was nothing he could actually do with the advance directive in my notes. Having a supportive midwife does make a world of difference I think.

Very interested in following this thread as I was induced using syntocinon the first time kind of against my will (is amazing how vulnerable you are in labour and all they have to do is threaten the health of your baby and you agree to anything) and now I'm ttc I'm determined to refuse it next time even if that means going straight to CS.