Opinion from my friend the doctor!

[ohthegoats]

I have a friend who is a high up anaesthetist. We were just out for lunch with her and a group of others, most of whom have kids already.

The doctor's advice on birth is:

If things go early and seem easy, then all is fine - go for the natural option. If you are overdue and they start talking about induction, then do the following: don't turn it down, they are suggesting it for a reason. Go in for the induction sooner rather than later, have an epidural as soon as they will let you. If things work OK for you at this point, then go for the 'natural' option. The minute they start talking about interventions because something has slowed it down, or you're not progressing etc, refuse the drip to speed you up, refuse forceps or ventouse and just ask straight away for a C-section, before things get too far along. Put your foot down on the issue. The epidural is already in, you're not already massively knackered, and often a calm, non emergency C-section is easier to recover from than a failed induction/ natural birth/ forceps tear/ cut. That's what all doctors would do.

So... what do you reckon to that suggestion? Oddly, as she was telling this story I remembered another friend's birth story - she's in obstetrics somewhere, not sure detail of her job, and that was her exact situation.

In the context of the OP, what does overdue mean?

41+6 is still just full term

I didn't say anaesthetist is there in the room as the baby's head pops out of the fanjo. He doesn't have to be there in the room during the episiotomy and PPH, for example, to know that they happened.

I said anaesthetist follows a birth once he is involved, and therefore would know about normal uneventful births as well as complicated ones. And I said that in reply to martha's claim that "And anaesthetists never see calm, normal births to be able to make a proper balanced judgement."

I don't have any experience with how this stuff is done on the NHS but the anaesthetist was the person who topped up my epidural, changed the bag when necessary, checked if I wanted more/could have more etc. It is ultimately his responsibility (and so am I, if anything goes wrong with his drugs) and in the hospital I gave birth in, they would not (could not) take off and leave it all to the midwife.

I'm afraid you don't know what you are talking about CoteDAzur. It is beyond me why you would get yourself into an argument on a subject that you clearly know very little.

Cote - for the woman who goes in and delivers with only a midwife present, are you really trying to suggest that the anaesthetist just happens to pop their head round the door every now and again? Or toddles off to see how a home birth is conducted?

I think not - I think you are saying that vaginal deliveries can happen with an epidural. So in practice, there are a whole set of births of which an anaesthetist has no experience.

Another thing I would have liked to have seen discussed is if they advise an induction ask them why it is necessary in your own case, or whether it's just because a date on a calendar has been reached.

I had an epidural to stop my arthritic pain during labour. One dose before birth and anesthetist returned to check me and dd immediately she was born.

After a 30hrnatural labour which started to go sour with heart decelerations, I asked for a Cesarean. The Dr agreed and it was the best decision I've ever made!

Oh, I get that it's just one opinion - I just thought it was an interesting one is all.

She has been involved in quite a lot of births where things have gone wrong, hence I think her opinion that if you are suggested an induction might be good, you take it. She didn't elaborate on this point, just her speaking from experience. I know she has witnessed some straight forward births, including delivering her own best friend's second child at a dinner party when an ambulance didn't arrive on time! Probably not enough to not skew her experience of childbirth when she is mostly there at the point things go very unnatural.

I thought it was also quite interesting that the one person I know who is involved in obstetrics had exactly that situation with her birth - just seemed quite coincidental!

I'm not claiming to be an authority on this subject (unlike others ). I just know my births and those of my friends (all of whom had epidurals and went on to have mostly uneventful births). What I am saying saying is that OP's friend the anaesthetist who gave her the advice in question would know what she is talking about, as someone with medical training and practical experience in childbirth, having followed hundreds (thousands?) of women.

Have you even read the advice in the OP? If you are to be induced, refuse further intervention such as the drip to speed up the labour and ask for a CS because "often a calm, non emergency C-section is easier to recover from than a failed induction/ natural birth/ forceps tear/ cut."

This is not a home birth. It is not a completely normal, no-intervention hospital birth, either. We are talking about an induction with complications.

I fundamentally disagree with accepting an induction for the sole reason that you are overdue. Because pregnancies can and do vary wildly in length and although the evidence does show an increase in rates of stillbirth once you reach 42 weeks +, there is no discrimination between 'normal' pregnancies that have reached this length and 'problem' pregnancies which have other issues.
I also wouldn't think an anaesthetist would be an expert on birth, they are going to see a self-selecting group of difficult or long labours that are resulting in an epidural. What percentage of labours end in an epidural?

Agree that views from a very experienced midwife would be much more worth listening too.

I also know a consultant anaesthetist who insisted his wife had epidurals and c-sections for her pregnancies, based on what he saw at work. I think my home water births flummoxed him somewhat.

Apart from the induction part, my friends/family who are doctors all say exactly the same thing! Different when one is In the midst of things though.

I'm sure an experienced midwife would be the one to speak to yes. I don't know one though! The only one I know of, is my friend's mum - who was retired by the time it got to her daughter having children. My friend's husband called her after 28 hours of labour with nothing happening, and the midwife said 'Put the phone down, go back and demand a C-section'. She's probably not a good example.

Sounds like perfectly sensible advice. You are under no obligation to take it, though. Any advice from a midwife should have similar caveats.

I would agree.

I was wondering if anyone has experience of refusing the drip and requesting a CS instead? I didn't even manage to get an epidural so not sure how easy it would be to insist upon a section when it hasn't been offered. I suppose there are ways of asking!

No Cote, the OP wasn't talking about an induction with complications.

The statement was that if they talk about inductions it's for a reason. The reason might be a hospital protocol and as another poster has pointed out, (somewhere, maybe another thread) hospitals serving the same demographic have widely differing rates of inductions, which does suggest that some 'reasons' are more valid than others.

Although there seemed to be some merit in OP's friend's arguments, in that I can't imagine many women want to endure something like a 60 hour labour with complications which then ends up in an EMCS anyway, so better to go for it sooner rather than later, I would be wary of anyone giving blanket advice. The advice should, IMO, be firmly centred around what is considered best for you and your baby at that moment.

I think the op's example would have been the best for me.

Ds was born at 34 weeks and they initially tried to stop the labour, this only actually slowed the labour and 12 hours later they decided to put me on a drip and "strongly advised" I have an epidural.

I pushed for 2 hours, they had no idea that ds was back to back(I was examined 5 times by different people so they could work out which way round ds was)

Was eventually taken to theatre for forceps delivery. In one word it was brutal. Ds was horrifically bruised and I've suffered terribly with sciatica and coccyx pain since. They used the wrong forceps due to not knowing his positioning also.

Ds had ten days of double phototherapy, largely due to the bruising he suffered. And we were initially warned to expect some degree of brain damage.

I believe I should have been offered a c section as an alternative to what did happen. I believe our first few weeks with ds would have been much less worrying had I been given a section after an hour of pushing and failed attempts to work out whether he was back to back or not.

As a first timer I simply went with what I was advised, I'd be much firmer if ever there's a second time

LaVolcan - re "the OP wasn't talking about an induction with complications."

Of course it was:

ohthegoats Sun 15-Jun-14 19:04:00
"Go in for the induction sooner rather than later, have an epidural as soon as they will let you. If things work OK for you at this point, then go for the 'natural' option. The minute they start talking about interventions because something has slowed it down, or you're not progressing etc, refuse the drip to speed you up, refuse forceps or ventouse and just ask straight away for a C-section, before things get too far along. ... often a calm, non emergency C-section is easier to recover from than a failed induction/ natural birth/ forceps tear/ cut."

What OP's anaesthetist friend has said is if you are induced and they start talking about interventions, refuse those interventions and ask for a CS.

So yes, this thread is about an induction with complications.

Cote- Unlike you I do have nearly 20 years experience in all aspects of NHS maternity care- home, birth centre, delivery suite, theatre. For the fourth and LAST time, the OP's advisor may well have some valid views based on vast experience, but those views will not be based on a varied experience and it is quite possible, even very likely, that the advisor has never been witness to a normal birth without complication or intervention.

I had a drip. It speeded things up. Baby was born without any further intervention.

Tbf, they were talking ventouse, forceps, emergency c-section, to happen in rapid succession, if drip didn't work quickly. Luckily DS unstuck himself and got himself born within their allotted timescale (15 minutes, iirc).

Well, at least I can read and comprehend English.

Have you not noticed that the OP is talking about inductions? Not even straight-forward inductions but and inductions with complications that need further interventions.

This thread isn't about "normal births without complication or intervention" so I have no idea why you are banging on about those.

Cote - you seem determined to miss the point that some inductions are more necessary than others. Some, I don't know how many, are booked primarily because of a date on a calendar.

I was watching an old Horizon programme a few weeks ago, which was on the induction craze of the 1970s. At one point they gave some stats which showed that at the JR in Oxford between 1972 and 1975, i.e. before the induction craze started and when it was in full swing, the EMCS rate doubled, but with virtually no reduction in the still birth rate. This latter had been the raison d'etre for the inductions.

Maybe they got it wrong a generation ago, and they don't now, but unfortunately, I don't think so entirely - I think protocol rules too often now.

Thecircle - have you seen a chiropractor for the coccyx? DS dislocated mine badly, NHS said nothing could be done and offered physiotherapy which "probably wouldn't work". I saw a chiropractor privately and now only have coccyx discomfort on very, very rare occasions. They aren't on NHS so my doctor just didn't bother recommending (as he later told me).

LaVolcan - I didn't pass any judgement on the necessity of any induction.

I'm reading OP as "Accept induction if you are offered as they likely have their (medical) reasons. While being induced, if it looks like further intervention is on the cards, refuse those and ask for CS instead".

SIL just had a baby at 42 weeks on the NHS and was not offered an induction, so I am well aware that going over due date isn't sufficient grounds to be induced.

Cote - I would certainly agree with your last statement, about the further intervention, but I didn't read the first statement the same way as you. I didn't make the assumption that inductions were only offered if they were medically necessary. OK so your SIL wasn't offered one - many women don't realise that it is an offer, and in my book, 'We'll book you in for induction at..." doesn't count as an informed discussion. You have someone up thread asking whether you can refuse a drip. Yes, if you are mentally competent, you can refuse all treatment, but not everyone knows that.

whats I haven't, but may consider it. Ds is 3 now, the sciatica bothers me more. I've kind of just lived with it, the pain from both is not constant but the flare ups cause some pain.

I did have physio initially and I also had an episiotomy which was very sore for quite some time.

I don't think I could have another baby, the op made me think again about how different it could have been