Choosing to meet a consultant in event of induction reco

[Ellsiedodah]

Hi all, we have a baby that's gone from 50th centile at 3 months to 6th centile for last 2 scans (35 + 5 weeks and 37 + 5 weeks), as tested by Kings, which is apparently the leading sonography team in the world. They've recommended an induction at 39 + 3 weeks and were merrily just going to book it in when we said woah there we want to talk to a consultant. For such a huge change of plan, I was amazed at this casual attitude to a process that presents significant risks.

I wanted a natural birth and had wanted the wee nipper to take the time it needed to pop itself out but the seeds of doubt have been sown because of risks to small babies staying in utero. It's an impossible decision I'm now facing. Has anyone gone through the same thing and had a pretty serious discussion with a consultant as a result? Would love to know the approach you took and how they responded. Right now, I want statistics and written advice to avoid misunderstandings, sweep ONLY if I'm already 1-2cm dilated AND they can do it timed and monitored leading to induction, and booked caesarean (with senior docs only) in case induction doesn't progress etc. I know that as patients it is within our power to insist on certain things, however difficult the hospital may find it to manage so I'd like to know what experiences people have had where they've been a bit strong willed about things! Thanks very much

Hi OP. I’m sorry that you’re having such a worrying time.

Is all of your care at King’s? I don’t have direct experience of what you describe but I had excellent care there under a different set of complex circumstances. As a general point I would say that what might come across as casual is often down to the fact that they deal with very complex, high-risk cases on a daily basis. I can imagine that this might come across as casual but it’s really not - simply a common occurrence for them!

I think it’s reasonable to ask for further advice. Be aware that you are unlikely to see a consultant, but rather a registrar on one of their teams. They will be experienced and knowledgeable.

Finally, however, please be realistic - you cannot demand the level of seniority of the surgeons involved if you need a C section. King’s is a teaching hospital. Any surgery or other treatment will be done under the supervision of senior staff, even if they are not directly administering the care.

Good luck.

I'm sorry it's such a worrying time. It's never ideal being told you need to be induced, but I don't think being induced at full term is especially risky? It can lead to further intervention but not always. If they've recommended it it's generally because it's safer for baby to be out than in. I've been induced with both pregnancies - once at 35 weeks and once at 42. Both quick, no instrumental delivery, and healthy babies.

As a pp said - you can't demand to see a consultant, but if you see a registrar they will be properly qualified and knowledgeable. Equally with a section- you are able to ask for one but you can't demand who does it. Also if it is a maternal request you might find you have to wait for theatre space as emergencies take priority. Good luck with the doctors meeting and birth of your baby!!

You can ask for some things but what will be done will depend entirely on the safety of the baby. You cannot demand a certain team or doctor for the C section. It depends on who is on duty on that day.
Most hospitals have a standard induction procedure and they will take you through it prior to inducing you.

You won’t get written advice. They will have a face to face chat with you. Also if you refuse a sweep/induction then it will be noted to be against medical advice.

Kings College Hospital has done some ground breaking work in reducing stillbirth. They have found two overwhelming factors point to stillbirth. One is fetal movement and the other is a non growing baby. By intervening quickly on these two bases Kings has been doing some excellent work on reducing stillbirth rates.

So you can see why you are being advised an induction.

You can ask about something's but you can't demand certain Drs etc it will depend on who is working, other emergencies etc. They will just have a face to face chat with you I imagine and make a few notes in your maternity notes.
They will have advised an induction for a reason so make sure you are open minded about what they think is best.

Have the induction. Kings know what they are doing. I know it's hard to see the wood for the trees here, but if there is even an inclination that your baby is at risk then heed the advice.

You acknowledge that Kings is a world centre for high risk pregnancy. Take their advice. If you don't, the outcome might be fine, but if it's not, you might find that a burden to live with.
No one can precisely predict pregnancy outcomes, only probabilities. Kings know more than the vast majority from their huge dataset.

Hello all

Thank you for your responses, really appreciate you taking the time. It's great to hear so much confidence in this hospital, I had a moment of doubt today when I looked at NHS ratings and saw it lower than George's and at Thomas's... Though looking at the reviews I got the sense its admin staff were actually the ones bringing the score down rather than something more serious.

Anyway, by way of an update, we did meet a consultant at the start of the week. It was a very disappointing meeting from the point of view that he did not respond to my anxieties at all, just talked and talked at me and when I said I felt he wasn't responding to me he asked me what I wanted him to do about it. I realised I was on a losing streak and left shortly after feeling even more disempowered than when I went in.

But it did make me feel that perhaps I'm searching for the moon on a stick and that one has to accept a certain amount of scary chaos because no matter how you birth, there are risks.

Have just found it surprising how little any professional I've met there has been able to show they've heard my fears and offer the right words. Feel all a bit at sea with this induction, now wondering if I should hire a doula but worrying about disempowering my husband.

Ho hum, I guess what will be will be at this stage!

Thanks again all.

Did he explain in any greater detail why they are keen to induce? Do they suspect that your placenta is failing? I know that the thought of induction is nerve wracking and sounds very clinical in comparison to a spontaneous, straightforward delivery, but if there are genuine concerns about your baby's life then surely it's the only wise decision?

My babies heart rate started drooping in early Labour, so I was rushed into a delivery suite and hooked up to the drip for induction pretty quickly. My induction didn't go to plan as my dd was getting more distressed and I ended up with an emergency c section. Was it the birth I wanted? No! But my baby needed to get out asap and these were the options I had. My baby arrived safely which in the middle of it all was all that really mattered.
If the consultant thinks an induction is the best choice there must be a reason for that. Your baby isn't growing which I presume means they are worried about your placenta failing.
What exactly is it you want them to do? Do you not want the induction at all? Cause waiting for spontaneous labour may not be an option or they may feel like it puts your baby in more danger. Birth isn't straightforward even if you go into spontaneous labour so many things can happen that could lead to interventions etc.

I had a similar situation with the baby dropping down the growth charts. Mine was due to a problem with blood flow through the placenta. I was very closely monitored from 28 weeks. By 33+2 they felt the situation was such that the baby needed to come out as soon as an incubator was available. I begged to try induction but they didn't think she was strong enough to survive it and insisted that a section was the only way. This was my worst nightmare. I forced myself to go along with it, but it was a horrible and extremely stressful time. I think sometime healthcare professionals underestimate the human impact of these things. Ultimately I got through the section and me and the baby came out the other side but it took me a while to come to terms with it. I hate it when people say that a healthy mother and baby are the only things that matter. Of course that is the most important thing, but it's really dismissive to say it's the only thing that matters. My advice would be to go with the induction advice and take your time to come to terms with it afterwards.

I think you need to chill out.
Any obstetrician would like you to have a simple non medicalised VB with health Baby and mother and 6hr discharge. It’s cheap. It’s safe.
Next best is whatever is the minimum intervention to keep both of you safe from harm. That can be a difficult compromise and your ideal wishes being followed may mean catastrophe. THEY ARE NOT SUGGESTING INDUCTION FOR THE FUN OF IT.

I speak as mother to 3. All born early due to reduced movement and faltering growth. First was a fruitless induction (painless but boring) then CS at 39+1, CS 2nd at 35+5 and 3rd CS at 37+5. First two would have I believe been still born if left to nature.

If you want to choose your surgeon, go private. Beware that won’t necessarily Have the Nicu or ITU that kings does and you risk being separated if those facilities are needed. If you have a CS there will be at least one registrar present. My first was a Reg and a much more junior dr. Subsequent ones were consultants assisted by juniors as I believe is common as subsequent CSs surgery is potentially far more complex.

The birth is one short part of parenthood. I’m not saying it’s not important. But it is a means to an end. Even a highly medicalised one can be ok.

We all get anxious before delivery because it is a potentially dangerous business for mother and baby. The choices one has about delivery are minimal at the end of the day because until it happens one cannot really plan. At best you can have preferences.
You have made a choice to be under the care of Kings , an outstanding teaching hospital with a particularly strong department and reputation for management of foetal health. It sounds as if their experience is strongly advising a delivery before 40 weeks. Are you saying that you want to weigh up increased risk of stillbirth against your idea of a 'natural ' birth? As a PP said there is no guarantee that spontaneous labour will mean an intervention free delivery. Are you wondering whether you should have a planned Caesarian section?
You are under the care of a teaching hospital so have to expect that to take place.
You are naturally wanting the absolute best for your child and feel that as it's mother you have to be sure that all decisions made are in its interest. The team at Kings want the same outcome as you and will give the best advice that they can.

What specifically were your anxieties over the induction? 39.3 is term - there is a slightly higher risk of needing intervention with any induction but the risk of that needs to be balanced against the far more serious risk of placental failure.
Obviously this is just a guess but it seems that they’re wanting to get the baby here quickly and not let you go to 40 w or beyond.

Did the consultant explain that? It can be frustrating when your anxieties are not heard, I’ve had that myself.

A healthy mother and baby ultimately is the only thing that matters.

Op it's very confusing to work out what you want. In the first post? You are alarmed that they recommend an induction without any huge fuss or drama - which for a lot of people would be very reassuring, who want their doctors panicking and nervous about a choice? And then later, you say that you will need to resign yourself to "scary chaos" and call induction a "huge change of plan".

You say the consultant didn't listen to you, but did you also listen to the people you were talking to? Induction of a full-term baby is an entirely routine, everyday intervention that makes an enormous difference in the health outcomes of babies. It's as simple as that. Yes there are some risks to it and you should be fully briefed on those, and these are largely known and manageable and can be mitigated and corrected if they arise. You need to understand all that to give full consent. However there are also really serious risks to continuing a pregnancy with a full term baby whose growth rate has plummeted. In your case, your doctors feel that the risk to your baby and you from induction is much less than the risk of non-intervention, hence a clear recommendation.

If you'd prefer a c-section, ask for that and discuss the risks and benefits. But they will almost certainly recommend the section for the same date proposed for the induction, for the same reasons.

In your case, it would seem remaining pregnant beyond term is the riskiest option. You can decline or accept their advice of course, but it should be a fully informed decision.

Thanks ladies. I think everyone has made the same points now and I take them on board fully. No need to say more - I feel a bit heckled! I have been full of anxiety about the change of plan as you can see but OF COURSE I will take Doc's orders on the basis of an increased risk. Feels like several King's doctors have found my thread..?! I think my stress is a result of being full of advice from the natural birth community, some over bearing family who are highlighting the fact all the women in my family have long gestations and small healthy babies and just a surprising (for me) need to control the unknowns! By the way, I have huge, huge respect for our NHS and am beyond grateful for it but I'm also aware that a lot of people are driven to inductions with no medical reason and there also seems to be a general sense of the mother doesn't matter too much so long as the baby's fine, but I've personally known a lot of people who had terrible injuries, psychological and physical from emergency births and so you can't blame me for trying to manage things! Anyway, this thread is done, appreciate everyone's views. Thank you

All the best, OP

Thanks so much buxbaum

Best of luck OP - there’s a lot of societal pressure around birth. The natural lot can be as bad as any other.
But it’s your baby, your body and your birth - and while family history isn’t irrelevant, your own medical history in discussion with your own doctors is what you would be best listening to.

Good luck! Induction doesn't always mean a scary intervention led birth. I've had two for different reasons and both have been positive experiences.

I don't think anyone's going to suggest you go against medical advice. I know that Obs staff at Kings are v experience and experts etc but I do wish Drs and Midwives would remember that while the process is something they see multiple times a day it happens only once or twice in the lives of most people - most women I should say. It is totally out of the ordinary for most women.

Good luck OP. With luck your baby'll show up before 39 + 3 anyway.

I should have said many Drs & midwives. There are many who do remember too, I think.

I was induced 2 weeks ago with DD as I’d been told her growth had slowed possibly due to failing placenta. It really wasn’t the birth I’d hoped for (I hadn’t planned a birth just hoped, luckily.)
But she’s here safe and well and that’s all that matters to me.
Good luck.

Not King’s doctors- just someone with an interest in premature birth and stillbirth and miscarriage with a complicated obstetric history. King’s didn’t look after me or my babies (ChelWest and it’s antenatal team and then it’s fab fab fab NICU did for several months), but I know of their team by reputation.

Unfortunately our time in the NICU was a harsh reminder of what happens when full term babies go wrong (at one point the ITU had as many full term as prem babies)- it’s very sobering to see it from the other side. I have had two C sections, both emergency (and one MORE of an emergency than the other- the one where a button is pushed and they are anaesthetising you in the corridor practically), and there is a part of me that really would have loved a natural birth. And I also had a small first baby. But it has subsequently become clear to me that I have failing placentas not just ‘small babies’ and timely intervention prevented certain death second time around even though my son was born very prematurely. He’s a bouncing toddler now and in very quiet moments I do remember what might have been and initially how disappointed I was that my ‘birth plan’ had been chucked aside only to realise that there was so much else to worry about.

The new GROW scans which weren’t there when I was pregnant with DS1 but have now been introduced are a small step to reducing stillbirth in the UK. We still have some of the highest rates in Europe. We don’t routinely scan in late pregnancy, till recently we did a basic measurement of fundal height and left it at that and we don’t really look at blood in the cord etc or the placenta unless like me you have complications. So if you were wondering why I know this stuff, it’s not because I am a King’s consultant or even a medic (I have a doctorate in something very very non science-y), but because I volunteer with various organisations that look after sick neonates and I have an interest in the question.