Induction vs twice weekly monitoring.

[mango1821]

Hi, I've had many episodes of reduced movement during my 3rd trimester. Scans and CTG's have came up fine, although baby does tend to keep me on the monitor for a long time due to her being asleep/inactive! But she does meet the criteria in the end.

I'm 37.5 weeks and the doctor said she would like to do the monitoring instead of induction due to the rate of failed inductions this early. Totally agree with her and would obviously like to keep baby in for as long as I can.

However, when do I call it a day and ask for further conversations about induction? I'm not great at advocating for myself and tend not to express my worries well! However, I don't know if I can go to 40 weeks with only have 2 ctg's a week and still experiencing reduced movement possibly! Like the monitoring it great, but you only know the baby is okay in that moment... I don't really want to sit there guessing about my baby's health...

When is the earliest they induce for this kind of thing? I was thinking of pushing for 39 weeks but don't want to if this is not commonly done! Help!!

Thanks!!

Personally I would push for induction ASAP in this scenario. A close friend had similar and it turned out the cord was failing and the baby was tangled, none of which was noticed until birth.

I also had reduced movements and it was caused by my placenta, again not noticed until birth despite weekly scans.
Luckily with DC2 I had no reduced movements or worries at all and they came out 2lb heavier so it really confirmed to me that it’s best to listen to your instincts!

It seems like a gamble to me, there are so many babies born at 38 weeks without an issue (DC1 was 37 weeks and perfect!)

Good luck with whatever you decide!

Thanks so much for your reply @Doglikeahorse

Really helpful to hear yours and your friends experience!

Your friends situation is what I'm worried about, at this point I feel like I'm playing roulette a bit! One day she's fine and the next she's not and it's really freaking me out! I'm just not sure how to go about pushing for induction. I don't want them to think I'm just eager to give birth (I'm not!! I'm terrified!) and dismiss my queries. It seems unhelpful for them to just say oh the CTG is fine or the scan is fine and just leave it there. Like something is nagging me in my mind saying there's something more to it!

I definitely agree with you about following instinct! Maybe I'll ask to speak to a doctor again when i go in for monitoring!

Thanks so much again!

I was in this situation at 37.5 weeks. I developed obstetric Cholestasis (side effect of which is liver damage and still birth) as well as pre-eclampsia. Hospital wanted to monitor me every single day rather than induce me. I was beside myself but DH and I stayed quiet. In the end my sister came with me and kicked up a fuss. I was admitted that day and induced 2 days later. Successful induction and healthy baby! She was tiny though and it turns out that the placenta had basically failed in the last few weeks so keeping them in as long as possible isn't always the best thing.

I would push for induction or Caesarean at 38.5 or 39 weeks. All that matters at the moment is a healthy baby being delivered, not HOW that baby is delivered. I would not take any chances with reduced movement

That sounds similar to me. I kept going in with reduced movements and all was always fine eventually on CTG, but there really is only so much they can tell on the CTG’s. All the midwives: obs doctors said they were rubbish but the best they had. I think if your instincts are trying to tell you something, then listen. I’d push for a c section in the next week? Or would you be willing to attempt induction with the option to have a section if it doesn’t work?

You say that during the scans “Scan and CTGs have come up fine” and “she meets the criteria in the end”. Do you mean criteria for not having reduced movement? (some reduced movement is normal as they run out of room in the 3rd trimester) so the question is did she meet criteria for actual reduced movement, or did she meet criteria for normal movement for 3rd trimester? It’s not very clear from your OP.

• If she’s meeting criteria for normal movement, I agree with your doctor on the monitoring and I would re-address at 40 weeks and push to schedule an induction NLT 41 weeks.

• if she’s meeting criteria for reduced movement, I would honestly push for monitoring every other day and have induction scheduled now for NLT 40 weeks. With the understanding that if any monitoring session showed a decline in movement, then an induction (or C-section) would be scheduled within 24hrs.

(I’m not a medical doctor, this is just advice from another mother).

@Skala123 I've been tested for OC last week too, came up normally but I'm still so itchy!! I think I'll ask them to do another blood test! Glad to hear your induction was successful and baby girl arrived safe, I'm terrified that something similar may have happened with my placenta in my case so I am going to get on to them about this!

@DSGR Yeah from what I've read it seems like that's the best course of action! I can't quite shake the feeling that something just isn't right... exactly- I just want her here safe and sound and couldn't care less how she gets here! It seems like the doctors and midwives don't have a sense of urgency with it really, but I feel like I'm playing a game of roulette and it's making me totally uneasy 😞

@ricketybeauty Yeah that's the impression I get when I have them done too! Like it's all they can do but really it doesn't tell them that much about baby's wellbeing! I'm really not fussed about a c section, I would prefer to avoid it but honestly as long as she get here safe I don't care! I do want to push for an earlier induction but I just have no idea how to do it and have them take me seriously! It's a hard one because I know it's their job but I just have a horrible sinking feeling about it all!

Sorry my post wasn't too clear @EmpressCixi the criteria is something the midwives at my hospital just refer to! I believe it's something called the Dawes redman criteria? Although that might not be correct so don't hold me to it! It apparently is just used to analyse baby's heart activity (accelerations, decelerations etc) although that's about the extent I know about it! So baby has to meet a certain criteria for the CTG to be classed as 'normal' if that makes sense!

It's good to hear your opinion on the monitoring because this is initially how I felt! I guess I'm just scared that if something was to go wrong between the monitoring sessions I would be devastated and it would have been totally preventable. It really is a hard one! I do agree with pushing for an induction to be scheduled at some point and any sign of decline to be dealt with straight away! I'll mention this to them! Thanks so much!

@mango1821 I mean if I were you I would just keep going in at the slightest inclination of reduced movement. Surely you’re seeing your midwife every week now? I would just keep on about it.

For what it’s worth I’m sure everything is fine, it was all fine with me except having an absolutely enormous baby that I don’t know how I’d have delivered naturally. But it’s so horrible the anxiety. I found movement tracking the worst worst part of my pregnancy.

I would also ask for your request for induction/Caesarean due to concerns over reduced movements to be recorded in your notes (and make sure they do it)

@ricketybeauty I'm seeing my midwife every 2 weeks still and tbh she's not great, the service has been changed so they don't really communicate with the hospital and things get a bit confusing!

Thank you for the reassurance, I'm sure she is fine it's just a horrible time! Yes movement tracking is horrible, I think it's because it's such a huge responsibility that solely falls on us, there's a lot of pressure to be felt!

@DSGR Can they reject my request? I think I'm just going to tell them I'd like an induction at the earliest and safest point possible due to everything! I will make sure they put it in my notes! I don't want to sound like a know it all to them but I really do think mothers instinct needs to be taken into account!

@mango1821 if you are worried I would push for an induction now. I went in at 37+2 with reduced movements. They said baby seemed good but Took 2 hours to meet criteria so I was induced that evening.
Baby did have jaundice which is a bigger risk the earlier they are but after light therapy he is absolutely fine. The midwife and consultant strongly recommended induction for me and didn't even want me to go home and get my things between monitoring and induction so I'm surprised yours is wanting to hold off. I think NICE guidelines are to offer induction after 3 episodes of reduced movements

@mango1821 I would be astonished if they don’t start talking about induction in a week or so if you have any more episodes. Just think, this is on your mind so you WILL notice if there is a reduction and you’ll go in the same as every time before. I’m sure once I got to about where you are they essentially said “we’ll recommend induction if there are any more episodes”.

Just try and hang in there, this last bit is hard but keep doing what you’re doing!

@bumphope2020 Thanks so much for sharing your experience, glad to hear baby arrived safe and well when it happened to you- it really reassures me!

Yeah I mean the doctor who I spoke to was good, and did take my concerns on board but still feel like it's not being met with much urgency, which is frustrating when you're so anxious about it 😩 I think I'll try and get hold of someone today, I just want her here safe and well!

@ricketybeauty I'm hoping this is the case! Because I'm so in tune with the movements now I will for sure go in at the first sniff of any change in movements! I just hope they don't wait too long as everything seems so uncertain! Thanks so much for your kind words and advice x

My daughter had induction at 38 weeks for reduced movement despite regular monitoring which all appeared Ok. The consultant quite rightly explained that there are no guarantees that all is 100% ok just by monitoring and the safest option was to induce.
Induction went really well and baby born without any drama .

@Clockstooforward that's great to hear, thank you for sharing! I'm glad everything went well for her and it definitely reassures me of how I'm feeling! I think she may be better out than in at this point, as you say there are no gaurentees! Thank you x

I had many episodes of reduced movements from 34 weeks onwards and had regular monitoring and by 38 weeks was on daily monitoring. Sometimes had CTG for an hour before criteria were met. One day I had monitoring twice.
My nerves were stretched. I already had a planned C-section booked for 39 weeks and was on the verge of asking for it to be brought forward.
Do talk about your options and good luck.

@mango1821..bless you . Just try and be as assertive as you can . Luckily the HCP where my daughter was ,were just really approachable and listened to any worries my daughter had . Also her community midwife was a brilliant advocate for her . 💐

@Arecklessmanor that's exactly how I feel! Like my nerves are just fully stretched and I can't really take it anymore! I suppose me looking into it all is making it worse but I really have reached a tipping point where I am so scared... I think I'm going to try and get in touch with my midwife to see if there's anything she can do to help, I feel like I'm bothering everyone but I just can't shake the feeling! X

@Clockstooforward I'm so glad they listened to her concerns and took her seriously, I'm crossing my fingers that they approach me with the same kindness and professionalism! Thank you x

If you're still itching keep getting them to test you. My results showed as normal until 37+5 when they went sky high

Is there any reason why you would be adverse to having a planned c section? My trust offers from 38 weeks onwards.

I echo that you should request an elective section at 38 weeks. I wouldn't risk a vaginal birth given the history here.

Good luck

Rang my community midwife for a bit of advice on the situation and said to the receptionist on the phone that I just wanted to speak to someone about it as I didn't feel like I could voice my concerns very well to the hospital doctor as i don't know her and she was very busy etc...

But I really wish I hadn't to be honest. She said to me "what do you want the midwife to do? Override the doctors opinion?" I honestly was just lost for words. She said she would get a midwife to ring me back but stressed that they are very busy and "there wasn't much they could even do and it'd be helpful if I could just try to stop worrying"

I just feel a bit lost now, like there's no one to turn to for some reassurance and advice 😞

@Skala123 I will definitely get them to book me in for another blood test when they hopefully give me a call back!

@Suprima no reason at all, I just want her here safe now! An elective section hasn't even been mentioned, I don't feel like any other options other than monitoring have been discussed unfortunately! 😞

@Babymamaroon I might bring this up as a suggestion when I finally get through to someone... I just feel like they're going to tell me to bugger off though, they don't seem to be bothered 😕

[quote mango1821]@Skala123 I will definitely get them to book me in for another blood test when they hopefully give me a call back!

@Suprima no reason at all, I just want her here safe now! An elective section hasn't even been mentioned, I don't feel like any other options other than monitoring have been discussed unfortunately! 😞

@Babymamaroon I might bring this up as a suggestion when I finally get through to someone... I just feel like they're going to tell me to bugger off though, they don't seem to be bothered 😕 [/quote]
Request an elective section. Call the midwife now and ask for an appointment or a referral. This is your right.

I honestly don’t know why they are fucking around with inductions and monitoring- get baby out safely. Monitoring is fine until it isn’t.