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!!

I was induced at 38 weeks for other reasons. If I ever expressed any concern I was told it wasn’t early because 37 weeks is term, and there were no concerns about babies born at 38 weeks. Indeed it was all fine - good birth experience, healthy baby. If they want to go for monitoring over induction I’d want more frequently than twice a week, that doesn’t feel nearly often enough.

@Suprima Just been on the phone to the midwife who gave me a call back. Honestly she didn't give two shits. she just said there's nothing they can do and told me if I'm worried to go back down to maternity triage. She just told me the midwives knew what they were doing and they wouldn't put my baby in danger. She couldn't have cared less about me sobbing telling her I was so worried about my baby and I wanted something else to be done. So so stressed, I feel like I don't have a single healthcare professional helping me or in my corner 😞

@BobbinHood my thoughts exactly, I just don't think leaving that much room for risks to take place between monitoring is necessary. They have honestly made me feel like such an idiot for even querying this though. Basically said the midwives/doctors at the hospital know best... 😩

@mango1821

All I can say is advocate for yourself. From reading your posts I would say you're a FTM?

Have a look at NICEA Guidelines and RCOG guidelines. Go equipped. Challenge them. Ask questions - if they get shirty tell them that you appreciate their frustration but you haven't done this before so you want better understanding of the risks, benefits and options available to you.

As for not being heard. I feel you on this today but that's a whole other story.

Just throwing my experience in- I had reduced movements and was monitored twice a week and had a scan every other week. They could never find anything wrong, always fine on the monitor and placenta, and flow was all normal. They induced me at 39 weeks which was horrific BUT the baby had two knots in its cord so it was the right decision to get her out but we were lucky and with hindsight I should have asked for an elective C section ASAP. She was in distress during the labour but because I labour fast she was out before coming to any harm. If I’d had a long labour ( which a lot of inductions do result in) with the two knots in her cord I think she’d have been in trouble. C section would have been less distressing and safer all around.

@2under2in2022 Yeah I am a first time mum, I think that's why I'm so terrified, because I literally have no idea about anything! Saying that, I've done a lot of reading up the past few days so I am going to raise this with them. I just need to be more assertive I suppose. It really feels as if they don't care! Stress! Thanks for your reply! X

@Notwithittoday This is what I'm thinking now, that maybe if I request a c section it will just be a better option considering everything! Because even though scans and monitoring are fine, something definitely feels very off. Thanks so much for sharing your experience, the doctors/midwives haven't even given me the option of a c section, haven't even mentioned it- I can't say it wouldn't be nice to be given different options! I'll get on to them about this!

@mango1821 I know it's sometimes hard to advocate for yourself so maybe it would help to frame it as advocating for your baby.
Find out who's the lead consultant and call and ask for an appointment with them or one of their team.
It's rubbish that you don't feel listened to. I must admit I was very surprised at my hospital how many midwives said to me that the ELCS seemed like a good option in my circumstances, especially as the hospital scored Amber on Birthrights list of hospitals in terms of access to maternal request C-sections.

I just got to the point where the stress of the monitoring was too much (also for DH) and there were too many times where it was taking longer to meet the criteria.

I had reduced movements with dc2, was induced in the evening of the day I was 39 weeks and he was born very early hours of 39+1.
With dc1 I also had reduced movements 3 times between 39 weeks and 40+4. On the 3rd time, they said that is the point at which they offer induction, especially considering I was over 40 weeks by then. I was booked in for the following evening but he was born that morning (40+5), before I was induced. He ended up needing resuscitation at birth and a weeks stay in NICU for various reasons, potentially but not necessarily related to the reduced movements. This made me more keen to be induced at 39 weeks with dc2 because I wanted to know he was ok, for him to be monitored and we could actually see him breathing once he was out! I just felt, by 39 weeks he was safer out than in after the reduced movement episodes.
Induction at 39 weeks was absolutely fine by the way. Pessary kicked it off, didn't need a drip and from pessary to baby was 5hrs.

Hi OP
I had a similar ish choice except we were under monitoring for low fetal size (2nd centile) instead of reduced movements.

I went ahead with the early induction at 37+3 on the basis that I didn’t want to wait to give birth until she was already showing signs of difficulty - it’s stressful enough! The other option was daily monitoring as they didn’t have any elective c section availability.

One thing worth asking is whether the reduced movement history means you and baby would be on the monitors throughout the induction, as this really restricts your ability to move about and actively labour (and therefore have a successful induction).
I wish I’d known we’d be on the monitors constantly and pushed harder for an elective section, in hindsight, as I ended up with a section anyway after 48 hours of induced labour with no progress.

I was induced at 38+2 with my 2nd and it was pretty easy induction. He was much bigger than my first who came spontaneously at that point, especially shoulders (still is bigger than big sis in shoulders).

I only needed 2 of the gels to get started then dilated and waters went on their own rather than hanging around waiting for a slot for them to do it.

We'd had a couple of reduced movements episodes, no idea why but the induction was absolutely the same as the spontaneous labour in pattern except I spent a lot less of it in the car...

I was able to be on a monitor while bouncing on a ball - the leads are long enough for that. Being upright was definitely encouraged!

@randomsabreuse

I was induced at 38+2 with my 2nd and it was pretty easy induction. He was much bigger than my first who came spontaneously at that point, especially shoulders (still is bigger than big sis in shoulders).

I only needed 2 of the gels to get started then dilated and waters went on their own rather than hanging around waiting for a slot for them to do it.

We'd had a couple of reduced movements episodes, no idea why but the induction was absolutely the same as the spontaneous labour in pattern except I spent a lot less of it in the car...

I was able to be on a monitor while bouncing on a ball - the leads are long enough for that. Being upright was definitely encouraged!

You were allowed on the ball because you weren’t on pitocin. Once you have that, you’re stuck on the bed. At my hospital they only give you two hours from them breaking your waters to go into active labour then they put you on the drip and that’s where trouble starts. For most women who aren’t yet 40 weeks gels and ARM will not be enough to go into active labour. Most women who have a traumatic experience of induction have been on the drip. You’re lucky if you avoided it during induction

OP this is a good article www.sarawickham.com/articles-2/ten-things-i-wish-every-woman-knew-about-induction-of-labour-the-article/
I post it not because I think you should leave things to nature ( I don’t if you’re having reduced movements) but just so you understand induction better. I naively thought they’d break my waters and it would be like my first natural labour.

I know I was lucky - but it was an "early" induction which was "easy" not needing the drip.

I have no real further advice just wanted to say I hope everything goes well for you with requesting an induction or c section if that’s what you choose to do.
I really struggled to get anyone to listen to me in either pregnancy, I like you needed to be more forceful! I always felt like a told off child
I was very lucky that both of my children were born safely and healthy but I honestly think it’s luck more than any success of the hospital or the consultants who didn’t listen to anything I had to say. Please try not to stress about the birth too much though, you will get through it

If you need to go in as many times as you can for monitoring, even if it’s twice a day don’t wait or sit at home worrying- just go!

There is no way I would wait any longer nor risk an induction with this history, I would be asking for an ELCS at the earliest point they can fit you in.

Hire a doula immediately, explain your situation and have them come with you and advocate for you if you are struggling to make yourself heard with the midwives.

This is not the time to be meek and mild. Whatever course of action you choose, please don't let yourself be walked over. You don't want to look back with regrets and wish things had gone differently.

I had obstetric cholestasis too op, they said they would closely monitor me(I was 37+4) I just said I would prefer an induction and they seemed fine with it, we started the induction process the next day and he was born at 38 weeks, it was quite a nice birth too.

Just reading this thread . I will say mums intuition is everything and I wouldn’t hesitate here and ask for an immediate induction. I had the same experience - multiple episodes of RTM in the 3rd trimester . I went in for CTG around 37+5 and the doctor said at this stage even though CTG is perfect that better out than in if it keeps happening and they booked me for an induction at exactly 38 weeks . It was a long process , baby was born about 28 hours after first propess and I needed help with a forceps but baby was perfectly fine (a little jaundice as previous posters said) but she didn’t need the light therapy . Just go in tomorrow For monitoring but ask for speak to the doctor and ask for induction. It actually will suit them better if you are induced as it’s a managed delivery then , hospitals like inductions ! Is see others suggesting elective c section . As someone who has both an induction and ‘normal’ delivery and an elective c section I would advise you to try the induction first. Having a section is no walk in the park and it limits your options with future births. X

You were allowed on the ball because you weren’t on pitocin. Once you have that, you’re stuck on the bed.

Might be anecdotal, but that's not my experience either time on the drip. First time, admittedly I didn't move around much, but the option to do so was always there. Second time I was walking laps around the room, bouncing on the ball, and on my knees next to the bed, all while on the drip, for a good part of my labour.

Not had experience with RFM, but if I were in your situation, I would also push for an induction. Both mine have been prior to 38 weeks, and positive experiences. First was successful. Second only resulted in a C-section due to baby being back to back and brow presentation (aka very stuck). But the malposition was in no way due to the induction. Just bad luck.

Thanks everyone for your replies! There's quite a few but I've read them all. Thanks for all the advice and experiences shared. Unfortunately baby's movements have still not improved, been to the hospital this morning again. CTG fine apparently. Took 60 mins each time to meet, baby very quiet then heart rate shot up she moved like crazy, heart rate was rocketing above 180 for minutes at a time, this is normal I was told but I have no idea.

I told the midwife how unhappy and stressed I was, she agreed I should probably be induced. However the consultant unfortunately disagreed and is making me wait 8 days for a growth scan (my last one was over 2 weeks ago), said she will induce after that if needed. I told her I wasn't happy and still worried and she just kind of said tough luck and I wouldn't be induced until then. Despite numerous episodes of RFM despite constant worrying, despite huge spikes in heart rate on the CTG. I'm at the end of my tether and have nothing left to give or say to them. I tried so hard to advocate for myself and quite literally the consultant did not care. Now I guess I just have to cross my fingers and hope for the best. My feeling is that there isn't enough staff available as there's always such a long wait for the doctor when there. 😞

@mango1821

Thanks everyone for your replies! There's quite a few but I've read them all. Thanks for all the advice and experiences shared. Unfortunately baby's movements have still not improved, been to the hospital this morning again. CTG fine apparently. Took 60 mins each time to meet, baby very quiet then heart rate shot up she moved like crazy, heart rate was rocketing above 180 for minutes at a time, this is normal I was told but I have no idea.

I told the midwife how unhappy and stressed I was, she agreed I should probably be induced. However the consultant unfortunately disagreed and is making me wait 8 days for a growth scan (my last one was over 2 weeks ago), said she will induce after that if needed. I told her I wasn't happy and still worried and she just kind of said tough luck and I wouldn't be induced until then. Despite numerous episodes of RFM despite constant worrying, despite huge spikes in heart rate on the CTG. I'm at the end of my tether and have nothing left to give or say to them. I tried so hard to advocate for myself and quite literally the consultant did not care. Now I guess I just have to cross my fingers and hope for the best. My feeling is that there isn't enough staff available as there's always such a long wait for the doctor when there. 😞

Pals complaint. Write it now from the hospital.

You have the right to request a caesarean birth. Make sure you tell them about your history, deteriorating mental health and the callousness that you have been met with.

@Suprima Absolutely, couldn't get through to them so sent an email to them detailing all points too so there's something written. Absolutely no idea what they'll come back with but fingers crossed! It really is causing so much emotional distress, I can't stop crying I'm so angry and feel like there's nothing I can do. Thanks so much for the advice. Hopefully they'll come back with something positive x

Go back again OP.
Request another consultant and don’t leave until you’ve been given one.

Honestly I had this, my consultant was awful and dismissive. I had a different scenario but with DC2 I knew she was huge. She was measuring 95th centile on all growth scans. I am tiny and my previous baby was 5lbs, anyway despite begging they would not induce me and made me wait to go into Labour naturally at 41+ weeks. She ended up stuck as predicted and I was injured (mildly but still!)
I know it’s a different story and it’s all what ifs but I’m sure if they had listened to me and induced earlier I may have not been in that position.

I would go back and complain as loudly as you can!

I would put in a request for an elective section. Can you ask for a different consultant ?

@Doglikeahorse I'm going to have to go back I think, I just can't believe the sheer negligence that this consultant has displayed. Sorry to hear of your ordeal, absolutely awful how you weren't listened to! Completely unfair for them to dismiss mums like this!

@3WildOnes I mentioned this and said this was something I wanted/was highly considering. She told me that even if they did put me forward for one there would be no point as they wouldn't do it until after my scan. I explained that I feel as if my baby is in distress and she just reiterated they wouldn't do anything until a growth scan 8 days away... I feel at a complete dead end 😩

I can’t believe the hospital aren’t recommending induction, you’re full term and have had multiple episodes of reduced movements. Are you able to attend another hospital? I would complain to PALS.

I had Gestational diabetes and was scheduled for induction at 39 weeks. At 37 weeks I had an episode of reduced movements along with my blood sugars (which had been stable) becoming completely unstable. Even with one episode of reduced movements, I was offered an earlier induction but one that was 5 days away as it was only one episode at that point. I still reached the point that I’d rather have her here safely, even if it meant a long induction and potentially a c-section so accepted the earlier induction. I did a hypnobirthing course and they said to think of choosing to accept an induction for your health or your baby’s health, to me that absolutely includes your mental health. I was a FTM and induced at 38+1. I had a positive induction with the pessary working and baby arriving less than 12 hours after my first contraction. Baby was absolutely fine, as was the placenta but no amount of scans would have made me feel at ease at that point. I was also monitored throughout and didn’t find myself able to be mobile, mostly because I had a cannula, but labour was still quite quick. I hope you get a solution (induction or elective soon).