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 given a sweep bang on 37 weeks

Hi @mango1821
Midwife here. Firstly I'm really sorry you aren't being listened to or your fears acknowledged by your midwife and the consultant you were seen by. God knows we are having enough bad publicity with the horrendous Shrewsbury cases.

From the dates you gave I make it you will be 38 weeks on the 30th March. You have mentioned multiple episodes of RFM in this trimester. Babies movements DO not slow down in this trimester as a pp has said. They should continue to move right up to the onset of labour and throughout labour.

In my unit we would most definitely be offering you induction now as any decrease in fetal movements from the norm should not be ignored.

The ctg's you are having are being analysed using the Dawes-Redman criteria which is evidence based on more than 100,000 ante partum (prior to labour) ctg. Your gestation will be entered into the ctg machine and the analysis is based on that gestation.

It can take 10 to 60 mins to meet the DR criteria and if not met after 60 mins then this is an abnormal Ctg and should be escalated to the medics for review/action.

The ctg will look at short term variation the fetal heart rate, accelerations decelerations and fetal movements.

It is your absolute right to ask for induction or caesarean section. I would contact your midwife again tomorrow re induction they can arrange this for you after discussion with medics. I cannot understand the reasoning why they aren't duscussing this with you at 38 weeks.

Induction is not an easy process and can take 48 hours just to get you into labour and there are no guarantees that it will be successful, we refer to this as an ineffective induction after which a section is discussed.

Good luck, always go with your instincts only you know what movements are normal for you and they should be listening to you.

Would you be so kind when you have time to let us know how you get on with your labour/birth.

@InTheNightWeWillWish I can't understand it either, it's absolute madness to me why they won't help me 😞 I can switch hospitals but I don't even have the support of a community midwife to help me with this really so wouldn't know where to start!
Thank you for sharing your experience, I definitely need to go back tomorrow morning as I'm pretty sure this isn't how it's supposed to be handled!

@Mummapenguin20 it's crazy, they haven't even offered me so much as a sweep yet. I just don't know what they're waiting for...

@Thedogscollar thank you so much for your reply, so informative and has helped me to understand things much better- making me realise I need to definitely go back as things are being handled in such a horrific way! Most of the midwives who have looked after me have been great, but the consultants just don't seem to care and I just can't get my head around why they are choosing to risk things like this...

What do I do if the consultant just won't listen to me? She told me they wouldn't induce me until after this growth scan in 8 days, it's nuts. Like I can't physically force her to agree to induce me. She didn't even want to listen to me 😞 I just know in my heart of hearts something is a little off, I don't know what but at this point I truly believe she's better out than in.

If I do go back in will they magically change their minds? It's really knocked my confidence, I always always go in for reduced movements and never leave it to chance but the consultant has left me feeling scared to bother anyone again 😞 although I know it's more important to get her checked so of course I will put my anxieties to the side on this one!

I will of course update when she's here, hopefully sooner rather than later!! Thank you so much for taking the time out to reply x

@mango1821
You can definitely ask to see another consultant and give the reasons you feel like you do.

Can you take someone in with you for moral support?

If you are having ctg at 38 weeks for multiple episodes of RTM then it makes sense to induce now.

I'm so sorry you are being put in this position. I wish I could advocate for you. Call triage tomorrow and tell them you are coming in for monitoring and would like to speak to a Registrar as they can make a clinical decision based on the reduction in movements. Consultants do not always have to be involved.
Keep us updated and stand your ground for you and your baby. X

Thank you so much @Thedogscollar I definitely feel more equipped with information after your replies- so grateful you've taken the time to help me like everyone else on here 🥰

I will be ringing triage first thing to get this sorted hopefully, I think I'll take my husband in too, only reason he's not been coming with me is work but I think it would really help to have him there as he tends to stand his ground a lot more than I can! Will ask to speak to a registrar. I'll update this thread when I've hopefully got some more news! Thank you for being so lovely, your patients are obviously really lucky to have such a great midwife advocating for them through what is such a scary time for some. X

About c sections, you might find it helpful to refer to the NICE guidelines on 'maternal request for caesarean birth'. I've copied them down screen but basically if the the consultant disagrees with a c section they still need to respect your decision to have one and refer you on to a different consultant for it.

'1.2.25 When a woman with no medical indication for a caesarean birth requests a caesarean birth, explore, discuss and record the specific reasons for the request. [2011, amended 2021]

1.2.26 If a woman requests a caesarean birth, discuss the overall benefits and risks of caesarean birth compared with vaginal birth (see the section on planning mode of birth) and record that this discussion has taken place. [2011]

1.2.27 If a woman requests a caesarean birth, offer discussions with the woman, a senior midwife and/or obstetrician and other members of the team if necessary, for example an anaesthetist, to explore the reasons for the request, and ensure the woman has accurate information. [2011, amended 2021]

1.2.30 If a vaginal birth is still not an acceptable option after discussion of the benefits and risks and offer of support (including perinatal mental health support if appropriate; see recommendation 1.2.28), offer a planned caesarean birth for women requesting a caesarean birth. [2011, amended 2021]

1.2.31 If a woman requests a caesarean birth but her current healthcare team are unwilling to offer this, refer the woman to an obstetrician willing to perform a caesarean birth. [2011, amended 2021]'

If you’re close to another hospital, I would just try ringing their triage in the morning. Explain that you’ve had multiple episodes of reduced movements you’re still worried and you’d like to come in for monitoring. I would take your husband with you because I really don’t know why they aren’t offering an induction, another hospital might try to find space on their wards for you to start your induction later today. If you aren’t close to another hospital, I’d ask to see another consultant. Keep trying to contact PALs and if you still don’t like the answer you’re getting then try to put a complaint in with the head of midwifery.

Community midwives can’t override registrars or consultants. I had to ask the registrar to record in my notes that I could have a sweep before 40 weeks, which he was reluctant to even though he offered me an earlier induction, otherwise the hospital or community midwives wouldn’t have been able to do anything.

Fingers crossed that later today you get a date for induction or section and possibly even start the induction process.

@mango1821
Hi just wondered how you got on today? Did you manage to speak with a Registrar re your worries about baby's movements.
I would have thought in view of the heartbreaking and shocking Ockenden Report published today they would be having a conversation with you about your options re multiple episodes of RFM at term.
I hope all is well have been thinking of you today.

@Thedogscollar Hi! Unfortunately wasn't the outcome I was hoping for, baby's movements completely reduced again. 1st CTG she didn't meet then met the 2nd finally after a 30 minute walk around the hospital. The only person available to talk was a consultant who literally reduced me to tears. She tried to send the midwife in to relay the review to me and I got the impression she was angry that I told the midwife I'd like to speak to her face to face. Like she didn't have time for me.

I just cried and told her how frightened I was. She was so rude to me and told me I needed to chill out and she could tell I wasn't in the right mind, she spoke over every word I said. I was just gobsmacked and totally lost for words.

I asked her for her reasoning behind her decision and She told me although she couldn't promise my baby was okay she was more concerned about a failed induction, even after me reminding her I wasn't bothered about getting a section, I just want my baby here safe. She also said that it's normal for baby's movement patterns to change and stated 'she's probably moving when you're sleeping at night'. Which goes against everything I've ever been told by any maternity healthcare professional. To be honest I stopped listening to her after she said that. Even I know what a toxic piece of misinformation that is.

She told me if I was worried I'd just have to come back to the hospital and repeat until I got to 39 weeks. I have a scan tomorrow and she said someone would review it for me but couldn't guarantee it'd be someone who could make an alternative decision... said it might just be a nurse if one was available.

I'm just heartbroken, I've cried all night long and I'm genuinely scared to go back in to the hospital. I feel sick to my stomach that something is wrong, I'm just wondering why my case is so different and why my baby's movements are being ignored. Thank you so much for checking in on me. I wish I could've provided a more positive update. I'm so burnt out and I'm just trying not to stress for my baby's sake x

Oh OP that is awful, you poor, poor thing.
The consultant is not doing her job properly. Everyone I saw for extra monitoring listened, and sometimes left us on the monitor after criteria had been met, just for reassurance.

I know you had said you were intending to bring DH as he could be more assertive.
If that's the case get him to contact the hospital and speak to whoever is in charge of obstetrics, say you are there with him and he has your permission to speak on your behalf, and get across very clearly how worried you are. If not your DH then your most assertive friend.
I personally preferred C-section to attempted induction but people on the thread have had straightforward inductions at a similar gestation to you.

Good luck, get onto PALS too and if you have to even mention the Ockendon report do so, and the Health Secretary's promise of change. I thought maternity units up and down the country would be rushing to prove they are better...

Hope you get some rest 💐

@mango1821
OMG I am so incensed on your behalf. How dare she say those things to you. It is not normal for movement patterns to change infact that is exactly what we ask you as the mother to look out for!!

A baby should move right up to when you go into labour and throughout. If you look at Tommy's website they give great info on RFM.

Yes some consultants like to get you to 39 weeks as prior to this if labour is induced it may be ineffective resulting in a caesarean birth.

As for saying a nurse might look at the scan but couldn't guarantee it would be someone who could make an alternative decision. Why on earth would a nurse be looking at your uss.

A consultant or registrar should be reviewing your scan and based on the findings discussing with you the options open to you re induction or planned caesarean birth.

I know it's easy for me to say but please try to relax for you and baby. I hope all goes well tomorrow at the scan and you get the chance to speak with someone with more empathy.

If you are not happy with your care contact PALS and ask for a second opinion with another consultant. I'd even go as far as to refer to the Ockenden Report which is just scandalous and truly awful that this atrocious level of bad care continued for so long.

Good luck. Let us know how it goes. I'm looking forward to your post saying your baby is here and all is well.

If I were you I would jump in my car and go to a different NHS trust …say you are visiting the area and you are concerned about lack of foetal movements ! Sounds extreme but that would be my move. Good luck 💐

I know you probably don't feel like you have the energy for it but I think PALS should be your next step. The hospital will have an office there. When I had a serious issue with my care (heart related not pregnancy) I went down there and broke down on them. Things moved very quickly afterwards. Get someone to go with you if at all possible. Don't give up OP, you're being treated so unfairly.

I am disgusted that the week of the Ockenden report being published, you are being treated so poorly by staff at an NHS maternity unit. Shame on them! Even if they don't agree with your concerns, they should be kindly and calmly engaging with you, listening, explaining and helping reach an agreed joint plan you are happy with. This is infuriating!

I’m disgusted on your behalf.

Please complain as loudly and annoyingly as you can. Officially.

In the mean time I would also go to another hospital.

I’m so sorry that the hospital are not taking your concerns seriously. I don’t even know why a nurse would look at your scan. The sonographer should be compiling a report that the consultant reads.

Please go to another hospital. I know it’s scary potentially going to another hospital but the before and after care you need, even if they agree to induction/section before 39 weeks, just isn’t going to be there. I went to the big, teaching hospital and they are so big that I didn’t get access to pain relief (not even has and air) until 8cm when I could get on the delivery ward as they were just so busy and your hospital sounds similar. If they are dismissing you now, I think they’ll be dismissing you if your induction does work and you go into labour (I was told I wasn’t far along and wasn’t “coping well”). I think you’ll also struggle getting the postnatal care you need.

You can give birth in any hospital. One closer to home is obviously ideal if your DH can’t stay and needs to visit but I would go to your next closest hospital. The promise of a scan and “maybe a nurse reading it” wouldn’t be enough for me.

If you do go to your hospital today, try to take someone with you. Even if DH can’t make it, try to take a friend/relative/neighbour just someone who is prepared to stand up for you.

I'm so sorry you're going through this @mango1821 as others have said, please find the strength to go to a different trust or at least speak to PALS, you're not being unreasonable at all. We're all behind you. Xx

@Arecklessmanor Thanks so much for your kind words and advice, I've woke up (hardly slept) feeling so sad this morning. It's just such a horrific situation to be in. I too am particularly disgusted that a consultant is acting this way in the light of all the news lately/ockenden report, it makes no sense to me why I'm being treated in this way... thank you for the support x

@Thedogscollar thank you for the ongoing support on this thread! I physically don't know what to do next. I'm still not happy with baby's movements and nobody will listen.

I think she was trying to upset me almost when she mentioned a nurse looking over my scan and reviewing. You know like saying oh it's not important SOMEONE will do it... I could tell her intention was to upset me because if obviously offended her by challenging her professional opinion! Overall I am 99% sure there won't be anyone to review my scan with me today and I'll just be sent home and told to go back to the hospital if I'm worried about baby's movements.

However, I'm trying to stay calm and will update with how it goes! It all just feels like one big nightmare and I'm terrified to go back in with RFM in the fear of being spoken to like that again 😞 x

@Clockstooforward this has also crossed my mind, I just would rather be at any other hospital than the one I'm at! X

@Skala123 I have emailed them, however yesterday was a new level of poor care! So I will be chasing it up with this experience. Only thing is I'm terrified that I'll get this consultant again and she'll treat me even more horrifically/purposely mess up my care. I know it's irrational but it's how the whole situation has made me feel! X

@Circlesandtriangles My thoughts exactly, I cannot understand why I'm being treated like this. It's the poorest care I have ever received!

@Doglikeahorse Thank you for the support. It is just awful, it really is. I do want to go to another hospital and need to sort This out quickly, but I don't know the first place to start. Hopefully by me complaining, another woman will receive a better standard of care. X

@InTheNightWeWillWish My hospital is also a huge teaching hospital! I have got the same feelings that you've explained here. I'm worried another the standard of care I'll receive, I really am. They are literally doing against so many NHS rules and guidelines it is just craziness. Thank you so much for the support.

@feliznavidad2 Thank you so much, I'm trying so hard to pick myself up today and fight for myself and my baby. I feel at a total dead end but I know I need to keep going. The support really means a lot to me x

@mango1821
In my unit after our ladies have an uss for RFM they come back to maternity triage and the scan is discussed with them by a senior clinician, most certainly not a nurse! Why on earth would a nurse be discussing an obstetric uss to decide ongoing care. What this consultant has said makes zero sense.

After the uss today if there is no senior clinician to discuss your uss with you then what is the point in scanning you and sending you home to await events.

A scan is performed to assess fetal wellbeing and should most definitely be discussed with yourself and a plan made for ongoing care.

I completely understand why you are stressed which again is not good for you or your baby but I would stand firm and demand that you are seen by a senior clinician.

Let them know that you do not want to see the consultant you saw yesterday as she was both dismissive of your worries, gave completely the wrong information re babies movements and was unprofessional in her approach to your case.

There will be other senior obstetricians in the unit that you can see. You may have to wait if they are busy on labour ward but I'm sure you would be happy to.

I would be knocking on PALS door today and I would be contacting the Chief Exec of the hospital. Take this to the top. In view of the horrendous Ockenden Report which you should quote this should not be happening. I'm so on your behalf.

Please let us know how you uss goes today. x

I’m actually in shock. I would be bringing a notepad and pen and writing down the midwives names etc to freak them out aswell and I would go to PALS today demanding to speak to a senior consultant . OP I don’t mean to sound offensive but are you young ? Im just trying to get my head around why they are treating you like this and the only thing I can think of is if your a young mum and they are being dismissive because of your age.

BTW I am not condoning that at all I’m just trying to get my head around why they are being so unprofessional and rude

@Thedogscollar exactly! It's just not correct protocol at all, that's what I was saying to her. What's the point in having a scan without a proper follow up/review?!

I've emailed another huge complaint and rang PALS too, detailed everything In it so it is at least written down somewhere. I feel completely deflated and really don't know what to do, because I can scream and shout as loud as I want but nobody is still going to listen to me 😞

Will update when I've had my scan, fingers crossed it's a positive experience even though I have little faith it will be x

@SaraKitty Yeah I think that's what I'll do! I've contacted pals outlining exactly what I want and the way I've been treated! I am 25 so not extremely young yet maybe on the slightly younger side. I did get the impression the consultant saw me as a silly little girl! I do think she felt she could bully me a little bit more x

I also would be contacting Pals and telling them you will start a formal complaint. I’d also say you’re not willing to see that consultant due to what happened and who else can you see?
It’s not normal to have reduced movements. Their behaviour is awful.
I know it’s hard but keep fighting.
And once it’s all over put that complaint in anyway. Because that’s the only way they learn

@mango1821 Maybe you can knock on the PALS office door today aswell ask them if they can review your email urgently ? Best of luck x