Failing induction - any similar experiences or advice?

[Overdueandworried]

Hi all,
I am currently 40+6 with my first baby. I was advised to come into hospital for an induction on Sunday 29th June at 8 am when I was 40+4.

I was given the propess pessary which had absolutely no effect after 24 hours and I remained 0cm dilated after a couple of examinations. Yesterday, Monday 30th June I was given two of the prostin gels. These caused painful contractions for about an hour after each insertion but the pain tailed off eventually. After examinations I was still between 0-1cm dilated.

I then had to wait until midday today 1st July for a doctor to check me and agree to the third gel. I was checked and still 0-1 cm and told there’s no way would they be able to break my waters at this level of dilation.

I have now been in hospital for 3 days remaining on the antenatal ward which means no pain relief beyond paracetamol when I was having contractions and have made absolutely no progress whatsoever so have requested a c section asap as my consultant wanted baby born by 41 weeks due to my high BMI and her being a big baby (8.14 at last growth scan). The doctor here pushed for me to wait the rest of the day and see if anything more happens in terms of dilation. I’m no longer having any tightening whatsoever.

The midwife on shift today even said it’s like my body is doing the opposite of what they expect.

Am I right in thinking I’m well within my rights to now push for the c section? I can’t sleep here as everyone around me is actually in early labour and so making a lot of noise , I can’t eat the food, it’s 31 degrees today and I’m becoming more and more uncomfortable and upset.

I genuinely didn’t want to go to C section if I could avoid it but not really seeing much other option. The only option I was given was to rest my body 24 hours then begin the induction process again but they didn’t seem very confident that would work.

Has anyone else experienced this? Or can anyone offer any advice on best course of action

Thank you x

I’m also not keen to wait 24 hours on the ward and try again because it’s just awful being here and no guarantee it would even be successful

I’m sorry you’re experiencing this. I can imagine it feeling pretty rubbish.

can you discharge yourself for the 24 hour rest.

id question the doctors as well about the reason for the induction. A recent trial about big babies and induction showed that over half of the women induced for a big baby didn’t have a big baby. Scans aren’t that reliable and often don’t take into account the genetics of the parents.

also there’s debate about the need to induce just because of BMI.

if it was that urgent I think they’d be keener to do the c section ….

Oxytocin plays a huge role in labour and birth. If you’re stressed and uncomfortable your oxytocin is likely on the floor. Going home and resting there, in your environment, being active and generally caring for yourself could well be what is needed to get going.

Thank you for your reply. My consultant has since left her role after advising the induction and it takes between 8-10 hours to speak to the doctor on shift since being here. I did ask to go home but I was told that I live too far from the hospital and am now too overdue for them to agree :(

You can discharge yourself. If there is no one there who can authorise a c section for 10 hours, exercise your right to leave. It’s not prison. If you are aware of the risks and as an adult are making an informed decision about your care….

Hey OP.
There are multiple procedures that get lumped into the category of ´induction’.
The gels and pessary might not have started you dilating, but have they softened your cervix and made it shorter and closer to dilating? Worth asking.
The last possible procedure in an induction is to give synthetic oxytocin via a drip. Have they told you anything about that?

This. I would be discharging myself for some rest and relaxation and requesting a call with a Dr who can discuss your c section request. Evidence shows that prolonged inductions are more likely to lead to intervention and ultimately an emergency c section so I think you are making the right call in requesting one at this stage if your body is not responding to the pessaries and gel

Hey, they have said yes my cervix is very soft and has shortened a bit. The oxytocin drip I have said I wouldn’t want without an epidural as I’m conscious anecdotally and even my community midwife said it’s incredibly painful and advised to make sure I have one. I can’t have an epidural on the antenatal ward and I can’t move to the labour ward until I am 4cm dilated so that’s a bit of a non starter otherwise I would happily do it. The only pain relief here is paracetamol

Have you had that discussion with the midwives on the ward? Did they actually say you can’t have an epidural until you’re 4cm dilated even with the drip?

I’m not in the UK, but where I live they send you to the labour ward when they place the drip. I had an induction and they were doing more or less continuous fetal monitoring from the start of the drip too.

They said that they would only do the epidural on the labour ward and that you can only go to the labour ward at 4cm. There’s a queue of ladies waiting to be moved from antenatal to labour too

If I were you I’d just go home. Get some proper rest and reassess in the morning.

Yes they wouldn’t be starting the drip on the antenatal ward, that’s only done on delivery suite with one on one care.

Have you been offered the third prostin? Would you consider having it? It sounds like things are happening, it’s just a very slow process which is normal unfortunately. The induction process is trying to recreate what happens on its own in a spontaneous labour, but it’s nowhere near as fast or effective as nature unfortunately.

Hi there it's a midwife with labour ward experience. Oxytocin wouldn't work properly unless they broke your waters first. Apparently, your cervix is still too unfavourable for this. If you were to go on the oxytocin drip, you could absolutely put your foot down and insist on epidural first. You don't need to be 4 cm for the epidural if you are being induced with oxytocin. If you just make it clear you will not agree to oxytocin without epidural the alternative is to offer you a Caesarean. Based on what you described I really do feel a Caesarean might be a better option for you. I suggest insist on a frank and comprehensive discussion with your consultant tomorrow morning to discuss risks and benefits of both options.

I refused the drip, as the pessary just gave me hyper contractions with nothing else and the drip can't just be taken out. I went to cesarean straight away, as there were other risk factors and the baby needed to be out. Good luck!

Not exactly the same but I had similar that contacts stopped and was waiting 2 days for bed in labour ward for them to break my waters and I had a complete breakdown (to be honest I was exhausted and hungry as the food was crap) when I was told to pack up for the fourth time only to be told the bed had gone to someone in active labour (completely get it but I was at the end of my rope we’d literally been told two weeks before my Dad had terminal cancer so a lot was going on) I threatened to leave and go home- big ugly tears and fair play to the midwife who’s fault it wasn’t she went and got a doctor from the labour ward to speak to me as I just wanted to go home….. she did a sweep and promised they’d get me up as soon as possible and said she hated seeing my name on the board still wishing when she started her shift but would advise me to go home so we stayed (and snuck out to the pub behind the hospital for a decent dinner) but my breakdown seemed to wake them up that we weren’t happy can you or your birthing partner be a bit more forceful…. My DH was at this point and as much as neither us liked doing it it seemed to work as they started to listen to us!

Have you got a point beyond which you won’t go? I had an induction at 38 weeks for medical reasons and had a couple of deal breakers. The first was no oxytocin drip without an epidural first. The second was that if the pessaries and gel etc didn’t work I wasn’t going to wait, start again on antenatal, go home etc but wanted a CS. Ending up with days of no sleep and inadequate food isn’t a great way of getting started with a new baby.

They eventually managed to get my waters broken on the labour ward, after I got to a couple of cm dilated. It took several attempts by multiple HCPs. Contractions weren’t regular and weren’t progressing even then (despite being v painful!) so I got the epidural and the drip. The epidural made such a difference and meant I finally got some sleep after days on antenatal!

Good luck!

Ditto what@RidingMyBikesaid the epidural meant I could sleep as I was beyond shattered mentally and physically and by the time I woke up I was ready to push!!

I would just go home, it sounds like your body just isn’t ready, you’re exhausted which is only going to make it all harder, and you’re not being listened to. Going home getting a decent rest and reassessing once you’ve recovered a bit sounds sensible to me. I would also agree with a PP - do your own research on the reasons they’re suggesting induction because there are pros and cons and they’re notoriously bad at estimating when babies are big. Dr Sara Wickham’s website has some really good info.

Please insist on speaking to a doctor not a midwife and ask about c-section (risks of waiting versus risks of c-section). Don't just go home. Good luck!x

clarifying a couple of points re the epidural/synto thing...it's not uncommon for women to ask for the epidural to be sited before starting the drip. It doesn't guarantee the epidural will work perfectly, but it is often easier to site the epidural before the contractions get really intense and 7:8 do give good pain relief. The synto can also be stopped - they don't really like doing it if poss because it slows the labour back down again, but occasionally if a woman's crawling up the wall and wants and epidural but we can't do it safely because she's hanging onto the ceiling, then we do ask for the synto to be paused. There's pros and cons, but it may be an option. Epidurals are only used on labour ward not antenates because you do need 1:1 care and fetal monitoring once it's in.

In the context of an induction, there isn't really a magical cut off dilatation for siting an epidural, but you do need to be making some progress (or about to be making some progress by having an ARM/starting synto). There is an association between epidurals and needing an assisted delivery (association though, not necessarily causation), but a very early epidural may increase the chance of needing a c-section too (occasionally women request one reeeally early on when they've had along latent phase and it may make a difference then....but if they understand that and are still keen then that's fine).

It wouldn't be routine practice here to start synto on the antenatal ward - it's a labour ward intervention. In the context of an induction, synto normally follows an ARM though so if you're not ARM'able then synto's not likely to be an option unless your labour gets cracking on it's own.

It would be fairly normal for codeine/dihydrocodeine to be offered on the antenatal ward, and gas and air is an option for things like examinations etc if they're painful. HTH

At this stage I would demand c section. I had one after failed induction (I became ill from the medication so they had to remove it). It’s shit to recover from but looking back now I am happy as DD was safe and so was I.

I was also told, many times, that I couldn’t be moved to the labour ward and given an epidural until I was 4cm, and then I was. I was 1cm - just - but I was in absolute agony and not coping. I guess the difference was that I was having very painful and regular contractions after the pessary, and they were able to break my waters. I didn’t need the drip after that. Also, I don’t think the labour ward was very busy that day. But in any case it wasn’t nearly as set in stone as the midwife in antenatal led me to believe.

I agree with PP- I would also speak to a doctor - not a midwife - about a C section. I really wouldn’t dismiss out of hand your consultant’s recommendation to deliver the baby by 41 weeks. Doctors are often accused here of being risk adverse, but so they should be when it comes to the safety of your baby. I don’t see why they should want to take any chances with that.

Also on the C section point - what is your preference on instrumental deliveries? I was dead set against, especially forceps, but I was assured at NCT that I could opt for a C section over forceps at any point during the birth. Turns out this is true in theory, but not in practice. When it became clear that I was going to need help getting my daughter out, I did ask for a section over ventouse/ forceps. But she was low down the birth canal, and a c section would have involved pushing her back up, which would have been risky for both of us. So I consented to ventouse and forceps. I wish I’d known in advance that this could be the case.

Good luck OP, hope you had a more comfortable night

You can make a maternal request for a c section at any point. You may need to call you partner or someone else to come in and help advocate for you. You make the request and you get your partner to back you up and insist on it. I had a cs by maternal request at 7cm with a lack of progress. DH had to insist though

Aww sorry you are going through this. I had something similar but was sent home after 3 days as the reason I was being induced was no longer valid due to test results. The ward was awful and had a really negative impact on my mental health. I’m due to be induced again soon and not sure I can face being on that ward again, a c section might be better. Sorry I don’t have the answers, if your Bishop score is low, I think it’s unlikely the induction will work :(