Please help! (induction advice)

[maidezmoi]

Hi, I 39+3 weeks. Scheduled for a induction tommorow due to rising blood pressure (130/90 currently). I have swelling in hands and feet-although this has been slow onset over the past 2 months and no other syptoms such as headaches/impared vision/protein in urine etc. My baby is currently monitored several times a day on the tracing machine and appears to be perfectly happy and movements are good.

The hospital has done a blood test which they say has shown something suggestive of early pre-enclampsia (don't know what) and have given me a pill to take morning and night to bring my blood pressure down. It has now been steady for the past 3 days at 130/90. They want to induct me tommorow despite my baby not being engaged and my cervix not being at all favourable. I am worried about this as I don't want to cause distress to my baby or needless pain for myself. I had been been hoping for a home birth and now I feel that everything is spiralling out of control towards the c-section scenario.

Does anyone have any experience of being in this situation and have any advice whether professional or personal?

Not exactly, but despite being 40+11 my cervix was completely unfavourable, yet it still took only one dose of gel to get me into labour. Slightly different to your situation I know, just wanted to reassure you that unfavourable cervix does not always mean unsuccessful induction. Hope it goes ok for you.

Thank you. Was your baby engaged at the time. Mine is not engaged at all

Um I can't remember exactly but think he was maybe 3/5 engaged. Certainly no more than that.

I was induced for pretty much the same reasons as you at 38 weeks.

I had a prostaglandin overnight to ripen the cervix. In the morning they saw my cervix was favorable so they broke my water and started a pitocin drip. I felt a contraction about 6 hours later and 6 hours after that ds1 was born.

My advice would be to ask for a walking monitor (don't know if they're available) It allowed me to have some movement while I was in labor.

You can ask for a meeting with the consultant - get him to explain to you what the signs are that they are picking up on.

If they NEED to induce you (for yours and your babys health) then have a plan - i.e. one dose of gel/passary and if nothing has changed after 4/6hrs (hospital policy varies) then ask to go straight to c/s - or opt for one more dose - but if nothing is happening don;t let them continue with the induction and if yours/your babies lives/health are at risk then they will opt for c/s anyway.

make surer you feel empowered and in control - ask them to discuss your options all the way and ask for time to discuss this with your partner - unless it is a 'real' emergency they will give you this time.

Good luck, I hope all goes well.

p.s. babies don't always engage before labour - some won;t engage until labour begins.

xx

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Hi.

Seems very similar to my experience. If your body isn't ready to give birth, ask for a c-section. I had to go through labour pains before c-section.

I was 40 weeks when I was enduced. It was purely because I was exhausted and had been bleeding so they wanted to get him out. I went in and had a pessary. The pain was almost instantaneous. I had diarrhoea in the loo, couldn't move because I was in so much pain it was terrible. I should have asked for an epidural to start off with. They broke my waters after a few hours, after more pain he was out. They checked my BP during the delivery to find out it was 150/120, a little high so this freaked them out, I think it was the pain though. I do recommend that you get adequate pain relief as your body does not have the opportunity to release it's own pain relief mechanisms. I hope it goes OK for you.

I was induced at 39+6 - very little pain for first 3 hours of labour, followed 45 mins later by birth. Everyone is different. My cervix was "tight as a nun's" on induction according to my lovely midwife, too!

with no other symptoms I would be reluctant to agree to induction, if it was me. I would be insisting on vigilance and expectant management, especially as spontaneous birth could be so close. You said that your bp is currently maintained. I'd be getting dh to give me loads of massage, have a glass of wine, dim the lights, watch a good side tickling comedy, stay warm and get an early night.

Normal blood pressure is below 140/90 mmHg. The first number (systolic pressure) is the pressure at the height of the contraction of the heart. The second number (diastolic pressure) is the pressure in the arteries when the heart rests between each heart beat.

• Mildly high blood pressure is 140/90 mmHg or above, but below 160/100 mmHg.
• Moderate to severe high blood pressure is 160/100 mmHg or above.

High blood pressure can be:

• just a high systolic pressure, for example, 170/70 mmHg.
• just a high diastolic pressure, for example, 130/104 mmHg.
• or both, for example, 170/110 mmHg.

So I'd chat with Cons and consider the Brain mnemonic:

BRAIN

B What are the Benefits to me or to my Baby?
R What are the Risks?
A Are there any Alternative courses of action?
I Ask yourself - what is my Intuition?
N Must it happen right Now...can we wait? Or is Never OK?

After this kind of consideration then maybe you can make an informed decision to accept induction or to wait it out. Best of luck with whatever you chose

Klaw,

I'd have to disagree with what you say about BP, sorry. A normal BP is different for everyone and I imagine that Maidezmoi did not book with a diastolic of 90. This will be why they're concerned - its the increase not the actual number. Normally a raise of 20 diastolic (some people wil say 15) is a cause for concern.

And she does have another symptom, all be it not noticebale to her - the blood test. I imagine its your creatinine levels that are raised as this is an indicator of pre-eclampsia.

But the brain mneomic is very good and you should definetly get your consultant to explain their reasons and your options to you.

Good luck - I'm guessing you're actually posting from hospital as I'd have thought you'll have been admitted?

Stripeyknickers, I see what you say, especially as my base reading is usually fairly low... And did not mean to disregard her higher diastolic as if it were nothing

However I did take that info from here which I accept does not point out that individuals have different base diastolic.

I am not medical and do not advise that she should refuse induction, just that I possibly would and would definitely want a lengthy discussion first.

As a medical person, what are your thoughts on the fact that her bp is currently maintained? Can that be considered a good thing? Especially in the absence of headaches/impared vision/protein in urine etc....

Well I'm not a medical person, I'm a midwife so I deal with normal pregnancy and labour and refer on to the drs when its not normal. At the end of the day they have more expertise on these decisions. Thats not to say I would blindly agree with everything a Dr says though. I will argue a woman's case if I think the Dr is talking poo.

Yes its good that the anti-hypertensives are controlling her BP. The fact that she isn't having headaches, visual disturbances, etc isn't always significant - women can get full blown eclampsia without any of these signs.

Where I work the Drs would not normally recommend an induction on raised BP alone if controlled by anti-hypertensives. But its where you draw the line - a maintained diastolic of 90 may still be too high if booking was 60. The Drs may have been hoping to lower it. So the fact that its not going up is good, but might be better if it was going down???

Drs will normally make a decision on induction in such cases based on blood results. A raised creatinine will often be an indicator for induction, far more than other symptoms.

Whether the Dr is talking poo or not in this case I have no idea. But if a woman I was looking after had raised creatines and a raised B/P then I'd know that the Drs would want to induce.

I also agree with stripey. I am an independent midwife so am certainly not into routine or unnecessary induction at all. I do think that posts such as klaw's can border on giving medical advice which is an absolute no no on an internet forum where you cannot have access to a full medical history. As stripey says, often pre-eclampsia symptoms can be very minimal and the only indicator can be a full blood screen which I presume the doctors have done. I do agree with klaw about using the BRAIN mneumonic and to question the doctors fully on their rationale. I often recommend this mneumonic to mums.

On the plus side, IF you do have pre-eclampsia, even with an unfavourable cervix, inductions often work well and labour can be quite rapid. It's almost like the body realises that it needs to get the baby out quickly for a reason.

I do think we need to be very careful about giving out advice for or against induction recommended for a medical reason to women on an internet forum. We are not talking about "routine" post-dates induction here. That is a whole other issue!

I was in the same situation but my bp was higher and rising and there was a +2 protein or maybe +3.I ended up asking for and getting a c-section as the prostin doses had no effect whatsoever and they wanted to give me an epidural and start a fairly high dose of pitocin to get the baby out quickly.At this point I knew in my heart I would end up with a section anyway and I didn't want to be messed with any more.I was also by this point really stressed and scared. hopefully your experience will be totally different but do prepare yourself emotionally for a c-section just in case.I had assumed I would have a natural delivery and i felt traumatised by the birth and a failure,especially as I had asked for the section.It took my doula with me at my next labour to heal the wounds from the first delivery,so prepare and go with your gut instincts and ask for clear explainations at every point.If you end up not having a vaginal delivery understand that birth experience is a lottery and it is not your fault.Good luck and love to you and your little one in utero x x

Claw & stripeyknickers, at the beginning of my pregancy I was 110/70 ish. Upon booking into hospital roughly 4 days ago I was 140/90. Today I am 140/100 even with the blood pressure meds they are now giving me. Still no progression on the induction I am having my forth dose of gel this afternoon.

Hi Howdie, yes they found a trace something in the bloods but I cant remember what they said. They have also now found a trace of protein in my pee.

Thank you everyone for your comments. Looks like I will be having a c-section if there is no movement after tonight. I'm really upset and scared about this but that's a whole other thread.

I'm posting from home for those of you that were wondering. They let me out for a couple of hours a day before I have to go back in.

Can you ask for a round of prostaglandins and see if your cervix ripens a bit?

I was induced for same reasons at 38 weeks. Ds not engaged at all. Had stretch and sweep in the afternoon, and when first gel went in at 8pm I was already 2 cm. Worked a treat and gave birth at 6am.

MKG - she says she's already had four doses of gel! meaning prostaglandin gel.

Maidesmoi, I wish you the very best of luck and hope that things change overnight for you. They wouldn't automatically c/section you just because the gel didn't work. Ask the Obstetrician for ALL your options.

maidezmoi thinking of you and wishing you well. Thanks for the update

Had my 6th round of prostin gel today at 40 +2. I have had back pain and back cramps for the past 3 hrs but it does not seem to be getting any worse. This morning the MF said that my cervix was still back and closed but seemed to be getting a little softer I don't know what state it's in now. These pains dont feel like I imagined contractions to feel like;-they sort of feel like heavy period pain crossed with very sharp painful trapped wind. I also feel constipated although I did a poo this morning fine. Maybe I have trapped wind?

?

That's the same kind of pain I had with my induction, before the proper labour pains started.

I really hope you have some joy soon. Thinking of youxx