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Childbirth

Share experiences and get support around labour, birth and recovery.

To induce or not to induce

50 replies

Shazzyd · 11/03/2005 21:31

Hi, am really desperate for advice!
I was due on the 27th feb, had an emergency c-secton two years ago. Basically the consutant and the midwives are pushing me to be induced on 14th March.
They tried to push me into a cesarian today, which I refused. Now they think I am a trouble maker and I have no support from them at all.
When I refused the c-s, at my appointment, the doctor and midwife discussed the induction directly with eachother, as if I wasn't even in the room! They then proceeded to book the induction, and any concerns I voiced about it were ignored!
Now, I don't know what to do.
I know I don't want to be induced, I have it in my birth plan, but they are acting as though I have no choice, I feel rather like a silly child who isn't fit to make decisions at all. Yet I have thought long and hard throughout this pregnancy, about what I want to do, and what I want to avoid.
At the same time I don't want to jeopardise the health of my baby.
I now don't trust the hospital; where I am about to have the baby, I don't trust the doctors and the midwives, I feel totally alone, and bewildered.
I am so stressed about it, and can't sleep at night, keep bursting into tears for no reason, and am absolutely frightened about having the baby.
Please help me, how can I handle this?
Shazzy

OP posts:
Are your children’s vaccines up to date?
Shazzyd · 12/03/2005 07:15

It was very rushed, and when I asked questions about the induction, and voiced my doubts, this was what the midwife said to me,(i.e about arm, then gel, then drip )I felt to shut me up.
I sound very paranoid, but the procedure was not explained to me, and I came away feeling bullied and not very confident about having the baby there. 'When I said that I was afraid of uterine rupture and possible hysterectomy, the midwife said actually said, that I shouldn't worry about that, why do I want to have more kids anyway!(angry)
shazzy

OP posts:
Willow2 · 12/03/2005 10:18

don't know if someone has already posted this but you cannot have oxytocin intravenously until your waters have broken - either naturally or artificially.

mears · 12/03/2005 13:33

shazzyd - am looking for some info for you then will pop back.

Here is one overdue

mears · 12/03/2005 13:34

website

mears · 12/03/2005 13:34

overdueleaflet

mears · 12/03/2005 13:36

inductionguideline

bambi06 · 12/03/2005 13:43

i was overdue with both mine ..first was 43 weeks and i had to stick to my guns and i was monitored to check and everything was fine and started all on my own and secind one was 10 days but i used homeopathy to kickstart it which worked and was a very easy labour..DONT let them bully you if it comes to it ask for a home birth? your baby will come when theyre ready, its awful how they try to push you into doing something you dont want ..try homeopathy..(ask a local homeopath for a birthing kit or just the remedies to kick start the labour ..its not very expensive and not harmful at all...good luck anyway and ill be thinking of you

mears · 12/03/2005 14:03

Shazzyd - can you tell me if you went into labour on your own last time or were you induced?

If you did go into labour on your own, were you over your dates?

Long menstrual cycles do have an impact on your due date so that may be why you are over your date predicted on a normal 28 day cycle.

Do you have a community midwife who is different from the one you met at the hospital? If so, would you feel happier speaking to her?

I would suggest you print off the information I have posted on the links below. This shows that you are making an informed decision about what you want to happen regards labour. You cannot be made to do anything that you do not agree to. They physically cannot induce you or section you against your will.

You need to have a discussion with ther professionals looking after you to make a plan that suits you. Take your DH with you.

As a midwife I have to say we do get concerned when pregnancies go beyond 42 weeks. As you have said that your cycle is long, you may well go over that. Have you asked the consultant his thoughts on that? Make sure you tell him everything that you have thought about. Be firm but polite and ask them to listen to you. Care is meant to be 'woman-centred', so you could drop that phrase in

The placenta tends to start to work less efficiently in a pregnancy that goes 'overdue', however, that can be monitored. If the fluid levels are fine and the baby is moving well then that is all good. However, you could have a scan that shows reduced fluid (very common) and the placenta may look as though it is deteriorating. You have to think what you want to do in that situation. You may be offered induction on that basis so you need to know what your response will be.

If you are keen for a vaginal delivery, then I would suggest you agree to induction if there is an indication for it. That will reassure the professionals that you are not refusing induction at all costs. However, it is making sure that there is a valid reason other than just you being past your dates.

In my own hospital we do use prostin gel for previous C/S women if it is needed. If the cervix is not favourable for labour (soft, in a good position and slightly open) then breaking you waters will not be enough to get you labouring and you would need a syntocinon drip.

In some cases, prostin can be enough to start the labour process and if contractions are good enough, the waters may not need to be broken.
Pupuce is quite right to point out that prostin is not really recommended in previous C/S, but experience has shown over the years that it can be used successfully. You would need to be continuously monitored if prostin is used with a previous C/S. However, you can still stand, sit in a chair, use a gym ball etc. You do not need to be stuck in a bed.
You could also let the professionals looking after you know that you want to be as mobile as possible.
Remember that the reason sex works as induction method is that there is prostin naturally there in sperm ( as well as other factors involved )

The order of things in induction is prostin gel (which may be enough), followed by waters being broken if contractions haven't started. If after gel and/or ARM there are not enough contractions, a syntocinon drip may be started.
Syntocinon is used very cautiously and as a last resort with previous C/S. Progress is monitored more closely and if the cervix is not dilating well then a repeat C/S would be advised sooner rather than later as there is an increased risk of uterine rupture.

Hopefully you will go into labour on your own over the weekend and you will no longer need to worry about getting induced.

If not, then phone the hospital to say that you will not be coming for induction on Monday, but to discuss all the options available to you.

I will stop there just now to see if there is anything I haven't mentioned that you need to know. I need to go out just now but will be back.

mears · 12/03/2005 14:20

Just before I go out, I would also add you need to have an idea of that you want to do if you start in labour yourself but do not progress well. Would you agree to ARM if the cervix was not dilating very quickly? Would you want to try a short spell on the drip if ARM didn't work?

I would also advise staying at home as long as you can when labour starts. That is ofcourse if all is well, i.e. baby moving well, water clear if they break early. No bleeding or severe pain.

lailag · 12/03/2005 14:24

not an expert, just to say I went that way as Mears mentioned, previous cs. Then "electively" induced, with prostin pessary, ARM and syntocinon drip.
Sespite all that things were slow in progressing and so they were keen to proceed to another sc. Only by protesting did they wait and ended with VBAC. So good luck and son't just "give in" on what they say....

Shazzyd · 12/03/2005 16:03

Previously I went into labour without chemical induction, although I did have a sweep, which I could barely feel. I went 11 days overdue. I had a child 16 years ago, and went 2 weeks overdue with him, and was induced. That was a horrific experience, but I did manage to avoid a c-s.
I am not keen on ARM at all, as I know from experience that all this did was to increase the pain, without much progress. With that much pain, I was unable to communicate what I wanted, and the doctors took over, it was awful.
I think I would like to know what are the levels of dosage with the prostin, and also if I can refuse to continue once the process has begun. If I have just the one dose and labour doesn't start succesfully, can I then just refuse to continue?
I think I am going to push for the monitoring, and if the situation warrants it, I may agree to minimum induction, if I can do that.
I fear the whole process starting off, and then spiralling out of control.
I am also angry that I always get forced into a situation where I am left with no choice but to accept everything the doctors say to me, it is so hard to make decisions at the drop of a hat, when in so much pain from induced labour. I don't want to feel that out of control ever again.
Shazzy

OP posts:
Shazzyd · 12/03/2005 16:05

Lailaq, I really admire that you were able to persist, just out of interest, how long did they allow you to wait? Did they have a time limit?
Shazzyd

OP posts:
lailag · 12/03/2005 16:14

They put a time limited on the whole thing after the ARM, because of risk of infection. They didn't mention that however before they performed the ARM, which ennoyed me. The pessary and ARM was done friday afternoon. They then reluctantly agreed to do nothing til next morning. (They had wanted to start the drip friday afternoon as well and if nothing happenend after 4 hours or so to proceed to cs)They then started a drip saterday morning, again with a few hours time limited. But the drip wasn't working well, leaking etc. Luckely dh is a GP so he helped me in the whole thing.
Having said all this, ended up with forceps delivery. I recovered much quicker after sc than this time.
Now pregnant again and really dreading the whole birth thing. Hope things will start at home without people messing about....

Shazzyd · 12/03/2005 16:30

That sounds like an awful time you had there. Could you have a homebirth this time?
I am hopping to have a homebirth, if this one goes ok, actually even if it doesn't. Well, especially if it doesn't!
I would have one now, but I think it is too late for me to push for that, but next time, I tink I will. I hate hospitals!
Good luck with your pregnancy, Lailaq, x.

OP posts:
mears · 12/03/2005 17:23

Shazzyd - since you have actually had a normal delivery, albeit 16 years ago, you have a good chance of having a vaginal delivery again. Labour can be induced with prostin alone, but that does not always work. Prostin comes in gel and tablet form. Depends what hospital it is as to what they use. I will post the professional induction guideline at the end of this for you to see more.

There is no doubt that an ARM makes contractions more painful. However, that is because the contractions become much more effective. If the prostin did not push you into labour, then an ARM is the next thing to get done. Perhaps you were stuck in a bed last time, possibly on a monitor which makes labour more painful as well. You would be able to cope better if you were more mobile.

If the process of induction is started, I am not sure if there is much to be gained by stopping it after 1 dose of prostin. Different if you weren't so overdue. We have had women asking to be induced when only a few days over and when the prostin has not worked, they have gone home for a few days and come back. However, I think that you need to be happy about being involved in the decision to induce in the first place, understanding the process.

Once that decision is agreed, you may well need an ARM to get labour going. If labour does not start with prostin, do you want to have a C/S?
If you are examoned and they find that you do not need prostin, you could ask for a sweep to see if labour will start. Again you have to think what you want to do if that does not work. Would you agree to ARM or just go straight to C/S?

As I said previously, you need to discuss everything you want to happen if labour does not start itself. How long are you prepared to wait? You need to have a back-up plan if labour does not start soon.

induction

Shazzyd · 12/03/2005 17:33

Mears,
you mentioned previously about a 'bishops score'. Could you explain that to me please?

OP posts:
pupuce · 12/03/2005 19:39

Here is more info on the Bishop score

I agree with Mears - if you had a vaginal birth - you can do it again... and it does appear that you do go past 42 weeks as a matter of course.... since you have never not been induced !!!!

I totally agree with Mears, get your stuff printed and just stand your ground...

Shazzyd · 13/03/2005 06:56

I have another area of confusion:
I have looked at the form that the nurse filled out, and it says that I am to be given 3mg of prostin, shouldn't they decide this after giving me an internal, and isn't it better to give me 1mg at a time.
I know that if I had to make a choice, I would choose to be induced than have another c-s. But I am worried that I may end up with a c-s any way if I go down the induction route!
Anyway, it is Sunday and I have not gone into labour, so I will have to phone them today. I am going to say that I do not want to be induced in the morning, and that I will like to come in for monitoring, and also to discss further the details of the induction, incase I need to have one.

OP posts:
mears · 13/03/2005 18:02

Hi Shazzyd. The NICE guidelines recommend the 3mg does of prostin so that in itself would be fine.

The main thing is to decide is if/when you should be induced. I do not think you are happy with this decision so I think you need to get a plan agreed that you are happy with. Say you ask to be left another few days, then if nothing happens you can then agree the method of induction.

If you do need to be induced, then prostin 3mg tablets are the way to go. That may in itself be enough to push you into labour. I would say that it is worth trying induction first as you may find it goes quite smoothly. Fingers crossed for you.

mears · 14/03/2005 09:06

Let us know how you go Shazzyd. Hope you are pleasantly surprised

mears · 14/03/2005 21:53

Hmm...

mears · 15/03/2005 11:44

Hope we get a birth announcement soon since Shazzy has not returned.

pupuce · 21/04/2005 13:05

No news still?

mears · 21/04/2005 15:08

I have often wondered how things went.

deeeja · 20/04/2008 01:28

Hi Mears,
Tis me, Shazzyd.
I posted this years ago and then stopped posting because someone had worked out my true identity, even though I tried to hide it, so stopped posting. I had a baby boy, he is 3 years old now. I ended up having to have another c-section because he got well and truly stuck, he had to have oxygen at birth, but we went home after a week. HE weighed 9lb 7 oz. He also has dx of autism, and an extremely cute winning smile.
I had another ds, by vbac, who is now 18 months old, who was born one day after my due date. I didn't expect that at all!
Sorry about not posting for so long!
xx

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