worried about pre-eclampsia pregnancy NHS treatment

[reaktor24]

Hi. My gf and I are currently in hospital maternity ward. She has a number of ailments. She has pre-eclampsia with protein and high bp. She has a dodgy kidney which is hurting her due to the pre-eclampsia. She is also diabetic which occurred during the pregnancy. On top of all that she has a cold. We were told on our last scan at 36 weeks that she was high risk and the situation was/is an emergency. That was last Tuesday and she has been in hospital since Wednesday. She has been given an insertion twice to induce the baby as well as membrane sweep which she said she didn't want. She wants a cesarean but is told no. What can we do?? She doesn't want ARM either due to the risks involved. The staff are not being helpful and are giving us no choice about the treatments. You will have this for so many days and then we will break your waters. This is bloody ridiculous so what are our rights? Can we demand a cesarian?

That all sounds very difficult, you must be very worried.

I'm not sure if you can demand a c section, but you can certainly demand a proper explanation as to why they aren't doing one, request one and then say you want it written in the notes that a c section was requested and denied if they won't do it. Make sure all requests are written on your partners notes.

Presumably, although your partner has been in hospital since Weds they have only started the induction process in the last day or so? Certainly they should not be doing anything without your partners consent, including a sweep, so you should complain about that.

Hi. Thanks for the reply. Yeah it's quite concerning. The induction started on Thursday. So she had one then and one yesterday. They want to do a third induction today and then rest tomorrow only to resume again the next day. She doesn't want this but they are being quite forceful. It is in your best interests etc. Also they are saying the whole induction process is leading up to breaking the waters as an inevitible conclusion. We will try formally ask for a cesarian and ask for it to be noted down that it was requested and refused.

at 36 weeks it can take quite a lot of pessary treatment to get her cervix favourable for arm. and then you can still end up with a c section because intervention often promotes other intervention. you need to insist on seeing the on call consultant when they do rounds this weekend. talk to them about the risks of this prolonged process against the surgical risks and be clear that your partner is nite happy with her treatment.

I agree that getting the request, the refusal and the reason for the refusal written up into the notes is important. Then take photos of the relevant pages of the notes using your phone before you leave hospital (you may have to do this when there are no nurses present) - the number of times the paper notes get conveniently "lost" when someone wants to complain about something is shocking.

There probably are genuine medical reasons why a non-caesarian option is better for your gf and/or the baby but all options include a balance of risks and benefits, there are no risk-free options, and their own guidelines say that therefore the choice should be with the patient. Be assertive in insisting that they explain all options and risks to you and then let your gf make her choice.

She is 37 weeks now. She seems quite adamant that she wants a cesarian. There seems to be a family history of complications during pregnancy which they are just not taking into account. Her sister lost her first baby during very similar circumstances. Her second baby was delivered via cesarian. It's quite uncomfortable being here are starting to feel like we are being trouble makers or something like that. Who has these notes? Who is this consultant? Is he independent?

Sounds crap. She is probably feeling really run down now, you need to agree a course of action and be her advocate, stand up for her. If they performed a sweep without asking I would no longer allow any vaginal examinations. You can refuse the ARM.

Don't worry about being seen to be trouble makers!

Yes you are right. We want a cesarean as we believe with her situation and family history it is the best course of action. If we refuse any further treatment what can they do? They can't send her home as she is high risk. She asked to go home for a day but they won't let her. Maybe we will just refuse all further induction attempts. What can they say? They can't force her to have it.

I completely agree with what others have said. Get your gf request for a CS written in her notes and be prepared to have to repeat it several times to the different doctors/midwives involved in her care. I've got protein and border-line high BP. I'm 34 weeks and was admitted on wednesday because they were worried about me developing pre-eclampsia and I found myself constantly repeating myself about a number of things because they didn't seem to read my notes. Fortunately I've been discharged now. But only after being put medication for my BP.
I developed pre-eclampsia when I had my DS and they said they would induce my labour although I had wanted a CS. Stick to your guns. Be firm about what you want. I wasn't last time and was very unhappy about it especially when being induced caused him distress and I had to have a EMCS anyway.
Talk to her consultant and explain what she wants. If they refuse ask them to explain the reason clearly and get written down. I personally find doctors can be really hard to understand sometimes when there's a lot going on. Good Luck. I hope everything goes ok.

You also need to ask how long they feel it is safe to wait until delivery ie get a deadline after which CS becomes the only option; it doesn't sound right to keep trying induction for days if the baby isn't shifting.

What worries you about ARM? I didn't think it was a risky procedure. And whilst they insist on continuing to attempt induction, it will be in the baby's interests to try everything to speed it along. And if it fails too, it strengthens the case for CS.

This is getting ridiculous now. She has just been to toilet and been sick. Her arms are white and her hands are dark and blotchy. Pressed the request assistance button and still no response after five minutes. This ward is taking the piss now. Awful experience.

Every patient has a consultant, the named senior doctor in charge of the team looking after her. At a weekend there will just be 1 or 2 consultants covering emergencies, but you have every right to ask to speak to him or her. Again, ask that this request is written in the notes and the time put in. The consultant may take hours to come and see you, but that will be because they are dealing with emergencies.

You could also ask the midwives for the contact details of the hospital PALS service, they are there to advocate for you and explain things. It will also ensure the mw take you seriously. Another thing you can do is get a notepad and obviously make notes whenever anyone comes to talk to you, and ask for their full name and grade. This is not trouble making or rude, just being assertive.

Tbh it sounds like it may all just be miscommunication. I'm sure they are trying to do the best for your gf, but sometimes, especially in obstetrics, there can be a rather paternalistic attitude and you have every right to expect explanations and options. Before you refuse treatments I'd ask to speak to the supervisor of midwives or the consultant about risk vs benefit.

Good luck, let us know how you get on.

You need her diabetic team to get on to them right now. I dread to think of the effects of PE on a diabetic's kidneys. You need to speak today to a senior consultant and find out what the fuck is going on before she goes into multiple organ failure.

Having had the misfortune to have seen obem it seems the squeaky wheel gets the oil.

I too had PE and was induced at 36 weeks ending in emcs. The process from start to finish was less than 12 hours and my organs were in a sorry state.

You need her diabetic team to get on to them right now. I dread to think of the effects of PE on a diabetic's kidneys. You need to speak today to a senior consultant and find out what the fuck is going on before she goes into multiple organ failure.

Having had the misfortune to have seen obem it seems the squeaky wheel gets the oil.

I too had PE and was induced at 36 weeks ending in emcs. The process from start to finish was less than 12 hours and my organs were in a sorry state.

This woman is an emergency, why the hell is she not being seen? Do the midwives know she's type I diabetic.

Hi. Thanks. This is all good advice. I am getting more stressed by the minute here but I know that won't help matters. I have asked to see her notes but they said I have to put it in writing. Are they for real or what??

According to the OP it is gestational diabetes not type 1.

My advice, having had all these issues in my first pg, is to go for the ARM. I really wouldn't want to run the risk of full eclampsia developing, like mine did, through me not wanting ARM.

I nearly died, and so did my baby. ARM is more painful (though I only found that out when my waters broke naturally with DC4!), but I coped with pethidine and G&A.

Good luck with your new baby, whatever you and your DP decide to do. I bet you can't wait to meet your new baby!

That's true I'm afraid OP, but don't worry, simply making the request will improves matters. It is very true that those who shout loudest (metaphorically) get the best treatment. (I work in the nhs).

Ask every hour to speak to the supervisor of midwives (that's the head mw manager, not however is most senior on the ward btw) or the consultant in charge of her care. Get PALS involved now. If the mw refuse to give you te number then phone the main hospital switchboard and ask them.

Hi. I'm really sorry to hear your partner is going through this . I have been induced three times myself, twice for actual P-E, and once because the Consultant said that my blood results/protein levels etc. were "heading that way again".

My first was the only emergency though, and I was given a definate "we will induce you now, you have 24 hours & if baby has not arrived we will be giving you a c-section". I was also vomiting continuously (yellow - bile I think) and was really poorly. The other two inductions were much more laid back & a c-section was never an option unless I ran into problems mid-labour.

Putting myself mentally back in hospital in your DP's situation I think I would argue, shout & cry until I got what I wanted TBH. You shouldn't have to do that & may be worried about making a fuss but really the safety of your DP & baby are all that matters. The staff will get over the "troublemakers" in time, I assure you.

Good luck, I'll be thinking of you.

Having read on, given the family history, I can see why your DP wants a cesarean. I would insist that it goes on the notes, as well as their refusal, and as a PP says, take a photo of the notes.

Can I ask why you and your partner are so against ARM? I found it to be an almost painless procedure. My first DC I ended up having ARM at 35+5 as induction by pessary had failed. I also had a syntocin drip.

I would rather have done that than not, especially as my hospital were also refusing a cesarean. Currently it is to do with pressure from above to avoid cesareans if at all possible, to lower the hospital's cesarean rates, which are published.

I'm sure if you are noisy enough about it, and insist on seeing the consultant, things will move a lot quicker.

I have to say, though, I can't understand your issues with ARM, as I found that started labour off for me, with the aid of a drip.

I never ended up with forceps etc either.

3/4 of my DC's I had ARM with, and they all had good Apgar scores, and no other interventions apart from3 stitches with my 3rd DC - but he had a head on the 99th Centile due to his SN's.

I hope you get what your partner feels she needs, but I want to reassure you that ARM is not usually a terrible thing, especially if it means your baby is born healthy and your partner is safe from developing full eclampsia sooner.

Hi. Just updating. I think the midwife was getting concerned with our 'attitude' for want of a better word so she fetched the consultant who we spoke to and that was quite reassuring. We mentioned that we wanted the fact that we had asked for cesarian and it was refused to be written into the notes and he was happy to do that. Whether he does or not I don't know. She is going to have a third induction soon. I will make sure they don't do a sweep. Just to confirm it is gestational diabetes she has.

I'm sorry you are going through this. I feel if they deem you gf an emergency enough to Induce her now, she should be being offered or at least being considered for a CS. They want her cervix to dilate enough to do a ARM which is standard, but what they seem to be missing is 2 pessaries in she still isn't ready for an ARM. I was induced at 42 weeks. After two days of mind numbing boredom of nothing happening a sensible doctor came to me as said, if no baby through the night, we do a CS in the morning. Which is what they did. I never got past 2 CM dilated. There was no way they were going to be able to do an ARM on me.

Insist on speaking to a doctor, get them to explain exactly why they think this route of induction is the best and safest way. Explain the concerns you have clearly and calmly. Write them down if it will help. If you get no joy contact PALS or the supervisor of midwives. Get someone on your side that isn't emotionally involved.

I wish you and your gf all the best. Good luck.

We have just read about the risks in ARM like cutting a vein on the membrane and also the lack of fluid during a contraction can cause restricted flow of oxygen to the baby. Not sure what the chances of this are. We really do seem to have a fight on our hands. I am quite shocked really. The consultant has said he wants to perform an ARM tomorrow and we aren't sure what do.

I'm gob-smacked that you're not getting answers to why there is such a delay. "Put it in writing"? FFS, did you bring your finest note paper with you? Are they testing her BP and bloods regularly to check for deterioration? What are they giving her for the PE? V glad you got to see the consultant anyway! And massive pat on the back for getting the midwife to do something.

PS Thanks for clearing up the diabetes thing.