Hospital want to induce me this Friday (38+0) - help!

[worried88]

I was diagnosed with gestational diabetes at 36+0 weeks and am now 37+5. I've been monitoring my blood sugar levels at home since the diagnosis and have managed to get them under control.

At my 36 week scan the baby's weight was estimated at 7lbs 1oz and the head circumference was 35.5cm (97th centile), so the baby is already on the large side because of the GD.

My midwife rang this morning to ask how everything is going and then asked what my thoughts were on the birth. I said I was confused over whether to go for an induction or c-section due to the size of the baby's head, so she went to speak to the consultant to get his thoughts.

She rang me back 10 minutes later and said the consultant thinks an induction is the best option and that they could get me in this Friday to start the process. I was quite shocked as the phone call began as a routine chat about GD and ended with the possibility of giving birth in two days' time.

The midwife explained that the baby will just keep on growing from here on in, so it's better to induce sooner rather than later for a vaginal delivery before they get too big. She also said that if I did go for a c-section then that could be done at 39 weeks.

I said I'd think everything through and get back to her, but I'm so confused now. Should I take their advice and go in this Friday, wait another week (when I'll be 39+0) or two (when I'll be 40+0) to be induced, or ask for a c-section?

My head is spinning - if anyone has any advice it would be much appreciated.

I'm not sure that they were more intense but there was no real build up. One minute I was having twinges and then 10 mins later I was having proper contractions not far apart. I think I'm just one of those people who gas and air worked very well for. DD1 was close to 9lb so possibly similar size to your little one.

For me the pessaries were a walk in the park. It was the drip that was awful. The difference between the drip and natural labour is that naturally it builds and your body rests.

With the drip it was like labour x 100, all the pains, all at once and no rest between constant contractions. Like I said, my epidurals fell out and failed so I had no let up from the pain. I think if the epidurals had worked I would have been fine - in fact - the epidurals only worked on one side of my body so when I turned to my other side I was pain free for about ten minutes until the other side started to hurt. I was sat up laughing and joking and chatting happily in those brief pain free periods. And I'm as tough as old boots, I have a ridiculously high pain threshold and the drip had me ruined and curled up in a whimpering ball on the bed because I had no relief from it.

I strongly recommend the epidural, mine was shoddy because it was done at 3am so I had a very tired anaesthetist. I think if I'd have had the day shift it would have been a different story. The head anaesthetist, when looking me over for surgery, said it had been done badly and too low down which was why it hadn't worked.

@anguauberwaldironfoundersson I will be having another round of monitoring this morning to determine whether to give me a pessary or break my waters (ARM). I’m getting quite a lot of tightenings already according to the monitor, but my cervix is only a little bit open, which is why they’re deciding which way to go. I’m hoping for the pessary as I’m scared to go onto the labour ward!

If I do go down the ARM route I will definitely be having an epidural once my waters have broken.

@worried88 I know the monitoring and guidance from hospital staff is even more important when being induced, but just to say, it is still your choice e.g. you could opt not to do ARM for a few more hours if you want to give the pessary more of a chance. You just need to use BRAIN - benefits, risks, alternatives, intuition, nothing - with each suggestion. Intuition is important and the nothing part is too, because, what happens if you do nothing and wait for another 15 mins, or hour, or two? Etc. Just wanted to make you feel a bit empowered because it sounds like you are saying you have to do things, which is not the case. It's still your choice. Of course they are likely to know best BUT some interventions can actually slow things down so it isn't always the best thing to go full steam ahead on everything quickly.

Have they already inserted a pessary? Are they deciding whether to do another one? x

Also, breathing through the contractions - count of 4 seconds in, 6 or 8 seconds out - will really really help as it gets the oxygen and blood flow into your uterus which needs it as there are some important muscles doing the contractions. This is especially important if you are scared. Fear will make your flight or fight response kick in, which will push oxygen and blood to your legs and arms, and make contractions much more painful.
When it comes time to pushing it helps to suck in air quickly through your nose, then breathe out forcefully downwards through your mouth during contractions. Ofc if you have an epidural you'll need to actively push harder as you won't feel it, but, you never know, you might not need an epi. One advantage of not having one is being able to remain upright so have gravity on your side. But can imagine the drip contractions are super intense.

I hope you aren't feeling too tired! x

Thanks @IslayBrigid! I’ve just seen another doctor - they’re now saying that because the cervix isn’t particularly soft and open they will probably give me a pessary. However, because the baby is also not fully down in the pelvis, this will need to be done on the labour ward, so I can be closely monitored for cord prolapse due to extra fluid around the baby (polyhydramnios).

Earlier they were saying they wanted to have a go at ARM but now a different doctor has come on shift and seems more inclined to try the pessary. Is it normal for them to change their minds? I think it’s the fact that I’m having tightenings with an unfavourable cervix that is causing the indecision. I’m getting worried they don’t know what to do with me!

Also they keep asking if I’m in pain from the tightenings, but they’re barely perceptible!

(I haven’t had a pessary yet - just several rounds of monitoring and a cervix exam by the midwife).

Ah ok, interesting. I think different doctors are likely to have different ideas about what is best. Popping your waters this early definitely seems a bit risky though... it will increase chance of infection, and induction can take days, so I would definitely think about it deeply before letting them do that.

Pessary sounds like the best way forward.

As you are not full term it makes sense for baby to not be fully down yet.

Perhaps ask them to stop asking about pain, if this is annoying/distracting. Tell them you will tell them if you are feeling pain.

Also it could be worth asking them to explain the process as they see it? Like from now till baby being born? Obviously things can change but seems like youre a bit in the dark and only being told the next action, but not feeling informed about the full pathway? x

Also do you have a midwife you can speak to? Often they can provide comfort and another perspective/explain the doctor's views as well.

And remember - if you're confused or feeling like they are being inconsistent - ask them about their decision making process. Ask for the risks/benefits/why they think this/that. It will help you feel empowered and hopefully mean you feel more looked after too, if you understand their reasoning.

Thanks so much @IslayBrigid. There was a lovely midwife here last night but she’s finished her shift now, so I’m not sure who I’ll get next.

ARM doesn’t sit right with me when my cervix sounds so far from ready, but it sounds like they’re moving away from that now thankfully.

I’m starting to wish I’d just pushed for an elective c-section to avoid all this faffing around. I think I’d also be in and out of hospital quicker if I’d had one.

@IslayBrigid I’m guessing with ARM they’d move me onto the drip after a couple of hours, so it would most likely be a fairly quick process.

Unfortunately, different consultants will have different opinions. On day 2 of induction they were fairly certain they would have to deliver by emergency c section. I had to call DH to come in (it was middle of the night), get someone to watch DS etc etc. In labour ward they decide to monitor me for a bit first. Eventually, on duty doctor decides that while he's not 100% happy he doesn't think an emergency c section at 3 am is the right move at this point so tells me he'll keep me in labour ward for rest of night under close observation and recommend that a foetal specialist sees me in the morning and that the c-section is done the following day. Fine.

Except, the next day, the consultant on duty decides that no, the guy who was monitoring me all night (and bless him, he was as they weren't that busy so he spent a large part of the night with me and the midwife) wasn't right and they'd keep on with what they were doing. When I finally DID have the emergency c section 2 days later, the midwife in surgery happened to be the midwife who had been the one who originally flagged that she thought I needed a c-section then. As I was wheeled in and she saw who it was she said, "Aaah, we knew we should have done this on Saturday."

Sorry. My point is that if I have one regret it's that I didn't push harde for a c-section. I knew there was something wrong. I'd spent 6 hours hanging out with a doctor AND a midwife who had spent hours watching every single beep of that screen. The first doctor and midwife knew I needed the c-section. But a consultant who had spent zero time with me was the one who made the final decision.

@worried88 no worries, I find all this so interesting and want to help if I can :)

I'm not a medical professional, but yes ARM feels quite premature at this stage so good they moving away from that idea for now. Yes that makes sense they might put you on the drip soon after if they do it.

Your body may still need a bit more time though even with the drip as you aren't full term, so I would think doing very invasive things like ARM would be better to do further down the line when you are more dilated, softer cervix and contractions are coming stronger. This makes sense to me as would more likely be beneficial. However, I am no expert and if they had a good medical reason to do it earlier then good to listen to them about it and follow the advice if you feel comfortable! Just always useful to ask them the whys and hows etc.

Hopefully the pessary will work! And you can avoid a drip! I'm actually quite surprised they were even considering ARM if you haven't even had a pessary? I thought pessary was first step, after sweep, but I don't know. Did you have a sweep?

Is your birth partner with you or can they only join when you're in active labour?

@BlingLoving that sounds super frustrating! :( So interesting (and bad) that you had such divergent advice. Was the c-section OK in the end?

OP, I think this is why it's good to try to listen to your intuition, ask questions and push for what you feel is right. Of course you are still early on in the process so there is a good chance the induction will progress and you won't have to have a c-section. C-sections are not the easy way out, so good to try for a vaginal birth if poss. So don't feel disheartened. Just good to manage the expectations in terms of how long the induction might take x

I'm actually quite surprised they were even considering ARM if you haven't even had a pessary? I thought pessary was first step, after sweep, but I don't know. Did you have a sweep?

@IslayBrigid No I didn’t have a sweep. I also thought pessary was the first step, but they seem fixated on the fact that I’m having these “tightenings” (aren’t they just Braxton Hicks?) despite the fact that my cervix doesn’t sound particularly ready. Apparently the tightenings mean the pessary could bring on contractions very strong and quick. I’m starting to worry about the back and forth and am feeling quite unsettled.

I’m about to have another half hour of monitoring the baby now I think.

Sorry I have one more question. Are the tightenings you're speaking of the same as contractions? Does that mean you are actually already in latent labour and have got there on your own?

If so that is a great sign and hopefully the pessary will speed that natural process along!

@BlingLoving that is annoying! Did it all turn out ok in the end?

Oh just saw your post.

Hmmm. It sounds like you need more info. Can you request a chat with the doctor and midwife and ask them about all this, and their reasoning for various things e.g. no sweep, pessary, tightenings and whether braxton hicks or not, etc? I'm sure you'll feel better if they give you more information. It sounds quite stressful x

Sorry I have one more question. Are the tightenings you're speaking of the same as contractions?

I don’t actually know! I asked what they meant and they said about my stomach going hard. I’ve had that for a while now, but it’s totally painless and I assumed it was just Braxton Hicks! I’ve had the occasional pressing down feeling on my crotch but it’s been few and far between, and they’ve said today that the baby isn’t very far into the pelvis. I think I need to clarify.

If the baby isn't engaged will induction even work? Personally, if they started banding about words like 'cord prolapse' I'd be backing out and opting for the section.

Remember, you are entitled to refuse any and all treatment and you can change your mind about the induction if all they've done thus far is monitor. I had tightenings where my stomach went hard from about 36 weeks, but baby wasn't born until 39. If they're painless and irregular, that's Braxton Hicks.

With what you have said about your baby's position, I would ask for a section. My ds was already 3/5 engaged when I started the induction at 36+5, but after 3 days my body was just not ready to go in to full Labour & my induction failed & I had a C section. I was shattered from no sleep or food & ended up extremely poorly, had I had the section as soon as I was admitted, I could have already been home, but instead ended up being in hospital for another 5 days.

Yes this is also what I was wondering... if baby isn't engaged, will the induction work? Perhaps it will, but will take longer? They must think it has a chance if they are doing for it...

Definitely try to get some clarity and let us know what they say x

I'm pleased to say yes, the c-section was fine (although I really really would have preferred a nice civilised Sunday morning at 10am c section rather than the slightly panicked version at 2am on a Tuesday....). My recovery was swift and easy - probably because although it was done in the middle of the night, I had never actually gone into labour so my body wasn't exhausted etc. And I suspect an emergency c section on a woman's body that isn't contracting has to be easier than one on a body with contractions happening.

Also, for all that I'm annoyed the original doctor was not listened to, I am incredibly grateful for the constant monitoring. They sent me to theatre about 5 minutes after my second contraction because they could tell there was something wrong. It turned out that the cord was wrapped extremely tightly around her neck, twice. It's why the pessary probably didn't work and when they broke my waters and put me on the drip, thereby forcing more activity, she immediately went into distress as there simply wasn't space for her to enter the birth canal as the cord was too tight. They saved her life.

I just wish they'd decided to save it two days earlier!

I think the key takeaway for me is that while it was frustrating, when things really did get to the "there's no question here" stage, they were quick, efficient and absolutely on the same page. So when things were less clear and could go in different directions, there were different opinions. But once DD let it be known she really really wasn't happy, they leapt into action. The frustration is just that the people who had actually spent time with me and watching her (as it were) were not necessarily listened to. But for all that this has negative implications, I still feel good about her birth and am incredibly grateful to the staff who looked after me. Even with all their different views etc, they were always kind and I truly believe they all wanted the best for me.

Induction can work even if baby isn't engaged, DD1 wasn't engaged at all. It sounds as though they haven't actually done anything yet. For me it baby heart rate monitoring, check cervix (hard and high), pessary in, further heart rate monitoring and then free to move around a little.
Everyone on here seems very pro c section but it's not always a great experience either. If this is your first and you want more DC I would only have one if it's necessary for you or the baby. I had to have a section with DD2 as they wouldn't deliver a breach baby and the c section went wrong even though it should of been a straight forward ELCS.