Induction failed - can I go home?

[muvaa]

I came in to triage on Sunday night because I had only felt my baby move a few times that day and wanted to get checked out. The criteria had met but then the midwife said the doctor recommended an induction because of how many weeks I am and being full term. I was 38 weeks and 4 days at that point. I'm a FTM, when I was asking the midwife questions she was getting a bit impatient with me and was saying that I don't know if I'm not going to feel movements again in the future and can't keep going to triage to be monitored since it's not 'sustainable'? So I decided to proceed with the induction even though I wasn't totally sure on the reasons but trusted that the docs had good reason to suggest it. They gave me a pessary which was supposed to ripen the cervix, it caused some very mild contractions, they took it out after 24 hours and I was 1cm dilated. So they decided to go ahead with the prostin gel and so far I've had 2 doses, 3mg out of the maximum 4 and it's not worked and I feel like I'm back to normal, no painful contractions or anything. They're talking about forcing my cervix to open mechanically so they can break my waters, I have no health problems like preeclampsia or diabetes or anything, the only reason for this induction was because I was worried about the baby's movements on Sunday. If all else fails I'll have to consider a c section but my iron levels are low so the risk of needing a transfusion is high. I want to go home and just wait until the baby and my body is ready. I can't stand being in this cramped antenatal ward.

When they come around this morning OP tell them you want to discuss your options and be really firm with them that you want to understand what you can do now.

I also had a Failed induction ( for lack of movement ) mine was 4 days and then I had my waters broken because I wanted to proceed and I didn't want to go home.

I know how lonely the antenatal wards are at the moment so am thinking of you

I wasn't allowed home in similar circumstances, even though I lived in walking distance.
Had to sit it out. They finally broke my waters on day 3, baby born 16 hours later on day 4.

How have the movements been since you’ve been in hospital? If they think the baby is struggling then they need to get it safely delivered.

Ask them for a clear plan of action. You are NOT a prisoner.

Everything that they suggest needs your consent to happen. Consent has to be given freely and not coerced. At any point you can say you need time to think about it.

Ultimately if the induction isn't going to work, you can say you want a C section.

As you have access to your phone, find out about your hospital PALS contact. Send them an email if needed. In my experience they will fall over themselves to reply.

@ThePricklySheep

How have the movements been since you’ve been in hospital? If they think the baby is struggling then they need to get it safely delivered.

The movements have been absolutely fine since I've been here, baby has always met the criteria every time they've monitored the heart rate. I just feel like hes not ready to come out and my cervix is still completely closed even after all the doses of prostin

@Mummyof2Terrors

Ask them for a clear plan of action. You are NOT a prisoner.

Everything that they suggest needs your consent to happen. Consent has to be given freely and not coerced. At any point you can say you need time to think about it.

Ultimately if the induction isn't going to work, you can say you want a C section.

As you have access to your phone, find out about your hospital PALS contact. Send them an email if needed. In my experience they will fall over themselves to reply.

Im absolutely resisting a c section, the chances of me needing a transfusion is way too high due to my low iron levels and I don't want foreign DNA mixing in with my blood if it can be avoided.

Ask them what’s the risk of doing nothing? Sounds awful for you.
I was convinced to have induction for reduced movements but I was 40+9 so they could break my waters at that stage with no pessary. I ended up on the drip as no contractions for 4 hours.
At one point I was considering going home & waiting a little longer before attempting the drip (advice is 4 hours but they can’t ‘force’ you to do anything) but I decided to just go for it.
Ask for medical advice & make an informed choice but it’s your body, birth & baby

Of course you can go home. They have a duty to tell you all of the reasons why they'd advise against you leaving at this stage but ultimately they cannot keep you there.

Although it sounds as if someone hasn't managed your expectations very well. The point of the pessary and the prostin gel is to ripen your cervix, it might cause labour to begin in some women (mostly those who've already had children) but it's not all that common in FTM's. It's usually used to ripen the cervix to be open enough to break the waters, at which point an oxytocin infusion would be used to cause contractions.

@catsarebetterthandogs9

Of course you can go home. They have a duty to tell you all of the reasons why they'd advise against you leaving at this stage but ultimately they cannot keep you there.

Although it sounds as if someone hasn't managed your expectations very well. The point of the pessary and the prostin gel is to ripen your cervix, it might cause labour to begin in some women (mostly those who've already had children) but it's not all that common in FTM's. It's usually used to ripen the cervix to be open enough to break the waters, at which point an oxytocin infusion would be used to cause contractions.

But what to do if it's not even open enough to break waters and they're talking about forcing it open mechanically?

I believe if you're 1cm, that's enough to break your waters

@muvaa I'm not really sure what they mean by opening it mechanically. Have they mentioned using Dilapan rods? Otherwise the best the can do is try to stretch it enough to get the amnihook in to break the waters.

Out of interest, was Sunday the first time you presented with reduced fetal movements?

[quote catsarebetterthandogs9]@muvaa I'm not really sure what they mean by opening it mechanically. Have they mentioned using Dilapan rods? Otherwise the best the can do is try to stretch it enough to get the amnihook in to break the waters.

Out of interest, was Sunday the first time you presented with reduced fetal movements?[/quote]
That's what it is I believe, that's what they mentioned. Sunday was the first time. I just don't know how to feel about them intervening so much to get the baby out if my cervix isn't budging. All of this just because of my anxiety on Sunday. My iron is 94. They took a blood sample in preparation to find the same blood group for a donor.

Even with haemoglobin at that level, you won't necessarily need a transfusion. I had similar, a pph and hb went down to 73 after birth. Didn't need anything except iron tablets.

I'd be asking if you could have an iron infusion and then go home.

I'd also have a very low threshold for going back in though.

That 'sustainable' comment is absolute bullshit and I'd be complaining as it's your first episode of reduced movement. Some women got for freakin' daily monitoring!!!

Okay, that's unusual. Unless for maternal request, all of the Trust's I've worked for wouldn't recommend induction unless 2+ episodes of reduced movements. There may be something in your history though that made them recommend it.

The Dilpan rods are very good. When they're inserted they're very thin, but they expand kind of like a tampon and stretch the cervix. They stay in for 12 hours.

I would advise to really think about what you want to happen now. Ask them why they've recommended induction after one episode of reduced movements, have they seen something they've not communicated to you? Then you'll need to decide if you want to continue. If you need a break, tell them you want to go home. You can come back tomorrow or you can wait and see what happens naturally. This is YOUR body and YOUR choice to make.

They may try to convince you to proceed and they have to tell you all of the things that could happen if you left, as if something did happen and they hadn't told you then they wouldn't be responsible. They will likely make you self discharge and sign a form to say you're doing so against medical advice. It's all legal.
Don't let yourself feel bullied, you have to do what's right for you and your baby.

They would be responsible

@catsarebetterthandogs9

Okay, that's unusual. Unless for maternal request, all of the Trust's I've worked for wouldn't recommend induction unless 2+ episodes of reduced movements. There may be something in your history though that made them recommend it.

The Dilpan rods are very good. When they're inserted they're very thin, but they expand kind of like a tampon and stretch the cervix. They stay in for 12 hours.

I would advise to really think about what you want to happen now. Ask them why they've recommended induction after one episode of reduced movements, have they seen something they've not communicated to you? Then you'll need to decide if you want to continue. If you need a break, tell them you want to go home. You can come back tomorrow or you can wait and see what happens naturally. This is YOUR body and YOUR choice to make.

They may try to convince you to proceed and they have to tell you all of the things that could happen if you left, as if something did happen and they hadn't told you then they wouldn't be responsible. They will likely make you self discharge and sign a form to say you're doing so against medical advice. It's all legal.
Don't let yourself feel bullied, you have to do what's right for you and your baby.

The doctor just came and spoke to me very briefly, she was rude and was acting like she just wanted to get it over and done with. She's saying the dilpan rods are the next option, if they don't work then it's a c section. I asked if I could go home and she said no because they've already started intervention, I went on to say I'm not mentally okay since I've not slept 3 nights in a row in this noisy ward and she said 'yeah but it could be your last night'. There's a lady in a bed opposite mine who's had a balloon thing twice from what I heard, and it's still not working for her so that's making me even more anxious

Do you feel able to tell them you're going? They don't get to say no! For goodness sakes I'm furious for you.
If not, are they allowing people in (birth partners)? Or can you get someone on the phone? Or a midwife you feel you can talk to?

It's your choice. You can leave at any point.

Ring PALS right now. Attitudes will change very quickly. Google your hospital name and PALS

They should of offered you daily monitoring if you didn't want to be induced. Pre 39 weeks is early for induction if no clear need (baby passing ctg after 1 episode of reduced movement), especially as first baby.
You can leave but I'd ask for daily monitoring if you are worried about movements - that is not unsustainable, I had it for DC2.

In your position you need to think of what you value more. Going home to get some sleep is a big attraction I’m sure. But if Labour starts and for whatever reason you need intervention like blood transfusions you’re better off in a medical setting. Depends how quickly you could get back there and get a bed

As a middle ground - could you speak to the ward sister and explain how you’re feeling, is there a side room you could have every for 24 hours so you can rest?

@catsarebetterthandogs9

Do you feel able to tell them you're going? They don't get to say no! For goodness sakes I'm furious for you. If not, are they allowing people in (birth partners)? Or can you get someone on the phone? Or a midwife you feel you can talk to?

I can tell them I'm going. The only thing stopping me is the safety of my baby. Will my baby be safe even though I've had the pessary and gel

Yes, you can leave whenever you want; it's not a prison. They are going against guidelines by inducing you pre-39 weeks solely for RFM in the absence of other concerns. You absolutely can come back in daily for monitoring if you want. Personally, I'd pack up and leave now; you can come back tomorrow if you have more concerns or if you go into labour.

@muvaa good. You can go back in for daily monitoring as PP's have mentioned for your baby.
The job of the pessary and gel is to ripen your cervix, it shouldn't have any effect on your baby.
Be vigilant with baby's movements and call if you have even the slightest concern.

I would make a 24 hour plan with yourself. Go home, rest, eat, drink plenty, watch Netflix or walk or whatever to relax. If you still feel well after 24 hours, make another 24 hour plan. It's not all or nothing. If you feel you want to continue with the induction at any point, call them and tell them so.

Also the iron levels aren't a big issue, I required several infusions my last pregnancy. Realistically every women who gives birth has a chance of requiring a blood transfusion so it's just a positive that they already have this on standby.