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.

[quote catsarebetterthandogs9]@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.[/quote]
I still want to leave and have not had any further intervention but doctors are telling me there's a risk of stillbirth because they've already started me on all these hormones. It does scare me but I'm leaving anyway and transferring my care to a different hospital, one closer to my house so I could go in for daily monitoring

I would be doing the same as you OP. Once you have your baby and you have the energy, I would also be contacting PALS about your treatment at this hospital. It sounds like a completely unnecessary induction and really appalling practice, that doesn’t seem to be following NICE guidelines. Best of luck with the monitoring and I’m sure baby will come happily when it’s ready.

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

I think that's what they're telling you, that in their opinion it would be better if you stayed. They can't give you any guarantees one way or the other.

It is your choice, but I would be guided by the medical professionals

You can certainly leave but is it easy to transfer care from one hospital to another at this late stage in pregnancy?
I would stay if they advised there is a risk of stillbirth . Obviously if you leave and something happens to your baby they will not be responsible as they have given you their medical opinion on the risks.

but doctors are telling me there's a risk of stillbirth because they've already started me on all these hormones.

Are you absolutely sure they said this?

If so, I'd be concerned - it's nonsense & I'd be amazed if any medical professional suggested there was a risk of stillbirth to a mother in their care.

I'm mainly wondering if you've fully understood situation & reasons for intervention. It doesn't sound at all plausible that they decided on induction for no reason, if foetal movements are good.

Of course you have agency over whether you stay or go, but I'd really encourage you to make sure you've all the facts.

About iron & c-section. You're wrong there for sure. Your haemoglobin levels aren't low (overall - they're a bit lower than they should be but definitely not in any worrying way). There's no reason to think if you'd a section that they'd need to give you a transfusion. They do this based on iron store levels (ie ferritin), and even when mine were extremely low (after a late m/c), they recommended high dosage of iron, instead. The 'foreign DNA' line is (sorry) just ridiculous.

Based on this I just would have concerns you aren't understanding all the info. Hopefully you can talk to a more sympathetic midwife or doctor.

I’d be very wary of leaving after starting the induction process. Labour could come on thick and fast (it did for me!). Also they keep you in to monitor the baby as induction can be stressful for them. I wouldn’t go against medical advice about the safety of my baby.

Can you speak to someone else there to make sure you have all the information?

Hope you left and got sorted out. Ridiculous situation

A useful tool I used in my last pregnancy to make decisions about interventions was B.R.A.I.N, so what are the benefits, what are the risks, what are the alternatives, what is your intuition telling you, and what if you do nothing? I was pressured towards an elective section due to a previous section and high bmi and was told about all these risks of a vaginal delivery but not about the risks of a repeat section. If you've left and are in a position to, think about the potential options you've got in front of you and look at them with BRAIN in mind. Also check out AIMS, they have loads of useful information.

I’m genuinely confused how posters can recommend leaving during the induction process if you’ve been told there is a risk of stillbirth. You’ve had pessaries and gels so your body has had a lot of intervention.

Can someone who has advised leaving explain why to me please? I’m not being goady, I’d really like to know if I’m missing something!

@Teakind I'll disclose by saying I'm fairly newly qualified and induction is a doctors remit. I would never advise without consulting a doctor first.

Firstly, OP has said she had one reduced movements visit and no other problems, she is also pre 39 weeks. This in itself is not a reason for induction.

Secondly, the pessary and prostin are synthetic hormones essentially. Their job is to open and efface (make thin) the cervix. Not induce labour (although this can happen), then the waters are broken. If waters had been broken of course nobody would recommend leaving.

Thirdly, I have never heard of an increased risk of stillbirth after the use of the pessary and prostin gel alone, and I've tried searching all reliable (and even unreliable!) sources today and can't find anything that says that. Now, if op had had say 5 episodes of reduced fetal movements I could understand the stillbirth comment, but again that would be due to the reduced movements rather than the pessary and prostin gel.

I've met several FTM's who've had the pessary and prostin and no progress and have been sent home for a rest period before restarting. Obviously if there were immediate concerns this wouldn't happen.

Finally, we have to weigh up the importance of OP's mental health at this stage. It's not just about how difficult not sleeping in the hospital is and how scary things are right now, a poor experience during induction/labour/birth can cause PND, even PTSD.

@catsarebetterthandogs9 thank you for that explanation. It does make sense but when I was induced, after each pessary they monitored the baby and I think at 4 hour intervals. They said this was to check the baby was coping with the pessaries. Is this just to be on the safe side?

Also just wanted to say its great you've highlighted the mother's mental health. I ended up with PND after my stressful induction where I wasn't supported at all. I'm pregnant again and facing induction so your information is very helpful.

@Teakind the pessary/prostin can cause the uterus to hyper-stimulate. I've never met a woman that doesn't know that's happening as they're tightening/contracting 5+ times in a 10 minutes period. This is the main reason we monitor, to A. see if that's happening and B. check to baby is coping okay with any tightenings.
OP said she'd only felt some mild contractions so no indication of hyper-stimulating.

One of my first comments to OP was to get all of the medical information of reasons for induction etc. They should definitely have said e.g. we're concerned about stillbirth because your baby didn't cope well with the pessary.

Mental health is incredibly important to me and something I think too many healthcare professionals forget about. Please do ask to be referred to your maternity mental health team if you feel you need support. It's so hard and I'm so sorry you had that experience.

Omg I'd say no OP, make sure you get the full facts but don't let them pressure you. Induction when you are not ready is HELL!

Praying for you and your baby hope all is ok x

[quote catsarebetterthandogs9]@Teakind the pessary/prostin can cause the uterus to hyper-stimulate. I've never met a woman that doesn't know that's happening as they're tightening/contracting 5+ times in a 10 minutes period. This is the main reason we monitor, to A. see if that's happening and B. check to baby is coping okay with any tightenings.
OP said she'd only felt some mild contractions so no indication of hyper-stimulating.

One of my first comments to OP was to get all of the medical information of reasons for induction etc. They should definitely have said e.g. we're concerned about stillbirth because your baby didn't cope well with the pessary.

Mental health is incredibly important to me and something I think too many healthcare professionals forget about. Please do ask to be referred to your maternity mental health team if you feel you need support. It's so hard and I'm so sorry you had that experience. [/quote]
I had asked the doctor what the reason for induction was twice, she said because I reported RFM on the Sunday and that even though when I came in to triage the criteria had met, that doesn't show what was happening to baby in the past and doesn't show what could happen in future, and that the safest option was the delivery of baby. I am now home, when I had the last conversation with her she literally said there's a risk of stillbirth because of all the hormonal intervention and doesn't recommend me going home but it's my choice. The plan going forward is to have a scan tomorrow to check the amount of fluid and I will have monitoring every two days. Throughout my whole hospital stay baby has been moving fine, and criteria had met on the CTG every time. The pessary did cause some period like pains but when they took that out and put the gel, those pains wore off and I got very infrequent mild contractions straight after the gel then nothing. A nice midwife told me the hormones wear off after a while so that was reassuring to hear that they're not going to further affect my cervix from the doses I got. I'm glad to be home and glad I made the decision not to go through with the rods or anymore intervention.

Good luck, OP. For what it's worth, I'd have made the same call. They do like to bully pregnant women. I've got to write a formal complaint about my most recent birth at some point tomorrow and still feel guilty for not standing my ground more with doctors who presumed to tell me what was going to be done, rather than ask.

Let us know how it goes.

Hi guys, thank you all for your opinions and messages, I'm now home and have had a scan today. Everything with the baby is absolutely fine, the consultant at the hospital said my risk has not increased, and that I'd be induced if I go beyond 41+5. The hormones have worn off and will not have an effect going forward so it was really reassuring to hear from a consultant that I can carry on with this pregnancy as normal. I asked if it has increased my risk of stillbirth as the registrar from yesterday had said, and she said my risk has indeed not increased, and that if anything bad was to happen as a result of the intervention they started, it would have already happened. It's so shocking that the registrars were willing to tell me anything so I wouldn't go home and give false information. I feel like if I did go ahead with those rods, things would've ended up badly, the baby just simply wasn't ready to come out and that's okay. I'm so relieved I followed my gut and I'm very grateful for everyone on here giving their opinions.

They will probably lean heavily on you to stay now that you have started the medical
Induction process and if you do insist on going home they will probably try to scare the bejesus out of you with possible scenarios to cover themselves of something goes wrong but as long as they have not broken your waters and you are alert to movements / contractions stating I don’t see why you should stay if you don’t want to? I had the same scenario - went in with reduced movements at 38 weeks - got checked - all ok but strongly advised to have induction (just in case) I held out and said no and my DD didn’t appear till 4days after due date. I’m concerned and a bit cross on your behalf that they pushed you into an early induction solely on the basis of your (completely legitimate) but happily unfounded concern over reduced movements. I feel that it’s the NHS’s fear of litigation driving this and that this in turn sets women up for a very medicalised birth. I think it’s a bit dangerous as it might put some people off popping into triage just to check things are ok. I wish you all the best with your birth whatever you decide however.

Sorry just seen your update! Good on you for going home! I hold you have a lovely Easter weekend and well done for following your gut!

@muvaa I'm so glad you're home and everything's okay. Look after yourself, you'll have your baby with you soon enough

So glad you stood your ground & are home! Best of luck with your lovely baby when they decide to come!

I had an induction I didn’t really want last week, my body was ‘ready’ though as I was already dilated enough to break waters (8 days overdue). It’s still a difficult decision & the hospital seem to make out it’s a no brainer, why WOULDNT you want induction? Drives me mad as there as so many risks. I tried to use BRAIN to decide & pushed it back to the next morning.

Luckily mine went OK (as far as births are) & I’m snuggling my newborn as I type!

Hospitals are worryingly keen on inductions on UK. Good to know you're doing ok OP, let us know how you get on x

My induction failed with dd I was in for 10 days. I wasn't given the choice to go home. They talked about breaking my waters but I was only 1cm dilated and it was just too early for dd. They wouldn't let me go home has I had episodes of reduced movement throughout my pregnancy and the words stillbirth were brandished about. I had to have a section, despite low iron levels I didn't need a transfusion but I was very weak afterwards. I am anaemic in every pregnancy but so far have not needed a transfusion.

If this is the first incidence of reduced movements I would do some research and advocate for yourself.