Pressure to induce due to high blood pressure - so angry

[jezza1234]

Hi all,
Have to vent. I am 39+3 wks and have borderline/high blood pressure that has been creeping up a bit during pregnancy, which i take medication for and monitor at home. I have never had any protein in my urine or sign of pre-eclampsia, baby growing absolutely fine (50th percentile), doppler of the Umbilical cord absolutely fine, all CTGs absolutely fine, no other symptoms.

About 2 weeks ago the midwives and doctors start telling me that i’m going to need an induction at 39/40
Weeks. I ask for evidence to better understand the risks and benefits of induction vs expectant management, and after a long conversation the doc agrees that it’s fine to wait until 41 weeks, the main issue is pre-eclampsia and slightly high bp is manageable. I agree to go into hospital for regular monitoring.

First monitoring appt today. I get bp reading of 140/90 and 145/90, slightly high but the same as i’m getting at home. New doctor comes in and starts telling me that my baby is at risk of stillbirth and i need an induction.

I was so angry and upset. I said to him that that the word ‘stillbirth’ is a very inflammatory word to throw around and asked him to explain why it was necessary to have an induction now. He immediately backed down, apologised for using that word and said ‘it’s pre-eclampsia we’re worried about not high blood pressure’.

What if I hadn’t done my own research and gathered evidence? What if I was younger and less self assured and not able or comfortable challenging the assertions about stillbirth?

I have never in my life experienced the kind of pressure and emotional manipulation from medical staff that I have since becoming pregnant. I usually am quite happy accepting the recommendations of medical staff because I feel comfortable that these are based on good evidence and research. This is absolutely not the case in obstetrics, and given the different information i have been given by different doctors at different times, there doesn't seem
to be any internal logic either.

The only thing doctors seem to want to do is induce, induce, induce - yes it might be the best way to prevent the possibility of something happening, but that’s like saying that leg amputation is a great idea because it will prevent 100% of sprained ankles! I know that in some cases induction is important and useful, but rates of induction have gone up and up with only small drops in stillbirths and negative outcomes for women. That means many hundreds of thousands of women are being needlessly induced.

This is what the research is showing - but it’s so hard as a pregnant woman to stick to my guns on this in the face of emotional pressure basically saying ‘you’re going to kill your child if you don’t induce’.

Please excuse the rant - just so frustrated that the last weeks of my pregnancy have to be spent feeling like this.

Personally I go with the doctors opinion. I was induced due to high blood pressure, after the first pessary I developed pre eclampsia, they did an emergency c section, and sadly after my daughter was delivered I went on to develop full blown eclampsia. Which resulted in post natal renal failure and I also had septic shock and was rushed to icu. I spent a month in hospital and then had a year of follow ups.

My Opinion is when multiple medical staff tell you to induce. You induce. They are not saying it to be cunty. They are saying it due to the risks. At this stage, why are you so against it?

I couldn’t agree more, it’s disgraceful. I’m due this week and I’m seeing on the April baby boards so many women being induced early for no real reason and being pressured into it. I think it’s to manage the pandemic baby boom workload, it’s so far from woman and baby centred care. I’m sorry you’re having to fight with them, no one needs this stress at this point in pregnancy. I refused to see my consultant again as they started pressuring me about not supporting my homes VBAC and talking about balloon inductions when I was saying I didn’t want any interventions unless essential, she just wasn’t hearing me at all.

There is an increased risk of stillbirth associated with pre eclampsia, so in order to prevent pre eclampsia and therefore reduce the risk of still birth, they are offering to induce you.
I don’t really see that as inflammatory tbh.
It’s the doctors job to tell you the risks, it’s then your decision and your choice to make whether you want to accept those risks or not. It’s your body, your baby and your birth, so as long as you know those risks you can decline an induction. However, that doesn’t mean they will stop offering you an induction if they feel it’s indicated. You just have to tell them in your response yes you know the risks and have chosen not to have an induction at this time.

If a doctor told me I was at risk of still birth I'd do absolutely anything that would avoid that

They're trying to protect you and your baby.

If you don't want to listen to their professional advice, then don't, but you can't really blame them for advising you as to what they believe is in your/your baby's best interests.

I wouldn't be happy if my BP was that high and as previous have said, it's their job to inform you of all possible outcomes etc, as hard as it may be to hear!

why would you not want to be induced? I was induced with both of mine as they were overdue, but would have been delighted to have been induced early.

The last few weeks of pregnancy are a total drag IMO

Mentioning the risk of stillbirth is obviously going to be upsetting, but if that's what the risk is, they need to be clear on that don't they!

It's their job to advise you on the risks of you reject the treatment they are advising.

Being born is the most dangerous thing your baby will ever do, and one of the most dangerous things you'll ever do (bar being born yourself!) and it's their responsibility to make sure as many mums and babies survive and are not damaged by the process. They aren't suggesting it for fun.

There is an increased risk of stillbirth with pre eclampsia. They have to use that word in the same way they have to mention death as a possible outcome of any surgery you consent to. It's all part of informed choice so nobody can say "I didn't know death was a possibility, if I had I'd have chosen another option".

This is just a comment on their use of that particular word, I can't comment on the appropriateness of their offer of induction.

I had a similar experience to @Bluntness100 - they induced me because they said my baby was small. Didn’t even really consult me about this decision, went in for a growth scan on the Friday and they booked me in for induction on the Sunday. I went in with the intention of refusing it if I didn’t think there was a good enough reason for it. Then developed pre-eclampsia and had emergency c section. When I think about what could have happened I go cold. However, I completely agree that they push induction so much, in fact one of my friends went in twice towards the end of her pregnancy because of reduced movement, and they said if you go in 3 times for this reason they will automatically induce. So she didn’t go back despite being worried. Baby ended up being 10 days overdue and absolutely fine!

Listen to the doctors advice OP. Like what op said, they’re not doing it to be unfair to you, they have experience and baby’s best interests at heart. God forbid anything did happen, you’d never forgive yourself.
Make sure you are clear about what YOU want from your birthing plan, so even if you are induced, you still have some control over it.

So a doctor has told you the risks of you develop pre eclampsia, which can happen rapidly, and you interpret this as being “inflammatory”? Did your own research not find there was a higher risk of stillbirth when preeclampsia is present? Or that higher blood pressure can rapidly turn into preeclampsia?
I can’t understand why you’d accept the increased risk personally. Dr Google isn’t who I’d put my faith in tbb.

They're fully informing you. Would you rather they didn't bother? If you don't want to hear it that's your prerogative.
The increased risk may be small, you may be happy to accept it. But you are at increased risk and they'd be irresponsible not to mention it.

So you would prefer that they did nothing ? I used to work with someone who thought their internet research was worth the decades of study and experience that the midwives and obstetricians had . There was a very sad outcome .

I do sympathise, I was reluctantly induced ( although I never considered going against medical advice) due to high blood pressure with dc3, the experience was a good one, after the initial induction I had as little intervention as possible with just a few puffs of gas and air right at the end and until the pushing part I was mobile and not strapped to a bed or anything. Best of all I had a beautiful healthy baby and was home in less than 24 hours.

I think the OP is cross (rightly so) at the lack of explanation. It's not coming across as an offer, but a decision that has been made on her behalf. This seems to be a regular complaint of women in pregnancy, and it is completely wrong.

3 times for this reason they will automatically induce. So she didn’t go back despite being worried. Baby ended up being 10 days overdue and absolutely fine!

But I find this a crazy perspective. If I’d been so concerned to take myself to hospital 3 times because my baby was showing lack of movement, I’d want that baby out! I wouldn’t be pleased that I took the chance of not going back, despite feeling concerned.

One of the only studies that have been done showed that in cases of high bp and mild pre-eclampsia, the difference in negative outcomes for women were 31% for induction compared to 44% for expectant management, with the vast majority of the difference around further raised BP. There is no clear evidence around neonatal outcomes.

Doctors want to be cautious, I get that - but there are risks and negative outcomes around induction too that are not discussed when helping women make a decision about their birth.

@Mistressinthetulips that’s exactly my point... i don’t want to kill my baby either... obviously! But the evidence is just not strong enough to support the assertion in my case that no induction = stillbirth.

@Bluntness100 I am so sorry that you had to go through that, it sounds awful. I think though that the studies that do exist suggest that this isn’t the typical outcome for most women with high bp.

Would you have preferred they hadnt made the risks clear?

As a mum to a full term stillborn son I know dozens of women who would tell you they would like to have known all risks and if their chances of it happening had become increased!

Women die in childbirth so do babies. The reason we don't have a high mortality rate in this country is due to early intervention. The doctor has studied for years and knows his stuff. An internet search won't give you his breadth of knowledge

I would definitely follow the medical advice on this.

To be honest I'd go with the doctors on this - I had pre-eclampsia but never had particularly high BP or protein, they caught it with a blood test. I was pretty unwell and needed regular blood tests and liver scans post-birth until I got back to normal. It had also caused the placenta to fail and DC was born weighing under 4lb. I was induced just in time at 35 weeks and I'm so glad I was.

I can sort of understand where you are coming from OP in terms of how induction seems to be prescribed alarmingly frequently, but I think YABU in your own situation.

Regardless if there is less than 1% risk or 90% risk of stillbirth they still need to tell you, would you rather they mollycoddle you and call it something else? It's called informed consent and that's how you can then weigh up the risks and benefits. A risk of death during GA (general anaesthetic) is 1 in 100,000 which is 0.001% but it is still discussed in the consent process of every GA because a risk is still a risk.

I do understand the feeling of being railroaded. I’m currently on the ward after being told yesterday I have to be admitted due to risk to baby. I’ve cried and cried because the ‘plan’ was non-existent and I feel utterly powerless. It’s very hard to advocate for yourself in the face of professionals which is why it should always feel as collaborative as possible. No plan about me, without me.

Good luck OP

I don't understand why mentioning stillbirth is 'inflammatory' a doctor rightly should be clear in terms of risk so that patients can be informed. I would not want a doctor to sugarcoat anything for fear of being inflammatory- that would make me distrust them.

I understand preeclampsia can come on very suddenly and be very dangerous for your baby and you.

Your body is giving warning signs showing that there is a preeclampsia risk.

The doctor is acting on these signs and recommending actions now which should keep you and your baby safer.

If you develop preeclampsia induction will be the least of your worries. You'll potentially have to have an emergency c section which is physically and mentally generally a lot harder than an induction for both you and your baby.

I'm sorry but I think you have your priorities very wrong right now. Your baby's safety should be what drives your decisions and I don't think that's what you are doing. Time to put baby first and accept the advice of medical professionals.