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.

@jezza1234 As you are having an induction, I would read carefully about the risks and avoidance measures. It is not without its own risks, as you say, so I would make sure I knew as much as I possibly could, and make sure your birth partner knows these things.

@thenameshastings

When things are offered it’s on the patient to ask for further information

Isn’t this what the Montgomery case ruled against though? The woman was told she would be induced, the dr knew that due to her circumstances she had a fairly high chance of shoulder dystocia (something like 1 in 10) if vaginal birth was attempted but purposely did not share that information. If there are risks it isn’t necessarily good enough to argue ‘well she didn’t ask so I didn’t share’, it should have been shared as part of an open conversation rather than being on the woman to ask, who may assume there isn’t any additional risk if the dr has insisted it’s the only/safest option or may not even know what something like shoulder dystocia is or what the consequences are.

This is correct. They have a duty of care to explain what can go wrong, and the pros and cons of a procedure. The onus is most definitely not on the mother.

I was induced 3 weeks ago and it’s my biggest regret. It was a horrible experience, sorry if this puts anyone off but it really wasn’t what I expected and wish I researched it more. I purposely avoided the internet as everyone told me everyone’s experience is different and take it as it comes but I felt so pressured by doctors like it was my only choice. I had a check up on the Tuesday and was booked in for an induction for the Friday, so I didn’t have much time to wrap my head around it all. First pregnancy so I had no idea what to expect or that I really could challenge the doctors but if I was to ever have a second baby I would avoid inducing at all costs and stand up for myself a bit more.

I've got 4 kids, 2 induced and 2 I went into labour but one ended in EMCS. The two easiest births were the inductions, I'd never thought about it before and I suppose that is a bit surprising. I have big babies and I'd say only one of the four was truly easy, that was the first induction, the other induction was a short fairly easy labour but with a horrible 5 minutes at the end when he got stuck.

I had pre eclampsia. I felt fine and I couldn't understand the fuss the hospital were making over my blood pressure. No protein in my urine at all. I thought they were overreacting. However I was very lucky and ended up having a very long recovery and a stint in high dependency. It can get serious very quickly.

Your blood pressure is very high.

Decisions are sometimes not black and white and it is hard to articulate every part of it. We cannot decide on here. All kind of factors you haven’t told us.

Yes obstetricians are cautious about pre-eclampsia, worldwide a significant cause of mortality.

My friend had sudden pre-eclampsia at 36 weeks (no symptoms eating breakfast, couldn’t stand mid morning) and had been blue-lighted in for C-section by lunchtime. Not overweight, no high BP or protein in urine, age early 30s. She is an anaesthetist so wasn’t unaware of condition.

Chances are you will be fine if you push back your induction. However if you could study 1000 women exactly like you, what you are saying is that you know for sure that overall the outcome for all those women and children would be better to wait, the obstetrician is saying on balance they think that on average induction now is safer.