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.

I had high BP at 41 weeks, waters broke naturally and they took over two days to get me on the drip as I was an unexpected induction, whilst labouring at night alone for 2 nights with monitoring every 4 hours and a very high dose of calcium channel blockers.

we both ended up with sepsis as they had refused to give me antibiotics in labour so safe to say I don't trust midwives much anymore but if the problem had come up earlier in my pregnancy I d have taken a prebooked induction rather than been left to go naturally especially during covid when they just don't have the time to help you if it's an unexpected rush of people.

I should add that I’m absolutely in favour of doing whatever needs to be done if either myself or my baby were in danger. If that were the case, I would induce in a heartbeat. But each time I asked the doctors to explain why I should induce now, and what exactly the risks are in my case, they changed their advice!! So how am I meant to react to that? That says to me that there is a knee-jerk reaction to induce, without strong evidence.

And yes of course induction will solve the problem of high bp, but what about the increased likelihood of instrumental delivery, which can lead to increased issues around incontinence and prolapse? What about the increased likelihood of c-section and the increased chance of infection, not to mention recovery times? These are factors that pregnant women have to consider, but obstetricians generally don’t because once you and your baby leave the hospital that’s their job done.

I think it’s to manage the pandemic baby boom workload

There is no baby boom going on just now though.

www.theguardian.com/commentisfree/2020/jun/14/no-baby-boom-in-the-time-of-corona

Though they are predicting one to come in a year or two after restrictions are lifted, but who knows, they wrongly predicted one during lockdown:
www.thetimes.co.uk/article/experts-predict-baby-boom-to-eclipse-postwar-era-50rlwqmrm
--
To respond to the OP, it sounds like frustration at having to deal with different doctors as you made your case to one and then another comes along with no knowledge of that discussion and puts you back at the beginning.
Personally, though I think doctors and nurses have your best interests at heart and are cautious so will not want to do anything with a higher risk even if it's just slight. As for the language they use it must be hard from their POV as you wouldn't want them to gloss over things and not mention the risks.

Sorry that everyone is missing your point OP. When it comes to labour unfortunately the medical profession seems to forget that you should have an active part in the decision making. When I was in labour I was told I would go on a drop, told I would do this. Once I reminded them that they needed informed consent, not coerced consent, things changed.

While I agree that they will be trying to help, the language medical professionals use when it comes to labouring women is often completely wrong. It's a process that involves the woman - it's not done to the woman.

Use the BRAIN acronym at all times and ask them for scenarios for everything so you have informed consent to make decisions.

@MimiDaisy11 Ok, I stand corrected on the baby boom, but I do wonder if the fact the NHS is under more pressure now due to Covid (and chronic underfunding) is leading to greater pressure on women to be induced? It feels like maternity care in this country is a bit of a conveyer belt where you're just expected to go along with the process and not question anything.

@Mummyof2Terrors thank you

Ask about your Bishop score and whether there's an option of elective section. Also whether section would be an option if the induction isn't going smoothly. That just means that you have more options to compare and contrast the different risks.

I do agree that staff are often very quick to suggest induction and often in cases where it isn't really warranted, and seem to gloss over the risks of induction as though they don't exist which clearly isn't the case. I did see though the other day that expectant management doesn't reduce stillbirth half as much as you would like it to. In your position I'd probably also want to know what it is they are looking for. For example is pre-eclampsia detectable through blood pressure or should there be other signs as well? Having read some of the historical memoir type stories (e.g. Call the midwife, the original one not the TV programme) the descriptions of eclampsia back in the 60s where it didn't have a good detection rate were absolutely horrific and not something I'd want to mess around with wondering if I had or not, if there's a lower risk alternative. If pre-eclampsia does develop into eclampsia it tends to be fatal for the mother as well, so really not something to wait and see around. But if you don't have pre-eclampsia, then there's no reason to induce. That's why I'd want to know what they are looking for and whether blood pressure is the only sign.

It's not fully informing OP though is it. Saying you're massively increasing the risk of stillbirth when she doesn't even have pre-eclampsia is misleading and if OP didn't have accurate knowledge herself could lead her to making different decisions.

Induction does carry risks of its own (none of which I've ever had mentioned by midwives/consultants until I've specifically asked about them).

OP it's your body and your baby. I don't imagine that anyone else cares about them as much as you do. Lots of people will offer advice.

Decisions regarding your care are yours to make. They can be as informed, or not, as you like. It's you that needs to be able to "own" the decisions and consequences afterwards (I mean this in a positive way; I've gone against consultants advice in 2 pregnancies and don't regret either decision - they led to better births for me and no problems for either DS's)

There is a risk. It’s a smal risk. But the doctor alerting you to it is not inflammatory. I think you need to consider carefully the training and experience the doctor has and hold it in slightly higher regard than your own google search

Why are you being so antagonistic towards advice given to you for health reasons? I wouldn't think they're throwing in stillbirth to be inflammatory, the doctors presumably have deemed a risk of this.

@BertieBotts absolutely agree with you: I’ve asked about other signs of pre-eclampsia, and am getting blood tests, checking urine for protein daily and am aware of other symptoms (headache, flashing lights, stomach pain etc). I do all this as well as taking my bp at home twice a day. I am following medical advice 100%. If any signs of pre-eclampsia emerge, I will induce. I just want this to be my decision, not a pre-emptive step taken just in case.

I haven't read the whole thread but I will give you my experience. I too hated the thought of induction. I thought it was a 'go to' for every maternity unit. I had high blood pressure with my first, no protein in my urine just a slow steady rise! I resisted induction until the words 'dead baby' were said to me by a consultant. I agreed to be induced but asked for a hefty sweep before hand that did get the ball rolling. My birth was horrific and my baby was very poorly indeed. I blamed myself for years for not inducing when they asked me to. I'm not writing this to scare you I'm writing it so you have a balanced view. I had preeclampsia with only high blood pressure and my baby and I nearly died. I induced with my second and it was by far the better birth with a healthy happy baby at the end instead of the resus team. Getting your baby put now solves the blood pressure issue. Yes you may have a c section, yes you may not have the best experience but the main aim is to get you both through it alive. I'm sorry if that sounds dramatic but it's true. Good luck.

High blood pressure is one of the leading causes of maternal death and can materially contribute to severe ischaemia/brain injury to the baby. The doctors have a duty to inform you of the risks and developing rapid onset pre eclampsia and stillbirth is one of those risks.

I may not have been typical op. But there is no indication you will be either.

Pre eclampsia can come on very suddenly. I had no idea at all I had it. It was picked up on a urine test. I was being induced for a variety of reasons, high blood pressure was just one, but they induced gave the pessary, I was not in Labour the next morning and the mid wife then told me I had pre eclampsia, there was absolutely no way for me to have known, it was sudden with no symptoms,

You’re pretty much full term so when multiple medical staff working in your interests say induce they are not saying it for any reason other than caring for you and your babies well fare.

Preeclampsia can come on in a matter of hours with absolutely no symptoms. High blood pressure is the first sign. Other than urine testing there is no way for you to “monitor symptoms” and be sure. None at all.

Reading your posts it does come across that you don’t really understand how quickly it can occur, and that it can occur with no symotoms, and you’re already showing the first indications.

Better to know ALL of the potential risks.

Personally, I'd listen to the doctor's advice. If you'd prefer not to be induced, you can also elect for a section. Having had an (emergency) c-section, I'd rather go for a section than induction.

@jezza1234 but it seems like it is your decision? Presumably you're not being induced right now so they've told you all the risks and you've decided accordingly. Their pre-emptive step was to inform you of the risks. Job done.

Those who have blind faith in the medical profession in obstetrics surprise me. So much contradictory information. I was 42 + 3 with my third birth and thank my lucky stars I was using independent midwives who just kept a close eye but never suggested induction. OP sounds thoughtful and like she’s done her homework so she just needs to stick to her guns and be clear.

OP - I agree 100% that the doctor came at it wrong. All women have the right to make their own healthcare decisions, even if it leads to poor outcomes.

However, I would challenge your assertion that high blood pressure even in the absence of pre-eclampsia doesn't lead to an increased risk in stillbirth - it does. Depending on your individual circumstances, the increase in risk may be small in absolute terms, but it still exists.

Having said that, inductions are increasing for a number of reasons, not all of them evidence based. I wouldn't automatically assume that a doctor or midwife was giving me up to date, correct information on the risks/benefits of early induction - despite the fact that the Saving Babies Lives Bundle 2.0 has come out very strongly against induction pre-39 weeks except in cases of true IUGR/other major issues this is still being pushed on women for everything from small for gestational age babies (which, thanks to the awful GAP GROW charts, could be a 6.5lb+ baby!) to "big babies" - which is also completely against NICE guidance and all the evidence we have.

@Bluntness100 - I hear what you’re saying, but as I’ve said I am monitoring my urine daily, the doctors are doing blood tests, I have no symptoms, and the doctors are happy that I don’t have pre-eclampsia. Only 10-25% of people with high bp get pre-eclampsia. Like I’ve said, any sign of pre-eclampsia and I would get an induction.

OP are you a doctor? Or a midwife? If not if you don't want to listen to those that have undergone vigorous training for years I suggest you get your solicitor to knock you up a waver of responsibility signed by you for anyone who is involved in your treatment at any time so that they are safe in the knowledge that any decision you make that is in direct conflict to their educated and trained opinion will not mean that they will be sued by you if anything ( God forbid) happens to you or your baby.
After all no one would want you to be deprived of your decision or opinion even if it is an ill informed one.

@Alyosha really appreciate your message - could you point me towards research that shows high bp leads to an increase in stillbirths?

This is a genuine question - I’d like to better understand the risks so I can make an informed decision.

I was induced at 38 weeks with my second. Not BP or pre eclampsia but head and abdomen measuring big, plus much smaller older sib needed a ventouse in her spontaneous labour at the same gestation.

The induction (as I just needed the gel pessary) followed an almost identical pattern to the spontaneous delivery except I got to do the dilation bit on a Swiss ball/bed/pacing my hospital room rather than in the car... Still had a bit of a rush to delivery jumping the queue, still needed the ventouse at almost the same point in the birth canal but no meconium and no cord wrapped around foot...

I'm not convinced that induction causes the increase in instrumental delivery but that situations where instrumental delivery is more likely tend to trigger an induction...

Op, ultimately you need to do what you personally feel is right. However I would not be angry at the doctors and nurses. They are trying to help you and they need to clearly articulate the risks to you. And yes this includes still birth sadly.

However you are fully within your rights to reject the medical teams advice, as you are doing, and deliver as you wish, when you wish. It is your decision.

I had pre eclampsia and my son was stillborn. Don’t take any risks and do as they say. The cost is too high.

@Bluntness100

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?

This x 100. Excellently put Bluntness (sorry for your experience).