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'd go with doctors advice based on years of training, education and research over google.

[quote jezza1234]@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.[/quote]
journals.lww.com/greenjournal/Fulltext/2015/03000/Risk_of_Fetal_Death_With_Preeclampsia.16.aspx
www.ghspjournal.org/content/3/4/525

@jezza1234 of course!

www.who.int/bulletin/volumes/96/8/18-208447/en/

This is a Chinese study, and reinforces that the risk is higher but not "high" as it were.

www.ajog.org/article/S0002-9378(13)01337-9/fulltext
This is a review rather than a trial, I think, but backs up the risk of chronic hypertension.

This actually suggests there isn't a link; caveat; based on closer monitoring and more interventions for hypertensive women (like...getting induced at 39 weeks - sorry!). pubmed.ncbi.nlm.nih.gov/18444213/

I think the OP is thinking there will be a period of time when it is clear that she is becoming at risk and will then decide to accept the induction plan. What I would want to be certain of in her shoes is how long is that period? Once it's certain an induction is required, are you already in a danger zone or is there still a decent amount of time to change the plan?

OP a brief search dug up this quite comprehensive study published by the WHO.

www.who.int/bulletin/volumes/96/8/18-208447/en/

There is a risk, and it is obviously greater when preeclampsia is added to it but why tempt fate? You are considered to be full term from 37 weeks, your baby is fully developed. Ok you are at risk of more intervention but who is to say that you won’t end up getting to 41 weeks and being induced anyway?

Seems that the only thing your doctor has agreed is that it is likely you did not have preeclampsia at that moment in time but it could happen and is more likely for you than a normotensive woman. I think if it were me, I would rather the controlled induction with the luxury of time so that more gentle methods can be tried rather than an emergency situation putting both mother and baby at risk. An induction can still be a positive birthing experience even if it wasn’t your plan.

FWIW I don’t disagree that there seem to be a lot more inductions nowadays.

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!

It isn't remotely comparable. To state the obvious, leg amputation has long term life-changing results, inducing your baby simply means that s/he is born a few days earlier than might otherwise have been the case.

You are making me 😡 by not heeding the expert medical advice.
Regardless of all you have read you are not a medical expert.
My ba y was stillborn at 38 weeks and the loss of your baby is the worse pain to indure and never leaves you.
Heed the advice for the sake of a few days until due date. Things can change suddenly and catastrophically as you are always playing catch up if the baby goes into distress.
Nothing overrides having a healthy precious baby in your arms.
Rather than feeling angry focus on that and all the thorough care you have had to ensure your baby will arrive safely!

OP surely you'd consider the fact that the potential negative outcome from not being induced is so much more terrible than that from being induced, even if it is considerably less likely?

@Nith there are harms associated with inducing pre-39 weeks, which is why NICE & other bodies recommend against it unless there are serious concerns over foetal/maternal wellbeing. It should really be very rare to induce pre-39 weeks but sadly it is not at the moment!

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!

Except in terms of life impact (not literal logic), it's actually more like saying sprained ankles are a great idea because it would prevent 100% of leg amputations

[quote Alyosha]@Nith there are harms associated with inducing pre-39 weeks, which is why NICE & other bodies recommend against it unless there are serious concerns over foetal/maternal wellbeing. It should really be very rare to induce pre-39 weeks but sadly it is not at the moment![/quote]
But still not harms that are comparable with the inevitable harm caused by unnecessary limb amputation, which was the comparator OP used.

Whilst I understand where you are coming g from I got high BP and it was managed with medication and was even discharged from hospital by a trainee consultant I was back in within 6 hours severely ill reduced movement and my urine output became virtually non existant so I was induced. Things can change rapidly with high BP in pregnancy please listen to the doctors on this 1 my husband was told if he hadn't took my back he could have lost us both.

[quote Alyosha]@Nith there are harms associated with inducing pre-39 weeks, which is why NICE & other bodies recommend against it unless there are serious concerns over foetal/maternal wellbeing. It should really be very rare to induce pre-39 weeks but sadly it is not at the moment![/quote]
I have a genuine question about this; what is the potential harm associated with induction?

@Nith not on the whole, no. However, if everyone was induced at 37 weeks there would a big increase in admissions to NICU and an increase in neonatal mortality and morbidity. So for some, the consequences could be very severe.

Induced twice due to High BP (admittedly I had other signs of Pre-E).

In 10 years time you’re never going to even think about the fact you were induced a wee bit early but if something happened to your baby you’d think of it every day for the rest of your life. It just doesn’t matter. Go with the medical opinion.

@LemonadeFromLemons The harms are not from induction per se but from inducing before 39 weeks. Being born at 37-38 weeks is associated with poorer outcomes: www.ncbi.nlm.nih.gov/pmc/articles/PMC5721566/#:~:text=Early%20term%20delivery%20is%20associated,%2Dterm%20delivery%204%E2%80%93%206.

I had an emergency c section and a critically ill baby.
The trauma of that night will never leave DH and I.
And unlike previous posters we were lucky enough to leave hospital with a baby that was alive.

It is I'm sure very frustrating to be given vague information that doesn't seem in proportion to actual risks.
It is also difficult not to be treated as adult capable of analyzing risk and taking informed decisions.

But the doctors they will have seen the impact of the small percentage of cases that do go wrong.
When I believed my dc had died it felt like an endless abyss I was falling in with no possible way out.
I cannot imagine having to live with that grief forever.
I wouldn't fault medical staff for being cautious in trying to prevent stillbirths.

The op is already post 39 weeks.

The key thing about pre eclampsia, as it can come on suddenly with no symptoms, you can test your urine at say 10 am and it’s fine, and by 2pm, your already in the danger zone and you don’t know it. The risks of organ failure, brain damage, stroke, and even death is sadly high and it makes emergency delivery a necessity.

The issue is, you don’t know you have it. Becayse it came on suddenly after your last urine test, and you’ve no symotoms. So you won’t know till the next test the next day. That’s what the docs are trying to avoid.

They are trying to avoid she does a urine test, she is fine, then she develops it suddenly and she doesn’t know as she has no symptoms. Then the risk is very very high indeed.

In OP's position I would choose induction. But she is right to point out that many women are pushed into inductions that aren't backed up by evidence.

Unfortunately, in her case, it actually is backed up by the evidence.

Personally I’d chose induction if that’s what the consultant suggested, hospital don’t want to induce people without needing too, they need the beds the space not you stuck in a hospital for days on end awaiting labour.
It’s not a risk I’d being willing to take, each to their own

You are missing part of the picture OP. It’s not just ‘the majority of high blood pressure cases don’t have negative outcomes’. It’s also the fact that there is no reliable way to predict in advance which women will have the negative outcomes and which won’t. So the known risks of induction are weighed up against the potentially catastrophic risks of not inducing and a recommendation is made.

Mentioning still birth in the context of describing risks is not inflammatory. It is accurate.

I really hope you have a safe delivery and both you and your baby are healthy and well. I think the best way to achieve that outcome is to listen to the recommendations of highly qualified medical team advising you. Severe anger is not a proportionate or rational response. Best wishes

@Alyosha @Haiyaa appreciate the links, thanks - will have a read.

@Mistressinthetulips (And @Haiyaa) Yes appreciate your point about timings - my understanding is that NICE guidelines for pre-eclampsia are induction within 24-48 hours, so urgent but not emergency, although I’m sure there are cases that require emergency action.

For the many other people who are suggesting that I should trust the years of experience of doctors and midwives over Google - I guess my reluctance to do that is that 1) the doctors keep giving me differing information, changing their recommendations when I question them a bit further - so who/what should I believe? 2) I was encouraged to read the research by a doctor to help prepare me for my conversation about delivery - and not just Google, but the actual research that doctors use to make decisions 3) I think it’s really important to understand how doctors arrive at their recommendations, which is to follow guidance from bodies like NICE, who in turn base their guidance on good evidence. If a doctor is basing their recommendations on ‘well we always do it like that’ or ‘it’s trust policy’ or ‘because I say so’ that isn’t good enough for me - and that’s when you get instances of gross misconduct:

www.theguardian.com/society/2020/sep/29/english-hospitals-have-not-learned-lessons-of-past-maternity-scandals

Of course i want what’s best for me
and my child but I feel like I need to be deliberate in understanding what that entails, and why certain action is seen as necessary.

You’re making me really angry actually. You’re looking at studies and what not but the doctors have told YOU that YOU need to be induced based on their knowledge of your medical history. Why are you so against it? The life of my baby would be the most important thing to me.

@EasterBunny21

Induced twice due to High BP (admittedly I had other signs of Pre-E).

In 10 years time you’re never going to even think about the fact you were induced a wee bit early but if something happened to your baby you’d think of it every day for the rest of your life. It just doesn’t matter. Go with the medical opinion.

This absolutely . There is one point to labour and that’s to have a baby. Labour and the process of birth are not an end in themselves, I have three children, one was a diagnosed breech but I went into Labour naturally and they let me try to have a go at delivery , I ended up with an emergency section but I still have very positive memories . Dc2 truly awful pregnancy , high BP, a clot, in and out of hospital and then a forceps delivery . Dc3 high BP at the end and an induction but otherwise no pain relief and mobile until the end and a bit of gas and air .

So , all very different , they are very different children but the experience of parenting them has had nothing to do with their births. It begins with the birth that’s all.

Please listen to the doctors advice OP. I have been in the same position as you and believe me, it was a good job I was induced when I was. In fact, they should have given me an emergency c-section as DS nearly didn’t make it and had to be resuscitated (I don’t mean to worry you but I just want you to know that the risks are real.) They are obviously worried about you as well as your baby.
Go with the advice, and get ready to welcome your baby. Soon hopefully. Good luck