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.

@Cinderellashoes

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.

I know. I’m going to have to hide this thread. It’s incredibly upsetting.

Doctors don’t induce for the bloody fun of it do they? They don’t think ‘ooh I know I’ll induce some randomer today, spice my shift up!’ They do it to keep the mother and baby alive. What possible reason do you have for refusing?! They’ve said you need it, you need it. I hope you see sense and I too am going to hide the thread. I don’t know why you’re playing Russian roulette Op. so so frustrating.

@jezza1234

I don’t get it
You aren’t exactly being induced at 37 weeks or even before that where perhaps I could understand more concern on this specific instance

The thing about it is either you ignore and refuse and

• and have a healthy baby after going into labour naturally.
• go into labour and have serious problems : you or the baby are very unwell possibly fatally so
• you accept their advice and expert opinion and have your baby a bit earlier than you wanted but based on clinical and judgment. Hopefully all will be fine.

The fact that the middle one is a possibility would make my decision very easy.
I have been induced with all my three children. I didn’t care. I just wanted them here safely and to get through it

You are coming across as argumentative and when all these people are doing is trying to get your baby born safely for the both of you seem ungrateful and unappreciative

Op we all understand where you’re coming from, even if we don’t agree your position. Google is not a great tool for you, if you feel the doctors aren’t clear, then take a further discussion. They cannot quantify your specific risks there is no way to predict that. So you need to think what you’re asking.

You seem to think if you test or show symptoms you’ll go and get induced. Which totally and utterly ignores the fact that pre eclampsia can come on suddenly, and after you’ve done that days test, and be totally symptomless. This is the risk you face.

You test, it’s fine, no symptoms, you don’t plan to test till the next day, bp is the same, you go about your business, and at some point after that test you develop pre eclampsia, with no symptoms initially and you’ve no idea you have developed pre eclampsia . Then your risks are very very high of a terrible outcome. This is what the doctors are trying to avoid and rhey cannot tell you if it will happen or not.

Yes you may need an intervention if you’re induced. But you also may need that anyway. Again. No one can predict that for you. You maybe asking the impossible. You habe been clearly told the risks and why they wish to induce. They cannot tell you more than this.

As another person induced with high blood pressure that developed into pre-eclampsia very suddenly/quickly at 39 weeks, I find it utterly insane that you aren't taking medical advice and listening.

You are weighing up the risk of a stillborn baby against your health (prolapse/incontinence/infection). I think your priorities are skewed here OP.

Studies have been published since 2008 that detail the link between stillbirth and high blood pressure without pre-eclampsia - it was highly appropriate that this was called out to you.

You have a medicated bp condition that is still high now.

High Bp without pre-eclampsia recommends induction from 37 weeks onwards.

It's a difficult thread to read and as such this is a difficult comment to write but, you seem you be prioritising yourself in relation to your outcomes from induction over the risk to your baby's survival in not proceeding.

Regardless of the conviction of the opinion that you hold, it's not a risk I would gamble with. Information and advice can be at times contradictory, I understand. But I'd feel safer with a planned induction that 'watchful waiting' with a high blood pressure like yours.

Hope whatever you decide it all works out well.

Wow. Imagine being so self centered that you think you know more than an obstetrician who has probably 10+ years of medical training plus experience on the wards and in theatre. Just wow.

Go ahead and do what you want as you know best. My best friend and baby would have died if she got the home birth she begged and pleaded for. Thankfully her husband saw sense and finally convinced her to go to hospital.

I don't think they've done anything wrong
They've given you there medical opinion and have to say what the risks are if not induced 🤷‍♀️
I was induced at 35 weeks for pre eclampsia and she induction was very very straightforward. 2 pessaries. 3 hour labour. Baby absolutely fine . No assisted delivery or section needed.

Imo the risk of still birth would outweigh the higher chance induction gives of medical intervention 🤷‍♀️

Op is this your first child? Is it fear that’s making you react as you are, and which is causing your anger? Are you scared.?

I'm now 31+4 weeks with my second and if a doctor ever says they recommend for induction for my baby and me I'll say yes straight away

I have never been induced, but my second baby was born critically ill. He has a condition that is almost impossible to detect antenatally but there were a few small ‘warning signs’ that something was wrong. Each sign was practically nothing on its own and I’m sure the research would have shown a tiny risk of something being wrong.

I was fortunate to have a doctor who reviewed what was going on in this pregnancy compared with my previous pregnancy and medical history. He recommended a section at 39 weeks. I followed this advice and have always been grateful for it because it allowed my son to be born in the best possible condition for the major surgery that followed. He would have struggled with a natural birth and the outcome could have been very different (he is three and doing well now).

Doctors advice is about so much more than research and statistics, it’s about how that interacts with each woman and their pregnancy / medical history.

I spent months in NICU after my son’s birth and it really opened my eyes to how risky being born is for babies.

Op your an idiot. I spent 7 weeks in hospital with high bp just to get me to 38 weeks and eventually was induced. I had oedema but didnt get protein until 38 weeks
The lady in the next beds baby died due to PE , another was in a different hospital with kidney damage while her baby was in an incubator again due to PE.

People are being quite unkind; doctors are not gods who never make mistakes. Indeed, many hospitals don't follow guidelines and cause avoidable harm. Not a huge amount of respect on this thread for women's autonomy - OP is not being selfish or awful or unpleasant just because she has declined intervention.

@jezza1234 It's a tough decision to make, but there is some good evidence that elective induction at 39 weeks actually reduces risks of caesarean. I'd also have a think about c-section vs. induction. I hope everything works out for you.

All that matters is that you end up with a healthy baby. At 39 plus weeks the baby is safer out than in.
If a Dr advises something that is safer for your baby, you do it.
Are you one of these “natural is best” people?!

Having lost a daughter through still birth where there were no obvious issues I would follow the medical advice given to you.

When the consultant told me they wished to induce I accepted it immediately. What he couldn’t have known, but was weighing the risks up for happening was the very next day I developed pre eclampsia suddenly and with no symptoms.

If I’d not already been in hospital my daughter potentially would not have been born healthy , or even alive, and instead of me making a full recovery it would have been a huge risk to my life and I could have had life changing impacts if I’d survived. He made a decision and playing the odds and I trusted his judgment one hundred percent. No way would I have been sitting googling and arguing and ignoring. If I had it would likely have cost me and my daughter.

They don’t “induce induce induce” they do it when they see the risk to,life

[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]
www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.115.06752

www.ajog.org/article/S0002-9378(13)01337-9/fulltext

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

OP you are getting a bit of a pasting here , for what it’s worth I understand that need to be in control , to have all the facts , to be sure . I also struggled with feeling that I was losing control. You don’t say if this is your first pregnancy but one of the hardest lessons I have learnt in my years of parenthood is that sometimes ( frequently in fact) you just can’t control everything , sometimes no amount of evidence based research will make you feel in control , sometimes you have to trust other people and many times in parenthood you have to cross your fingers and just go for it.

Your medical team want the best outcome for you and your baby, there doesn’t seem to be anything in their advice which has been negligent, Obstetricians are known for being cautious, but wouldn’t you rather that than they let you go home and the worst happened ?

OP, reading your post has actually made me quite angry as it looks like you are putting yourself first rather than your baby.
You are talking about induction and risks of instrumental delivery-you do know that there is always a risk of instrumental delivery no matter what? I would in a heart beat prefer having an episiotomy/forceps and deal with the recovery from it but have a healthy baby in my hands!
You have a responsibility for this unborn child and while we all want to have control over our birth as much as possible, when there is even a minimal risk that your babies life can be at risk nothing else matters!
I would go with the medical advice because it’s just not worth the risk.

My best advice would be to learn to “go into battle” for your child. I had to do this even before he was conceived because it was a long road. But you have to fight for their health and well-being and put it above your own. You are prioritising yourself wanting a natural vb over your baby who needs to be out, now. It’s understandable, even excusable but it isn’t what a good mummy does. Fight for your baby, at the expense of yourself.

I can see both sides to be honest. The thing is women are entitled to a balanced discussion about all their options and clear unbiased information presented them, the risks and benefits of each choice discussed (eg there are risks associated with induction as well)

Unfortunately this is not often the case and it seems very specific to women’s healthcare, particularly pregnancy and childbirth. Look at the Montgomery case. Also look at how varied different hospitals are with their approaches. My local hospital advises induction 7 days past due date, another hospital up the road it’s not until 12 days. One will offer an elective c-section if you’ve had a previous caesarean, the other doesn’t see it as a valid enough reason alone. When you get great variation between different trusts, hospitals and doctors about what is the best thing to do, you realise how important it is to have discussions with women as individuals about their options.

To the increasingly angry respondents: I’ve already said that I’m following the obstetrician’s advice. I’m already booked in for an induction in just over a week. Obstetricians themselves have said that they are comfortable with my BP and do not identify it as posing a risk to the baby - they are concerned about pre-eclampsia.

My issue was the overplaying of the risk of stillbirth (which is very small, as confirmed by the obstetrician today and the studies highlighted in this thread - the risk rises from 0.5% to 1% at 41 weeks, and is much the same as non-hypertensive women before that point).

I am also highlighting the issue of the increasing use of inductions without strong evidence - something which is also acknowledged by many obstetricians, including my own at various points and others in this thread.

I should also add that research shows potential negative outcomes for baby from induction: should these risks not have been highlighted at the same time?

Neonatal jaundice
Low fetal heart rate
Neonatal retinal haemorrhage
Neonatal seizures
Brain damage due to oxygen deprivation
Low apgar scores
Premature Ventricular Contractions (a type of abnormal heart rhythm)
Fetal death

As I have said - if my doctor told me I needed an induction urgently today, and explained why, I would do it. But each time I’ve been told that I’m on track for an induction and I’ve asked why it’s needed, I’ve been told it’s broadly recommended but not something I need to do immediately, in my particular case.

I think that the strength of emotion in this thread is exactly the issue I’m struggling with - of course I want to do what’s best for me and my baby, but where there is ambiguity about what that means, doctors and the medical profession should be clear about it.

Ok that was a drip feed op. Of epic proportions. Why didn’t you say you’re hooked in for an induction and rhey don’t wish to induce earlier. What’s the point of this?

You should be taking the advice of medical professionals. Because you refuse to they are telling you the possible consequences.

@thenameshastings agree with your post and it must be so hard for hospitals to create these policies because as you say every woman's case is different hence theres no clear 'cut off' date for induction. They probably do need to look at standardising things across trusts.

But equally I don't see any indication that OP wasn't treated like an individual?