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.

@Musmerian

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.

I’m always surprised at the people who have blind faith in the medical opinions of total strangers on the internet. And at the people on the internet who are prepared to offer the advice having no knowledge either of the medical history of the individual or the possible outcomes of the condition.

I think this is an unfair point @viques. A lot of posters on this thread (me included) are simply sharing our experiences and encouraging the OP to listen to her medical professionals that are advising her. Most of us on here are not trying to advise. If the OP didn’t want “strangers” commenting, giving their opinions and sharing their stories then she wouldn’t have started this thread surely?

Although re-reading your post following that quote. Your point was completely fair sorry!

Is there a way that the doctor could have mentioned the risk of stillbirth without you perceiving it as inflammatory? Stillbirth is a risk, and obviously it would be absolutely horrendous, so they have to. I think a lot of doctors may take the "safe route" - in this case induction (and I had an induction that ended up being a c section - so I definitely do not automatically see it as a safe route) but I think that is driven more by the utter disasters that they've all seen rather than a sense of "this is the most convenient option for me".
There is no baby boom, so I can't see why that would be a factor.

Also, saying that someone has "done their homework" when she's talking to a medical professional with actual years of specific training in this precise subject is... Hmm. Yes, the OP has spent a few hours on Google. No, that's not in a million years equivalent to what the doctor knows/has seen. Ultimately, the doctor knows that there is a small, but real, chance that this baby could die due to holding off. And I suspect you don't have to see that happen too many times to err on the side of caution forever. I think people ascribing unpleasant motives to doctors about this sort of thing really need to take a look at themselves. I am not saying their motives are perfect, but I don't believe for one second that any of the medical professionals I came into contact with were pushing an induction because it was convenient to them.

What a thread!! I am truly sorry to the many women on here who have endured such heartbreak and trauma.

OP I am a massive overthinker, have to be informed down to the finest detail and find it exceptionally frustrating when the advice seems to differ depending on who you speak to. So I get that side of things.

However, I do not for one second feel that doctors induce because it is more convenient or any other silly notion. It is in fact much more work for everyone involved to have a woman induced than to allow her to go naturally.

Moreover, I think I can safely say that if I was a medical professional who had seen some of the tragedies experienced by women on this thread then I would also air to the over cautious. Personally I think it is far better to be too cautious than too relaxed when it comes to mums and babies.

Lastly, I would be absolutely livid if my doctor didn't discuss the worst case scenario with me during the decision making process. Not mentioning it is equally preventing you from achieving informed consent.

I do think medical staff are damned if they do and damned if they don't. Mumsnet is full of threads of women who feel they are not getting enough intervention and equally full of threads (more often than not FTMs) resisting intervention. You are absolutely entitled to make your own decisions and if you choose a different path than that which is recommended then that will be your cross to bear. But I do sincerely hope you continue to be composed and polite in your assertiveness. I recongise that being a medical professional does not inherently make you an angel and tossers exist in the same way as they do in any other profession. But my god is their job more testing than ANY other!

Discussing stillbirth risk is very important for informed consent but it needs to be done in a measured way and as part of a discussion where women are shown clear statistics and evidence about exactly how much their risk will be increased, as well as a proper discussion about alternatives and the risks and benefits of those, again backed with evidence and statistics.

Often there are a range of options that need to be discussed. In the Montgomery case the doctor did not discuss different options but just decided what they thought was best and the woman wasn’t given discussion or choice, the court ruled that this is not informed consent.

When I was last pregnant I valued my consultants knowledge and expertise, their job was to use that expertise and knowledge to advise and inform me so I could make the best decisions for myself and my baby. Thankfully I never needed to research or google because they did a proper job of discussing all my options with me, sadly many women get a totally different experience of care.

OP, you are 100% right that there are too many inductions happening unnecessarily nowadays and too many women having them without being informed of risk either way.

I'm glad you have made an informed choice and I hope everything works out well for you.

I get very angry hearing about inductions happening for no reason. Of course, whenever it is justified, inductions can and do save lives- there is no doubt about it. But blind faith in the medical field is foolish.

My friend was coerced into an induction because baby was measuring big and she was 10 days overdue. This was her 3rd baby and she'd been 12 days overdue with her other 2 so she asked to be left for another 2 days. She was refused and was induced on a hormone drip. Unfortunately things went wrong very quickly, baby's heartbeat was dropping, they forced her to push against a not yet fully dilated cervix, she had a terrible cervical tear. Baby was born not breathing and spent a while in NICU. Her baby is unfortunately brain damaged. The forced contractions caused her uterus to rupture but nobody realized that for several hours, whilst she was haemorrhaging internally. Her blood pressure became dangerously low at which point they realized something was terribly wrong, and rushed her to theatre where they found the rupture and had to perform an emergency hysterectomy. And her baby was all of 7lb so not big at all...

Now I am first to admit that such complications are VERY RARE. But the point is that she was induced against her will, her body was clearly not yet ready to go into labour but very likely would have been ready a couple of days later, and most importantly, nobody informed her of any risk of induction whatsoever, only warned her many times that not inducing hugely increases the risk of stillbirth.

So OP is right that there is huge pressure to induce and mention stillbirth- but the risks of induction are not mentioned and induction is presented as risk free.

Every woman should be empowered to make the correct decision for her and her baby- with the right information, because no decision is risk free.

I get very angry hearing about inductions happening for no reason. Of course, whenever it is justified, inductions can and do save lives- there is no doubt about it. But blind faith in the medical field is foolish

Which ones happen for no reason? There are guidelines as to what constitutes an increase risk.

I’m not sure how you know before one is offered whether it’s justified? Having an induction and nothing going wrong doesn’t mean it isn’t justified. Having a precautionary induction is just that.. a precaution to avoid certain risks.

How can someone insert a hormone drip without her consent? She would, at the very least, present her arm for the cannula. Or are you saying she was somehow drugged and it was done whilst she slept?

How can someone insert a hormone drip without her consent? She would, at the very least, present her arm for the cannula. Or are you saying she was somehow drugged and it was done whilst she slept?

The Drs told her that if she doesn't consent to the induction, they are not taking any responsibility for her baby and if anything goes wrong it is not their responsibility. They basically left her with no choice.

Which ones happen for no reason? There are guidelines as to what constitutes an increase risk.

I’m not sure how you know before one is offered whether it’s justified? Having an induction and nothing going wrong doesn’t mean it isn’t justified. Having a precautionary induction is just that.. a precaution to avoid certain risks.

Well I can't talk for other people, although in my own experience, I've been offered induction with 2 of my 3DCs because I was measuring small throughout. In my family we all have "small" babies- between 5 and 6lb so not ridiculously small. So when I was offered induction I asked for a growth scan first, and in both cases they said baby isn't that small, so we can wait... both of mine were 6 and 7lb (at 39 weeks) so that would totally have been a needless induction had I opted to go for it.

My sister was at a different trust and also measuring small. When she asked if the decision could be made according to the growth scan, they said no. She was induced and her baby went into distress so she ended up with a c-section. Baby was 5.5lb so again not too small.

The Drs told her that if she doesn't consent to the induction, they are not taking any responsibility for her baby and if anything goes wrong it is not their responsibility. They basically left her with no choice.

Erm no, they were explaining that legally there would be no repercussions against them in the event of a still birth or similar. It doesn’t make the outcome any less traumatic for your friend of course but she did in fact agree to the procedure.

when I was offered induction I asked for a growth scan first

Offered.. nobody is forcing you like the language in some of your posts suggests, you asked for more details they provided and you had other investigations first.

Id actually explain your feelings to the doctor but apologise to him, think you overreacted.

I'm sure delivery suites are busy enough & under enormous pressure without inducing women 'for no reason'.

My little boys heart stopped 17 years ago today .. he was still born 2 days later at 39 weeks and 4 days!! The only factor they could find was my blood pressure was slightly high and they were monitoring it very closely.

Losing your child in these circumstances is just the worst thing ever.. you have to give birth and leave the hospital empty handed

Your body , your baby your choice, and I respect your decision to make the right one for you ..but please think carefully I wouldnt wish what happened to me on my worst enemy..

Good luck whatever road you choose .. just remember any birth where mum and baby are alive and well after is a good birth.

Pre eclampsia is a serious risk. I think a doctor would be failing their patients to not mention stillbirth as it’s a genuine risk, it’s like getting a diagnosis or going into an operation and they have to say there’s a 2% chance you won’t wake up, or if this goes well 50% of patients are still alive in 5 years.

I’ve never been pressured to induce, quite the other way around with my first being induced at 12 days over after my calling them every day (& I think it was needed) and my second not induced despite my asking, he came at 9 days overdue. some elements of my firsts birth made me concerned going over was increasing the risk levels but they wouldn’t do it.

Eclampsia does not always result in still birth. It can result in a baby deprived of oxygen long enough during delivery, to be damaged for life.

Don't take that risk.

Honestly I would take the advice of the Dr/midwife who has seen you the most over your pregnancy. And please think if something was to happen and you didn't take their advice to induce you'd never forgive yourself

Hi OP. I can understand why you feel you don't have much agency in these decisions, I didn't feel like I had a huge amount of agency in my first birth, which was a long induction (2 weeks late) ending in a forceps delivery. I am currently expecting my second child, and am very much hoping for a natural, straightforward delivery.

But, I have no way of guaranteeing that. And that's something I learnt first time around. I did all the hypnobirthing, raspberry tea, meditations, bought a TENS machine, packed my two piece swimming costume etc etc. But that made it no more likely that I would have an easy experience.
I understand that you can feel 'railroaded' into decisions when it comes to obstetrics, but remember that doctors are there with the ultimate aim of a healthy mum and a healthy baby. Whether you give birth with no drugs in a birthing pool, or with all the drugs on an operating theatre, makes zero difference really, as long as you and the baby are healthy at the end of it.

I think a poster above made a good point. You said that you feel like you are being made to feel like you are a 'vessel' for this baby. I know that feeling, but fundamentally you are a vessel for this baby. You chose that when you became pregnant (assuming it was planned). I understand the loss of control is scary, I really do. But in my experience, you just need to accept that, to a degree, you can't control birth. If the doctors are telling you that an induction at 41 weeks is advisable, then it is advisable. They're not doing it for fun.

Additionally your analogy about a leg amputation to avoid a sprained ankle is missing the point. Obviously amputating a leg to avoid a sprained ankle would be ludicrous, because a sprained ankle isn't that bad. A stillbirth is that bad.

I think you need to think carefully - why exactly are you so reluctant to be induced? Ok it can lead to more intervention, but I know plenty of people who had a straightforward induction. I also know some people who had a spontaneous labour that became difficult and ended in EMCS/forceps etc. There's no way of knowing. Ok you might not get the 'water birth' ideal, if that's what you want, but the point of giving birth is to have a healthy baby, not to have a 'birth experience'. Of course it's preferable to have a straightforward labour, but it's not guaranteed in any case.

As I said, currently expecting no.2 and hoping for an easier time. But if the medical professionals tell me that they advise an induction? I'll accept it, get an epidural, and look forward to meeting my (hopefully) healthy baby. Good luck.

@Tabitha1789 I'm quite shocked by you saying OP is a vessel - no, she is a human being, with her own human rights and desires and risk appetite.

Exactly what are you expecting us "vessels" to sacrifice on the altar of doctors who apparently can do no wrong?

What about women who suffer horribly from double incontinence because their pleas for a caesarean were ignored? Is that just a case of them expecting too much control over the process? Did they sign up for it when they got pregnant?

If hospitals and doctors and midwives truly wanted to lower stillbirth rates they would allow all women to be induced at 39 weeks electively, they would allow elective caesareans without making women jump through hoops. The fact that they don't is because current maternity care is about enforcing compliance to policy - the policy is often not evidence based.

@Alyosha you've completely missed my point. My post was very sympathetic to the OP, speaking as somebody who has experienced a miserable cascade of interventions style induction.

I'm not quite sure what your point about doctors refusing to give elective c-sections is about, of course I don't agree with that.

My point is that fundamentally when you are pregnant you should do everything you can to protect your baby.

Did you cut down on/eliminate alcohol when you were pregnant? Your caffeine? Did you stop smoking if you were a smoker? Did you make sure that you avoided soft cheese, unpasteurised food products? Did you stop taking aspirin and ibuprofen? Yes? Ok, then why on earth would you refuse an induction when trained, experienced medical professionals tell you that you had high blood pressure and were at risk of pre-eclampsia, a potentially fatal disorder to both mother and baby?

@2bazookas

Eclampsia does not always result in still birth. It can result in a baby deprived of oxygen long enough during delivery, to be damaged for life.

Don't take that risk.

Not to mention a catastrophic, life threatening stroke for the pregnant woman.

@Tabitha1789 - you quite literally said that women are just vessels for their foetuses.

My point is that sometimes doctors are wrong; sometimes the interventions they suggest harm both the mother and the baby. No one should have blind faith in the medical professionals looking after them.

And that treating women like vessels directly leads to avoidable harm and deaths in maternity care.

Just look at the US, where they are trying to criminalise (and sometimes succeeding) the list of harmful and not-so-harmful behaviours you mention. Women are not treated as patients but as a "wrapper" for their baby, that is subordinate to the needs of the foetus. The US's terrible outcomes show what a dangerous road this is to go down.

@viques don't be ridiculous, who cares about the health and needs of the mother? Certainly not most people on this thread!

Hmm, she said "are a vessel" didn't she, not are just a vessel