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.

Dd's bp was increasing in the last week of pregnancy. She was prescribed medication and regular mocitoring.She went for her routine appointment and they asked her to come in to be induced even though BP was relatively stable. By afternoon she had pre eclampsia. She was well and baby was happy and no indication that things were going to change rapidly. I'd say if you have been advised to be induced you should follow medical advice.

@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.

Ok so you do realise that preclampsia comes in stages right? The protein in the urine is a late sign. Your BP readings suggest it might only be a matter of time so the consultant wants to plan

The doctors are trying to minimise your risks OP. You sound like ridiculously hard work. You have zero medical knowledge and doctors must feel frustrated by you. You’re full term, stop being difficult with people that want the best outcome for you and your baby.

You ARE increasing the risk of your baby being stillborn.

Just because you think the risk is overall still low enough that you’re happy with it doesn’t change that, and doctors aren’t going to hide facts from you.

And I don’t mean to scare you but I had silent preclampsia - no high bp, no protein. I was already on blood thinners and aspirin due to another condition and demanded an induction which probably saved both of our lives. The placenta was riddled with clots - my consultant said it’s something they usually only see in severe preclampsia.

[quote Alyosha]@viques don't be ridiculous, who cares about the health and needs of the mother? Certainly not most people on this thread![/quote]
I think most posters care. There are few things worse for your mental health than losing a child.

For those saying there are lots of unnecessary inductions. I suspect it is difficult to be sure as a medical trial would be unethical.

However, if the risk of still birth is 1 in 200, that suggests 200 inductions to save 1 baby. You could say 199 of those inductions were unnecessary. The trick is knowing which.

Ok so you do realise that preclampsia comes in stages right? The protein in the urine is a late sign. Your BP readings suggest it might only be a matter of time so the consultant wants to plan
I spent 6 weeks with lower bp between 190 and 105, all of those in hospital being monitored everyday to get me at 38 weeks. Got to 38 weeks and it was decided not to induce yet as i was not ready. The 2 days later my bp shot up to 125 and i finally got protein in my urine and i was induced .
As i said above being in hospital that long i saw women come and go including sadly someone who lost their baby to PE , someone elses BP was permantly high after the birth and another with kidney damage. Its not just the babies life that is danger it is also the mothers!

@Mishmased thank you x

@frasersmummy much love to you and your little boy

Hmm from past experience I would take on board medical advice. I had borderline high b.p for the duration of my pregnancy never any protein or anything then pre eclampsia literally appeared overnight protein ++++ and bp through the roof. I was hoping for a Vbac but ended up having a csection as sweep failed. I don’t regret any of it as both me and my baby are here safe and sound.

One of the Mothers I was looking after in Labour had a seizure,a massive one.She had had slightly raised BP,no other problems.Pre-eclampsia is a killer,it can happen suddenly.

Because it happened in hospital a Medical Team were on hand and she was safely delivered.It was one of the scariest things that happened to me as a Midwife.So easily could have lost the Mother and the baby.

OP,please listen to the Doctors and stop doing your own research,no good will come of it.

OP I know three women who have had stillbirths. Two of them were absolutely militant about their right to the birth they wanted, refused all doctor’s suggestions and pleadings to be induced. One of the women documented all her arguments with doctors on a birth forum I was on. Everyone was cheering her on (it was very pro natural birth and home birth). I knew her through another person so I know that the baby was stillborn. But that was never mentioned in the natural birth forum, it was all hush hush hidden away out of respect. But it doesn’t present a true picture to other mothers who would be reading her story later and thinking yes this is me I’m doing the right thing. And they never get to find out the ending.

I ended up having an elective caesarean due to high BP and gestational diabetes and a baby that hadn’t descended into my pelvis. Was there a different way of doing it? Frankly I don’t give a shit as I got my healthy baby at the end of it, the same baby that would have been put in my arms no matter what I did to get her there.

I'd be following obstetricians advice, I wouldn't feel comfortable waiting with a BP as high as yours.

Another poster suggested they are doing it to try to manage workload related to the "baby boom". 1) there is no evidence of a lockdown-related baby boom and 2) induction requires more medical staff than vaginal birth, not less.

That was meant to say than normal birth, not vaginal!

A lot of survivor bias with induction stories - “they forced me to be induced and baby would have been fine anyway! It was unnecessary!”

But as a doctor, I’ve seen many many stillbirths. Yes the overall risk is still low, but it happens. And it really really does happen. Pregnancies can go from being fine one day to gone the next, and doctors understandable massively err on the side of caution for this. That means more women get induced than necessary, whose babies would have probably been fine anyway. But there is no way of telling before which ones will or which ones won’t.

It may only be a risk if 3/1000 or whatever, but the average hospital unit will see about 4000- 5000 births a a year, so that’s upto 15 still births a year in a local unit. One + a month. Enough to make the doctor want to prioritise getting baby here safely.

@Alyosha ok, you are completely misquoting me now. I didn’t say ‘just’ a vessel. Also your point about making it illegal to have caffeine/alcohol when pregnant - not sure how that’s relevant and I think that’s ludicrous, obviously. I’m not suggesting we live in Gilead.
The point I am making - for the final time - is that when you are pregnant you should do what you can to protect your baby, just as you should look after your child when it’s born. You don’t leave a young child alone in the house because you have other commitments, and then complain when questioned ‘what?! Do people ONLY think I’m a mother?!’
No of course not. But you have a responsibility. there is no way I would refuse induction if I was at risk of pre eclampsia. It’s too big a risk.
Anyway that’s my last point. It’s up to the OP she can do what she likes of course. But if she wants to maximise chances of a healthy baby she should follow medical advice.

@Tabitha1789 it's illegal to leave your child at home, it's not illegal to drink or smoke in pregnancy. That's because during pregnancy the woman's rights are paramount. My point is that by elevating the needs of the foetus over the needs of the mother we do nothing to improve maternity care for either.

There's a logical disconnect by pointing out an illegal act and equating it to a legal one - it sounds like you do think smoking/drinking should beer criminalised in pregnancy!

My second point is that no one should blindly follow medical advice. HCPs aren't gods who never make mistakes. Read the latest Mmbrace report for live examples of where women have been badly let down.

@alyosha it’s not just that doctors can make mistakes, it’s that often they don’t explain all the viable options and let women decide. Often there will be several different pathways with different risks that should be discussed but only one option is presented to women. I ended up with an induction and horrible instrumental delivery which has left me with lasting pain and damage. In hindsight a proper consultation and weighing up risks in pregnancy and I would have pushed for an ELCS in my situation, but this was not mentioned or discussed. Thankfully I’ve had better care in subsequent pregnancies but as I’ve said in PPs all too often there’s not real discussion about different options and the different risks but a ‘this is what is going to happen to you because I say so’ approach. Hopefully since the Montgomery ruling more women will be giving proper informed consent to their care.

But they are right.. I find your reaction very strange but then everyone is different.

OP would it be better to look at the details of induction and what parts you would be willing to consent to under what circumstances?

For example in my second pregnancy I was open to a drip and an epidural if my waters went early again. I wasn't willing to have a pessary and then be left to labour in a bay on antenatal. What options are you actually being given here?

@Alyosha ok please stop misquoting me. Of course I don’t think smoking/drinking should be made illegal. I never said that. I have the odd drink in pregnancy so under your logic I should lock myself up.
Anyway you are completely misunderstanding me but I’m bowing out now. I made a very sympathetic post to the OP, speaking as somebody who has experienced a horrible induction. Anyway just leave me alone please.

FWIW, I've had two spontaneous labours that ended in instrumental delivery (no injuries/damage with either), and one induction where the baby pretty much dropped out.

You're over 39 weeks, OP. I do believe babies on the whole don't do quite as well when born before 39 weeks than after (my own 38-weeker - not the induced birth - wasn't as ready for the world as the two 41-weekers were) but at that stage we're not talking about prematurity, and the effects of pre-eclampsia aren't particularly conducive to a baby doing well either.

I can't quite understand why (in your own account) you've been so combative. 'Stillbirth' is a dreadful word, but how much less dreadful than the event itself?

Scrunchies' post above is good.

Look on google scholar for clinical studies on pregnancy and hypertension.

It seems to be an important distinction as to when you developed hypertension, was it before pregnancy, before 20th week of pregnancy or more recently.

The chronic risk seems to be primarily around the higher blood pressure damaging the blood supply in the placenta which reduces the amount of nutrients and oxygen that can transfer across to the fetus. The acute risk is a rupture in a blood vessel causing immediate placental failure.

The biggest problem in all of this, which is what seems to make most of the doctors nervous about waiting is that in most cases they dont yet understand why hypertension occurs and why and when the pattern of failure starts.

If I were you I would induce (I have had 4 inductions myself, all ending in unremarkable vaginal deliveries with healthy baby and Mum) but if you choose not to, I would start testing your urine for protein every 4 hours and get up at night too.

I found this quote
Hypertensive disorders during pregnancy are the second leading cause, after embolism, of maternal mortality in the United States, accounting for almost 15 percent of such deaths. Hypertensive disorders occur in 6%–8% percent of pregnancies and contribute significantly to still‐births and neonatal morbidity and mortality. Expectant mothers with hypertension are predisposed to the development of potentially lethal complications, notably abruptio placentae, disseminated intravascular coagulation, cerebral hemorrhage, hepatic failure, and acute renal failure. The etiology of most cases of hypertension during pregnancy, particularly pre‐eclampsia, remains unknown.

Working Group Report on High Blood Pressure in Pregnancy
Marvin Moser MD
First published: 31 May 2007 doi.org/10.1111/j.1524-6175.2001.00458.x

My point is that by elevating the needs of the foetus over the needs of the mother we do nothing to improve maternity care for either.

But your point is moot since nobody is elevating the needs of the baby over the needs of the mother. The mother is given options. If a mother feels ‘guilt tripped’ into having a procedure then it’s clear that they do in fact care about their unborn child enough to try and mitigate anything awful happening to them. If they decline that’s their wish. Why do you even think the NHS has an ‘increased monitoring’ procedure in place for 42+ weeks? It’s for women who want to let nature take its course over and above the 42 week standard gestation deemed safe here.

Don’t act like women are strapped down and forced against their will to have induced contractions. They tell you how bad it can be, that is all, it’s not about blind trust you just trust them otherwise you wouldn’t even be there under their care.

Giving more control to the woman is generally a good thing but a lot of people myself included rely upon and trust in the judgement medical professionals. That's not to say I wouldn't speak up if I thought something was wrong. I've just been in a situation where a doctor has explained different options and then asked me what I wanted to do. While that gave me more agency I found it quite stressful as I had no clue which to choose.