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.

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

I wish the needs of the foetus had been elevated in my case. I wouldn’t have found myself holding a dead baby if they had.

Surely a key need of a mother is to give birth to a child that is alive?

My heart goes out to all the women who had the experience of a still birth on this thread.
The time when the medical staff and myself thought that one of my dc had died was unforgettably horrific.
That it tuned out to be untrue was the single greatest blessing of my life.

Yes woman should be treated with dignity, yes they should be listened to and be given the opportunity for informed consent.
But you choose to keep a pregnancy so you can have a baby. Every else is secondary to that.
Not that it is unimportant but it is surely secondary, not only for their baby's sake but for their sake as well.

@FTengineerM doctors regularly don't give women enough information to facilitate informed consent. And women are regularly threatened with SS referrals for going against medical advice, even though this is something both the RCM and RCOG are clear is not defensible in law. You don't have to be strapped down to be coerced.

The Montgomery judgement, Shrewbury scandal and East Kent scandal - where the hospital is being prosecuted! - shows clearly that women are rarely given enough information to make their own risk judgement. I'm sure many a woman at Shrewsbury and East Kent wished they hadn't just followed medical advice.

@Alyosha whilst I comment that family for using that horrendous experience as a force for good, it is still a rare occurrence.. ’thought to be the first time the watchdog has brought a prosecution over the safety of clinical care’ article referring to the Kent case.

I completely understand your point, but I think it’s a bad idea on the whole for women to wander into antenatal appointments wielding wedMD refusing antenatal care.

If women were given clear proper information at appointments, backed with evidence and statistics and all options explained then I doubt many would resort to webmd or google to try and get more information. Simply being told ‘we’re going to induce you at 38 weeks as it’s the safest option’ isn’t good enough, why does the dr believe this is the safest option? What are the risks of waiting a week longer? What are the risks of the induction itself? Would a planned c-section be preferable? And so on. Often there’s no conversation beyond ‘this is what we are going to do’ and as pointed out often it will differ between doctor, between midwife, between hospital and trust what their actual policies and guidelines are so what one women is being told is happening to her, another woman at the hospital up the road in the same situation is being put down a completely different pathway.

I completely disagree. Shrewbury & Telford & East Kent are not isolated scandals. Remember Stafford hospital? Until very recently JR hospital in Oxford was refusing women ELCS despite it being in NICE guidelines. It's very rare to get to prosecution stage - doesn't mean the experience of either East Kent or Shrewsbury is rare.

Women (and indeed anyone!) should always arm themselves with as much information as possible, understanding that HCPs are only human. Healthcare is a joint decision making process and HCPs often do not bring relevant information to the table - especially in maternity care - again, look at the Montgomery judgement.

You only have to spend a minute on the health forums of this very website to see examples of poor care. No one should be a passive recipient of healthcare.

I agree with you. I was told because I had three episodes of what I thought was low movement I had to be induced otherwise my baby would be stillborn. I heard those words and was shook up, when I asked for more information I was asked by the registrar why I wouldn't want an induction if it could save my baby. I complained to pals. What she failed to explain was early inductions often fail leading to a more medicalised birth. My dd moved every time I came in for monitoring,I had an anterior placenta and was anxious because a pattern of movement was never established. I did have issues with low fluid levels around her picked up at 34 weeks and if I had been told she needed to be delivered immediately as a result of that I would have consented. I am a medical hcp although not a dr but I could better understand the jargon than a layperson and yet I still wasn't told of their concerns.i saw a consultant with regards to the birth of my ds and they explained exactly what prompted the decisions of the drs that looked after me when I was having my dd. It was good to know but why couldn't they have shared this information at the time?

I was treated secondary to the baby and I had remind them that I was a person in their care not just a vessel. Ultimately the needs of both the mother and baby should be considered, noone wants to lose their unborn baby but hcp should give parents as much detailed information as they can so we can make our own judgements not just behave in a patriarchal way that the expectant mother just has to follow. I now am armed with a lot of information and will not be bullied but as a ftm it was a different story.

Op my circumstances were different to yours and of course pre eclampsia is a risk to both the mother and baby. I would ask for a second opinion and see what they say. If they still recommend an induction and you are full term it is worth considering. My post wasn't to highlight that in my own circumstances I knew better than that of drs just that hcp have a duty to explain their actions.

@Ineedaneasteregg

Surely a key need of a mother is to give birth to a child that is alive?

My heart goes out to all the women who had the experience of a still birth on this thread.
The time when the medical staff and myself thought that one of my dc had died was unforgettably horrific.
That it tuned out to be untrue was the single greatest blessing of my life.

Yes woman should be treated with dignity, yes they should be listened to and be given the opportunity for informed consent.
But you choose to keep a pregnancy so you can have a baby. Every else is secondary to that.
Not that it is unimportant but it is surely secondary, not only for their baby's sake but for their sake as well.

And this comment hits the nail absolutely on the head

As people have said I think it is a measure to manage the number of births and to have optimum staffing levels.
Research does show poorer outcomes at weekends and nights, where consultant cover isn't so available. Research also shows increased problems with babies born after 40 weeks.

Although not ideal, and something I would research carefully, induction is generally very safe.

I agree OP

I agree with you OP, i was told on my first midwife appointment that id be induced (my 1st DC and an older IVF mum) but met a few experienced pregnant women who got me to ask questions then I started researching and point blank refused to be induced or have a sweep. I ended up having an EMCS due to other reasons and the consultant said thank God id said no to the inductions the hospital were pressuring me to have.

Its not necessarily for your benefit, often for theirs!

@Alyosha I was quoting a news article about it, I haven’t ever heard of it but I’m miles away so I don’t think that’s indicative of the severity of the incident.

I don’t wholeheartedly trust doctors, I haven’t picked up the last 2 prescriptions for my DC because I didn’t think he needed them, he didn’t it cleared up without it but I’m sure they just did it to get rid of me.. again.

But the things I’m taking him to the doctor for are not possibly life threatening, at all.

I think we’re mostly agreeing, information to help guide choices isn’t ever going to be a bad thing. It should be found from a good source though one which knows your specific circumstances. I referenced wedMD because someone like me, not medically trained at all, can get some general information but I’m not going to know or understand possible links/affects of things like someone who has trained for more than a decade in it. It’s just not possible.

When things are offered it’s on the patient to ask for further information if they’re unsure of what things mean/they don’t understand. If they ask then get a ‘nah it’s safe, don’t worry about it’ then that’s obviously awful.

Inductions are more effort for medical staff, not sure why you think they'd bother pushing it for no reason. Of course they err on the side of caution, no one wants to have to say well we did see some warning signs but thought fuck it. I agree women should be able to make informed decisions themselves, but I think it'd be fair to sign something to say you're going against medical advice. High BP is an early sign of pre-eclampsia, you might not get any others until its severe. Why so against it anyway at full term?

@notagainmummy

As people have said I think it is a measure to manage the number of births and to have optimum staffing levels. Research does show poorer outcomes at weekends and nights, where consultant cover isn't so available. Research also shows increased problems with babies born after 40 weeks.

Although not ideal, and something I would research carefully, induction is generally very safe.

But it doesn't manage numbers, inductions can go on for different periods of time and also its taking up a bed/staff time before it would if someone went into labour naturally and came in when 4cm or whatever.

You're downplaying the risks massively.
Pre eclampsia can not be present at 10am, and be life threatening at 10.30am. It comes on SO quick, and then it's too late.
They're trying to prevent you from developing this. High bp is a risk In itself. Google isn't qualified to tell you what's best for your baby, you are at full term anyway - induction doesn't mean forceps. I've had a "natural" labour that ended in forceps and a baby born not breathing and in ICU, she pulled through by a miracle. And an induction which needed no help and a perfectly straight forward birth with no intervention.
You really need to listen to what they're telling you - inducing you benefits them in NO way whatsoever, but could save you or your baby's life. Why the hell are you fighting this???

Let's hope the op is OK as she hasn't posted for 48 hours.

The OP chose to bow out after being unfairly attacked. This was about the language HCPs use.

The consultant told my husband in labour that if I didn't consent to forceps, there would be absolutely no other options to get the baby out. Coerced consent at it's very very worst. That was to avoid a C-section but left me with a terrible 2nd degree tear. Why do I know this? Because the anethetist was stretched and that was also the reason they didn't bother calling someone for pain relief as they sewed me up for 2 hours unmedicated as I screamed through the process.

If anybody is reading this thinking they have to submit to everything in pregnancy, trust me, they really don't. Due to give birth to second in 12 weeks time and things will be so so different this time. I am not a piece of meat.

And no, I shouldn't just be grateful that things turned out ok. If they'd actually listened to me and followed the rules of consent, I would've had a C Section. Coerced consent is not consent under any circumstances.

@Mummyof2Terrors

The OP chose to bow out after being unfairly attacked. This was about the language HCPs use.

The consultant told my husband in labour that if I didn't consent to forceps, there would be absolutely no other options to get the baby out. Coerced consent at it's very very worst. That was to avoid a C-section but left me with a terrible 2nd degree tear. Why do I know this? Because the anethetist was stretched and that was also the reason they didn't bother calling someone for pain relief as they sewed me up for 2 hours unmedicated as I screamed through the process.

If anybody is reading this thinking they have to submit to everything in pregnancy, trust me, they really don't. Due to give birth to second in 12 weeks time and things will be so so different this time. I am not a piece of meat.

If they didn't have an anaesthetist available then they didn't have one. There possibly were no other options at the time to get baby out if it wasn't coming naturally. Not saying it's right, but what alternative, bearing in mind they didn't have the medical staff for a C section would you expect?

Stretched, not unavailable.

I expect not to be butchered against my freewill and having to endure internal and external stitches without painrelief.

If you walked into a&e with an injury that was bad enough for 2 hours of stitching, would you allow them to do it without the offer of pain relief?

When things are offered it’s on the patient to ask for further information

Isn’t this what the Montgomery case ruled against though? The woman was told she would be induced, the dr knew that due to her circumstances she had a fairly high chance of shoulder dystocia (something like 1 in 10) if vaginal birth was attempted but purposely did not share that information. If there are risks it isn’t necessarily good enough to argue ‘well she didn’t ask so I didn’t share’, it should have been shared as part of an open conversation rather than being on the woman to ask, who may assume there isn’t any additional risk if the dr has insisted it’s the only/safest option or may not even know what something like shoulder dystocia is or what the consequences are.

Compromise on a planned c-section at a date of their choosing. At least that's what I would do!

Surely the doctor was just highlighting the increased risk of stillbirth, he wasn't saying if you don't have an induction your baby will be a stillbirth. If he feels that is the case then he has to tell you doesn't he? The increased risk might be small but he would be negligent if he didn't tell you.

I was induced twice, the second time the Consultant said he wanted me to have an induction on a certain date, I wanted to wait another week, we compromised and I had it three days after his preferred date. When the doctor examined me I was already 3 cm dilated although I hadn't had a twinge but he still broke my waters and baby arrived 5 hrs later, just over 10lbs and I'm glad he didn't get any bigger.

Hope everything goes well.

@Mummyof2Terrors

The OP chose to bow out after being unfairly attacked. This was about the language HCPs use.

The consultant told my husband in labour that if I didn't consent to forceps, there would be absolutely no other options to get the baby out. Coerced consent at it's very very worst. That was to avoid a C-section but left me with a terrible 2nd degree tear. Why do I know this? Because the anethetist was stretched and that was also the reason they didn't bother calling someone for pain relief as they sewed me up for 2 hours unmedicated as I screamed through the process.

If anybody is reading this thinking they have to submit to everything in pregnancy, trust me, they really don't. Due to give birth to second in 12 weeks time and things will be so so different this time. I am not a piece of meat.

Didn't they do a local? They don't need an anesthetist, I was stitched after a home, the midwife gave me a local.