Anyone been told they need an induction because of uterine Doppler levels at 20 week scan?!

[Wimbymom]

Hello ladies!

I’m a bit panicked and upset as I have been told by my doctor I need an induction by 40 weeks because my uterine artery Doppler numbers at my 20 week scan were a bit high (mean was supposed to be 1.25 and I was 1.28). I am currently 38 weeks 5 days and now it feels like I have this pressurised date to pop the baby out or else…
I am a huge proponent of natural birth and I had a lovely water birth with my first son so I am devastated at the idea of being induced so early for an otherwise healthy pregnancy!! They want to induce via Dilapan rods too which sounds painful and as with all inductions it could lead to tons of medical intervention squashing my dreams of another natural birth.
Has anyone been told the same thing about this reason for needing to be induced? And has anyone been induced successfully and easily with Dilapan?!
Any thoughts greatly appreciated!! I’m at the point where I want to do a runner and go have my baby in the woods somewhere far away from the hospital and all these scare tactics and policies…
Thank you so much in advance!!

You don't have to accept the induction if you don't want it, but ask the doctors to talk you through benefits, risks, alternatives. Have you had any more recent scans?

Hi @FusciasBright21

Yes I’ve had two scans since at 28 and 36 weeks and all is totally normal. Baby was 6.5 lbs at the 36 week scan so a great size and all else is healthy. I’m just being told that they “induce around 40 weeks” if you have elevated uterine artery levels that aren’t normal at the 20 week scan because there is a risk is the placenta could give out later in pregnancy?

You don’t have to agree to an induction or a particular type of induction if you don’t want to. But doctors don’t do it to scare you, but to try and reduce risks. You could always ask for a second opinion or another discussion with the consultant. FWIW I had an induction (different method) - it was reasonably quick, intense but not super painful contractions and no further interventions.

I'm about to have my 20 week Doppler scan, because I've got low papp A and will need extra scans and consequently baby won't be able to go to term as I understand it so far, makes it high risk. I appreciate you would prefer a natural birth, but I have to have a section because of this, second baby also, its a bit much to describe it in such terms as scare tactics. I believe in natural birth too, but I can't have one. Is it because your cord blood supply from placenta isn't optimal, as shown on Doppler, then you are at higher risk of complications due to not enough oxygen to baby? Thats not a scare tactic is it? I wouldn't want an induction, but I don't want a section either, I do want me and my baby to survive the birth, so I'm going with what is recommended after a bad do last time. Not clear when they want to induce you, now, at 38 weeks, or later, at 40?

The increased risk is of still birth once you get to 39/40 weeks, more so if you go over, that doesn't scare you more than an induction? You might even go into labour sooner and naturally and not need to be induced, fingers crossed you get the labour and birth you would prefer.

I was induced 2 weeks ago but with different reasons to yourself. I was 38 weeks and also wanted a water birth.
I had no warning of induction though, was taken to triage and they induced me that evening. I wasnt given an option and i didnt want to be induced but I was suddenly classed as very high risk and they needed the baby out. I would have been silly to refuse, the staff honestly know best and wouldnt induce for no reason.
I was given the different options including the rods, pessary and drip if i didnt progress.
They start with the rods as they take the least amount of time until they can break your waters.
The thought of it sounded barbaric to be honest and i asked for the pessary which i was aware had to stay in for 24hours.

My induction started in the small hours of the morning and things escalated super quick. 5.5hours after inserting the pessary i had contractions which ramped up within an hour to be back to back with no gap between them. Midwife didnt believe me when i asked for pain releif so i begged to be examined and i was 5cms dilated and rushed to delivery.
Baby was born less than 2 hours from the 1st contraction.

It wasnt the birth i wanted. It wasnt calm and medically things werent great for me (not related to the induction but due to the reason i was being induced).
But, i had a super quick labour.
The induction worked a little too well!
Baby was born healthy and is absolutely gorgeous.
I know it isnt the way you want things to go, neither did i but the staff were amazing in my situation and made a terrifying time for me bearable and they made me feel at ease. Trust the midwives and doctors, they want the best for you.

Hi @OakRowan! Thanks so much for your response! My pregnancy has thankfully been all low risk and every number has been normal (and at subsequent scans) except for the uterine artery PI at the 20 week scan which was just slightly over. I was told that this meant they would just give me a few extra scans throughout pregnancy to watch for preeclampsia or low birth weight (and neither have been the case) so no one has ever mentioned needing an induction this early until now and it is made to seem like it’s hospital policy if you get this one abnormal result at 20 weeks (even if it then is normal in subsequent scans). The only thing they have mentioned is that sometimes the placenta can “give up” at this stage but it doesn’t seem to be backed up with any stats or evidence…
Of course I want baby to be healthy and understand that birth can’t always go as planned but I am very skeptical of the reasoning for this proposed induction (scheduled as of now in one week when I will be 39 weeks and 5 days). Probably a good idea to get a second opinion but I was of course curious if any other mamas out there were ever in the same situation!
I wish you the best of luck too and thanks again for your message!

Thanks for your story @Flutterby8! I’m so glad to hear things went well for you and that baby is healthy!
What was the pessary you had and did have to stay admitted to the hospital once they inserted it? Were you able to go to the midwifery unit once contractions started or did they have you stay on the labor ward? Many thanks again! And glad to hear a positive induction story!

Have a look at the myth of the ageing placenta by Sophie Messager.

Good luck, they wouldn't be recommending it without good cause, the stats I have read around low papp a and the associated placental blood supply are significant once you get to term, doesn't mean its guarantee but its an increased risk of still birth as time goes by. So you've had a low risk pregnancy, (brilliant) but it becomes high risk at the end, because of what came up on the Doppler when they diagnosed you back then. Talk to your midwife, keep talking about it, ask questions. I still have ideas of a water birth, or labouring at home, if I go into labour early, but if I'm at risk because of potential problems with placenta and blood/oxygen supply to baby then thats just too much for me. Every birth is different, I had this last time, and it made no difference, because I went into labour early, 36 weeks and it became an emergency section for totally, completely different other reasons, I still feel the loss of a natural birth over that kind of, but we survived, without life changing birth injuries or lack of oxygen. That's what they want to avoid. My perspective is different this time, I can't take any chances, for me or baby. Ask them about the statistics, it is a risk assessment, for the life of you and your baby.

As well as the Sophie Messenger reference above, check out www.sarawickham.com/announcements/in-your-own-time/#:~:text=In%20Your%20Own%20Time%3A%20how,to%20the%20current%20induction%20epidemic.

Ask them to share the evidence with you so that you can make an informed decision on behalf of you and your baby.

@Wimbymom the pessary I had was the propess which released a synthetic prostaglandin hormone to ripen the neck of the womb and help dilate the cervix. The midwife described it as almost a tampon that is inserted high up next to your cervix. I won't lie, when she inserted it, it hurt and I was bleeding afterwards. I may have just had a heavy handed midwife though.
Because I was admitted for induction due to a medical reason I wasn't allowed to leave. I went home for one hour before being admitted to the induction ward to get my bags as I wasn't prepared but realistically I was told I was going nowhere until baby was born. Even if that took 3 days as they anticipated.

I wasn't allowed to go to the midwife unit either due to the high risk nature and induction. I think if you're induced for a medical reason you're stuck on the normal delivery ward in case there is an issue. My labour started off where I was induced then I was transferred by wheelchair to delivery.
I wasn't thrilled about this but from my experience, I am bloody glad they kept me away from the midwife unit.
I needed the crash team twice for myself following delivery due to haemorrhage and collapse. I've never seen so many medical professionals in one room before for one person. If I had have been in the midwife unit I wouldn't have been given the care I needed when it all went pear shaped and would have had to have been transferred elsewhere as an emergency.

I think the thought of induction is alot worse than the reality. It takes away your birth plan and calm birth but realistically, it's happening for a reason and you get the same end result.
I was glad I had a super quick labour in the end. I couldn't have gone through days of it. Induction does heighten your contractions and they can feel worse than a normal labour but, its quicker in some cases.
While it was far from my ideal birth I coped and couldn't have done it without the amazing staff (and DH!)

Hi OP, I had exactly this problem with my last pregnancy, though my numbers were a lot higher than yours (mean 1.5). I was also advised to induce at 40 weeks. Like you, later scans were fine and umbilical artery pi readings were consistently nice and low. I went to 41 weeks (by my count — the dating scan had me at 41+4) and gave birth spontaneously. There was a lot of pressure to induce and it ruined the end of my pregnancy. What stopped me from inducing was my own research into the condition. So, a couple of things that I find out that you may find reassuring and that you could raise with any consultant you discuss this with.

1. Your mean reading is really not that high and would be considered high end of normal in some hospitals. I read a lot of scholarly articles on this and in most, including the one on which some NHS trusts base their advice, the ‘high uterine pi group’ has a lower cut off of 1.4-1.6 mean. In other words, the medical studies would have included you in the normal or control bracket rather than the study group. What studies are your consultants basing their advice on? Caveat: if one artery’s reading is very high (>1.6) that looks a bit riskier than if both are around 1.2-1.3 but see below for why you may not need to worry too much given that you’ve reached 38 weeks without a problem. (My higher reading was 1.8!)
2. There are risks associated with high uterine artery pi at 20 weeks but those documented in the scholarly literature almost entirely relate to increased rates of pre-eclampsia and IUGR or SGA. If you do get PE you should obviously induce, but that’s something they can monitor for easily. Your baby is growing well so IUGR and SGA seem not to be an issue. Finally, there is an elevated risk of stillbirth associated with this condition but again, it is largely as a result of PE/SGA and according to the literature I looked at this association weakens the later into the pregnancy you get and disappears after 37 weeks. That is, there’s no evidence in the scholarly literature to suggest a link between high UtA pi at 20 weeks and greater chance of stillbirth after 37 weeks gestation, especially in the absence of PE or IUGR. There is, of course, a fairly well documented increase in the risk of stillbirth after 42 weeks gestation in any pregnancy, regardless of UtA pi, and a more dubious link between gestation beyond 41 weeks and stillbirth. So you might want to think about where, for you, the balance of risk changes. (I was prepared to go to 41+5 by my dates.) Your consultant will likely days that there’s a greater chance of placental dysfunction in pregnancies with elevated UtA pi. This is, as I understand it, a theory based on research indicating that the cause of the higher pi is the placenta’s failure to change the functioning of the uterine arteries early enough in the pregnancy. So they’re hypothesising that poor placentation early in the pregnancy might cause or predict premature placental failure late in the pregnancy. To my knowledge, there is no actual evidence to support this theory. That doesn’t mean it’s wrong, necessarily, but it does mean that it is educated speculation rather than evidenced medical fact. Hope that helps you decide what to do, and good luck. It can be very stressful going against medical advice, so you may find that it’s easier mentally to go ahead with induction even if you don’t agree that it’s necessary, or you may conclude that induction really is safest. If so, that’s not some kind of failure. Spontaneous birth is not the be all and end all! But if you’re weighing up the risks of induction v waiting or you want to push your consultants to explain their reasoning behind invocations of ‘hospital policy’ the above will hopefully help you to do that.

Oh sorry! I’ve just seen how old this post is! This advice won’t help you at all. Well, I hope you made a decision you were happy with and that it all went well and you’re now safe at home with you’re snuggly baby.

Im in the same boat as OP. Still helpful one year on, so thank you!

Hi! I’m the OP and just as an update, the baby came 5 days early all on his own so I was lucky to get my natural birth and didn’t have to worry about any intervention! In fact he came out so quickly that he was born on the bedroom floor (my mom had to to deliver him) because from first contraction to baby in arms was only 15/20 minutes. We didn’t even have time to get 999 on the phone (we were on hold with them)! So I definitely got my natural birth! Haha. Baby was perfect too. 8 lbs 1 Oz and all healthy.
I had an induction scheduled on my due date but an appointment with a consultant a few days before because I was adamant about pushing that back and did not want to show up for the induction. Didn’t have to worry about either appointment in the end though.
I went for a sweep 36 hours before the baby was born and they said I was already 3 cm dilated so I’m sure that got things moving. I also walked 4 hours the day before, took 3 baths and did tons of bouncing on the exercise ball as I was determined to have a natural birth.
Good luck to you!!!! Such an exciting time to be pregnant and anticipating the little ones arrival!!!

So pleased to hear you got your natural birth! Sounds like it went perfectly, if a little fast in the end - what an experience.
Thank you for the well wishes. I had my sweep this morning, and I'm busy bouncing on the birthing ball as I type..!

Ah congratulations OP, glad you got the birth you wanted ☺️

Amazing!! Good luck and happy bouncing!!! X

Thank you!!