Induction

[RaeRaeMama]

Why is nobody talking about how medicalised the NHS has made birth?

I didn't know the shit storm I was walking into when I got pregnant with my first. I think a lot of the treatment of women is absolutely disgusting and I cannot understand why we are all letting it continue.

I wish I'd been on Mumsnet before. Lots of posters saying I needed to have an induction might have saved me.heartache.

Hugs @MouseyTheVampireSlayer

@MouseyTheVampireSlayer I’m really sorry about what happened in your situation and yes people should be informed about risks and not just told say ‘infection’ but told ‘infection that could cause x,y,z’.

But as you say most people go into labour naturally after their waters have broken and most people don’t get an infection. I don’t think it’s fair to say that hundreds/thousands of women should undergo potentially unnecessary interventions because there is a chance that it could stop something bad from happening. It needs to be a choice but women need to be informed fully about the risks of the interventions and the risk of doing nothing.

I’m sorry I know this is emotive and I mean this respectfully but I’m sure there are women on here who have birth trauma or long lasting birth injuries who would have also been saved a lot of pain and heartache if they had been fully informed about induction.

The new draft Nice guidelines have done this amd they’re proposing to bring the standard induction date forward…I think to 40+7, it’s 40+10 at the minute.

There was a Swedish study recently where they tested later inductions. Unfortunately they had to halt it, but the results they had available said that week 41 was the optimal time. Link to article about the study, Trigger Warning www.theguardian.com/lifeandstyle/2019/oct/28/post-term-pregnancy-research-cancelled-babies-die-sweden

My point is I was told the risks. They seemed small and very unlikely. And yet, here I am.
And nice guidelines allow a wait of 24 hours. Knowing what I know now, that's obviously right.
I don't think that inductions are happening without reason. Waters breaking, going over forty weeks- can have devastating effect and it's not justified just because some people are fine. If induction is proved to lower the risk it should be used because you don't know who's going to be unlucky.

And my induction was awful. Hugely painful and traumatic.
But I'd choose it in a heartbeat again if I could change things for Ds.
Birth trauma can be rehabilitating. It can be treated though. I'm having rapid eye movement for mine.
But brain damage or stillbirth can't be addressed in the same way.
I might feel ok about the trauma of birth at some point.
I will never, ever get over the fact my beautiful boy has a disability that could have been avoided.

Debilitating not rehabilitating.

There's two different issues here.

One is, are all inductions 100% necessary? Including past dates when the woman believes the nhs dates are wrong and her baby is in fact a bit younger? A woman from my nct group - healthy, under 30, low risk all along - got told she'd better induce at 39 weeks at a routine check. No medical reason other than "39 weeks is at term so might as well, you don't want to wait and have a stillbirth". She did, of course, who doesn't follow medical advice? Traumatic, instrumental birth, episiotomy, the works, didn't manage to breastfeed which she wanted to do beforehand. But from the nhs point of view, she is alive, so is her baby, and due to the induction she gave birth at a time when there was space on the ward and they were fully staffed so yay! All good. If they had waited a week or so maybe the ward would have been understaffed and having a midwife spend time with her might have meant giving less attention to other patients, some of whom might have been high risk and in need of a lot of attention.

Two, are women who are being induced given a level of care in line with the level of pain / trauma caused by the induction itself? And there I would strongly argue the answer is a big fat no. Women's pain, cut up bodies and months / years of recurring flashbacks and nightmares just do not count in this country in this day and age. And that's why lots of us turn to alternative medicine and general woowoo - not because we're stupid or uninformed but because, for mental health reasons, it is perfectly rational to look for the kind of help who will not inflict a lot of pain and trauma on you without thinking twice about it. Even if that does carry medical risk.

We know the cure to all this don't we. More money for maternity services. And yet will it happen? (rhetorical question)

More money for maternity services is, I feel, the real feminist issue this thread should be about.
Not demonising induction.
And don't underestimate what a thing it is to have a live mum and a healthy baby. People take it for granted. I know I did.

Mousey I'm so sorry to hear about what happened to you and your baby - it sounds like it's been an awful experience for you.

I don't have children yet, but the lack of information to make informed decisions about giving birth is something that worries me a lot. How much flexibility is there to choose something else than induction? If I was pregnant and didn't go into labour 'naturally,' I'd far rather have a planned caesarean at that point than to go through a whole series of interventions that end up with an emergency caesarean anyway. Is it even possible to make that choice?

@InvisibleDragon officially, yes. It's your body, your birth, your choice.

In reality, no. They'll strong arm you into whichever option is easiest for them (and they do have internal targets on how few csections the hospital has).

Also everyone talks down to you like you are a dangerous, fractious child the moment you get pregnant.

In short, prépare to fight right at the time of your life where you feel most vulnerable.

@MouseyTheVampireSlayer so sorry about what happened to you. Thank you for sharing your story.

I'm not sure. I did think I needed a CS at one point because the baby was 'stressed' but the team carried on with the induction because he wasn't 'distressed.'
I was really really scared of a CS which did factor in our decision, as we were trying to avoid, 'cascade of intervention'.
We don't know exactly when baby had the stroke. Quite possibly when we were left for hours on end he became distressed and it could have not been picked up. He was born with a really good apgar score, so he must have stabilised. It does just go to show that hospitals absolutely need more staff and money and that you can't rely on *if something goes wrong someone will press the red button".

Great post Hoping

I've been thinking about what everyone has said so far, and trying to come up with a list of how things should be, or what should be improved. What does everyone think of this? (I’m not a medical professional, and I’m not suggesting that there aren’t protocols in place to this effect already. I guess this is my own personal wish list.)

• There is a place for both medicalised and “natural” births.

• Women should receive comprehensive and accurate information about the different options available to them. This information should be open about the risks involved, but also open about the likely experience of that route e.g. levels of pain.

• Women’s decision-making shouldn’t be at risk of being heavily influenced by the individual view of any one HCP.

• Women should be free to make informed choices, but should not feel like they have to carry the psychological burden of having the full responsibility of making that choice.

• When doctors and midwives advise women, risks should be carefully balanced. Although we all want to avoid the ultimate risk of serious illness to the mother or child, this should be very carefully balanced against other less-serious but perhaps(?) more likely outcomes of a traumatic experience of birth that can affect a woman’s post-natal recovery or mental health. (Hope that one makes sense. I’m not suggesting those risks aren’t balanced at the moment, but I don’t know that the balance is right.)

• Women undergoing induction should be given honest information about the likely experience at each stage, and should have a plan in place for adequate pain management, the treatment of side effects, and the involvement of a birth partner.

• Women shouldn’t feel, or be made to feel, that they are in some way weak for wanting to avoid pain or other discomfort during childbirth.

• Women shouldn’t be made to feel guilt or shame for going down a more medicalised route.

@pinkplantcase I can totally identify with that about not being told the whole process. It was very much, oh we'll pop in a pessary, maybe need another one, then you'll be off. No discussion about the various different pathways it might go down (hyperstimulation on the first one that they almost got to point of reversing it, then it didn't work well, what the drip means in terms of extras like catheters, what the drip itself can do, and so on. And I'd considered myself well- prepared and also had lots of time to read while I was waiting for pessary to do whatever).

So perhaps it's not that induction itself is bad, but that the 'marketing' for want of a better word isn't very well done. I think anyone talking about C-section gets a lot more input and information on all aspects than a woman being induced does- obviously it's got the surgery aspect that an induction doesn't have but perhaps if as much effort went into the prep and discussion of induction patients might not feel so strongly about them both before and after?

If there's going to be a push for more inductions then there needs to be a hell of a lot more effort to improve the experience for the women undergoing them. It needs to take place with the woman's comfort and dignity in mind and not just be all about getting a healthy baby at whatever cost to the woman.

@MouseyTheVampireSlayer

More money for maternity services is, I feel, the real feminist issue this thread should be about. Not demonising induction. And don't underestimate what a thing it is to have a live mum and a healthy baby. People take it for granted. I know I did.

Absolutely I think that's it. Can I say as well thank you for sharing your story, it must be painful to keep going over it but I'm sure a lot of people will read it and remember you when they are making their decisions

@MoreAloneTime

If there's going to be a push for more inductions then there needs to be a hell of a lot more effort to improve the experience for the women undergoing them. It needs to take place with the woman's comfort and dignity in mind and not just be all about getting a healthy baby at whatever cost to the woman.

This.

@BlueBrush I would wholeheartedly support that, I wish I'd read your post before putting my garbled one up 😂

Induction is a great tool for improving outcomes in my opinion but the information around it really needs some work. I advocate for them now where appropriate despite having an unpleasant, complicated one and hoping to avoid another, but the balance definitely isn't out there in the public domain at present I feel.

The PP that had a friend induced at 39 weeks 'just cos' I suspect you weren't told the full picture by your friend as I know I was a massive drain on NHS resources sat there waiting, taking up a bed for nearly a week, and then being medicated to the eyeballs. I can't believe for a second there wasn't at least something that gave a nagging doubt about allowing the lady to at least get to term if she truly had no underlying worry.

@BlueBrush

Thanks for compiling what’s been said, thinking about the posts on this thread it seems interesting that hospitals at the moment are caught in an odd place of pushing natural birth in a way that restricts pain relief eg. In some cases making it difficult for people to access anything other than gas and air. But at the same time recommending inductions that may be unnecessary.

I guess these two things combined mean that the women who have the inductions find it harder to access the pain relief they want, at the stage that they want it. When in fact an induced labour is often quite different to a spontaneous one and so the women experiencing them have different medical needs.

Like we’re at a weird halfway house of maternity care that doesn’t really fit with what either party “natural” or medicalised necessarily want.

@Heyha I think part of the process not being fully explained relates back to women being infantilised during pregnancy the whole language of ‘we’ll just pop this in’

I was wondering what had happened to what were women's support groups and campaigns for better and more choice when giving birth.

they seem to have faded away and the two well known campaigns turn out to be more about returning to work (Maternity Action and Pregnant then Screwed).

But Birthrights seem to be carrying on the lonely struggle (haven't read their material so may be a let down) www.birthrights.org.uk/ and there is a relatively new group campaigning for better care of Black Women in maternity services www.fivexmore.com/ who are currently running a survey on Black Women's experiences (although they do also refer to birthing people?).

[quote RaeRaeMama]@CovidCorvid

I would argue that the interventions cause more harm than good

I read yesterday that in the past 16 years induction and interventions have increased but still birth rates have not fallen [/quote]
Where did you read this, as it is incorrect with regards to stillbirths. The link shows an ongoing decrease in stillbirths, and a fairly level rate of neonatal deaths. Stillbirths are counted when a baby is delivered dead from the 24th week.

Your post replying to @YourSexNotGenderIsOnFire sounds a little strange. If a woman’s waters break, but she doesn’t eventually go into Labour naturally, what would you suggest happens? Sit and wait? Do nothing?

[quote RaeRaeMama]@Hoping4second

Exactly

Of course our children are important, but a woman's experience when she gives birth MATTERS

I also think people do forget birth is experienced by a woman but also her baby

Why are we always so quick to jump to medicalised intervention that can actually cause more harm then good?

The stories I've heard make my blood run cold and I can't understand why everyone isn't trying to do more. I hate that women are being treated like this whilst we are doing one of the most important jobs in the world [/quote]
I have had 2 babies. Both pregnancies were fine, but both deliveries were traumatic. In my experience, it was because of the care I received from my midwives that both my children and I survived. You have said you had a good experience because you paid for a private midwife. That’s great - so why are you saying that interventions are so awful?

My point is I was told the risks. They seemed small and very unlikely. And yet, here I am.

My heart goes out to you. And I think you're a good illustration of why this is so difficult. People will often tell you that the risks (eg of avoiding induction and going two weeks overdue) are very small. But when you have 650,000 women giving birth a year, a very small percentage of babies being injured or dying translates into quite a large number. So a risk of, say, one in 100 or one in 200, may feel quite small. But when you have 200 women going well over their due date, that means that one of them is going to end up with a baby who didn't live. (These numbers are made up - they're just to illustrate the point.)

I'm not entirely sure what the answer is. Others on this thread may think that if 199 women managed to avoid an induction that resulted in a very difficult birth, then we should accept the one birth that had a terrible outcome.

Obviously women should be given the opportunity to make a properly informed choice, with the risks explained to them. But making an informed choice is hard - because the guilt attached to making the "wrong" choice will be huge.

I've had a baby in Canada, and a baby in the UK. Both ended in EMCS, I was induced (2 attempts!) in Canada, but not in the UK

Both were national healthcare systems which didn't cost a penny (at point of delivery)

In Canada I was listened to, talked to, treated like a grown adult able to understand options and make choices. The surgeons actually introduced themselves, and checked me afterwards. I was given pain relief, I was headed for a home birth before going to 41 weeks, and in one of the scans due to that, discovering low amniotic fluid (hence the induction). Food was delivered to me at my bed, there was a large shower etc.

In the UK I was kept in the dark, nothing was ever communicated, even as I went overdue again (except occasionally in an attempt to scare me into doing what they want) I was persuaded to VBAC (and the offered pre-arranged one evaporated when someone forgot to confirm it after I went overdue again), I was left without pain relief despite having been having regular contractions (as in 20 mins apart) for days (and so being exhausted). The midwife tried to make me stay on my back in the bed (the most painful position for me), no food ever came, I was left bleeding and sweating in a bed that was straight from call the midwife, and had to manouver my still swollen belly and catheter bag into an 80x80 shower, through the 40cm sliding door, a good 6-8 inches off the ground, after major abdominal surgery, and out of visiting hours, so that was having pushed the baby in the fishbowl into the communal toilet so I could wash the worst of the blood off. I was sent home with no pain relief, and a box of injectable blood thinners, which no-one had told me how to use.

So yes. It can and should be better. My Canadian experience, as a first timer, with everything going much more wrong than my second, I have nothing but positive feelings about. The NHS one still makes me angry when I think about it.