Saturday, 10 October 2009

induction, birth choices and going overdue

Peggy at A Mother's Secret has had me head her call again. Her topic this time is "Pregnancy Lows". Well, I had a reasonable pregnancy with Cubling (ok, having all day morning sickness while on honeymoon wasn't ideal, but other than that there were no major complaints). The lowpoint came the day before my due date, when I changed from community midwife to hospital care. These are my (edited) thoughts from back then.

8th March 2007
Apparently, I'm due today. Happy International Women's Day! Due. It sounds as if I'm about to go off, sour, or whatever. And really, is it me who's due? Should it not be Cubling?

Anyway, due as I may be, today is no different than any other day in the past week, and probably won't be much different to the next few days. Except that now my NHS care has switched from community health centre to hospital. After getting used to 2 female GPs and one midwife at my community health centre, who I all liked very much, and who made me feel relaxed and calm for things to come, I was now seen by two male doctors neither of whom respond to the name I was given as my consultant. They were both nice, but still managed within minutes to put me off any rails I've ever been on.

The problem, looking back, was honesty. I mentioned every possibly worrying twitch and niggle I experience - just in case it's a sign of something serious which needs treatment. Not because I'm a hypochondriac. I may not feel bouncy, happy and full of energy, but hey, that's alright, it won't last forever and I can cope. The consultants, however, assumed that I'd had enough and offered to start induction. Before my due date. Without medical indication. Just because I've got no appetite, big feet and a sore back/pelvis. The suggestion took me by surprise and my nerves continued shaking until I fell asleep last night, and I believed caused my heart (read Cubling) to sink (read descent).

I refused. Just that this wasn't as confident a reaction on my part as I would have hoped, because after all my reading, hypnobirthing, and knowledge that it is my decision and not a doctor's, at the end of the day, if a doctor suggests something, it undermines everything you believe in. He is the doctor. He must know best. Why does he even suggest induction. He must have a reason. He sees pregnant women all the time. It's my first pregnancy. What do I know.

Yet I still managed to refused. He asked me twice if I was sure. I wasn't, but said I was. And it was only when I happened to bump into the midwife visiting my friend who'd just had a baby that my doubts subsided. She simply found the idea of induction before a due date very odd indeed. I felt reassured. It took another medical professional to make me believe I had done the right thing.

So I'm not so empowered after all. Women's lib still has a way to go and I wish I was in the sole care of midwives.

21st March 2007
My confusion and insecurity on the day of my hospital visit was largely due to being confronted with new people at a very vulnerable point in time. Pregnancy has put me on a rollercoaster of emotions, partly due to hormones, partly because of the simple fact that it changes your life. It makes you more vulnerable, which is further strengthened by entering a crucial stage of pregnancy, where important decisions need to be taken. It isn't a good time to change the main caregiver. I took time to trust the two GPs and one midwife who cared for me in the local health centre, and there is no time now. While my GP, knowing my medical history, was extremely cautious of any sign pointing towards pre-eclamsia, a blood pressure that made her refer me to the hospital for monitoring was brushed off as perfect by this new consultant. Literally, a new file was opened and all my medical history seemed to have been lost, why else would he ask me if I had ever been pregnant before, had a miscarriage or termination?

Now interested in induction, the reasons for it, advantages and disadvantages, as well as success rates, I did a bit of research. As I did with each part of my pregnancy, to make informed decisions. This was all very useful and I'm now a bit more confident about my thoughts on all forms of speeding things along. Interesting though were attitudes of other pregnant women on the same topic, which didn't seem to match my concerns at all and made me wonder if I'm on a different planet.

First of all, there's an overdue club on a pregnancy forum which I frequent for the sake of passing time waiting for labour to kick in. Every single person on this forum moans about being overdue, and every single person is hoping for induction appointments rather sooner than later. Apparently, some hospitals aren't as quick with speeding things up as mine is, and most overdue women seem to be very keen indeed to get similar offers that I refused so readily. Unlike the women on this forum, I'm not particularly impatient or frustrated, though keen to meet my baby. I can't understand the desperation of wanting to end pregnancy, or the obsession with seeing themselves as overdue, when the normal gestation period is anywhere between 37 and 42 weeks, and overdue should really only refer to being 42 weeks plus. I always expected to go beyond 40 weeks, because almost everyone I know did. It's perfectly normal, but this does not seem to be something many women know or want to know.

Similarly, at an aquanatal class, fellow splashers weren't just amazed I was there at my advanced week count, but they were also sure not to see me the following week. "They won't let you go beyond 10 days over" was their conviction. I responded that they might have to let me go 10 days over because I would not agree to induction before 42 weeks. Ignore that they obviously didn't understand my point of view (why would you choose to wait if you can get induced?), they also thought that it was the hospital's/consultant's decision. While I obviously respect and consider medical opinion, the decision for any medical intervention is that of the patient, and I was shocked that educated, mature women did not consider this to be the case.

So why am I so reluctant? Well, to start with, I don't think intervention without medical need is ever a good thing. Bodies are amazing things and usually do a lot of good stuff themselves. Not always, though, and that's where medicine comes in. But to induce for the sake of it, I don't get. Induced labour is more painful, and has a higher likelihood of leading to other forms of intervention, particularly assisted delivery. While I'm positive about labour and looking forward to experiencing it, the thought of cesaerian section, ventouse, forceps and needles in my spine make me go weak on my knees. Truly. I do actually faint if I think of it too much. It scares me senseless. I also don't want someone to stick a hook inside my private parts. I'll accept the sweep though for the moment, I'm not trying to be difficult, honestly.

So maybe I was the victim of assumptions. Maybe the consultants thought I was like those women screaming for an end to big bump who would do anything to get induced on their due date or even earlier to get it over with. Maybe they were simply trying to be kind and not stand in the way of my choice of birth experience. So I won't be to harsh on them should I meet them again, but patiently explain that I may be a bit different.

I'm very pleased with the midwives at the hospital who really managed to calm me down and give me back my sleep last night. I'm 41+6 today, and after checking that baby is doing fine and things are moving, if slowly, along, they assured me that induction wasn't necessary at all but they would do it if I asked for it. They are happy for me go over 42 weeks even and assured me that I will go into labour naturally. Soon. And it looks like all is set for a natural delivery as well. I'm both impatient now and overwhelmed that Cubling will be with us in the next few days most likely. I can't wait to experience birth and I'm trying to sleep as much during the day and at night to gather energy for this.

Labour kicked in naturally the following day when my week count was 42 exactly and Cubling was born healthily and not overcooked 15 days overdue. The woman beside me in the postnatal ward had given birth 17 days post EDD.


kathryn said...

With my two boys both having birthdays in October I spend a fair amount of the month going over what happened 11 years ago and 14 years ago - a sort of tradition - as old as they are they still like hearing how the whole thing went (suitably censured of course!) - so glad you stuck to your guns! ps have change d the blog and you can now find me at - don't seem to be able to work out the whole wordpress dashboard thing but I will still be following you even if I don't appear to be!!

Mwa said...

I'm one of "those women". I get very antsy around my due date, and have accepted inductions with both my children. I'm sure this has to do with me being told all my life that it was the last two weeks of being pregnant with me (weeks 41 and 42) that ruined my mother's body, and that ALL babies in our family are induced in the end anyway.

I'm not as extreme as my first gynaecologist, though, who asked me when I wanted to deliver, telling me she'd induced her kids three (!) weeks early because that was more convenient for her medical practice. At least I wait until after my due date each time.

I'm glad you managed to have the birth you wanted.

Metropolitan Mum said...

Aiaiaiai. That reminds me painfully of my fight 'against' the system. Why on earth are they so keen on inducing people? Little L was born almost three weeks past EDD. Healthy, happy, normal weight.

cartside said...

Kathryn, I still revisit too, and was actually very influenced by my mother's horror stories (which I overcame through hypnobirthing)
Mwa, I didn't have the birth I had wanted, but in the end that don't matter ;) At least I managed to control the part of birth that I did have control over.
Met Mum, to be fair, after my refusal, nobody mentioned the i-word again. I couldn't believe it! I was well monitored and felt very safe. My hospital was good to me, a different story in other places where induction is "done" at 10 days over.

Kelly said...

I wish I had known more and understood about induction. I had a horrible experience (I wrote about it here )

If I have another baby I will refuse to be induced unless they are worried about the baby. If I am monitored and the baby is ok I am just going to stand my ground and let my body do what it needs to.

When we were in hospital after Piran was born there was a lady there that had 'found' someone to induce her at 36 weeks. The baby was in the SCBU. I don't know her reason for doing it but as she had to find someone to do it it wouldn't be for a medical reason. I just do not understand why someone would do that.

Anonymous said...

You've got me wondering bout us now. Supermum went over by a week but faced with a barrage of scary facts about women over a certain age and pregnancy, a baby facing the wrong direction and the wrong way up, she opted for the proffered c-section. We were possibly also influenced by how horrendous the whole experience had been last time around, mind you and the hospital did have a reputation for promoting natural birth.

Noble Savage said...

It is absolutely criminal for a doctor to offer or suggest induction before the due date, and irresponsible for anytime up to at least 42 weeks. Babies are born when they're ready (they release a hormone that kicks off labour) and those who are induced before they're ready are many times more likely to have breathing problems and need time in the SCBU. The mothers are way more likely to require narcotic drugs and epidurals for pain relief from the crushing force of synthetic contractions and end up with "emergency" c-sections because of either maternal exhaustion or a drop in baby's heart rate from the stress of it all, being forced out before they're ready. This, in turn, causes longer recovery times, affects early bonding and breastfeeding abilities and increases one's likelihood of experiencing PND.

It really, really angers me that the medical community gets away with this all for the sake of 'convenience' and that mothers don't feel they have any choice in the matter. Just because you're having a baby doesn't mean someone gets to make all your decisions for you! Know your patient rights and refuse any unwanted offers of 'help' if there is nothing to indicate a problem. Being 'fed up' is not a good reason to force your body through a process that, if not brought on naturally, can lead to major complications. What is a few more lousy days after 40+ weeks of pregnancy?!



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