Refusing Induction

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The pressure for induction began around 25/26 weeks of pregnancy. My bump was measured at that date and my daughter was showing as small so I needed to get checked at hospital.  I had to have some steroid injections as I would likely be induced early and baby's lungs would need help to develop. I was given a scan and they checked my baby's organs and growth and placenta function - everything was fine, except my amniotic fluid was on the low side.

When I finally got this information around 7pm, after a full day of waiting, being prodded and hooked up to monitors, it was completely overwhelming and scary. They were talking as if I would have to be induced there and then, the implication was that something would be wrong with my baby. If we went to term, I was told there was a huge risk of stillbirth. Low amniotic fluid could be a sign that the baby's lungs are not functioning correctly.

I was told I would need to come back for another scan and consultant appointment in a few more days, and a plan was put into place. I would be having monitoring 2-3 times per week and also a scan and consultant appointment each week.

So the cycle began. Every couple of days I would have to be hooked up the monitor with all the straps, click the little button if I felt a movement, and baby's heart-rate would be traced at the same time. Anyone who has been in that situation knows how uncomfortable it is to sit still on a small, hard table/bed for hours at a time, with your tummy all strapped up and unable to move, sweating and aching.

My daughter, being as stubborn as I am, often did not move at all while I was at the hospital. She slept through the day and became most active at night - much as she still does now. This was her pattern, and had been since I first felt her early flutterings, it was as familiar to me as my own heartbeat. However my opinion on this wasn't taken into account, so if she didn't move enough to satisfy whichever staff member checked the trace graph, I'd have so sit there for another hour. I learned fast, and brought chocolate, Haribo, coke, Lucozade and icy water with me for future appointments to get her wriggling.

In the early weeks I went along with this routine, believing the doctors and midwives knew best. But as time passed, I began to feel that the constant monitoring was doing nothing for me except causing stress. It was at least a 30 minute drive to the hospital, longer in rush hour, then I'd have to wait for 2-3 hours in Triage on the monitors, then go to a consultant or scan appointment which could be delayed for an hour or more, and then finally after a full day waiting at the hospital, rush back home to collect my son from nursery. Then do it all again on the Wednesday. I was missing 2 out of 3 of my working days at school, planning cover work and ensuring my classes didn't go off-target was an absolute nightmare. The only thing the monitoring showed was that baby liked to sleep during the day, and that her heart rate was fine for those hours I was strapped up.

I also began to feel more like my wishes and voice was not being heard, and that I was just the carrier of the baby rather than a human being in my own right. I'm sure the staff I encountered were absolutely professional, and they obviously cared about the well being of my baby, but I felt completely overlooked as a person. Nobody trusted my opinions or even listened to them. I felt dismissed a lot of the time. Nobody cared that I knew my baby only moved around at night. Nobody cared that my daughter's measurements were being compared to my son's growth charts, which was ridiculous to me - in my opinion, every baby grows at different rates and they don't all fit neatly onto the charts. Plus my son always measured small too anyway, and was born at a healthy 7 pounds something. So I didn't trust those numbers they were measuring my daughter against - I trusted my baby's pattern of movements and the weekly scans showing her organs functioning perfectly. Nobody cared that at each scan my amniotic fluid went up, then down, then back up to normal again. I felt this was simply due to the excessive heat and amount of water I had or had not consumed. Heatwaves on and off during June and July, sat in a stifling hospital room, restricted under layers of straps for hours on hand, certainly did not help my hydration issues.

At some point I asked for the empirical evidence to back up the terrifying 'stillbirth' warning I had been given - but none was provided. Doctors simply would not discuss it with me. I then asked for other examples of low AFI cases they'd worked with, but they could not give me the information. One of the consultant's registrars became frustrated with me refusing induction and said, 'This is just the way things are done'. Another wanted me 'ticked off the list' before she went on holiday and wanted to get my induction booked in for the day before she went. I did not feel those explanations were good enough to outweigh the positive scan results, or my desires not have induction. I told them I wanted to reduce the amount of monitoring, but would still go for my weekly scans. I felt this was a good compromise. 

I also began to carry out my own research, but it was hard to find anything official for low AFI - just anecdotes from other mothers in my situation. Going against the various consultants’ plans for induction each time I went to hospital was very hard. Scans showed my placenta function and baby’s development were still absolutely normal. So to continue with the pregnancy based on that evidence was for me was the informed choice, and early induction was the unknown, unproven and unreliable option.

To bring her early via induction could result in an assisted birth or even a C section (read about the cascade of interventions here) and she'd be far too small to survive on her own. She'd be on the neonatal special card ward; I wanted her to stay safe in my tummy. To the hospital it was the opposite way round, consultants felt that bringing her out was the known, safer decision. But I actively decided to go with my instincts and make the decisions that I did. That's not to say these decisions would be right for everyone, or that you should go against medical guidelines. It was right for me and my baby and we were closely monitored to ensure the risks were minimal. I'm aware that we were very lucky, and everything was fine. If I'd continued with the pregnancy against hospital advice and something had happened to my daughter, my story would be very different. 

At my 38 week appointment, I had been told I would have to have a sweep at my scheduled consultant Monday morning clinic appointment following a scan, when I'd be a day off 39 weeks. I planned not to consent to this if the scan result from that morning was looking fine. But if an intervention had to be done, 39 weeks felt a lot better to me than the earlier dates I'd originally been given. 

At almost 38 weeks I was due to be a bridesmaid for my 2 best friends, and definitely didn't want to be getting induced at that point. Luckily baby decided to stay put for that weekend, and I had a great time - except for worrying that she'd decide to arrive during the ceremony!

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I tried some natural induction methods and the result was that my waters broke at 2.30am on the Monday morning of the planned sweep. I could almost hear the 'ner ner' from my baby. Interestingly with my son's birth, the contractions had begun first and my waters went in a big gush less than an hour before he arrived. This time the waters had been a gentle pop that had woken me with no accompanying contractions.

I ended up having an internal scan at 10.20am, just 2 hours before my daughter was born. That scan (below) showed her face actually in my birth canal, but I was told I was only 2cm dilated and still had quite a lot of cervix that needed to thin out. In actual fact, shortly after that scan I was examined and was suddenly at 6cm. Less than 20 minutes after that, baby was born without me ever knowingly reaching 10cm - so I personally don't hold much stock in the idea of measuring cervical dilation.

Interesting to note that, even though I knew I had lost lots of my waters when they broke at 2.30am, during that internal probe the measurements were showing the same level of fluid present as I'd had at the scan the week before ¯\_(ツ)_/¯ Scans are great, but they certainly can't tell you everything. There is obviously no way I had the same amniotic fluid levels as the previous week, because I'd left a lot of them in the bed, the floor and the shower!

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