Refusing induction at Kings?

[monniemae]

Embarrassed to post this as I'm sure I'm an obsessive Kings information gatherer..

But just wondered if anyone had any experiences of refusing induction etc at Kings?

[Fuschia]

Various, yes ...

With my twins I declined induction at 37w, was being monitored daily, then was admitted with mild per eclampsia. Still declined induction till a scan showed one twin stopped growing. Agreed to be induced, got a slot two days later, had waters broken and went into labour

With last baby, was panning home birth, my blood pressure was up and down from about 39.5, admitted and let out... Then rushed by ambulance with everything spinning and high bp. Accepted induction but didn't want waters broken if it could be avoided. Several days of pessaries etc had no effect, on day 5 I accepted AROM, drip.... Finally went into labour then.

Do they count as refusals? Baby no 1 went to 41+4 but I was under independent midwife so not actually under kings as such

[Fuschia]

If you mean, how did they respond, they were pretty respectful of it until the point that they begun to worry. The midwives will support the mother regardless, the doctors tend to discuss things in terms of levels of risk. Some consultants are direct but understand is ur choice, some are rather patronising

[monniemae]

Thanks Fuschia, tried to pm you but your invox is full - I won't relay everything here but I guess I'm also wondering if it would get to a point where I could i sist on a section rather than risk traumatic failed induction / emergency c section.

All academic as I'm more than likely to go into labour spontaneously *hopeful face*

[Fuschia]

Space in box now x

[Mellors]

Yes - after horrid 1st baby induction/EMCS experience I refused induction with No 2 at 41 weeks (was eventually born naturally at 42+1 after a spontaneous labour), and again with no 3 (who, very considerately came along at *only* 5 days post due date).

It was a bit of a fight with no 2 - they were nervous after a previous CS, but I agreed to close monitoring by midwives, and a growth scan at 41 weeks showed all was fine. I went in at 42 weeks, a Friday morning, for a consultation with Leoni Penna who advised me she would rather induce there and then, but we agreed instead to leave it for the weekend and that if it got to Monday morning (42 + 3) they would have me in for induction no matter what. Thankfully she came the following day.

I had to be pretty tough to stand my ground, but ultimately my midwives and the consultants backed me up. In hindsight, with my first I would just have told them to get stuffed and waited it out, but I was scared (it was Tommys, not Kings first time).

[VeronicaSawyer]

It's a while ago now, and before their policies changed, but I was allowed to go to 42+5 before induction, and was only induced then because monitoring showed a slowing of my daughter's heartrate. I'd made it very clear from my first booking in appointments that going by family history I was very likely to be overdue, and wanted to avoid induction if at all possible, and they were very supportive. In the days following 42 weeks I was up being monitored one way or another more days than not but came under no pressure to be induced, until there was a valid reason for it.

Crossed fingers that it's not an issue for you.

[CocoC]

FYI it's worth bearing in mind that nobody can force you to have an induction. You are 'allowed' to carry on as long as you wish. It's just a careful weighing up of risk versus benefits. Have just read a brilliant book as I am pregnant with my first baby and want a homebirth - and am prepared to fight for it no matter how late baby ends up being.

[Emski]

Just remember it's your choice! I found they do put quite a lot of pressure on you to be induced if you're v overdue. I managed to hold out until baby arrived naturally 14 days late - and got my desired homebirth which was fantastic. But I was told by 1 consultant 'We don't let women go over 10 days'. No acknowledgement of my right to choose!

I found the hospital's ethos of using all means necessary to get the baby out bizarre. They're so anxious to avoid the miniscule increase in risk for the baby the longer it stays in the womb, but they don't consider the problems that failed inductions, interventions and Csecs can cause - let alone the implications for a woman who's left feeling completely out of control of the birth experience.

If there had been any sign of distress on any of the late scans I had, then I would have gone in for induction. But my first child was 12 days late and I'd had a perfectly healthy pregnancy. Happily I had a v supportive Brierley midwife, and in the end was v pleased to have stuck to my guns. Didn't stop me feeling confused and worried and upset that the consultants didn't seem to believe I was doing what was best for me & my baby though.

[DaveR]

"I found the hospital's ethos of using all means necessary to get the baby out bizarre. They're so anxious to avoid the miniscule increase in risk for the baby the longer it stays in the womb, but they don't consider the problems that failed inductions, interventions and Csecs can cause - let alone the implications for a woman who's left feeling completely out of control of the birth experience."

I think it's unlikely that they are not entirely familiar not only with the level of increased risk, miniscule or otherwise, but also the countervailing risks that you identify. What you see as bizarre they will see as a policy based squarely on the latest medical knowledge and evidence. However, that doesn't mean that what is right statistically is right for you in your particular circumstances. My (vicarious) experience of 2 births at Kings is that, if asked, all the medical staff we encountered were happy to explain the advice they were giving and, although they were pretty forthright with their opinions, we didn't feel unduly pressurised.

[Mellors]

I think the thing is that its difficult to make an objective decsion when 9 + months pregnant, tired and hormonal. There are slight increased risks in going post dates, and as a mother to be, who in most cases has done everything "right" for the baby during pregnancy, its hard to fly in the face of that knowledge no matter how remote. To my inexperienced ears it sounded like "your baby might die if you don;t do what you're told".

Thats certainly how I felt with my first, despite knowing that my family history meant it a pretty sure thing that the baby would be v late. I felt unable to trust my instincts to just leave the baby alone to come in his own time, and pressurised by the "no more than 10 days" rule.

By numbers 2 and 3 I was having none of it, and made that clear form the off, lol.

[EDmummy]

I second David R! Without going into too much detail, my very late baby ended up in PICU with the risk of brain damage because he was so large and late (hyperbilirubinaemia - early onset jaundice). Myself and my GP practice midwife successfully fought against an induction but with hindsight I think I may have decided differently.

[katgod]

For people with histories of problems they do take a cautious appraoch. Having been in the fortunate position of 2 succesful issue free preganacies and labours, one at 39+5, one at 40+5 they were super relaxed about me going over and it was me insisting on being induced bang on 42 weeks. was not prepared to go a day over. midwife supported that decision but would have been happy to let me go longer. I had a colleague with a horror story worse that EDMummy sadly, and was no way I was exposing me or my baby to that.

I really don't think Kings or anywhere else are out to bully any one or deliberetaley make people unhappy. They are risk assessing you and it is not one size fits all, in my experience.

[LondonMix]

Agree... To the OPs later question. Changes in the law mean that if you are anxious about childbirth you can insist on having a C-section; however, your clinician may first recommend counseling if they believe your concerns are unfounded.

DaveR Wrote:

-------------------------------------------------------

> "I found the hospital's ethos of using all means

> necessary to get the baby out bizarre. They're so

> anxious to avoid the miniscule increase in risk

> for the baby the longer it stays in the womb, but

> they don't consider the problems that failed

> inductions, interventions and Csecs can cause -

> let alone the implications for a woman who's left

> feeling completely out of control of the birth

> experience."

>

> I think it's unlikely that they are not entirely

> familiar not only with the level of increased

> risk, miniscule or otherwise, but also the

> countervailing risks that you identify. What you

> see as bizarre they will see as a policy based

> squarely on the latest medical knowledge and

> evidence. However, that doesn't mean that what is

> right statistically is right for you in your

> particular circumstances. My (vicarious)

> experience of 2 births at Kings is that, if asked,

> all the medical staff we encountered were happy to

> explain the advice they were giving and, although

> they were pretty forthright with their opinions,

> we didn't feel unduly pressurised.

[Emski]

DaveR you make a fair point, but when I asked them about risks of intervention they wouldn't give or didnt have stats. If felt bizarre when the basis of their argument to induce was stats-based. I didn't feel they were giving me a balanced view and, as Mellors puts v well, in my hormonal and defensive state, I did feel accused of putting my baby at risk.

To return to the OP's original question, I'd say that you should have a firm view of what you want to do BEFORE speaking to the consultants, and be aware of the fact that they will advise you according to Kings policy - ie induction at 10 days over. It's up to you if you choose to follow their advice or not.

[Saila]

Went two weeks o/due, movements had stopped. Refused induction and insisted on elective section.

No regrets

My placenta had died and I'm grateful he came out safe and sound. Oh, and he was ten pounds! Thank god...

Good luck

X

[cazbee]

For anyone who may be interested, the NICE pathway for induction of labour, along with the clinical guidelines and the evidence tables that underpin the clinical guidelines are all published on the NICE website. I stumbled upon this the other day when I was doing some reading in preparation for arrival of baby no 2. I found the flow charts for care in labour particularly useful. They give an indication of what your options are but also a heads up on what the practitioners will do/offer you. I wish I had read this stuff first time round.

http://guidance.nice.org.uk/CG70

Also

http://pathways.nice.org.uk/pathways/intrapartum-care/intrapartum-care-overview

[bawdy-nan]

Both my babies were born "late" (42 +3 and 42+5) and at home. Advice and attitude from the staff varied: my consultant great - really clear on risks and guidelines without being scaremonger, scanning staff (at least the ones I had, and it was several years ago) really horrid, asserting "facts" that weren't (I;d checked out all the Nice guidelines and talked it through with consultant).

I had excellent midwives who I trusted completely (Brierley). If they had suggested I go into hospital at any point or had been concerned about the health of my babies I would have followed their advice.

[Ginster]

I was at Kings and they did want to induce at 10 days over - I said no about 8 days over so they sent me for a scan (which was fine) and booked me to see a consultant in a few days. I had a few unsuccessful sweeps then the day before my consultant appt I had a sweep on 10 days over which set things off - natural start to labour (just not natural end!) and had baby by emergency c section 12 days over after all that!

It's your choice as others have said, as long as you have all the information and are happy then don't let them push. I think they seem to be offering induction at 10 days over as standard as many of my NCT group had that offered / slightly pushed.

Good luck!