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    Default Planned induction due to high BP, but not happy...

    Hi all,

    I have been struggling over the last few days with the fact that I will be induced on monday. My first pregnancy ended in an induction at 38 weeks due to high BP. I had been on BP meds throughout the whole pregnancy and it just escalated toward the end so they induced me early. I swore I would do everything in my power to not end the same way in another pregnancy!

    So now I'm 40 weeks (today) with pregnancy number 2. Before I fell pregnant I lost weight and my BP was fine all through this pregnancy without any medication. A couple of months ago I became aware that if it was going to get high I would need to do something to keep it under control, because I so desperately wanted a spontaneous, natural labour. So I reduced salt and sugar intake, and I rested. Slowed right down on house work and just was generally lazy a lot! Also, I have had Pubic Symphysis Diastasis (bad pubic bone pain) so that made it easier to convince myself to keep off my feet.

    So a couple weeks ago my BP started elevating (140/93 iirc). The Dr reacted strongly. He put me in hospital and had liver and kidney blood tests taken, as well as the protein in urine test a few times while I was in hospital for a day. All tests were negative, so no pre-eclampsia. My BP went down over night in hospital til it was 115/70 in the morning. So he let me go home but I had to see him every 3-4 days after that to keep an eye on it. Every time I went it was borderline. Like 135-140 / 85-88. For me, a higher top number is normal and I was told as long as it didn't go above 150, for me, that is ok (by a specialist OB I had to see one time regarding management of my previous 3rd degree tear... anyway...). In total, over the last few weeks, it has only been at or over 140/90 twice, and even when over it was only slightly. But my Dr is reluctant to let me go spontaneously so I'm booked in for an induction on monday morning.

    I slipped into depression for a couple of days despite my best efforts to remain positive. It felt just like those day 3 baby blues where EVERYTHING makes you cry and life feels dull and worthless. I recognised it for what it was and dragged myself out of it, finally coming to terms with the fact that despite my best efforts I would be induced again.

    One of the reasons I'm so reluctant is that it will increase the risk of assisted delivery (and of having an epidural) which increase the risk of another 3rd or 4th degree tear, which may have bad consequences the second time. There's a chance bowel control after 2 tears is great reduced.

    So, YES, I have come to terms with it. That's the only way to move forward and give myself the best chance at a somewhat natural labour (because tension and fear will only make it worse). The only part I am having a hard time letting go is the fact that, logically, I can't bring myself to agree with the Dr. It has been borderline high, yes. But I wouldn't call those readings cause for induction. I have to trust the Dr with this, and I'm trying. But the logic thing still niggles.

    Am I being unreasonable? If the only symptom is slightly high BP do you think that is justification enough to warrant an induction? My internal exam showed, at the start of the week, that my cervix was still posterior and hadn't effaced or diated at all. Meaning... my body probably isn't ready yet.

    I want to feel completely at ease with his decision, and if i don't I want to be able to put my case forward convincingly on monday morning. Meaning, if the gel doesn't start labour and my BP is ok, to ask if he will let me go home for a few days and wait for my body to ready itself.

    Just FYI - last induction resulted in a perfectly healthy, beautiful girl. But to get there I had an epidural. She had the cord around her neck and it was cut while her head was out, because her SHOULDERS got stuck. Resulting in reduced oxygen. She came out not breathing and low APGAR so those few moments with her on the pediatrician's table felt like forever, waiting for that cry. I tore when they were trying to get her shoulders out. 3rd degree. Also, she didn't respond to the breast at all. I guess due to the epidural and the traumatic delivery. I ended up expressing milk for 12 months because despite trying, she never did attach to the breast.

    I know this was so long and boring, but I'm really reaching out to find opinions on whether I should just accept and move on or whether I should potentially upset the peace and realy push to not have the syntocinon drip IF my BP remains reasonable. Please advise...

    Thank you.

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    I would definitely get a second and third opinion. I'm not a medical professional but given what you've said it sounds like the reasons for inducing are fairly weak. At the very least, if other doctors recommend an induction and provide compelling reasons you should be more at peace with the decision.
    I hope you have a wonderful birth

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    The fact that it was high when you went in, then dropped overnight- couldn't it be very likely that all these BP tests are stressing you out and causing high blood pressure? That the closer you got to your due date, the more stressed about BP, hence the higher readings? I generally have naturally low BP, both times i went to ER with bleeding in pregnancy it rose dramatically. Can't they measure it over a longer time span so they can see if it really is higher, or if it's being raised by your stress levels?

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    At the end if the day the choice is yours- Sarah Buckley does a good thing (can't think of right word) for weighing up risks and benefits of a procedure - BRAN, here is a link I found that explains it http://ekwetzel.com/2011/bran-decision-making-model/

    Id go over this with your dr and suss out if there are alternatives, inc just waiting. Aside from that, second time hopefully will be a bit easier so try not to stress

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    I would get another opinion. Like you said its not overly high and all the stress about high BP and what induction might mean for you regarding the tear, might have something to do with your BP being elevated.

    I'm only 20 weeks and my BP is borderline high, but my dr is hesitant to put me on meds because it's not worryingly high, just like yours isn't, and she said my body is probably used to that so unless it gets a lot higher it will just be monitored.

    Being 40 weeks, you will he monitored anyway so I can't see why you couldn't go spontaneously unless it gets dangerously high. Definitely worth another opinion.

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    Most definitely get another opinion.
    As a PP said, BP can be affected negatively by just being in a doctors room. My parents bought a blood pressure maching (they are elderly) because my Mum had BP issues and when it was taken at the docs it was not good but when she was home it was fine.
    As what your options are. No one can make you get an induction. What about regular monitoring?
    I too was induced with my first and ended up with epi, instrument delivery and 3rd degree tear so was determined to have a spontaneous labour with my second, one of the reasons being that I wanted to minimise the risk of re-tearing which meant I shouldn't give birth on my back which meant I couldn't have an epi which meant I couldn't have an induction. This is a VERY valid argument. If you tore badly the first time there is every chance you will tear again if you end up with an induction and instrumnet delivery because it greatly increases your chances of tearing. Tell him you don't wish to spend the rest of your life with incontinence issues.

    Also, is youre cycle longer than 28 days because this would push your due date out (according to the LMP due date). Mine is up to 32 days long which means you can't use the standard calculation to calculate my due date, it has to have an extra few days to accommodate my longer cycle.

    Stand up for what YOU want! It's your body and your baby and you know best!!

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    Thank you all for responding.

    I do acknowledge that my BP is higher now than it was a month or so ago because I actually have a monitor at home. I bought it for my first pregnancy when BP was a real issue and I have made it a habit to check at home. At first only every week or so, but in the last couple of months I have done it almost every morning, first thing in the morning when I sit up in bed as my non-delivering Dr whom I saw up to 30 weeks always said that your true BP is when you're rested and he trusted my home readings more than my Dr room readings (after he tested my machine against his and found it reasonably accurate).

    So I do know it is higher. But it is never as high at home as it is in the Dr office, even if only by 5 points. Partly perhaps from stress/nerves but also because I suppose it will never be as low during the rush of the day as it is first thing in the morning.

    I should also add that a couple of times I have had weirdly high readings from nurse (when they do the weight, BP and urine check prior to sending me through to the Dr), only to find it lower and ok when I get to the Dr's office. But I was told (by my pre 30 week Dr (complicated in country towns with limited obstetrics)) that the high one would always be false in this situation and to only go on the lower one, when more relaxed. BUT I know my current Dr knows this so I figured it's a non issue.

    So yes, I acknowledge it is 'higher' but not really 'high'. I also do believe that since he put me in hospital and first mentioned the words 'possible induction' I have been stressed and this has likely kept it elevated too.

    Bec - my cycle is longer. It's 35 days, give or take a day. But this has been factored into my dates. I estimated, based on my cycle and expected ovulation date (then adding two weeks) that my due date would be 13th July, and the first ultra sound I had at about 9 weeks brought up the date 14th July so I'm pretty sure we have it right.

    I think what I will do, since this is already scheduled and I have to show up, is go to the hospital and talk to the Dr about my concerns. Have BP taken and internal exam done. Allow only the gel and nothing else and if I don't start labour ask to be left alone, with monitoring (either in hospital if BP is concerning, or from home with visits to midwife every day or two), for a while longer as long as BP remains ok.

    I won't ignore the Dr's concerns because I want my baby to be safe, but I will try and come to a compromise if it is safe to do so.

    I do like my Dr and feel he has my and the baby's best interest at heart. I don't think he will like me double guessing him but I am very diplomatic in my discussions so I will word it in a way to not get his back up. I want our relationship to remain pleasant and comfortable. But now after reading your responses I feel I am justified in requesting more time, if my BP is not bad.

    One thing which encourages me to stand up for this on monday is that when I asked him about the syntocinon in my last appointment and explained my fear he did seem sympathetic and was leaning more towards that being a last resort thing, suggesting it's possible I'll go from the gel or the ARoM. Which seemed odd to me, because I know the process and basically if the gel doesn't get you started, and the membrane rupture doesn't, then they have no choice, after a certain amount of time, but to put you on the drip because of the risk of infection. So his empathetic tone may have only been to be reassuring, if you know what I mean.

    Thanks again, everyone. If you have any other thoughts for me please share.

    Now please excuse me as I go use the breast pump to, again, try and stimulate labour! It's worth a shot.

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    I had a similar first delivery to yours. I was induced at 38+2 due to gestational diabetes on insulin and ended up with 2 lots of gel, then had my waters broken the next morning. I was happy to have an epidural, but it failed, so I needed a 2nd one which was then too strong, so I needed a vacuum extraction. I also got a 3rd degree tear and my ds was born with the cord loosely around his neck, but he was breathing, but then he stopped breathing a minute later and had to be resuscitated. He spent 8 days in special care and thankfully I was able to breast feed him, despite the rough start (not initially of course, but by the time I took him home).

    Fast forward a few years and I was game to go back. I got fit (to avoid not being able to walk from pelvic instability), tried to lose weight (suceeded, but then regained some before actually getting pregnant), and then eventually I felt ready to TTC & get pregnant. I kept as active and stress free as possible, eating as well as I could manage. I was determined to avoid getting gestational diabetes and therefore avoiding an induction and another tear, etc, etc, etc (you understand). I did get gestational diabetes - diagnosed at a ridiculous 35 weeks when I was sick and it was 'just' at the cutoff point. BUT, I didn't need insulin, so, I was allowed to go to past 39 weeks before induction.

    I was also determined to try & get to as close to 40 weeks as possible, but I knew that I wouldn't be allowed past 40 weeks due to my gestational diabetes and past history (my ds was 4kg at 38+3 weeks). But, my dd was measuring big on scans (even before I was diagnosed with gestational diabetes) and my sugars crept up in those final weeks. But my body wasn't ready. I had a few false labours (including one that put me in hospital overnight), but my cervix remained high and not ready. My Ob told me the risk of another 3rd degree tear was low and the risk of a 4th degree tear was very minimal, so it wasn't worth going down the c-section route. I knew that this time around I'd stay as active as possible in labour and avoid an epidural if at all possible (no small feat as I'm allergic to all other pain relief options except panadol!).

    I go to 39+2 weeks and I still wasn't in labour, so reluctantly I agreed to be induced. I understood the risks and I was getting worried that my dd would be too big if I left it much longer (which may be the worry in your case given the shoulder issues in your last delivery??). Sure enough, the gel wasn't enough, but it really did get things going a lot better than last time, just not established labour. I had my waters broken the day after the gel and that's when things got moving quickly. It was SO different to my 1st labour. I went from a high, almost closed cervix at 10am to fully dilated and ready to push at 2pm.

    I was screaming for an epidural by 11:30am as the labour was SO intense. They connected the syntocinon drip at about 10:30am, but I only ended up with 40mg, which is the usual dose given in the first hour (a low dose) and normally women need a lot more than that per hour and that's all I got in 5.5 hours! The epidural this time around was fantastic. It did not stop me feeling the contractions, but they weren't painful (hard to explain) and I had great sensation when trying to push. I ended up with a small episiotomy, but NO tear (woohoo!) and that's despite needing forceps to deliver my dd (her shoulders were a tiny bit stuck). My dd was 4.4kg too, so no lightweight .

    It was the best delivery (eventhough dh nearly fainted after standing still holding me while the epidural went in - the anaesthetist was more worried about my dh than me for a while there!). Seriously, I'd do it again if it weren't for the whole pregnancy makes me sick, sore and tired thing. My dd went straight onto my chest and cried her little lungs out for ages (best sound EVER!) and she had lovely breastfeeds within the first hour and cuddles for hours on end. I even managed to get up for a shower about an hour after the delivery despite having an epidural during labour.

    The bottom line is that 2nd labours can be SO different to first ones. The body has done it before and often 2nd labours can be a lot quicker. Everything was just a lot easier for me 2nd time around and I was a lot more relaxed and I sort of knew what to expect too and that really helped. You & I had rough first deliveries, but in reality most inductions aren't anywhere near as bad as ours were.

    I hope my essay has helped. My ds is fine by the way - no long term issues from his rough start to life
    Last edited by mim1; 14-07-2012 at 22:22.

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    Hmmmm if bubs isn't engaged, there is no use in trying to stimulate labour. But I guess it wont hurt to try

    I know that you ultimately want a natural labour, but you also have concerns about tearing and loss of bowel control. Have you ever considered a c/s, as it will prevent any tearing and the loss of bowel control?
    My main concern with postponing a few days at a time, is that things can suddenly go downhill very fast and you'll end up with an emergency c/s which is the least desirable of birthing options.

    Though in the end you need to do what you think is best for you and your child.
    If naturally going into labour is best for you and your child and you are not 100% happy with your doctors advice, I would immediately look for a second opinion if the gel doesn't work on Monday.
    Just in case your doctor tries to convince you to try other induction procedures.

    Having to choose for the birth you do not want, can cause depression afterwards. Maybe tell your doctor how much naturally going into labour means to you and that you're worried of getting PND afterwards because you haven't been able to have the birth you so desperately wanted....

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    Thanks Mim1 for your story. It's good to hear that everything turned out ok, and very encouraging to hear, first hand, that a second induction may be a lot less traumatic! I'll hold onto that thought!

    Also, one of my concerns with epidural was, last time I didn't know when I should push but had to rely on the OB to tell me when it was time. It ended up that I was pushing for a full hour, when he left me there with the midwife, and when he came back after that hour expecting a baby and there wasn't one he checked and my cervix had closed over her head again (!!!!) so that hour of pushing was worthless. Just another example of the body not being 'ready' I suppose. Anyway... this time I really want to FEEL that sensation of 'ok, the baby is ready to go and I neeeeed to push it out now!' that I never felt last time. Hearing that your second epidural was good like this is very encouraging! Thank you!

    Misschief, thanks for responding. I did consider a c-section. Actually, a couple of months ago I came to the conclusion that if I had to be induced I would request a c-section instead. But now, as the induction has become a reality, I have changed my mind. If I didn't intend on having any more babies I might think differently but having a c-section has its own associated can of worms, with long term effects and consequences (eg. the scar being a weakness in any future induction - meaning I'd probably have to have another c section anyway). And I'm still holding onto the notion that maybe I will go into labour from the gel, or the ARoM, or even if I have to go through with the syntocinon perhaps it will be a different experience and go much quicker anyway. The staff at the hospital are aware of my tear and prepared to keep a close eye on the perineum. Not that that guarantees it will not tear again, but I feel the chance is slim particularly if I can hold off on the epidural (yah fat chance I know) and birth in a better position. Tricky to do so when the hospital doesn't even own a mobile CTG though.

    On another note, I currently have terrible, consistent lower back pain and very frequent braxton hicks today! Not pleasant but very encouraging. I hope this is the start and if it isn't, it still feels like good news for my body's readiness coming into an induction tomorrow. Fingers crossed.

    I think the baby is a lot lower than it was before the weekend so perhaps that is the cause of the lower back pain, but anyway that's still good news. Come on, baby!!!!!


 

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