As you know, I've done alot of reading, my AIMS Induction booklet and Nicky Wesson's Home Birth book have been great, but it's not quite enough, especially when I have to stand up to my community midwife, telling me that the local NHS policy is to not let ladies go past 12 days due to depletion of placental ability to provide sustenance for the fetus. I saw her on Tuesday, and despite me planning to request no induction and to be monitored instead and wait for labour to begin of it's own accord, I just couldn't take on the argument in the end. My midwife didn't mention monitoring as an option anyway. I'd also been knocked by her question (which happens at each appointment), "you're still certain you want to go for homebirth, no worries about it?" (does she ask this for those booked in at the hospital I wonder?). The bit of luck I had was that my original induction date of Sunday was put forward two days because of short-staffing over the Easter bank holiday (I wouldn't want to be on a short-staffed induction ward then anyway so was a relief on two counts).
Another bonus was that my midwife was happy with my decision to decline the sweep, saying she'd do the same as it's an inexact science. More for those desperate to have their baby and who want hurrying along. I know this is maybe counter intuitive, as perhaps a sweep would make it more likely that my labour will start before my induction date, but I just wanted to step away and leave my body/baby combination to work for itself. Not as an experiment, but to reassure myself that I am OK and I can do this.
After the appointment and for days after I actually felt fine, almost peaceful, about the induction booking. That we'd be OK, we've done it before and know what to expect, will get an early epidural etc. But as the days increase and I'm less hopeful about labour starting of its own accord, my anxiety is on the rise again.
Unfortunately, the strength I've gained from reading the literature available to me hasn't been quite enough when I'm used to accessing scientific journal articles and literature reviews that weigh up dozens, or hundreds of studies, to come to a conclusion about what's best. I cannot access the reassurance I'm looking for, which makes me a difficult case I know. For example: "...studies show that the baby is at no greater risk if pregnancy continues up to 44 weeks, if monitored" (p30, Wesson cites Augusen et al., (1987) and Gibbs et al., (1982) - surely there are more up to date references? But then, if UK policy is to induce at +12 days where are the cases available to run studies coming from? So what about French studies?).
Induction anxiety - I'm trying to will it away, but not very successfully
To explain how I feel, I'll quote a section on the risks of induction from Wesson's book, even if it is seeming inevitable again.
"...they include an increased risk of infection in mother and baby; an increased likelihood of epidural, forceps and Caesarean section; postpartum haemorrhage has been shown to occur nearly twice as frequently; the baby is more likely to become asphyxiated and require special care; it is more likely to become jaundiced and to be affected by a greater use of pharmacological pain relief by its mother. All these are physiological hazards, they do not include the lasting psychological damage done to women who feel an enduring sense of loss and failure at not going into labour spontaneously" (p30).
I don't want to put my child, or myself, at any risks by refusing induction, but I do want to know that my booking for induction is necessary, based on valid scientific reasons specific to my individual circumstances. My cycle has always been long and irregular; contractions started the night before I was induced last time, but still told to go in for my appointment, as wasn't progressing enough; and pure speculation, my great aunt was 3 weeks late delivering all three of her healthy children (pre induction policy in the 1940's/50's).
"This guideline offers best practice advice on the care of women who are having or being offered induction of labour.
Treatment and care should take into account women's individual needs and preferences. Women who are having or being offered induction of labour should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals....Good communication between healthcare professionals and women is essential. It should be supported by evidence-based written information tailored to the needs of the individual woman"Guidelines don't match reality then, especially when I see how little time my midwife has at our appointments anyway - the harrassed expression is familiar. She has just enough to test my urine, blood pressure, fetal heartbeat and tummy size and book the next appointment mostly. Although I would like more time from my midwife, and have been disappointed, I am also sympathetic to how much she most likely is pressed for time and can only do the minimum risk-avoidance tasks, she doesn't want me to complicate things by deviating from the standard path of care.
I'm trying not to think about Tuesday, I'm trying to stay calm. I know that the most important thing is meeting my healthy baby at the end, which is perhaps why many don't expect induction to be a problem (the end justifies the means). Being able to deliver my baby myself isn't an egotistical thing though, and after my experience last time I agree with the psychological risks of induction... induction to me is handing over responsibility to synthetic chemistry, when if left alone, I could have done it for myself. Please note, any necessary induction according to the confirmed risk to that individual case is something I would never question.
you are going to do great!
ReplyDeletei think you just 'cook' your kids longer - abigail was 10 days late and may have been even later, if 'modern medicine' hadn't intervened.
smile & have another bath. it will do you and little brother the world of good. you will be in that birth pool and he will be breathing on his own before you know it. xxx