Our High Risk Pregnancy So Far: Why We’ve Accepted Induction Of Labour

The last few weeks have been stressful with no news and, as a result, no plan. Finally, at 36 weeks, we now have one, but it might not be the plan everyone was expecting us to have. If you haven’t read our previous post about our pregnancy journey so far, you can read the last one here

From the start, we always knew that I’d require some sort of medical input when it came to labour time and birth. Our biggest fears were that I’d be pressured into accepting a c-section which for me would mean a difficult recovery and relying on Alex and our families for almost everything for the first 8-12 weeks, both in terms of my care and little one’s. I’ve always been for a physiological birth, or as close to it as I can possibly get, only going for a c-section or other interventions if absolutely necessary, especially as it would very likely need to be done under general. Luckily, the result of the MDT meeting was that if I don’t want an elective c-section, then I don’t have to have one, but it’s under the condition that I’m aware we could still be heading down that route if either little one or I don’t cope well in during labour. 

How the option of induction came about and why we accepted

One of the biggest things about not going down the c-section route is unpredictability and the risks involved. For us, not only do I have a medical condition which means I can’t feel movements or contractions and have to palpate for them, but I’m also at risk of precipitous labour. Then, to top it off, we found out that I have Group B Strep at 26 weeks, and I’m also at risk of other complications. It meant that the idea of induction was proposed to us, with all the risks and benefits involved. Benefits? We’d have an idea of when my labour will begin, and with it, the option to ensure Alex is off work for a few days so that he doesn’t miss the birth. It also eliminates the risk of me giving birth at home with no help other than Alex’s Avmed training, which, whilst the scope of what Avmed covers is fantastic, where childbirth is concerned, it doesn’t equip you for a complicated labour birth. Cons? If it fails or something else happens, it’s a c-section since assisted delivery via forceps or ventose is out of the question due to dislocation risk. It also further increases my haemorrhage risk, something my consultant already factored in early on so that there’ll be medication drawn up and on standby if it’s needed. 

As my midwife talked to me about induction some weeks ago when Alex’s roster and being back at work was causing me stress around whether or not he’d even make the birth, Alex and I had actually spoken about the possibility of induction. We researched the risks and benefits before my consultant had even offered it to us to come to a decision together without feeling pressured. After those discussions with Alex and my midwife, I said that if induction was offered to me, I’d accept it to reduce the risk of that happening as him not being at the birth would be heartbreaking for us both. It also gives us some control over the situation as long as little one stays put and I don’t go into labour before induction day, something which could happen and my consultant warned us about when we accepted the offer. Alex had already made it clear that he’s scared of waking up during the night to find me still asleep whilst in advanced labour, something which we both know would affect him massively even with all of the training he’s equipped with, thanks to him being crew! 

As you can see, accepting an induction of labour was an easy decision for us once we’d weighed up all of the risks and benefits. Even with the risk of having to go down the c-section route if something goes wrong, the thought of having an unattended labour and birth with all of the dangers attached due to my complex medical history scares Alex and I more. We are also fortunate that we never felt pressured by the team looking after us to accept induction, mainly because we’d had that discussion ourselves beforehand, giving us time to fully consider everything. Not only is there information on induction of labour available to read in my handheld notes, but we also turned to Google to research the specific risks that are unique to our situation and spoke to other pregnant people who have EDS. But what if you’re enjoying a lower risk pregnancy and offered induction, or just don’t know if you want one?

Research is your best friend

Alex and I both know people who have been offered induction of labour and felt little pressure to accept, as well as plenty of people with low-risk pregnancies who felt forced into accepting an induction to keep their team happy. We started looking into our options quite early on once our consultant told me that she’d do everything possible to keep our options for labour and mode of delivery open. That kind of support from her when every other specialist outside of obstetrics had told me that c-section was the safest way forward meant the world to both of us. It also meant that we felt even more supported by the teams looking after us, both at our local hospital and the Silver Start Unit in Oxford, who we’re so thankful to have the specialist input of. 

Great places to research induction include Google (especially as you can tailor your search to your unique situation) and your handheld notes if your hospital provides information on induction of labour in these. I also highly recommend speaking to people who’ve had an induction of labour offered about their experiences, even if they didn’t accept the offer, as firsthand experiences can often help the decision making process. This same piece of advice goes for those who have medical conditions which could influence management. There are plenty of online groups on Facebook etc., which allow you to connect with others going through similar! If you can, start researching and discussing your thoughts with someone else early! This means by the time an offer of induction is given to you (if it is), you’ll have already thought about it and either decided on whether or not to accept, or you’ll have an idea of what questions to ask. It also means that whatever your decision is, you’ll be able to explain the reasoning behind your decision to whoever is looking after you knowing that you’ve given yourself time to consider all the risks and benefits. I’ve also learned to use one acronym that has helped us massively with each decision we make, called B.R.A.I.N. 

What is B.R.A.I.N?

B.R.A.I.N really is what it says it is; it’s using your brain to make an informed decision. 

B – Benefits (what are the benefits of this test or procedure for me and my baby?) 

R – Risks (what are the risks of this test or procedure for me and my baby?)

A – Alternatives (What, if any, are the alternatives?) 

I – Instinct (What is my instinct telling me? What do I think and feel about this test or procedure? Who else can I ask about it?)

N – Nothing (What could happen if I decide to do nothing or wait and see? Can this test or procedure be delayed? Can I take some time to think about it or research?)

B.R.A.I.N is something we’ve used throughout our pregnancy journey to make informed decisions and choices that we know are right for us without feeling pressured into doing something we may not necessarily want to do. It’s also something that we will continue to use and advocate that others use, especially as it is such a handy tool to have. With the NICE draft guidelines meaning that an increasing amount of people are already being offered induction at 39 weeks even if there isn’t a clear clinical need, now more than ever, birthing people and their partners must be able to make informed decisions without feeling pressured into accepting something they may not actually want. 

Have you been offered an induction of labour or had one in the past? Feel free to share your experiences in the comments with us! 

Accessibility When Pregnant: A Disabled Parent-To-Be’s Point Of View

Being pregnant and disabled seems to throw near enough everyone. If it’s not people making assumptions and comments related to becoming a disabled parent (see our blog post on that here), it’s the lack of access to maternity care. Society can’t get to grips with the simple fact that disabled people have lives, have relationships, create families, and need the same access to services as able-bodied people!

Healthcare settings, in general, are not the most accessible places for disabled people. For example, wheelchair users requiring cervical or other screenings often can’t get onto the beds or close to the machines and sometimes can’t even get into the room they need to go in. In addition, sighted guidance training doesn’t always seem to have been provided to staff, and thanks to Covid-19, masks mean that those who rely on lip-reading are often left not knowing what’s going on. This is just the tip of the iceberg of access problems.

For me, in maternity specifically, the access issues have recently become a nightmare. Whilst the antenatal clinic is relatively accessible at my local hospital for wheelchair users, the same cannot be said for labour triage upstairs! Right from the beginning, my midwife has made as many of my appointments as possible with her home visits. Not just because of my vulnerability status regarding Covid-19, but because my home is set up for me. I can transfer out of my chair onto the sofa or the bed when it’s time to check little one’s positioning and listen to their heartbeat, and I also feel much more at ease because hospitals and I have a pretty bad history.

At my local hospital, labour triage has two assessment rooms. Both rooms are so small that as a wheelchair user, I’m unable to move around in either. It also means I can’t transfer onto the bed on a good day, can’t be hoisted in these rooms on a bad day, and to top it off, if I need monitoring, then it’s done with me sitting in my wheelchair, which can mean that the CTG doesn’t always meet criteria. If I need other examinations for whatever reason, the only option available is to wait for one of the larger delivery rooms to free up. The problems don’t stop there either, as in labour triage there’s no disabled toilet. It’s a case of me making sure I take a urine sample in with me when I go in, or I have to go downstairs to the disabled toilet to do one. It also means that if I need to catheterise whilst upstairs, we then have to go downstairs to do that. So far, in the few visits that I’ve had for various scares, I’ve found two delivery rooms that have toilets I can use as they have grab rails in, although on one of these I’ll still need help to transfer as the grab rails aren’t on both sides.

My access needs have become a bigger worry as the delivery day nears. Will I end up being a burden on already overstretched staff when I need help in the times Alex or other family coming to visit us aren’t there? I’ve already been made to feel like a burden once when a registrar didn’t understand my needs. If it wasn’t for the fact that my own midwife was with me when it happened, I probably would have broken down even more than I did. At 33 weeks, when we were worried I may have gone into preterm labour, I was seen in one of those tiny triage rooms. The registrar was adamant that they could help me onto a bed that both my midwife and I knew I wouldn’t be able to safely get on without being hoisted. In the end, my lovely midwife said to me, ‘I’m going to go and speak with the others to get you into one of the delivery rooms because there’s no way we’re risking a dislocation!’ Having that kind of advocacy during one of my most vulnerable moments has been invaluable.

The lack of access around the hospital is such a worry that I’m dreading the postnatal period whilst in hospital. Will there be enough room around the bed for my chair and my case, especially with little one’s cot to contend with as well. Will I be able to use the bathrooms and toilet on the postnatal ward? If I need to be hoisted, will there be room for that? Thankfully, I have such a great midwife that she’s already thinking ahead to that period, even to the point of planning to ask for me to have a side room which will mean more space. Anyone who’s given birth in a hospital knows that side rooms on postnatal are a rarity, so if we do manage to get one, I’ll be even happier. With my medication having a sedative effect, I know that it’s going to be a tough ask, but my access needs are just as important as other needs in the bigger picture.

Many won’t realise this, but July marks Disability Pride month. If you didn’t know that, it’s likely because you haven’t seen the equivalent of rainbow washing that companies perform during Pride month in June. You see, companies don’t seem to bother with disabled folk; I’ve seen hardly any talk about how they’re helping disabled people or making their services more accessible. Our communities’ struggles aren’t for one month of the year, they are every single day, and that’s why active allyship and advocacy for disabled people and their needs is so important! As I’ve said in this post, how my midwife advocates for my needs is invaluable. Not only to me but to Alex as well because he is also worried about my needs not being met if he’s not with me in hospital for whatever reason. After little one has arrived, I’ll be doing a post about how having almost one-to-one care throughout the pregnancy has really helped me and why I believe everyone should have access to that level of support if they need it!