"Maternity services"

I attended RAH when 35 weeks pregnant for a scan following a second episode of reduced fetal movement. The sonographer reported that the baby was measuring big, everything else was normal. The doctor recommended an induction at 37 weeks. The impression we got was that it would be unsafe not to, we agreed to book a date the following day. 

That evening I read up on the NICE guidelines and RCOG advice on intervention when fetus measures big for gestational age. The advice is not to intervene unless there is diabetes or other health issues. That induction shouldn't be done unless the benefits outweigh the risks and scans are not reliable for measuring size late in pregnancy.

When I told the hospital I wouldn't go for an early induction, they brought me in to speak to another doctor. This one explained the approach was litigation rather than evidence based and explained due to a major case in Lanarkshire of shoulder dystocia resulting in cerebral palsy, they preferred to induce if a baby measures big, despite induction bringing risks. This doctor presented the information in a more balanced way and I chose not to be induced.

I was asked to speak to a consultant following that. The consultant I met pushed the risks of cerebral palsy as a risk of not being induced before term and dismissed the risks of induction. As with the previous doctor, I explained the evidence I'd read and my own preferences. They referred to needing an emergency c section as 'popping the baby out the sun roof' despite me being a pregnant woman rather than a car. They repeatedly took blood pressure measurements despite them all being normal in what I suspect was an attempt to get a high measurement and push the case for early induction. They tried to present my pregnancy as now being complicated and no longer green pathway although I still fit the criteria for an uncomplicated pregnancy and green pathway for labour. I had to push to verify my options such as using the midwife led unit if I wanted to.

All of this was based a scan measurement which is not recommended to be used to indicate size in an otherwise normal late stage pregnancy. And even if it could be known that the fetus was big, induction brings many of the same risks as delivering a big baby and doesn't reduce the risks. Shoulder dystocia is rare and complications like cerebral palsy as a result are extremely rare.

My pregnancy went over term and the pressure to get induced was immense. In the end, I agreed and I regret having done so. However I am very glad that I was not induced early, my baby was just below nine pounds, not the eleven to twelve pounds I was told to expect. I don't think she would have been as happy and healthy as she was if she had been born four weeks earlier. I shared a ward with two women who delivered early (my understanding was this was due to some other health conditions), both had babies being treated for jaundice and therefore couldn't spend as much time with them. 

I understand that if something goes wrong in delivering a baby, it can go very wrong but the risk of this occurring is very low. More often interventions are done and these usually lead to more interventions again and though they are useful when needed, often they are not needed and mothers have less control over their labor, more painful recoveries and more difficult first days with their babies. 

I read up on the case which inspired the push for early induction. What I take from this experience is the importance of listening to an individual patients circumstances and concerns and responding appropriately. RAH appears to have jumped to just induce me early to avoid risk or to appear to have taken action to do so while continuing not to listen to patients or respond to their individual circumstances.

I think the approach of the hospital should be challenged. I found it very difficult to make my case not to be induced early. I have worked in health research and reckon I am better equipped than the average patient to assess what a doctor is telling me and the evidence and to make my argument. I think that's really worrying and expect other women are being advised to be induced with it seeming like a necessity when it isn't.