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Induction at QMH

  1. #1
    HappyV is offline Registered User
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    Induction at QMH

    Can anyone tell what what steps were taken to induce at QMH? I will be having my first baby (induced at approx 36 weeks) very soon, and while I have read a lot about the different procedures that can be used, I am interested to know what the 'policies' are at this particular hospital. (For example, I have heard that they tend to jump straight from the pessary to c-sections, rather than using gels or IVs - is this true?)
    Any stories greatly appreciated!

  2. #2
    Slee is offline Registered User
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    Hi, induction was a big deal for me and I learnt all that I could about it as I nearly had to go through the process at QMH. My best advice is to listen to what everyone has to say about QMH, but be prepared for things to happen completely different as, in general, the practices vary greatly between different midwives and different doctors.

    'Gel' actually contains the same medicine as the pessaries - prostaglandins - so it's not suprising that you've heard of people not receiving this. They defintiely do use pessaries. I actually arrived at the hospital for my induction already in early labour, but all the same I was given a pessary while being examined. However, I know someone else who had her waters broken and and her pitocin drip started at the same time without pessaries being tried beforehand. She asked about the pessaries but didn't insist on it as she was assured that, although she wasn't dilated, her cervix was already ripe so they weren't necessary. The end result was that she got really, really painful contractions two minutes apart right from the start and then was given such a strong epidural she ended up pushing for three hours before her baby was plucked out with forceps. Therefore, if they try to induce you without prostaglandins say NO!!!!! Even if you need petocin/oxytocin later, at least you'd have had a chance to get some endorphins going and I read in one magazine (not the Lancet I know!) that they will kick start labour in 90% of cases.

    Rupturing your membranes has the duel effect of putting direct pressure on the cervix and causing a big flow of natural prostoglandins so if you can, try to get your doctor to perform an ARM and then give you some time to see if that works before bringing on the pitocin you will hopefully be able to move around still, which will also help things along on their own. It all depends on what doctor and what midwife you get though, as some won't have you anywhere else but on the bed and it is difficult to argue with the people who you're entrusting so much with.

    I'm sure the only reason I escaped my induction was because I managed to induce labour naturally. I used to be very sceptical of alternative medicine but faced with induction I was willing to give anything a go! I did everything in Zita West's Natural Pregnancy book - acupuncture, homeopathy, sex, walking loads etc - to get things going and I'm sure what clinched it was getting acupuncture induction points marked on me by a TCM which I was then able to strap my TENS machine on to. Osteopaths are also meant to be very good at starting labour by stimulating certain points, but I ran out of time to try this route.

    Since you asked about policies I should warn you that they're very keen on stripping your membranes, which is fine and a good 'natural' way of inducing labour, but they don't ask your permission first. My doctor told me she was just examining my cervix so I got a shock when she started doing something very painful all of a sudden down there. The same thing happened to a friend while being examined by a different doctor, so it seems to be their modus operandi. Before any vaginals, I'd just ask your doctor to warn you if he/she planned to do a sweep as well so that you're prepared for the discomfort. The same thing happened with the pessary, which was a real bummer as I wasn't allowed to go home after it was inserted. By the way, before they worked out that I was in labour, I insisted that they perform an ultrasound to make sure that I really needed the induction. This caused a bit of bother for them as they had to find a spare machine, but I'd made my OB promise me at our last checkup that she'd do so, so it happened. You could ask to what your 'Bishop's score' is (http://www.mother-care.ca/bishop.htm), just to reassure you that they are not just following the calandar or being gung-ho.

    If at the end of everything you do need to be induced, don't worry as you will get through it and will have a lovely baby to hold at the end. In addition to the pessaries, you can also give your body a chance to build up some endorphins by hooking up a TENS machine as if you were in labour before the pitocin starts. TENS machines actually work in labour by blocking pain signals and stimulating endorphins so it's worth a go. Keep in mind too that usually on monitor printouts pitocin contractions measure much, much larger than 'normal' contractions. Therefore, there is no shame in taking the epidural!

  3. #3
    Slee is offline Registered User
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    HappyV, I'm really sorry but my toddler was distracting me so I didn't read your post properly. I thought you were just asking in case you went over, not because you needed one early. Please keep that in mind when reading my last post! Are they planning an induction because they're worried about your baby getting too big due to gestational diabetes? Of so, then I'd double check with your private OB or insist on the U/S before they do anything else!

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    HappyV is offline Registered User
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    They will be inducing me early (36-38 weeks) as I have Gestational Diabetes, as well as thrombocytopenia (low platelets) and Lupus (including the lupus anti-coagulant antibodies) - quite a combination. (Not to mention having to have early labout stopped with drugs a couple of weeks back). They will basically be looking for a 'window' when my chemistry is 'optimal' for labour. They are basically waiting until the baby's lungs are mature. and then trying to get him out before there is too much pressure placed on the placenta/umbilical by all these complications.
    Thanks for all that info - I doubt I will have much chance to get into 'natural' induction methids, as it will be a case of 'you blood work is good - let's go' - but maybe some Rasberry Tea won't hurt along the way!!
    I will certainly be insisting that they explain each step to me before they do anything like strip the membranes.................what an irresponsible step to take without informing you first!

  5. #5
    Slee is offline Registered User
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    Wow, you're not doing things by half! I was wrongly diagnosed with Lupus for over ten years, including while I was pregnant so I understand a little bit of what you're dealing with. In fact, one of my reasons for induction was a possible narrowing of a blood vessel causing me to experience a possible stroke - very freaky!

    Although you will encounter a 'you don't need to ask questions or hear much from us as we'll look after everything' attitude they will have your best interests at heart. Moreover, I'm sure you'll be managed very carefully and as you say they will be watching you very carefully. You won't be one of those mums who are induced as soon as they reach ten days over without wasting resources on seeing whether it is necessary at that time or not - heaven forbid they ever have to ultrasound all women who go over!

    Do remember that ultimately it is your body and it sounds like you're reading up on the best medical induction steps so don't feel scared to tell your doctors what you expect. Once things get started, you'll probably not be wanting to enter indepth conversations so make your feelings very clear beforehand. If you're under Dr. Helena Lam then she was my OB and although she did sweep me and insert a pessary without first telling me, she did at least do the pessary the night before everything else was meant to be started and she honoured her promise of an ultrasound. She actually had to take me down to the reproduction unit, switching lights on as we went!

    One problem that I did have was that I didn't receive a shot of steriods at six weeks postpartum, which is very common overseas but not the procedure at QMH. I don't know whether it would have helped but in any event I had a severe arthritis flareup at four months postpartum. Luckily my GP referred me to a wonderful rheumatolgist (Chan Tak Hin) who sorted me out and rediagnosed me as having an 'undifferentiated automimmune disorder'.

    I agree re: the natural therapy route. I do know of one mum though who rolled up at an osteopath at 37 weeks to have her pelvis 'aligned' for whenever she went into labour only to go into labour that night! How many weeks are you now?

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    HappyV is offline Registered User
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    I am nearly 34 weeks now - so I have a couple of weeks to go.
    I have been dealing with Dr Leung through the High Risk ward, and I have not encountered any problems with him at all - he has been fantastic: he's answered all my questions, and been very willing to accomodate my preferences on aspects of drug balance and dosages. Couldn't recommend him enough.
    However, I have had several experiences over the last eight months of being in the ward for a coupld of days, and it is more the other doctors/staff that I worry about. I hate the idea of following blind procedure, with little or no reference to my particular situation - which is why I want to go in fully informed about what tends to happen. I have another OB checkup in a week's time, so I will be discussing all this in more detail then.
    Whilst I fully understand that a certain level of medical/physical manipulation will be necessary for me, I still want to try for minimal intervention, if at all possible. It is my experience that the staff tend to jump to 'worst possible scenario' mode, and follow that route..........whereas I want to be informed, and then participate in the decisions.
    First time Mum - can't you tell?
    As to the Lupus misdiagnosis - it's amazing how quickly the information changes! I am sure you know that up until about 30 years ago, women with Lupus were advised not to have children at all - aren't we lucky that this is no longer the case?

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    Slee is offline Registered User
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    You sound like a perfectly reasoned woman, not a first time worried mum! Going into labour was very scary, what with a suspected 'brain thing' to quote my doctor and the thought of an induction, but in the end I had a completely natural birth with a bit of gas and air. I know I am the exception and that I was extremely, extremely lucky but it goes to show that things can work out better than you expect. Just remember that no matter what, you will get a lovely baby at the end of it all :-) You're already 34 weeks and are being watched closely so you will be both safe.

    Maybe you should bring a draft birth plan of your induction with you and have your doctor sign it. From experience, that way, whoever you come across will look at it, ask 'Did Dr. Leung approve this?' with a shocked, alarmed look then follow it!!!!!

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    HappyV is offline Registered User
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    The best laid plans...........
    I had an OB checkup on Friday July 29th and showed some signs of possible pre-eclampsia. So they wanted to have me in on Saturday 30th for monitoring, before th eplanned induction on Tuesday.
    Once they hooked me up to the fetal monitor, the nurses all started looking concerned. It turned out that the baby had the cord wrapped twice around his neck, and that his heart beat was being compromised. Given that I was already at risk of blood clots in the cord, they decided to get the baby out that afternoon.
    So all my info-gathering on induction and labout turned out to be for nothing - I'm just glad that I had also read all the C-section info I could get my hands on. It was a relief to have an understanding of what was about to happen.
    So Jack was born on Saturday afternoon, and all is well!
    Thanks to all for the replies to this post.

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