Planned for 24 hours. It took three days.
My first child’s birth, and what I’d plan differently.
The weeks before the birth
By the end of the pregnancy, I was being monitored twice a week. I often couldn’t feel my baby move, even when the ultrasound showed movement, so I had nonstress tests and biophysical profiles (tests that check the baby’s heart rate and movement) twice a week. My blood pressure was climbing at home, and I’d been to labor and delivery triage twice for high readings on my own cuff. I’d gained weight rapidly over two weeks, and my face and legs were swollen. Near the end of the pregnancy, I also had COVID and strep throat.
Shortly before the induction, my doctor wrote that one more high reading “will be consistent with GHTN and delivery recommended at 37 weeks.” GHTN is gestational hypertension, high blood pressure that starts in pregnancy. We had discussed inducing at 37, 38 or 39 weeks. I was leaning toward 38.
One morning, early term, I messaged my doctor that I was feeling reduced movement and was calling the emergency line, and I went in. By that evening, I was being admitted for induction. The reason in my chart is gestational hypertension.
The plan I wrote for my care team
I had written a birth plan and revised it with my doctor line by line, and I had sent 32 numbered questions, from how long a Foley balloon (a small balloon placed in the cervix to help open it) can stay in to who would deliver my baby. (What the answers taught me is in “Working With Your Doctor.”) The answers to my questions were careful. The number of rounds of cervical ripening is “not preset and will depend on reality of the induction.” How long I’d be allowed to labor “is NOT preset and depends on the labor curve, fetal status and rupture times.” I was given an example of when a cesarean would be recommended. The induction took three days.
Outside those 32 questions, I also asked in writing that no one mention my baby’s sex, or that I knew it, during my appointments.
The plan I wrote for my family
When I realized an induction could happen with little warning, I wrote a second plan, for everyone else, titled “Unexpected Induction: Priority Plan.” One job for my partner, two people to answer everyone else’s questions, a bag in the car by 9 p.m. and the house handled. It assumed a 24-hour induction. (The full plan is in “Getting Ready for the Hospital.”)
The induction
At triage that day, my blood pressure was high. They monitored me for about three hours, and it went back down. A nurse said I could probably go home. Then the doctor said no, I couldn’t go home: I was early term, and I should stay and be induced. I said OK.
I waited about three hours for my partner to get there, and then I moved to my room. They started with a Foley balloon and IV antibiotics. I remember being told the antibiotics were because I’d had strep throat; my records show the plan was antibiotics in labor because group B strep, a common type of bacteria, had been found in my urine. I remember the first balloon being placed incorrectly and having to be replaced. The cervical checks hurt really badly.
The next day, they started Pitocin, the drug used to bring on contractions. As it ramped up, it started hurting badly, and I got an epidural. After that, I was pretty much just lying there. Time passed. Separately, I was trying to find a doula during the induction, and one came that night.
I asked them to turn the Pitocin down, and later they turned it back up. The doula and I tried to get things moving, and it wasn’t working. I felt like we were alone a lot. I mostly remember being on the bed. I wanted to try different positions, but I was exhausted and couldn’t think clearly.
At one point, a clinician told me I had progressed to 4 centimeters. Then my doctor did another cervical check and said I was only at 2.
I had asked a couple of times whether I could labor a bit longer. Not long after that check, they came in with paperwork. What I remember is being told that if I didn’t want a C-section, I would have to sign against medical advice. I said OK, let’s discuss it, and we did. I don’t have a record of that conversation. Two weeks after the birth, my doctor wrote that the “likely cause of failed induction” was cephalopelvic disproportion, meaning my baby’s head and my pelvis weren’t a good fit for a vaginal birth.
Afterward, I cried. I didn’t know why they would think I wouldn’t listen to their guidance. I was there because they had told me I needed to be induced. It felt like a strange escalation.
I know now that cervical checks vary from one examiner to the next: studies comparing two examiners found an average difference of 1 to 2 centimeters, and sometimes much more. That can’t tell me what accounted for my two numbers. It still felt strange to go backward on paper, not long before I was asked to decide.
The birth
The induction didn’t progress. My baby was born by cesarean, having squeaked past 37 weeks, with reassuring Apgar results.
My chart summarizes the rest in one line: cesarean “for failed IOL for gHTN c/b PEC w/ SF s/p Magnesium x12hr.” In plain words: the induction for gestational hypertension failed, and it was complicated by preeclampsia with severe features. My blood pressure was high afterward, so I was on magnesium for 12 hours to protect against seizures, started on nifedipine for my blood pressure and sent home on it. I was told I had gained a lot of fluid, and that they had to drain a lot of it. We stayed a few days in a private room, which cost a little extra, and then went home.
Five days later, at home, my pressure was up and I had chest pain, and the hospital’s emergency line and my discharge papers gave me two different blood pressure numbers for when to worry. That part is in “Preeclampsia: Know the Numbers” and “Chest Pain in Pregnancy and After Birth.”
I didn’t leave the hospital with my records or an explanation of my surgery that I understood. My debrief on the birth lasted about 15 minutes. Nine months later, a gynecologist reading my records told me things about my surgery I hadn’t known, and I still have questions about what they meant. That part is in “Nine Months Later, I Was Still Asking What Happened in My Surgery.”
Induction, and the days after
- An induction is a process, not an appointment. ACOG describes cervical ripening as a step that may be needed before labor can be induced, and how ready your cervix is, often measured with a Bishop score, affects how an induction goes.
- “Failed induction” is a medical term, for labor that doesn’t progress despite induction. It describes the labor, not the person.
- Preeclampsia can get worse after birth. Mine became severe after delivery, so the blood pressure plan has to cover the days at home.
- Discharge is a decision you’re part of. New York’s Hospital Patients’ Bill of Rights gives you the right to take part in decisions about your treatment and discharge, to receive a written discharge plan, and to receive complete information about your diagnosis, treatment and prognosis. Most states have a similar document; ask your hospital for its own.
Key points
- If your cervix isn’t ready, an induction may start with cervical ripening, a step to soften and open it. How ready it is, often measured with a Bishop score (a rating of the cervix), affects how the induction goes. Ask your provider how ready your cervix is, and plan your family’s coverage for several days, not one.
- New York’s Hospital Patients’ Bill of Rights gives you the right to a written discharge plan and complete information about your diagnosis and treatment. Ask for your operative report and an explanation of your surgery before you leave.
My family’s plan assumed an evening induction, a baby born by the following evening and home a day after that.
The induction took three days, and my baby was born by cesarean. I went home with blood pressure medication and a diagnosis of preeclampsia. I had been watching my blood pressure through the final weeks of pregnancy.
What I’d do differently
- Write both plans again, for the care team and for the family.
- Plan for the long version, including who has my toddler for several days.
- Talk through, before labor, how the team will explain a recommendation if I ask for more time. I had already asked in writing what would lead to a cesarean. What I didn’t have in the room was a clear picture of what had changed, why they recommended delivery then and what risks they saw in continuing. Next time, those are the three things I’ll ask for.
- Ask about IV fluids. After a reel about IV fluids in labor, I want to know how much I was given during my induction, and whether it could have contributed to how swollen I was afterward. I can’t say it did. It’s a question for my records.
- Ask for the operative report and a real debrief before discharge.
Take this back
To discuss with your care team:
- How ready is my cervix, and what would you use to ripen it?
- How will we know the induction is working? What would make you recommend a cesarean?
- If I’m induced for high blood pressure, what’s the plan if it gets worse after birth?
- If you recommend a cesarean, can we talk it through before any paperwork comes out? Who will go through my operative report with me, and how much time will we have?
- What medications was I given during delivery and surgery, and why?
To discuss with the people in your life: What’s your one job if I go in early? Who answers everyone’s questions so my partner doesn’t have to?
What I understand now
My doctor was right that nothing about the timeline was preset. I was told so in writing. I still built my family’s plan around a 24-hour window. Next time, I’ll plan for the long version and hope for the short one.
Don’t wait if
After birth, get seen right away for a headache that won’t go away, vision changes, pain in your upper belly, swelling in your face or hands, chest pain, trouble breathing, or a blood pressure reading with a top number of 160 or higher or a bottom number of 110 or higher. Postpartum preeclampsia can develop days or weeks after delivery.
Next in the series: “What Postpartum Care Should Include”
