"Pregnancy"

I am currently under care of Fiona Stanley Hospital and am sharing my story regarding the lack of a clear birth plan for my current pregnancy. I am currently 31weeks pregnant, having weekly bloods/urine tests, weekly ctgs, weekly bloods pressure profiles and at home blood pressure/sugar monitoring. 

I have multiple documented high-risk factors, including:

-Gestational diabetes with a large baby (87th percentile)

-History of severe pre-eclampsia in previous pregnancies

-Current elevated and labile blood pressure, including hypertension earlier in this pregnancy (170/100 requiring labetalol)

-GBS positive status requiring intrapartum antibiotics

-History of precipitous labour (1 hour)

-Previous postpartum haemorrhage

-Current use of anticoagulation (clexane and aspirin), requiring planned cessation prior to delivery (as per haematologist) 

-Living rural 1 hour 40 minutes to 2 hours from the birthing hospital

-Responsibility for three special needs children requiring coordination of care

Despite this, I have been advised that no induction date will be provided, even at 38 weeks, and that inductions are generally avoided unless there is an emergency. 

Whereas all 3x of my previous pregnancies at Fiona Stanly have had induction dates (provided - not requested) at 3x 37weeks, 2x ended with 35week inductions. 

I have also been advised of contingency plans that I feel are not practical or safe in my situation, including:

-Calling an ambulance in labour (without provision for my children)

-Relocating closer to the hospital (not feasible due to my children’s needs/education) 

-Seeking NDIS respite (which is not an immediate or realistic solution)

My concern is not preference-based, but safety-based. 

Without a planned induction:

-I am at risk of rapid, unassisted labour given my history (living rural with the main road down the hill being a no reception road)

-There is a risk of missing timely antibiotics for GBS

-There is no safe plan for managing anticoagulation cessation

-There are significant risks associated with my previous obstetric history (pre eclampsia) 

-There is no practical plan for the care of my children during labour

All I was requesting:

-A documented and agreed birth plan, including a planned induction window

-Clear guidance regarding timing of cessation of clexane and aspirin

-Consideration of my individual risk factors, including distance, history of precipitous labour, and prior complications

I am not seeking unnecessary intervention, but a safe and coordinated plan that reduces risk to both myself and my baby.

Now I am stuck seeking urgent review of my case with external sources to try advocate for myself and baby. I am so upset, I chose to move to Fiona Stanley because I had 3 good experiences there, and felt safe. Now I feel like my individual case isn't being assessed properly.