"Induction recommendation"

I am submitting this feedback about an upsetting interaction I had with a doctor at the Bunbury Maternity ward recently. I was 38 weeks pregnant at the time and the conversation with the doctor was concerning, their recommendation that I be induced, due to the small predicted size of my baby (based on ultrasound measurements). I felt the doctor was very aggressive about this recommendation, despite no evidence that anything else was wrong with my placenta or the baby. I had been having 2-weekly growth ultrasounds for the past 6 weeks or so, which showed that, although my baby was small for gestational age, it was growing consistently along its percentile line and there were no issues with the placenta. Twice weekly CTGs were also normal and my baby was moving a lot.

That day I had seen a different clinician at the Antenatal clinic at Bunbury Hospital and they had found a small dip in growth on a hand-written graph (some of which I found out after was seemingly drawn inaccurately). I was then referred for an emergency ultrasound to check Amniotic fluid levels, blood flow to the baby’s brain and blood flow through the umbilical cord, all of which were normal. I found out 3 days later that they had also done growth measures (although this was not requested) which showed an increase in growth, which I recall the doctor failed to discuss with me; I'm not even sure that the doctor looked at the scan results at all and if they did, they failed to update me with this information, which was pivotal to their recommendation that the baby be induced. The doctor acknowledged themselves that the accuracy of the ultrasound is questionable, yet this was pivotal to their assertion that the baby should be induced immediately, and that the death of my baby was imminent, although nothing else was wrong.

I had not seen the doctor before and they didn’t seem to know anything about my history, including that my last baby was born small, naturally, at term, with no issues at birth or long-term. I recall the doctor said twice during our conversation that they've been studying this stuff for many years, why do I think I know better than them? I feel they were outright angry that I wasn't obeying orders and in my opinion, came across as aggressive and a bully. I felt they were not interested in my reasons for not agreeing to the induction, except to imply that they were stupid, and they were aggressive and rude in asserting their belief that the baby should be induced ASAP. The doctor also failed to discuss the risks associated with induction, which is concerning given this is a very invasive procedure. I wasn’t told what the risk of stillborn for a small baby versus a normal baby was. It seemed to me they were working on ‘fear-based’ consent as opposed to ‘informed consent’. Based on my experience, it concerns me that medicine is more about following protocols and guidelines, without considering case-by-case evidence and the patient's wishes. I had a lot of questions to ask but they were unanswered at the end of the interaction, I believe because the doctor had no personal or listening skills and I feel was too concerned with bullying me into an induction. I was upset for days about this interaction, and it interfered with my sleep. It is fantastic that doctors have so much knowledge and expertise about their subject area, but I feel this information is only useful if the doctor has some interpersonal skills and is able to listen to the patient and their concerns and not aggressively enforce their opinions.

In the end, I was not induced and my baby was born naturally a day before their due date. The birth was very quick and easy and my baby did not require any assistance at birth. My baby was born weighing 2.7kg and we were discharged from hospital after 4 hours.