Confused about my birth options? Epidural or ELCS?

[Writerwannabe83]

Hello everyone, I'm just after any words of advice please. Currently 28 weeks pregnant and due to having 2 chronic health conditions the plan has always been leaning towards me having an ELCS which was discussed at my last Obstetrician appointment.

I saw my Obstetrician again today and due to my health having stabilised (I've had changes made to my medications) she now thinks we should avoid the ELCS and instead go for planned admission, insertion of epidural, then have an induction and aim for a vaginal birth.

Although I see benefits to this plan I'm also anxious and still wonder if an ELCS is the way to go. I don't really know enough about the induction process. My Obstetrician has told me to have a good think about it and we can hopefully make a final decision when I see her again at the end of the month.

Has anyone else been in a situation like this, or could tell me about their experiences?

Thank you.

[Outnumbrd]

Induction will involve a Prostin pessary which is put into the vagina, you then wait a few hours, or sometimes 24 hours depending on the type your hospital use. You will then be assessed with a vaginal examination where they will try to break your waters, the Prostin should have done its job and softened your cervix enough so that the doctor/midwife can do this. Breaking the waters is not as bad as "what they tell you", uncomfortable at the most.
Once your waters are broken you will have a drip in your hand which contains syntocinon, this makes tour uterus contract. It will be turned up around every half an hour, but you contractions will be closely monitored and so will baby's heart rate. This is done by being on a CTG which is two belts that go around your tummy. I expect the epidural will have been inserted when the syntocinon drip is started so you shouldn't feel the contractions.
You will have a vaginal examination around every 4 hours to make sure you are dilating. Once you reach 10 cm, you will then be encouraged to push the baby out, (2nd stage of labour).
If at any point they are worried about baby's heart rate or you are not going in to labour, you will be taken for a CS, you will already have the epidural so as long as it's working well it will be quite a quick procedure to deliver baby this way.

I think what you have to consider is the recovery time after a CS, only you can decide what you feel comfortable with, without knowing your full history, which your consultant does it's hard to comment further. Hope this helps.

[Writerwannabe83]

Thanks for that - it was really helpful. My mind is all over the place. I have been researching this morning into epidurals and a general consensus is that less that 50% of women with epidurals in place go on to have vaginal births without intervention - I.e without needing ventouse or forceps or episiotomy. Included in that statistic is women who go on to need an EMCS anyway due to labour not progress or baby being in distress due to prolonged labour - usually as a direct result of prolonged labour. It talks about the facets of the epidural drugs on the baby whilst still in utero but also how it can affect the baby after birth whilst the drug is still in it's system and the whole thing has left me feeling very cold. It certainly hasn't painted a very pretty picture or made me want to consider it over an ELCS.......

[rallytog1]

One thing to bear in mind about epidurals is that it may be possible that the women who need them may be statistically more likely to need interventions anyway, regardless of the epidural.

For example with back to back babies, labour can be more painful, hence an epidural more likely to be needed, but the fact that the baby is back to back may actually be what brings about the need for the intervention, iyswim. This is what happened with me. I had an epidural due to very painful back labour. I ended up with an emcs, but this was due to my dd being in a very awkward position with the cord wrapped round her chest. The epidural wasn't a factor. The doctor also confirmed that no amount of more active labouring would have helped.

It's the whole thing of correlation not necessary implying causation. I'm not sure I've seen any studies which manage to separate out these factors.

I hope you manage to work out what you feel most comfortable with, and don't have to fight too hard to get agreement for your preferences.

[Outnumbrd]

OP yes it is shown to be less likely to have a normal delivery with an epidural, as you just cannot feel how hard you have to push, however people do achieve it. I also agree with rallytog1 that a good number of people who have epidurals may be high risk or having a long labour anyway and so are more likely to have an emCS anyway, you may fall into this bracket, I don't know without knowing your condition? However your consultant thinks you have a good chance of achieving a vaginal delivery, believe me if they thought not they are very quick to recommend CS.

Just a thought, epidurals are often recommended for people with high blood pressure as it keeps your blood pressure down, in my experience high blood pressure causes people to labour quite quickly. Not sure if that applies to you or not?

Research risks of CS too both on you and baby, for example baby's born by CS are more likely to develop respiratory probs (grunting). With a CS you will have a spinal rather than an epidural and the drugs in this may also cross the placenta.

For me the deciding factor would prob be the recovery time after CS and not being able to care independently for LO or myself.

Keep researching and talk to your consultant, as a little knowledge i.e. from the media is sometimes worse than no knowledge, it is often biased.

All the best

[MyDarlingClementine]

For me the deciding factor would prob be the recovery time after CS and not being able to care independently for LO or myself

You can care for yourself and your baby after a section if you have the correct equipment and preparation..will you have help?

[Outnumbrd]

That's why I said independently!

[Writerwannabe83]

Thanks everyone. The reason for my CS in twofold - I have a cardiac issues which causes irregular heart rhythms and tachycardias and I also gave epilepsy. My Consultant does not want me to experience any labour pains due to the likelihood of it triggering off my heart condition, and she doesn't want me to have a long labour due to the increased risk of seizures with exhaustion/sleep deprivation etc. At one point the plan was to give he an epidural and induce me and put a time limit on the birth, I.e if I haven't given birth within 'x' number of hours they will take me off for a c-sec. However, she then said it probably made sense to just go straight for c- sec as the chance of giving birth following induction in 'x' hours was low anyway. But now she has changed her mind and presented me with this 3rd option. My obstetrician is wonderful, she's s really, really lovely Wonsan but the constant mind changing is making it hard for me to focus. My biggest worry is my epilepsy, I do not want to be having seizures either during labour or whilst with a new born, avoiding this problem is my main concern, hence why I'm more drawn to the c-sec.

I have a lot of support at home if I do have a c- sec. My husband has got a month off work and both sets of parents live very close to us be have said they will help out however they can.

[scissy]

Hi Writer, are you under the care of a neurologist as well? They may be able to help on the epilepsy front. I was given an additional (short term) AED to take during induction, to minimise the risk of seizures due to tiredness/hormones/etc. I guess what I'm trying to say is, if you want to try the induction route, there may be options

In the event I forgot to take them , but after an 18 hour labour I had no seizures at all.

[Writerwannabe83]

I'm under the care of an Epilepsy Nurse who is keeping me monitored but my Obstetrician has referred me to a Neurologist who I have my first appointment with in 2 weeks. My epilepsy is just so well controlled and the thought of having a seizure petrifies me, just thinking about what it would do to my life can bring me to tears. I just can't risk it, I can't bear the thought of it. I know that sounds dramatic but it is a constant, genuine dread.

[Katiejon]

Maybe u would be better with a planned csection so you can organise your help when u return from hospital.
Inductions are v tiring.
Dd was a failed induction, resulting in a csection.
Ds was therefore a planned csection, which meant i had my support in place.

[Writerwannabe83]

I think you're right katie - as my mom is also going to take a week off work at some point to sit with me once my DH is at work. I have been told that I'm at high risk of seizures within the first month of the baby being born so ideally I don't want to be home alone in case I do have a seizure, I'd never forgive myself if any harm came to the baby. I just feel there is already so much uncertainty around my labour in terms of my health that I just want the stability of knowing that with an ELCS the baby is coming out, no unexpected problems or hitches etc with labour.

[CommanderShepard]

On the recovery front - I had an EMCS and I was up and about 8 hours later (had her at 1am). I had no pain or any problems looking after my baby. I think I was mostly very lucky but recovery isn't always horrible.

[Scarletbanner]

I have had both. Dc1 was a normal delivery after an induction with epidural. No forceps etc. Dc2 was breach and I opted for an elective CS.

Although I managed a "normal" delivery the first time it was a long and exhausting process. This isn't the case for everyone though, as some inductions work quickly. Recovery time after dc2 was not that bad and I did have help. Speaking personally - and everyone 's circumstances are different - if faced with the same choice again I would opt for the CS every time.

Good luck with whatever you decide. Remember there is no right or wrong answer.

[rallytog1]

In your situation I think I'd be pushing for an elcs. If your consultant isn't keen you have the right to be referred to another one.

Given your medical condition, I would have thought that they wouldn't want to run the risk of ending up doing an emcs, as the risks of something going wrong with that are a little higher as you'd be tired from labour and potentially fully dilated. Ultimately, if you want an elcs I would keep pushing for one if I were you. Good luck!

[Writerwannabe83]

Hanks rally - thankfully I have a wonderful Consultant, she is just lovely. I saw her last week and although she did encourage me to think about other options she still went ahead and booked my CS date in her diary and booked me a bed on the ward for ELCS. I don't think she would have done that if she wasn't accepting of my decision - I think she knows I probably won't change my mind. My DH was quite eager for me to try epidural/VB but he has since said it was because he thought I'd want to experience what labour felt like?! Lol. Is he mad?! We have since done a lot more reading around the subject and it just seems like there are so many potential problems that could arise from such a drawn out procedure where I'm epiduralled (made up word) from the very start - the last thing I want is a distressed baby resulting in EMCS anyway and then my health being affected too. I would be nervous about knowing I was definitely having a CS but it still seems the lesser of two potential evils.