If you were me, ELCS or induction? (High blood pressure)

[ELCSorinduction]

I’ve been diagnosed with pregnancy hypertension at 36 weeks. I am now on labetalol 200mg a day. I’m to meet with the consultant but midwives have said they expect they won’t want me to go beyond 39 weeks at the latest. They have run a blood test to see if it’s pre eclampsia and I will find out today, although it is unlikely as I have none of the risk factors and no other symptoms.

Up until now my pregnancy has been very low risk, I’m in my 20s, this is my first baby and they are measuring on the 60th centile.

Would you choose an induction or an ELCS in this position? They have only really spoken about induction and have told me opting for a caesarean would be a much bigger decision with a lot more risk, but that I can if I want to. I’m just conscious that an induction might not work if my body is not ready to go into labour and I would like to avoid lots of stressful intervention. I also hoped to have baby on the birth centre and this is not an option anymore as I will need continuous monitoring on the ward.

Turning to Mumsnet, just to see what people would do in this situation.

I know it’s a personal choice thing btw but just wondered about the majority opinion as I can’t see the wood for the trees, despite researching both.

I had pre-eclampsia and wound up with a section, officially an EMCS but without ever going into labour (they decided I could not wait). Is the guidance no longer delivery at 37 weeks? That's what it was when I had #3, but that was several years ago now.

At any rate, my first choice would be for the midwives to have a look and see if you were favourable for induction, and do the CS if I weren't. But often that's not possible to wait and decide at the time because of needing to book further in advance. Unless you progress I don't think the situation warrants to going straight to a section, but if anything changed, I would reconsider that. (I would never want to do an induction if I needed to be on magnesium sulphate for example!)

Not really that helpful but I think it is one of those decisions that only you can make. Lots of people will give positive and negative experiences of both I'm sure.

I had EMCS last year following complications after induction...I also know people that have had successful inductions.

My biggest bit of advice would probably be do whatever you think you would feel most peace with...I sometimes feel sad that I didn't get to experience a vaginal birth but know it was out of my control in my personal situation. I don't know if that makes much sense...but I think you need to weigh up the pros and cons to both and see what you feel most ok with!

Good luck whatever you decide - there's no wrong or right x

Personally I would choose elective section. I would worry about the possibility of a failed induction and emergency section. But you need to talk through the pros and cons with your consultant. Presumably you would have an epidural either way.

I had the choice of both of these due to having a large baby and also a host of allergies. I went for a c section and can honestly say it was a really lovely experience despite it being 5 days early due to my waters breaking! We had our own playlist on and the whole thing was over in less than an hour. Your baby is born within a few minutes and after that it’s a blur as you’re just so focussed on them. The recovery has been far better than expected. I didn’t take pain killers from day 5, was back on long walks (10k) by the second week and was driving by week 3. I would definitely recommend it to anyone!

Having been through both (the induction ending up in a crash section after 36+ hours), I'd go for the elective. It was calm and peaceful and just a really lovely experience. Healing was way quicker than first time round too.

Good luck whatever you decide

I would definitely choose an elective c-section. Induction can be horrible.

I was you but it was pre eclampsia. I had an I dictionary at 37 weeks,as they would'nt let me go further. First baby, one hour from first contraction to pushing. BUT it was intense and what I didn't know,was that epidural lowers your bp. With subsequent pgs I insisted on epidural. You have to quite insistent. I was unwell after giving birth to my first so I was glad to mobile. It's totally your chouce

I'm a midwife, opted for IOL at 37 weeks on the nose with my first baby as had pre eclampsia since 34 weeks. Had my waters broken at 09.45am and baby born 4 hours later. Appreciate this isn't the way all labours go but notoriously and anecdotally women with high blood pressure tend to labour quite quickly and it therefore may feel more painful. They offered me an epidural prior to breaking my waters to help manage my BP and I declined and wish I'd just had it.

@RareitySparkles cross posted! Similar experience 🤣

As you said, it’s a personal choice. I’d choose a c-section. That is based partly on my experience of ore-eclampsia and partly on my age (I’m ancient in maternity terms).

A planned c-section is actually a lovely chilled experience. I speak from experience!

I’d have worries about induction outcomes - check both the general statistics and statistics for your hospital regarding all interventions following an induction. There is a pretty good chance you could end up labouring for a long time and then need forceps, ventouse or a c-section any way. If you go into a c-section after labouring, your recovery will much tougher because you are recovering from both labour and surgery.

I’d also want to know about risks to my BP during induction. For example, would the drugs, labour, stress or anything else cause my BP to spike?

Of course it’s a personal decision but as you’re ask a what would I do, personally, I would go for elective section as my understanding is that a failed induction could end up in an emergency c-section and at least with an elective you get a date to prepare for, they are ready for you and tends to be a much calmer environment. This is from someone who felt pressured into a c-section first time around and was angry about it. After some hypnotherapy and real reflection on it I was glad of it and am looking at another upcoming c-section (high risk factors) and am very much at peace with it.
It is major surgery and the recovery can be long and painful but in my personal experience it wasn’t too bad.
But you do have to go with what you feel is best for you and your baby and only you know that. Trust yourself, you’ve got this x

Being induced doesn't always work - it didn't with me. I ended up with an elective C section. It wasn't so much elective as only option, being as I was well overdue!

Slightly different situation to you, but I was induced with DC1, I was a few days overdue and whilst the induction worked, my heart rate was up, baby was in distress, so it almost ended up having an emergency section. Dc1 was delivered by forceps. I ended up losing a lot of blood and had sepsis. My recovery was terrible, even after 2 blood transfusions, I was unwell for months.

With DC2, I had gestational diabetes. Consultant and midwives recommended induction at 39 weeks, because of my first experience and being overdue I was concerned if baby was not ready to come then it would end in an emergency section, so I chose an ELCS. I was out of bed and on my feet 6 hours after, albeit a bit wobbly and in a bit of pain, I felt a million times better than first time around, although I know some of that is down to luck. DC2 was born healthy, cried as soon as they were pulled out and did not need any help breathing and no jaundice.

I was ready for discharge 24 hours after, although didn't go home till a bit later due to delays at the hospital but I was just glad to only have to spend one night. I did end up with an infection in my wound, but I had stitches which hadn't dissolved but as soon as they were removed, the antibiotics kicked in.

It is major surgery, I think you have to consider all of the risks and take what your midwife and consultant say but ultimately it's your decision. You have to weigh things up and decide if the benefits outweigh the risks for you.

Best of luck to you and a safe arrival for your little one.

I had a positive induction experience and a very swift/easy recovery. It really does come down to personal choice. You could ask if you are "favourable" for induction when you get to 39 weeks and then opt for an ELCS if you're not? This is when baby has dropped and your cervix is low and soft, it means an induction is more likely to be successful.

I had pre-eclampsia and was induced that day. EMCS late that night.
In hindsight if offered the CS at that early stage I would have gone with it. I was just short of 38 weeks.

I had high BP and an elective section. It was 100% better than my induction with a previous birth, recovery was fine and no lasting issues.

I’ve had 4 children, one induction (with #3) and it was my favourite birth. Just had the one pessary, waters broke naturally after 4 hours and ds2 was here a few hours later, and we were home a few hours after that. I’d only ever heard horror stories about inducing labour before so was pleasantly surprised with how well it went.

im scared of surgery though and would try anything first to avoid that.

I had this with both my DC but from a much earlier point in pregnancy. With my first I had a sweep from a consultant at 38 weeks and gave birth that evening. I had a really lovely birth. With my second I had sweeps from a midwife which seemed much less than the one I had from the consultant, I was then induced with a drip. My DD had shoulder dystocia and the birth was pretty traumatic. If I have a third I will need a CS. If I had the choice I would likely opt for sweeps (from a consultant if possible) then CS if that did not work.

While I'm glad you recovered so well this really isn't a usual timeline of recovery, walking 10k on week 2 is really unusual. It's major abdominal surgery and you should expect to need a lot of rest and help initially.

Saying that, I think I'd prefer that to a failed induction and the stress of that not working. That would be enough to raise anyone's BP!

I've had both an induction and an ELCS. As a one-off I'd go for the section every time. But you could have complications with either. Also if you want more children, then you'll have an increased risk of needing further sections due to scar tissue. Good luck, whatever you go for and congratulations 🙂

What's your preferred birth? Vaginal or caesarean? If you have an induction, you might have a vaginal birth, if you have a caesarean, you'll definitely not have a vaginal birth

I'd choose induction (had both elective cs and vaginal. Vaginal much easier, but that's just my preference

Also, my understanding is that you can go further than 39 weeks if it's not preeclampsia?

ELCS every day of the week. Safer all round.

Current recommendations are 37-38 weeks with preeclampsia although if the condition worsens, you may be induced or have a c-section earlier than that.

Without preeclampsia (or any other conditions that could affect the health of mother and baby), 41 weeks is usually when induction starts to be considered.

High blood pressure is not the same as preeclampsia but can lead to it so I think it is another factor considered for timing of inductions or c-sections.

We were really surprised by the recovery and I appreciate I was incredibly lucky. I was expecting it to be a lot worse!