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 don't think it's anything you can predict, one of those things where you have to prepare for the worst and be pleasantly surprised if recovery is easier, complete luck of the draw.

Definitely ELCS.

I had induction leading to EMCS and that was horrible!! Consultants love to talk about the risks of C-section but never the risks for vaginal births (until I was trying to plan a VBAC and then it was all the other way around!) C-section is safer for the baby, vaginal birth safer for you.

Also, with induction, you can go in on Monday but then not been induced for ages! One of my friends waited a week on the ante-natal ward for a slot and she was half-mad from sleep deprivation before she had even started labour.

All in all, the stats on a non-assisted birth as a first time mum being induced are really bad. You are more likely to end up with an EMCS or forceps (which have big tearing risks) than a straightforward vaginal birth.

I have been in this position twice - DD1 was pregnancy hypertension at 37w+6, DD2 was pregnancy hypertension at 36w, which turned into preeclampsia at 39w.

For DD1, i agreed to induction as I wanted a vaginal birth. I actually didn't need it in the end, as my waters broke before the induction was scheduled and contractions started by themselves. BP meds were labetalol.

For DD2, I went for an ELCS (added complication that she was breech). BP was pretty much uncontrollable. I was on monitoring every other day for 3weeks, with labetalol and nifedipine, both having to be increased at each visit. ELCS was booked for 39+5 which was very late because of the easter bank holiday weekend but my waters broke before then. When I went to triage, DD had turned head down so I decided not to have my section and go for another vaginal birth.

Pregnancy hypertension can affect baby's growth (both of mine were low centiles / one was suspected IUGR). If baby was small, it might be worth going straight to ELCS. DD1 was very little and she did start to struggle a bit during labour. But as you say they are tracking 60th, that is a good size and probably able to cope a bit easier with an induction.

If a vaginal birth is important to you, I'd also make a start on all the old wives tales - dates, nipple stimulation, kerb walking, bouncing on a ball etc. No harm in trying to help things along! But if you dont have strong feelings, everyone i know who has had an elective section has said it has been a wonderful experience.

If you are also worried about your body not being ready, I have seen people on MN say you can ask for something called a Bishops Score? It's to determine how successful induction might be. If you have a low score, then it could cement your decision for ELCS.

Thank you everyone, I’ve read all the comments. Interesting to see people’s views so far. I really can’t decide

I had HBP before I got pregnant and was monitored through out. I opted for an induction but it took four days before my BP got so high I ended up having ECS. If I were to do it again I'd just book the caesarian and save the stress.

Sorry not read the full thread, but epidural can reduce BP - not everyone's first choice I know. Can the anaesthetist or obstetrician advise on other alternatives
I'd second asking how likely a. Induction is to be successful with your presentation as I had an induction which failed, it was never going to work as baby had her head in my hip and was completely wrapped in cord, so second baby I had an elective after obstetrician said same conditions as before so it'll fail
Good luck

Thank you. Apparently inductions are less successful in FTMs anyway

4 days sounds horrible, I really feel for you there.

Just bumping for more advice

Another hopeful bump!

Do you want a big family? Having 4 children is easier if you have vaginal births. In which case maybe start induction but if it starts going wrong ask for the C-sectipn earlier rather than later? How do you feel about forceps?

Otherwise C-section all the way. The number of FTMs having EMCS following an early induction are really high. You will likely have a C-section anyway but it’s much nicer for it to be planned rather than an emergency.

I had this situation twice, and was induced twice. First time wasn't all that fun, took 49 hours start to finish but everyone was healthy. Second was genuinely a brilliant experience that I'd love to relive if I could!

I chose to give labour a shot, and quite glad I did. I've since had a tummy tuck which was hard work in terms of recovery and similar to a section scar. With both my births I was up and about the next day.

I had induction for pre-eclampsia at 36w. I had the pessary (I think I had two in the end as it wasn’t working), they broke my waters eventually but the baby still didn’t come. I was put on a Syntocin drip but that didn’t work either. The baby’s heart rate was dropping so they had to do a spinal block and pull him out with forceps. I wish I’d had a caesarean but I don’t think that was an option.

Edited to add he was ok! He’s now a teenager 😊