Induction or caesarean? I’m so indecisive - advice, experience or suggestions welcome.

[indecisiveaboutbirth]

I’m 36+6. Today I have spoken to the consultant about the timing of my birth given that I have recently been diagnosed with pregnancy hypertension.

The consultant is happy for induction from 38 weeks, but would not be willing for me to have a caesarean until 39 weeks. I am a bit apprehensive over the idea of induction so I have asked for an ELCS, which he agreed to immediately. The soonest date they have available is when I will be 39+6.

My preference would be to labour naturally but I am very scared about induction. I’d need continuous monitoring anyway due to my blood pressure and feel apprehensive that I would end up with a lot of intervention and very stressed. 2/3s of inductions at my trust end up in emergency sections anyway, so it doesn’t feel like the odds would be in my favour especially pre- due date.

I have read an NHS study conducted recently which says there is no difference for neonatal outcomes with delivering a baby at 38 weeks (via either section or induction) vs waiting to 40 weeks, and if anything it can have a better impact on mum as mum is less likely to continue with increased blood pressure and it removes the risk of pre eclampsia developing.

I just don’t know what to do and know I am the only one who can decide. If it makes any difference at all I’ve been low risk so far in this pregnancy until the BP diagnosis, in my mid 20s, baby is head down and on the 60th centile.

I can’t labour on the birth centre anymore due to needing monitoring and baby and I will have to stay in for at least 24h due to her needing blood sugar monitoring

If you were me, what would you do?

Posting on here for traffic, I know there’s a childbirth specific board

Bump!

I'm 90% sure I read a very similar thread on here in recent days. Let me see if I can find it.

Other than where there are major underlying health issues (rather than complications of pregnancy past/ present) most ELCS birth experiences tend to be pretty calm and generally positive.

Inductions can often be hard going, especially if the mother wasn't really ready to go into labour. Long, drawn out labours are hard going. Then there's the risk of EMCS or birth injury.

My experience of two spontaneous labours was of ending up in theatre, first for an EMCS and second time forceps resulting in 3rd degree tear. Both were hard recoveries. Different. The tear was more painful in the following month. I also had the complication of SPD both times which didn't help.

Vaginal birth can be the easiest option for recovery, but induction changes those odds compared to the body being ready for spontaneous labour. In the choice you've been offered, I'd choose the ELCS. (I hypothetically have a choice of VBAC or ELCS with my history)

I found the thread I read but the details are very similar. Did you post the other day?

I've had 2 kids, BP was rising with the first but the threat of induction put me into labour! Only kidding.... The medics couldn't decide if I had pre eclampsia or preg hypertension. I was over 38 weeks by then so they spoke of induction but my waters broke and I went into labour while waiting for a bed to be induced.
My second was prem EMCS under GA as I was mega poorly with sepsis after my waters broke at 34+4.

Given your hospital stats for CS following the induction process I would opt straight for ELCS. If you get induced, start to labour then need CS anyway you will be exhausted plus recovering from surgery. At least with ELCS you can rest up as much as possible and still know what date you'll have your CS. The only proviso is knowing what monitoring there will be while you wait for your date to come round, and what would happen if you went into labour before your date, would you try to labour naturally, or still want ELCS?

Do you have a partner? What do they think?

I had an induction at 37 weeks and it was fine, it was not too long or difficult, didn’t tear. My friends also had good experiences with inductions. You only tend to hear about the bad ones. Whereas lots of women have them.

I personally would not opt for major surgery when there is no clinical need- I would always choose induction due to the risks of surgery, scar tissue and complications including infection.

Just my two pence worth.

You're mid 20's? Just have the induction. Be a breeze probably.

I've had both. Induction over a section a million times. (even though neither was pretty to be fair)

My mums had
1 planned c section
3 inductions

Her first was the planned c section she just didn't go into labour and at 42 weeks was so worried and stressed she thought it would be the calmest thing. Same as her next 3 she was induced with all at 42 weeks as she never went into labour

She strictly refused c section with all 3 inductions unless it was life threatening for her or the baby, she said it's the most awful thing she's ever done and the recovery was horrific. My mum actually loved giving birth regardless that they were induced and said she didn't find it to bad.

Given her experience , if this was me I would opt for induction. In all honesty I don't think I could deal with the worry for another week and 6 days and wondering if the BP will turn to pre eclampsia ect.

I'm 22weeks atm and petrified of giving birth either way but will choose vaginal birth if possible. I just can't imagine having to recover from a CS with a newborn😅

I've had both.

Would choose the c section every single time. 100%.

Planned C. Safest all round.
Don't understand the desire to put self through torture because of idea it is more natural to experience.
If experiencing pain is so natural and magical maybe we should all enjoy headaches.
Speaking as someone who had a textbook water birth because of midwife led, natural birth pushing bullshit beforehand. And then had a elcs for the second and thought, you absolute bastards pushing me into that the first time. And that was with nothing going wrong except 2nd degree tear.
Elcs was calm, controlled and bonded immediately as no trauma. Couldn't even look at first baby for a while as found it all so horrible.

I was induced that lead to an emergency c. It’s really only classes this if it isn’t planned.

Induction was fine and surgery was straightforward. It took some effort but I was able to breastfeed if this is a consideration.

i would never elect to have major abdominal surgery (this isn’t hyperbole but the actual medical term) that isn’t necessary. I wanted VBAC with my second but alas that wasn’t to be…

Recovery is longer, Pain is prolonged. Risks from major surgery is real. Your insurance provider may not let you drive for some weeks as the steering wheel could cause major damage to a healing wound if you had an accident.

induction isn’t without risks, but again I would never elect to have a c if I didn’t need to and for reference I healed pretty well but have ongoing issues with scar tissue from the surgery adhering to my bowel. Good luck.

I had an induction (the drip) at 39 weeks and things sped up. Prior to that I had gels which didn't help much. In the end, I'm glad I had an induction as my stomach looks normal and I quickly went back to my pre baby size. I was also mid 20s. I've heard horror stories of c sections and lots of women have this 'shelf' or numbness for months, sometimes years around their scar.

I har an induction 2 and a half weeks ago due to hypertension, I am also in my 20s.

I went into hospital on the Monday at 40 weeks and had three gels over two days, it was incredibly painful due to my body not being ready at all, my cervix could not be reached during any of the examinations. I genuinely dreaded the examinations, I was encouraged to have gas and air during one of them to relax me more but I kept passing out I was in so much pain and I had to tell her to stop and was in tears. I didn't realise but during this time damage had been done to my cervix. On the Wednesday at 40+2 I had the balloon induction, despite local anaesthetic it was horrendous (not the balloon insertion itself but again the examination) and I had a massive bleed due to trauma of the cervix. When the balloon was removed I had to have another examination and unfortunately it hadn't done anything and they still couldn't reach my cervix.

At this point I opted for a section as I genuinely couldn't tolerate the pain and I was told there were no induction options left. While waiting for a section at 40+5 I went into labour, I progressed extremely quickly and went from 6cm to 10cm in minutes, it was so quick I was unable to have any painkillers. The babies heart rate dropped so I was taken to theatre, I managed a vaginal birth in the end with an episiotomy and ventouse, though it was looking like I'd need to be put under general. The staff were incredible.

If I had this dilemma again I would have one examination to see if I was dilated, where my cervix was etc and if it wasn't favourable I would opt for a section. I know a section isn't the easy way out, but spending 6 awful days in hospital has definitely put me off an induction, if my body is not ready. If its your first baby and they want to induce you early I would definitely have a check and then reevaluate, as an induction when your body is not ready is awful, in my experience. I know we are all different.

Good luck whatever you decide, it truly doesn't matter when the baby is here and its all so, so worth it x

Both an elective C-section and an induction will mean a very medicalised birth, so unless you decline both and wait to go into labour spontaneously, you won't be having a candlelit water birth.

But a medicalised birth doesn't have to be scary or stressful.

I've had one emergency C-section following a failed induction (my baby was very small and badly positioned, so he didn't want to come down and he got tired during my long labour) and one spontaneous vaginal birth with an epidural at the end.

In your position I would go for the induction and if they put you on the syntocinon drip, have an epidural first. Ask if you can have a walking epidural which would allow you to remain quite mobile.

Where I live, around 90% of women have an epidural and quite a lot are induced (induction at 41 weeks is standard here) and honestly, I know so many women who have gone in on the morning of their induction, had the epidural and the drip placed, then spent the day calmly watching Netflix until it was time to push. It can be a really good way to give birth.

Given how often inductions lead to emergency sections, I would definitely wait for the planned section.

I’ve had both and there was no comparison - the planned section was a million times better.

I would book a section in but request sweeps from 38 weeks. This is what I did with my son. I didn't want an induction and had a sweep 2 days before my section and my cervix was totally closed, I think if your body is close to going into labour anyway inductions are much more successful as they just move things along rather than forcing labour. That's just my experience of friends and family who have had inductions x

I had 2 inductions. 1st ended in vaginal delivery with episiotomy, 2nd in emergency c section. I found the recovery from the c section WAY easier. I'd definitely recommend elective c section.

I've been in your position twice.

DD1 in 2021. Pregnancy hypertension and induction booked for 39w. I went into spontaneous labour at 37+6 and DD1 born at 38w. Vaginal delivery - no induction necessary.

DD2 in April of this year. I had a csection booked as she was breech for 39+5. I developed hypertension at 36w and preeclampsia at 39+2. We were all trying to get to the section date when I went into spontaneous labour at 39+3. Actually had a vaginal delivery as it turned out she had flipped head down since the last scan.

Both times I needed continuous monitoring but had great births on the delivery suite with just gas and air. Both times, DD1 and DD2 had blood sugar issues due to the labetalol, but these were resolved. DD1 had a long hospital stay for other reasons (infection) but DD2 was home 2 days after the birth.

In your shoes again, I think I would book the ELCS and do all the old wives tales to try and bring on a labour. I'm pretty sure colostrum harvesting / nipple stimulation brought on DD1s labour. If you go into labour before your section, you can just go for a vaginal delivery or they will do the section as an emergency. They gave me the choice of what I wanted to do when I arrived at the delivery suite.

From 36w, I was on monitoring every 2 days and my BP meds were continually increased. They will be able to give you advice if they think you won't make it to your section date.

If you want to talk it over with a professional, I asked for a birth options meeting with the consultant midwife and it was a brilliant meeting, where we went through every option in detail and she was really able to help me verbalise my worries, which helped us to develop the plan.

Were the sweeps painful?

I was in a similar position in my first pregnancy, though I had quite severe pre eclampsia and wasn't full term. I chose a planned section as I thought I was very likely I would end up with a failed induction anyway as I wasn't anywhere near going into labour.
It was fine, and I don't regret it, but one thing I didn't think about and nobody mentioned was impact on future pregnancies. To be fair, at the time I would probably have dismissed the idea totally anyway as I had had such a terrible pregnancy I never thought I'd do it again. But I did. And in my third pregnancy I had placenta accreta - a complication which is much commoner if you've had a section and gets more likely the more sections you have. Not that I'm saying "Don't have a section in case you have problems in future pregnancies" just that it's something to factor into your thought processes and is often not discussed.

I was induced at 37 weeks. I was told baby wasn't in immediate danger but needed to be born very soon. However, it was better to have a trial at labour as C-section was the last resort.

The procedure itself was absolutely fine, wouldn't bother me having it again. I was in labour a long time, but my DM was even longer with me, so maybe that's in the family. I was in my 30s. I'm very small and required lots of stitches, however, I was able to walk into our village four days later - I don't think that'd have happened if I'd had a C-section.

All the staff were absolutely fantastic when I was in labour, and they will get you through it.

Thank you. This is a very helpful way of looking at things