To think this decision about how to give birth is impossible

[AliceAbsolum]

7 years trying, 5 rounds of IVF, previous loss. Consultant wants to induce at 39 weeks due to ivf. Or I can elect for a c section. I've been incredibly anxious through this whole pregnancy and I have no idea how to make this decision. Every time I read about it I just go back and forth. There are pros and cons on each side. It's impossible!

I'd like a straightforward natural birth but that looks unlikely to happen. How can you decide about something where you have no idea what will happen? I don't have any gut feelings or strong preferences either way. I don't want major surgery but I also don't want 3 days of pain and panic followed by surgery....

Maybe I'll just ask the consultant whats safest for the baby and go with that.

How did other people decide?

C Section.

I really wanted a nice natural birth, probably in a birthing pool. My second favourite option was for a c section. Worst option a complex labour/possible emcs.

This was following a previous loss at 23 weeks and the baby was ivf.

As you can't sign up for a perfect natural burth, I agreed i would hope for natural, but a low threshold for c section if things went wrong. My waters broke and my labour failed to progress.

I am SO GLAD I had a c section rather than an inductionat this stage. It was a wonderful, calm experience and I had so much less in the way of issues with recovery than any of my friends with their natural labours. Currently pregnant with DC2 and have my c section booked in!

ELCS

I've had two spontaneous term labours, the first was long and resulted in a EMCS after two hours of pushing and the second was a "successful VBAC" ending up in the operating theatre with rough forceps and a 3rd degree tear. The tear was considerably more painful for the next month or so than the EMCS that was far less problematic than the toll of labour/ complications and pregnancy.

I was offered a free choice of ELCS or VBAC as I met the criteria either way. I've never had to make it but now I'm long past the fug of hormonal desires to do things "naturally" I'd go ELCS; it's quicker simpler and rules out awkward EMCS when your body's already knackered

The birth stories I've heard from ELCS are generally positive, particularly when there wasn't a critical birthing risk involved. I've heard few happy birth stories regarding induction unless it involved late, subsequent babies that didn't need much of a nudge to get going.

I was in the exact same situation after 6 rounds of IVF. I went for induction (but was hoping it would happen naturally before that). It took a long time, had to have my waters broken, then a drip and ended up having an epidural which I really hadn’t wanted. Birth was traumatic, ended with forceps and losing a lot of blood, but recovery was straightforward and I was out of hospital very quickly.

Really, if I had the choice again, I’d opt to wait - the risks are almost no different to natural pregnancy if everything else has been straightforward and actually the consultant afterwards was unsure why I’d been told I should have been induced.

My friend had a C section after IVF and the birth was probably smoother but her recovery was longer.

You don’t know if an induction will be successful until you’ve had one. If your body and baby cooperate, an induction doesn’t have to be a horrible 3 day affair. I had an induction at 38 weeks and it was 30 hours from having the pessary to baby being delivered naturally and without further interventions. Other than the initial pessary to get me going, I had a natural birth with only gas and air (although that wasn’t through lack of trying to get other pain relief). I really loved my induction.

What people don’t tell you is that you can request a c-section during your induction before the medical team suggest it. So I think a lot women go through the drawn out process when they should be advised to go to c-section before then. If you choose an induction, I would pick a point at which you ask to go for a c-section. Research the induction process in your hospital and find a point you are happy getting to. For me, it was the drip. If they suggested that I have the drip then I was going to opt for a c-section but for you it could be after 24 hours. You can also ask for a scan before they start the induction to see if baby is engaged and in a good position. You can check your bishops score too. I didn’t check my bishops score but I had a failed sweep two days before my induction. My contractions had also started and I asked the pessary to be taken out before the 24 hours, they told me my cervix was still closed and back so I wasn’t dilated yet and I’d be a while. So I imagine my bishops score would have been low but I had the baby 9 hours after they told me I wasn’t dilated yet.

It's a very individual decision! If it was me i would probably go for the c section as what I've heard of both people are more positive about a planned c section, it just takes a little planning and awareness of your limitations while recovering.
All you can do is look up all the benefits and risks and think what will be easier to manage for you

If you want to know for certain when baby is coming out and that it's very likely nothing will go wrong, opt for the C. In an ideal world I wouldn't as the recovery was horrible but it's probably best for your peace of mind

IVF baby, previous losses. Before I found out I medically had to have a c section I had already requested one.

I'd do c section day over and over with no hesitation. I was unbelievably relaxed, it wasn't painful in the slightest, I recovered well on paracetamol and ibuprofen for two weeks. I left hospital and was home the day after the section. The incision site hurt but nothing like I'd imagined. Healed beautifully.

I have a very healthy, very happy little baby girl and feel extremely lucky.

Lots of love to you OP

Personally I'd wait for natural labour given that there isn't convincing evidence of an enhanced IVF risk.

@AliceAbsolum hey there 👋 What a treat to get to discuss birth options!! So excited for you. I'm going to go against the tide here and say a vaginal option is worth a go in my opinion. My first was an emergency section years ago, slow progression of labour which resulted in foetal distress. So when I had my IVF daughter the other year, I wasn't given many options. I had to have her by 39 weeks, not allowed an induction because of the previous section and in lockdown so couldn't try acupuncture/reflexology or ANYTHING to get myself into labour. So she was an elective section. It was ok, but not a lovely relaxing day like other people have. It's scary feeling them pushing and pulling and it's painful afterwards trying to look after a newborn when you can't bend in the middle. I'm desperate to avoid a third section with this one, but now my options are even more limited as they also now won't let me labour for very long before taking me for a section if I do manage to get myself into labour.
My experience of the consultants is also different to everyone else's - people seem to fight for sections and desperately want them where as all I have is them saying it's completely my choice. Which is difficult, I want them to tell me really!
I also thought for years that the scar from my first section was the cause of my secondary infertility and didn't forgive myself for years for ending up with that section (I know that's ridiculous!!)
look at the hypnobirthing stuff, labour is fine, it's painful but measured in hours, where as section recovery is measured in weeks. Absolute best of luck with your decision, but ultimately just having baby in your arms is all that matters ever 💖

C section is the only choice that gives you some Certainty in a procedure that's completely unpredictable.

en.m.wikipedia.org/wiki/Bishop_score

I wouldn’t consider an induction unless my score was 9 or above.

I had a 5 day failed induction and a fairly traumatic EMCS and found out later my score was 3. I should never have been induced.

My first was ivf and I was given the same options. I went for induction which to be blunt was absolutely hideous. 72 hours of labour later I was taken for an emergency c section (also a hideous experience).
I’ve had 2 more, both by elective sections which have been an absolute dream.

in your situation, I’d say if you go into spontaneous labour before 39 weeks try for a vaginal but if not I’d pick a section. My induced labour in comparison to the sections was awful, I’d have another section any time.

Personally wouldn't bother with induction and just have a planned chilled c section 😊

Is there a reason you can't just wait for baby to come in it's own time?

I mean any FTM has a roughly 30% chance of CS, 30% chance of instrumental birth and 30% chance of spontaneous vaginal birth. So if you’re dead set on a natural birth without instruments the odds are already against you, and a ELCS could be a compromise. It’s all about taking the risks you’re happy with.

Yes I should have said vaginal rather than natural. Makes sense.

If you do opt for a section let's say after pessaries but before the drip does that come with the same risks as an emcs? I know the recovery and infection risks can be lower with a Elcs.
Just thinking that might be a good middle ground.

Do any birth stats exist? Like how many 1st time mums at 39 weeks need the drip during induction? Is that on the internet?

For those you had horrible induction experiences, did you have an epidural before the induction was started?

im pregnant with my first ivf baby and I’m terrified of the pain. My preference is vaginal with epidural, then elective section.

my doctor also said I would be induced at 39 weeks. She said that one of the benefits of this option is that I can demand an epidural before they start the induction. Is t to his true?

I would only ever give any consideration to induction if my cervix were ripe. Otherwise, fuck no. ELCS all the way.

ELCS is awesome. Also the safest option for the individual mum and baby, my consultant said. No pain, really calm, I loved it.

@XjustagirlX I had an epidural with mine and was warned in advance to get the epidural before the drip! So I knew that and put it in my birth plan. I was induced on antenatal initially with pessary and then gel - only pain relief available there was paracetamol, warm bath and gas and air (which I had to ask for specially as they wheel it to the bed, it's not piped in like on labour ward). You don't transfer to labour ward until a certain number of cms or to have waters broken so I was about 1.5 days on antenatal before transfer to labour ward to have my waters broken.

So you can't get an epidural until you're on labour ward. I was told I could ask for it at any point but there might be a delay depending on staffing. So I asked for it and had pethidine in the meantime (contractions a lot more painful after waters broken). Availability depends on staffing levels etc so if only one anaesthetist and s/he already in theatre you will have to wait. I got my first epidural within about an hour or so of asking, but that didn't completely take, so I could still feel pain quite a bit. The second epidural (different anaesthetist) a few hours later was wonderful and meant I could sleep for a while and get my strength up for pushing. I couldn't feel anything then, although they lighten it a bit at pushing stage so you can feel when to push but it isn't painful. I did find it very difficult when the first one didn't totally work as I hadn't realised this could happen!

In your shoes I’d opt for the planned section. I’m sure lots of inductions are fine but in my circle, the majority of women who have been induced have ended up needing an emergency c section after days of unsuccessful labouring.

Was in exact same position as you was expecting an ivf baby and was told they didn't want me to go past 40 weeks. They asked me to chose an induction or elective c section. My baby was due at the height of the first covid lockdown when partners were not allowed in at all. I couldn't bear doing it alone so opted for c section. Had the circumstances been different maybe I would of tried induction but ultimately so glad I didn't. My c section was hugely positive. Probably the most complication free of my entire nct group who had a range of inductions which lead to emergency c sections and natural births.

The process is essentially pain free and quick, the whole procedure start to finish is about 20 mins. If you keep on top of pain meds after recovery is fine.

I also had an elective c section with my second which was just as wonderful and complication free I was home the next morning.

If you're anxious I think having that control is wonderful to ease your mind. All the best.

Such stats don’t exist unfortunately, I’ve looked! Had an induction at FTM at 37 weeks with the drip, having another induction at 37 weeks this time and hoping the pessary will be enough 😬

In fact now I think about it it does seem mad we don’t get told the chances of success of things like induction. I can’t think of any other medical procedure that would be, for example, 50/50 as to whether it worked, without that being explained beforehand.

@AliceAbsolum I have two DC after 5 MCs... Both born vaginally with induced labours at 37 weeks (both as they measured large).

I still did hypnobirthing to help keep me calm and delivered both on gas and air only.

The pessaries and breaking my waters with my first didn't kick things on enough so I was on the drip basically straight away. They do have a protocol about how quickly to increase but you can say no to increases, I did this with both of mine to allow me to acclimatise to the increase.

For me, the hypnobirthing helped keep me relaxed. Your body knows how to do this... The challenge is stopping our brains from over thinking. Have your birthing partner well aware of what you want as it's important to have a good advocate... Particularly if you want your drip turned off or down.

Please dm me if you want to talk further.