WWYD induction with previous c scar/ELCS?

[mamasunshine]

Well I have a while to think about this (30wks pg), but need to get my thoughts together. A bit of history:

DC1 ? EMCS at 34 wks due to foetal distress, had P.E.T and IUGR. Very bad experience and recovery from section, found VV painful, scar opened and was bleeding for 6 + wks, infections etc (although think that lack of rest DC1 in SCBU for 4.5wks didn?t help).

DC2 ? HBAC at 40+4, long back to back labour, tiny tear. Found the whole experience completely amazing, loved every second!! Was on blood pressure meds as developed Pregnancy Induced Hypertension at 39 wks (meds stabilised BP, P.E.T tests were clear so went home for birth).

Pg with DC3 ? was hoping for another homebirth (if all was well with pg). However, now have polyhydramnios. Consultant has said that they would try and get me to 38 wks if waters don?t go before then. At 38 wks he would be happy to attempt an induction with just 2 prostaglandins, then drip etc (if worked). Said labour would need to be constantly monitored, so lay down on bed, painful etc. May need an EMCS after all? Other option would be to have a ELCS?

My idea of a complete nightmare ? an inactive labour and induction on top of a caesarean scar. My thoughts are that this is just asking for an EMCS. Not liking the increase in uterine rupture with induction either? Is it really worth the risk, or am I better just getting my head around having an ELCS? At least with an elective I would ?know? baby was well. This is my last pregnancy, so don?t have to think about implications on future births/pg?s. I will have 3 under 3 though!

Thank you!

Just found this on NICE guidelines too:

uterine rupture is a very rare complication, but is increased in women having a planned vaginal birth
(35 per 10,000 women compared with 12 per 10,000 women having planned repeat CS)

Women who have had a previous CS can be offered induction of labour, but both women and healthcare professionals should be aware that the likelihood of uterine rupture in these circumstances is increased to:
? 80 per 10,000 when labour is induced with nonprostaglandin
agents
? 240 per 10,000 when labour is induced using
prostaglandins.

Bumping

non prostaglandin agents what are they? Does that mean just breaking your waters?

There are several issues here, but first I would have to say that if you had a normal birth last time, you have an excellent chance of a normal birth this time too.

But I have a huge problem with using prostin in women who have had previous c/sections, and I really dont believe it is safe enough, and most consultants / hospitals just dont do it. However, assuming that you can have an ARM and using the drip, there is absolutely no reason to be stuck on a bed. Even if your hospital dont have wireless monitors, you can still be monitored in a chair, on the ball, standing at the side of the bed, walking to the extent of the leads etc. And you can give birth in whatever position you like, and as long as the staff can keep an eye on babys heartbeat, there is no reason at all for them to be worried about your position in labour.

If the worst happened and you found the pain unbearable, (and if you can cope with a long OP labour at home then you obviously have a pretty high pain threshold) then it wouldnt be terrible to have some analgesia. But remember they will be taking it very easy with the drip if youve had a previous c/s, so the drip wont be turned up high.

So, yes you could have a c/section if you asked for it, but personally, I think you can have a successful vaginal birth. It might not be what you really wanted in a labour but its surely got to be better than the alternative of a c/s?

One thing - I found when I was induced with DC1 that I couldn't move from the bed because if I did the monitoring pads lost their connection and the midwives just kept telling me to keep still so I could do nothing to ease the pain or help gravity along. I don't agree that the worst possible outcome is a CS (having had one last time I am hoping for another). I think there are plently of ways on which a vaginal delivery can be far worse, inclduing the aftermath!

I was had an ELCS with my DD2 following difficult and traumatic birth of DD1. I too deliberated for weeks but went for the ELCS as I was also suffering from PGP and had developed pre-eclampsia. I found an ELSC is so very different in comparison to the stories i heard about EMCS.
Its calm, pain free and quick. The scar is often less of a problem as more time is taken so it often heals quicker. Within a week I was back on my feet and yes its painful for a while, but no more than the pain I was in down below after DD1's birth!

p.s when i say pain free, I mean the procedure itself not post op healing itme (ouch!)

• time

Thank you for the replies!

phoebe - not sure?! That's all the NICE guidelines say !!

There'e another thread an here about epidurals with drip induction, sounds rather scary TBH. I think the worst thing about my EMCS was how out of control with the whole situation I was. I would be very worried about being in a situation where everthing is spiralling out of my control again.

A big part of me thinks to try the induction and if it's very painful at least it's only for a short time (in comparison to section recovery). But then I'm worried about needing assistance to get baby out with forceps or something if it doesn't end well as such. And having worse damage down there, rather than another section scar?!

My worst nightmare is obviously a rupture, and still feeling VVV uncomfortable about using prostins and/drip, especially both together.

Having a review and scan with consultant on Thurs so hopefully things maybe clearer then. Will ask him what their rate of section is when using drip, uterine rupture etc. Is there anything I need to know?

I just want an obvious way to go really??!