Should i be induced at 38 weeks - advice please

[redclover]

I'll try to be brief:

I'm 36 expecting my first baby.

I have chronic thoracic spine pain - constant, significant pain affecting most of my body (due to a car crash).

I am under consultant care.

I have had to take medication throughout my pregnancy & I'm fortunate to have a very knowledgeable & expert consultant.

I can't have a needle in my spine - so no epidural, so I will be having Remifentanyl (if that level of pain relief is required).

My pregnancy has been hard - sickness throughout, additional musculoskeletal & nerve pain, sciatica, carpal tunnel... (on top of my usual pain - normally I have severe upper back pain that makes it very painful to sit down, during pregnancy I've had lower back & pelvic pain too + massive tiredness which makes me want to sit - it's a vicious circle.

I am now 36+4 weeks & have been finding the last few weeks very hard - killer pain & tiredness, and I just want it over with now - the thought of going up to 42 weeks (potentially) is a nightmare!

My consultant says maybe I should be induced at 38 weeks BUT this obviously means a greater chance of c-section.

I have never agreed with the due date given to me by the hospital (all dates quoted have been hospital dates) as my cycle was very erratic & long and the hospital changed my due date by 3 weeks 2 days at a 9 week scan despite this not fitting with early blood & urine tests (which concurred with what I though my due date should be, I always thought 20th Sept not 1st Oct - the first date they gave me was Sept 11th!).

I have been worried about labour from the start as my condition makes me terribly exhausted & I suffer from massive muscle spasm as it is.

If I'm induced at 38 weeks it will be around Sept 16-20th which is what I believe to be 40 weeks.

So should I or shouldn't I be induced???

Sorry, meant to say 'many thanks in advance for taking the time to help me' x

From everything you have said I'm wondering if you have talked about an elected C section with your consultant?

I was induced and wouldn't want to do that without the epidural they gave me. I don't know anything about the pain killer you mentioned.

Agree with being induced and no epidural. Can you talk to your consultant about an ELCS?

Sounds like it might be the best option.

Good luck whatever you decide. You will have an amazing baby at the end of it.

Ask your consultant to go through the risk issues surrounding induction. The evidence linking early induction with c/s isn't as cut and dried as all that. According to Cochrane review of induction at term (37 to 42 weeks) meta analysis of many studies showed that "women induced at 37 to 40 completed weeks were less likely to have a caesarean section than those in the expectant management group (RR 0.58; 95% CI 0.34 to 0.99). I don't know if this is consistent for first time mums. Ask your consultant.

Good luck!

If you are ripe for induction, soft cervix and babies head engaged, then i would go for an induction. Chances are a pessary would be enough to tip things over the edge.

IF however when you go in and the babies head is high your cervix is posterior and hard then i would seriously reconsider your options. That is what makes an induced labour awful sometimes.

You could find yourself in hospital with endless pessaries and being hooked up to monitors (they will do this if you are induced) on your back.

Of course you may be ripe for induction, have a pessary, have your waters broken and a baby within a few hours There really is no telling.

If i were you i would seriously consider your options when you go in. Be open minded and if you are in pain and not ripe for induction a c section may be the way to go. Labour hurts enough without extra pain on top.

I hope that doesn't sound too pessimistic. I have had most types of birth and am due dc8 in Nov. he may be induced or a section. It will depend on the circumstances at the time. I am a very hippy birth crowd. Most of mine have been at home, one induction and one c section. They are ALL different.

Thanks all. Really interesting points - I really don't know why they have not discussed c-section with me, especially as the additional pain & exhaustion could cause so many other issues.

I am very worried about starting motherhood as an exhausted wreck! I find it very difficult to recover from even a moderate amount of lost sleep / sleep deprivation, on top of this my pain is always worse when I am tired.

From what you've said I should ask for an examination to see how ready I am & take it from there.

They will examine you anyway. They wont know what course of action to take until they do.

The consultant could examine you first in clinic. Not really worth it until you are in there going for it though. I would just discuss the possibility of a section if you are not ready for induction.

Research it well before you go. You can get a very positive experience from a section if you go in to it prepared and ready to ask for all the things you want.

Search for elective section on here and see what others have asked for. Same as induction. Being prepared and open minded is the way forward. You will be fine and believe me the endorphin surge form holding your gorgeous snuggly newborn will keep you up It really is the most wonderful thing.

Hello Redclover

I have had similar issues with my 2 pregnancies due to a previous broken back and subsequent disc problems. Most (but not all) consultants I have met all agree that with existing back problems CS should be avoided where ever possible. This is because the cutting of the stomach muscles further weakens the back and can make recovery of back or pelvic issues associated/made worse with pregnancy very much more prolonged.

That said - what a fantastic thing it is that your consultant knows about Remifentanyl as an option. It is rarely used in the UK.

I was utterly exhausted by my due date due to the pain and having difficulty walking, I was induced. I was not "ripe". I would agree with posters above that, with the benefit of that experience, I will choose with baby 2 (31 weeks now) to simply go to my bed and rest rather then be induced before being ready. The pain is exhausting, I can hear myself trying to explain to people that just existing with it makes me knackered!!!

Surprisingly after one decent nights sleep when we all finally escaped from hospital I was raring to go (new Mummy hormones!). DD didn't object to a couple of expressed bottles thank goodness whilst I recharged. My pain wasn't gone, but very much reduced and having DD made everything OK. I can't explain why, it just did.

The very best of luck, let us know how you get on.

I just wanted to say re. planning an elective C-section. If the OP cannot have an epidural, could she have a spinal? And if not, a section will mean a general anaesthetic, no? Which for me would change matters greatly. Also the point that Katie makes about cutting stomach muscles is something to consider.

I think you need to find out more, redclover, about your anaesthetic options during a c-section. Also I think you need to find out about your hospital's policies for "management" following an induction. If you are strapped to a bed on your back for constant monitoring then your labour may be much more painful than if you are able to move around, and you may have much more back pain. This would change the decision for me too. With a natural labour you might be able to use the birth pool which might be fantastic for supporting your weight, helping you find comfortable positions, and easing some of your pain.

Having narrowly avoided induction and having heard lots of people's stories, I think induction of first time labours is something to be avoided if possible. Not that you can't have a good experience, but just that you increase your chances of a long and drawn out labour with a series of interventions.

And I hope you won't mind if I just add now, if you're exhausted and in loads of pain with a newborn, don't cling to any particular parenting ideologies or feel guilty about not meeting your aspirations... just do whatever it takes to get through. You'll be doing a brilliant job.

Just wanted to add I was in a similar situation, I have kyphoscoliosis, resulting in pain down the whole length of my spine and a twisted pelvis. I met with the anaesthetist who looked at MRIs of my spine and examined me and said no way was she doing an epidural, I'd have a remifentanyl pump. If I had to have a c-section, if it was an emergency she'd do general anaesthetic, if elective she'd try and do spinal block with my MRI pictures there to help her.

I met with a spinal surgeon when I was about 32 weeks, my obstetrician wanted his opinion on whether I could actually labour. He recommended close monitoring and if I was bed-bound from the pain by 38 weeks then look at doing elective c-section.

After all that, DS showed up 7 weeks early at 33 weeks anyway! Had no time for remifentanyl and managed on just gas & air.

One other thing I'd say is I was contracting for about a week and they gave me pethidine shots and tamazepam to try and help me rest, but they did nothing. They thought it was because I'd been taking strong opioid painkillers throughout pregnancy (and for years before that) so had built up a large tolerance.

So basically, have you met with the anaesthetist and possibly a spinal surgeon?

You seem to have a good consultant that you trust, so I would have thought he really only would do what's best for you and your baby.