Induction at 38 weeks apparently '60/70% likely to fail' - opt for ELCS instead...?

[babysaurus]

Due to a medical condition I have been advised that an induction at around 38 weeks is better due to the risk of still-birth being 5x if I go over. However, I have been told (by lovely obs consultant lady) that 'between 60 and 70 percent of them don't work and the they have to go to a section anyway. Also, even if the induction works, the chances of intervention such as forceps are very high indeed (shudder!)

I previously thought of a section as a worst case scenario, but now it is looking as if it might be likely I am wondering if it may be better to explore an ELCS instead. I don't want to be knackered after the failed induction and all that involves and have to have one anyway, so wondering if I simply cut out the induction part and have the planned (and hopefully calmer one!) instead.

Any opinions or experiences are very welcome! I think I need lots of points of view!
Thank you!

Hey, I was induced at 37 +6 as I had OC (they wanted to do it earlier but I couldn't face it). They first did the sweep, then the pessary at around 7pm, then another pessary 6h or so later (in the middle of the night!), as there were no sign anything was happening they broke my waters at 11am and there was still nothing happening so they put me on the drip at 1pm and I started contracted pretty much straight away, although I couldn't feel it. The midwife then sneakily proceeded in doubling the amount of syntocin every hour or so, so that by 5.30pm I was full on in labour. I tried G&A but it made me feel sick (although apparently that goes, you need to stick with it), I was staring to lose it a bit (I now realise it was the transition) and the midwife gave me a shot of pethidine at 6pm, which made me go to la la land until I apparently woke up and started pushing and DS was born without intervention or tearing at 7pm.

So, I'd say that most babies aren't ready at 38wks which may be why inductions don't work as well, but there are always the 30% to 40% that work and surely it's less risky than full on surgery.

Don't get me wrong, if you need a CS then you need a CS but I think you should give your body a chance, it might surprise you.

Oh, and try to be as active as possible, my hospital was pretty rubbish they wanted me to be attached to the monitor at all time but I've heard of people who could walk around with their drips. Also before you get the drip on, I'd say go for a walk as soon as you've had the pessary - I didn't and I'm not surprised nothing happened.

Good luck, it'll be fine!

The problem is there's no way of knowing if your induction is going to go smoothly.

Having had an induction with syntocinon at 42w that ended in forceps, a 3a tear and a retained placenta, if I was told that I had a 60+70% chance of a future induction failing and/or a high chance of needing forceps again, I'd take the ELCS every time. There is no way I'd consent to induction again.

oh tricky choice, i think i would be in the 'worth a try camp' but its hard, i was induced at 38wks with ds1 due to very sevre spd, unfortunately it didnt work, i was allergic to the prostin they use to induce you, and ended up with a hyper stimulated uterous and a baby in distress, i almost had an emcs, thankfully after lots of monitering and umming and ahhing by various drs the situation calmed down on its own.

i was then offered an elective section or they said i could go home, not what i wnated, but i went home and was then induced at 4 days over dates? i tihnk it was 4 days, maybe a week as i really couldnt carry on any longer. the labour then was very long and drawn out with arm and the drip etc, took 3 days but i DID deliver naturally.

i was then induced with my next 4 babies after getting to term plus 14, infact i went to term plus 21 with one of them, it seems i like to cook my babies for longer than normal! all the other inductions were very good, including one water birth, so it can work.

but if it s your first baby and as you are being induced early i would think the chances of it working are low, but it is maybe worth a go as long as you insist they dont leave you to labour for a long time, if it looks like its not working then get them to go to c-section sooner rather than later?

I was induced with DD2 at 39 weeks. 3 days, 4 gels, no chance of ARM, nothing happened whatsoever. The consultant came round and said chances are I'd need a ELCS, so I persuaded him to discharge me and I went back the following week to be induced again. That induction worked- 2 gels and a quick easy labour and she was born the same day,

If I had to have a baby at 38wks I would probably go for the ELCS too, given my past experience.

I've had inductions at 36+6 with dd1 and 37+3 with dd2. I had everyone telling me it would be a nightmare being induced at 36 weeks with first baby, but it was ok. Started with gel at 9am, and proceeded to breaking waters and having the drip and she was born at 11.05pm by normal delivery so not at all bad for first baby.

With dd2 they gave me the gel in the evening, I went to bed and woke up in labour and she was born that lunchtime, no intervention needed.

Would definitely opt for trying the induction if it were me.

Thanks for the replies. I am still none the wiser but the more points of view I can get the better!

Whenhenshaveteeth your story sounds great. I wish I knew that mine would be like that too! However, I am starting to get the impression that it is more likely to go the full on intervention / medical route. Such a dilemma!

I am thinking that perhaps giving the induction process 24 hours (more? any ideas about what is considered 'a long time under these circumstances?) is a good idea, but then also thinking that it may start well but then grind to a halt, meaning I'll be in the theatre in the end anyway, but also exhausted and frazzled.

Just spoke to a friend and she too had a failed induction at 10 days over and she ended up with a section. She said the op was, relatively, okay but the recovery made things a hell of a lot harder than she reckons it would have been with a natural birth. However, another friend was sucessfully induced but ended up with forceps. She is due to have surgery to her spincter (sp?) soon due to ongoing problems and she said she would opt for a c-sec every time.

I was induced at 38 weeks. Induction was started at 8am and baby was born less than 3 hours later with just a tiny tear.

Three hours?! Blimey! Am impressed!

I was induced at 39wks, it took 3 sweeps, 2 lots of gel, the drip thing and eventually they broke my waters to get it all started. It took 3 days from 1st sweep to DS being born, I was so knackered (having been awake the entire time) when he was born that they bought the forceps in (magically managed to push him out before they used them, after they cut me) and I can't remember him being born or holding him for the first time :(
That first night in hospital was hard as I was so tired.
If I have the good fortune of getting pg again I'm opting for an elc.

My mum had 3 inductions (41wks, 39wks & 38wks), she said they all hurt much more than her natural labour (37wks, and her first).

Good luck making a choice & with the rest of your pg babysaurus

I was given a sweep, had my waters broken and put on syntocinin in the early stages of labour because DS was not moving, in distress and they wanted to 'get him out quickly'.

Turned out DS was at a bad angle in the birth canal and his head was getting compressed. Forcing the labour for 24+ hours nearly killed him. The midwife wanted to let it go on and on to give 'natural birth a chance'- luckily I heard her arguing with the obstetrician on the ward (who was saying it should go to cs post haste) so I insisted on having the cs.

DS had a bad head injury and might not have taken that much more according to the doctors. I wish I'd pushed to got to cs as soon as they could see DS was distressed and would never go through the induction/ 'speeding up' process again.

meant to add: DS was my first baby

So you're at a high risk of stillbirth. And your consultant, who will undoubtedly be under pressure to reduce the hospital CS rate, reckons you've only got a 40-30% chance of an induction being successful. And that you're highly likely anyway to need an instrumental delivery IF the induction works?!
I'm struggling to see why this is a difficult decision!

Have the CS! in terms of cascade of risk the burden of risk is on you, not the baby. And a planned section is fast, controlled, painfree and what your consultant, who has delivered more babies than you or me put together, thinks you should have one. Do it. Simple!

Bagofholly the consultant doesn't think I should have one, she was pointing out the pro's and cons of an induction, along with success rates today. We were basically going through all the options and possible outcomes and I was asking for the stats re the likelihood of each thing happening. I am not that sure where she'd stand if I said I want an ELCS and to hell with the induction process, she may try and talk me round to trying I am not sure (I will in due course though I reckon, have next apt in a month!) The reason I am asking on here is to get some more points of view and experience from people who have been there.

AWomanCalledHorse hearing about experiences like yours make me want to go straight to the ELCS, but I still have concerns re recovery. I think a tricky recovery combined with looking after a baby (and I am a novice!) may be making things far harder than they would be if I had him/her the natural way.

Thanks again for the replies so far. It looks like the c-sec seems the more favourable option, all things considering, but the one's of you who had a straightforward and reasonably quick experience (Nextweekmustbebetter and Whenhenshaveteeth I'm looking at you two in particular) make it not quite so black and white.

Hard choice. I had failed induction and found recovery from c section harder than friends who had planned c sections - think they were less knackered. I had a five hour vbac next time though - so the labour from ds1 did help with ds2 birth in the end.
Do you plan on having more? Think I'd have a trial of labour but maybe just gel and refuse drip if I was doing it again

Mine was a different situation to yours OP but I was induced at 40+9 due to HBP. I was told by my consultant that I scored a 0/10 on how 'ready' my body was to give birth. I, like you, was told that it was likely to fail and I was put at a high risk to have a csection.

I was in labor for 2 hours and 6 minutes No-one could quite believe it and I dilated from 2cms-10cms in 10 minutes! No interventions whatsoever and was a v straight forward 2nd stage, not so much for the 3rd stage but that was not due to induction I believe.

So, it doesn't always go how they think it will and every birth is different. I would say as long as your 100% happy, go with it. My experience was amazing even though I didn't have time for pain relief! Good luck with it.

A cs certainly sounds more certain in the circumstances. The only thing to take into consideration is how many children you'd like to have and whether the reason for induction will reoccur. You can have them examine you before the induction get your bishop's score and make a decision on the day as to whether your cervix is favourable for induction or if it would be better to go straight for a cs.

Ds was a failed induction at 38+6 ending in an emcs and I didn't want to repeat the pain or exhaustion. However I still wasn't that keen on an elcs. It took most of the pg with the dts to come round to the idea and when o finally did the nhs changed tune and started majorly pushing vbac. I ended up with a twin vbac at 33+4, 2nd degree tear but no intervention.

At the end of the day it will just depend on whether your body is ready or not.

My DC3 was induced at 37 wks, medical view seemed to be that given previous two natural, easy deliveries, my body would know what to do and would be fine with pessaries. Only problem was, DC3 was definitely not ready to come out and my body was very much on his side! So we went through similar schedule to other posters..2 pessaries and 12 hours of nothing happening, waters broken, nothing, then drip, which definitely kicked things into action.

Imo my midwife was terrible, she continued increasing drip dose even when I was well into established labour (at which point my body definitely did know what it was meant to do and needed no further help from a drip ). DS2 became distressed, as did I, and we ended up in theatre, prepped for a go with ventouse and then EMCS. But thankfully ds2 appeared before either was necessary.

It was pretty stressful and unpleasant, especially compared to my first two births, but I still don't know if I would choose an elcs over it, because i found recovery pretty easy every time...but I think that is luck and with your first baby, you don't know how your body will cope with labour and birth (or recovery from a cs for that matter)... makes the decision very difficult. O

One thing I would say that for me, once labour did finally start with drip induction, things happened very quickly, the hanging about before was tedious but not exhausting, much less so than prolonged natural labour that can go on for days, from starting the drip to giving birth was about 2hrs for me.

Have you researched the difference between your risk and the standard risk if going over 40weeks and the ACTUAL statistical risk?

Inductions and c/s are not without risk either.

You'll find positive and negative experiences for all types of birth. Re cs recovery, its a LOT easier if it's planned. I've had 2 ELCS and as well as being v straightforward positive, calm, lovely experiences, the recoveries were nothing like the tough stories you might read - was back to pre pregnancy state in about 3 weeks - and a whole lot faster than my friends who had tricky instrumental births. Of course it's not the same as those very lucky women who have totally natural uncomplicated deliveries, but for me this was never within my reach anyway.
V best of luck with it all. X

Just to add, about the recovery - I was up and walking same day, on paracetamol for about a week, and was never in pain at all with my first. I had twins the second time and still had to lug my toddler about, and the only thing I couldn't do for a few weeks was lift him out of the bath without farting! But that was more to do with my giant twins and my pelvic floor than the delivery!

I was induced at 42 weeks and it didn't go that well and I ended up having an emergency c section. I personally, knowing what I know now, would have had an elective c section.

TiggersReturn I remember you by your previous name! I am having the induction due to the same reason as you had (Dear me, this means I spend far too much time on MN!)

Starlight I have questioned every single thing they have told me! Until the stillbirth possibility, however small, I was given a different reason and that reason, for me, was not viable as the risks of induction outweighed by far the risks of going beyond 38 weeks.

Bagofholly that's good to hear re the recovery for yourself. And thanks for wishing me luck!