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!

Okay. Sorry to hear you're in this situation.

It is hard to say what I woukd do without knowing the full facts but I have not yet come across a situation where I woukd put myself through an induction. It woukd always be c/s.

Good luck Babysaurus. I'm not sure the evidence is so conclusive for 38 weeks. I had ds and dts at st mary's and delivery date for ds was by 39 weeks. When I went back with dts born last summer (before knowing it was dts and being keen to vbac) I was told that if my control was as good as the last time they wouldn't mind waiting to 40 weeks to see if it would kick off in own time. When they discovered it was dts the date given was 38 weeks.

I know that UCH used to be 40 weeks I'm not sure if it still is. I tried them out mcd and was not keen on the establishment generally so didn't return.

My consultant told me that Queen Charlotte's didn't let singletons past 38 weeks so obviously there is differing opinion on this.

Equally though when the dts came out I heard the obs say "very well developed placenta" so there obviously is something in it. Both babies did very well considering gestation so it's not always bad.

Anecdotally on here there was a thread about 4 years ago in which a number of MNers were recounting placentas deteriorating around the 36 week mark. Equally anecdotally it didn't happen to me the first time and with the dts, the fact that there were 2 and we'd moved house 3 days before might have had slightly more to do with their early arrival

Of course, the most important thing is to have a birth experience which results in both a healthy baby and a mother capable of looking after the baby both physically and mentally. If you think this will be a vb then argue with them in the way that any other post-term woman would, e.g. ask for daily monitoring to check on state of baby and refuse any intervention likely to distress you or the baby needlessly. Also do ask your consultant why there are such different time scales in other well known high risk dealing hospitals.

Happy for you to pm me or if you start another thread with condition in the title I'm sure all with experience will come and contribute.

Thanks Tiggers. There may well be the option of going further along than the 38 weeks, I think that will be discussed more after the next growth scan. From what I have experienced so far though, it does seem as if that's the general rule. Today was the first time the stillbirth, and that being more possible than a 00.2% chance if you have bad control as well etc, was mentioned and I have to say it has put a different light on things.

All is good re control though (Hba1c was 5.1, previous one 5.3 to give you an idea) and baby is measuring in the middle of the graph so nothing untoward so far. The reason I questioned the possiblity of induction so much in the first few apts was because the only reason I was given was the fact that the baby would be large due to blood sugar issues - a reason which is not relevant to me, as they could see due to the size shown in the scans and also the Hba1c.

I may well PM you, thanks, as you seem very clued up on things (and I won't steer this thread off on a tanget as other people's experiences are still very useful!)

I've been induced twice, once at 37 weeks and once at 36. The 37 weeks induction went very smoothly, the 36 weeks went onto to emergency section but more because of medical issues with baby than because the labour was horrendous. Neither was traumatic, recovery was somewhat easier with the emcs.

Cory why? Was it due to exhaustion?

I was induced at 37+5, got the first prostin at 9am, walked round and round the hospital as the baby was high up. 2nd prostin at 3pm carried on walking and started getting bad period type pains, waters went of their own accord at 8pm and drip started soon after, contractions were very strong so had an epidural (highly recommend for induced labour) ds born at 3.17am with forceps and episiotomy as he became distressed when I started pushing, it was all fine, not too much pain after, just uncomfortable and the epidural meant I didn't feel anything at the time. My sister had a section a week before I had ds and she is still struggling to get about 5 weeks later where I have been fine for a few weeks now. I would try the induction if I were you, the recovery from a section is so much longer. I thought before I had ds that I would prefer a section to forceps but in reality it wasn't too bad having forceps though obviously not ideal. Good luck whatever you decide and don't lose sight of what you are working towards, once to have your little one, however it happens it will all be worth it.

Thanks ciwi. It is the recovery rather than the op which bothers me more about the c-sec, but as forceps are massively likely (and can be utterly horrific) I am still undecided about which way to go!

All these stories are helping me get a good list of questions for the apt with the consultant midwives on Monday!

Hi Babysaurus,

I was induced with both DC (diabetes) at 38 weeks.

DC1 two lots of prostin on day one and nothing happened. After the first dose on day 2 waters went, contractions started, syntocinon, 7 hours later I gave in and had an epidural which didn't work anyway and after 11 hours in total (one hour pushing) DC was born with just some internal tears which needed a few stitches.

DC2 weren't able to break my waters so had a dose of prostin then ARM, contractions straight away, synotocinon, this time I stayed upright the whole time though and just 3 hours 20 later DC2 flew out in 2 pushes. No tears nothing.

So I had two very positive experiences to add to the pot. I wish you luck in whatever you decide. (I was scared of induction and was leaning towards going straight for ELCS but my gynae and OH were very against it (he would have supported me though had I chosen it) and whilst it wasn't just because of this that I went for VB it was a big factor in my decision making and I'm very glad now I didn't have a CS but only because it turned out so well! Oh for a crystal ball....)

I had 3 inductions:

DD1 - 39+6 due to suspected low weight. Labour so 'easy' that they didn't think I was actually in labour, and had to look at the trace afterwards and ask me how I felt at each particular time, to work out when I went from the latent phase to the active phase. In fact, labour so 'easy' that a junior midwife had to ask the Supervisor of Midwives to overrule the senior midwife, to allow her to examine me (the senior midwife said 'no exam 'cos not in labour yet', the junior midwife got her overruled, and it turned out I was 10 cms dilated ) 4 hours from waters breaking to birth. Natural 2nd degree tear due to DD1 doing a high-five on the way out. Good recovery.

DD2 - 35+3 due to halted growth. 8 hour labour. No tears, no complications for me. DD2 had jaundice so needed phototherapy.

DD3 - 38+5 due to faltering growth/low amniotic fluid. Waters broken at 09.30, delivered at 12.50. No tears, no consequence for DD3.

Nobodythatyouwouldknow that is why I am meant to be induced. It sounds as if you had a similar mindset to the one I am in at the moment. Its hearing how yours went that makes me think it is better to go with the induction and hope it works (!) and also doesn't require too many other nasties (ie intervention.) The chances seem very high that I will end up needing intervention though, which is why I am to-ing and fro-ing...

Not read the whole thread but just wanted to say that at the point where they told me forceps was a possibility I insisted on a cs.

They have to prep you for surgery to use forceps so you get plently of warning that it is going to happen. At that point (I found) it is possible to refuse instrumental and insist on surgical. So perhaps you could give induction a chance with specific instructions that you do NOT want an instrumental (prefering cs)?

EBD I wasn't prepped for theatre when I had forceps, I was still on a bog standard delivery bed in a labour room, and my epidural had totally worn off for the pushing stage. Someone else was in theatre!

Another positive experience here!

Induced at 36+0 with DS2 due to Obstetric Cholastasis and crapping myself cos my 2 friends who had inductions had both ended up with C-Sections. And anyway, there's no way a baby should be ready to come out a month early is there?

I need not have worried: Cup of tea, gel and a sweep at 9am, First "twinges" and waters went at 2pm and DS2 born one hour and 7 minutes later. It was all so quick the epidural/anaesthatist man arrived AFTER the birth and DS2's head appeared in the hospital lift . It was bloody painful but a brilliant experience after a VILE and LONG spontaneous delivery with DS1.

OP is this your second DC? My consultant said the chances of a successful induction were much better if you have given birth vaginally before as your body seems to know what it is doing.

And I totally second the idea of refusing forceps - I did this with DS1 and the hospital staff were cool with that (he did appear with the last tug of the ventouse so no need for a Section in the end)

How long do you have left? It's such a difficult decision and I went into childbirth completely blinkered! Didn't do any antenatal classes or read anything etc and I have learnt soooo much since thanks to lurking on MN that I would have a completely different mindset today! I think, however, I would be happy with trial of labour, and as EBD suggests switching to CS (and not taking no for an answer!!) if things weren't progressing fast enough and I was getting tired or if they wanted to use forceps/ventouse. I just read back and saw your HbA1c results which are excellent. mine were likewise always between 5-6 and my DC were 7lb3 and 7lb8 respectively . DC1 had to stay in hosp for 4 days to regulate bloodsugar and then another 4 days for jaundice and DC2 was out within 24 hours which was just magic. If induction wasn't on the cards would you favour VB over CS? Have a and a while you cogitate

Hi all, I would rather chew my own arm off than have forceps, and I will have that (maybe worded differently) on my birth plan. However, I have had friends with experiences such as Flisspaps where they didn't get much prior warning either.

RickGhastley no, this is my first DC.

I am now 29+3 so have a while yet, but not that long!

I was induced at 38 weeks for IUGR. Had AROM, started drip, DD1 arrived 6 hours later. Was great - three pushes, no tears. My midwives were very positive about an induction at 38 weeks being successful with time and patience, though I think they were pleasantly surprised by the speed. I had considered an elective CS when deciding about induction and, honestly, I loved being able to be up and about immediately after birth. My recovery was a breeze and I quite bizzarely felt that after a really anxious and medicalised pregnancy that my body - with some help - finally did something right
I'm glad we gave it a chance - as others have said, you truly don't know how your body will respond beforehand, which can be both a good and a bad thing I suppose. Have they talked about things such as your Bishop's score? I was not given the same statistic about the likelihood of failure - I was told that my chance of CS was slightly higher than with spontaneous labour, but nothing as pessimistic as you've heard. I hope my story can remind you that it can really be worth trying for, and can work well.

babysaurus - you can take charge of the induction to a certain extent to try and make it a better experience. Here are some ideas:

1. Do a hypnotherapy course.
2. Try labouring in different positions. If they tell you can't because of all the monitors and drips, say that you know that isn't the case but perhaps they could send you someone capable of keeping the trace going as you know other people who've managed this (I did quite a part of labour standing up and with one dose of an epidural as did a friend of mine with a cfm)
3. See if you can argue for a use of a pool if you'd like to try a water birth, other people on here have
4. Ask to have everything explained before it is done to you. If they use medical jargon, ask them again.
5. Get a doula

HTH

Babysaurus - personally I would go for an elcs every time.
You sound rather high risk and your elcs will be done on the normal schedule during the day almost certainly by the consultant. If you 'wait and see' you could find yourself going into a risky situation at 3 am in the morning with no-one but a wet behind the ears registrar on duty. There is a major problem with the training of registrars at the moment (not their fault - systemic problems). The risk isn't worth taking.
The choice though, has to be the one you feel comfortable with so wish you luck

Ushy my emcs was done at midnight for this reason- to get the good team b4 they went off shift and risk ds becoming distressed and turn it into a true emcs.