induction or elective c-section at 42 weeks?

[HardCheese]

At 40+10 (first baby, 39) yesterday, I had a dispiriting session with a consultant. Bishop's score of 2, cervix tightly closed and long, though soft - she was only able to get a fingtertip in, so couldn't sweep. Amniotic fluid is getting low and my blood pressure had gone up significantly since I saw my midwife 36 hours earlier - though this was probably partly because I was terrified of allowing a sweep, as I find VEs very traumatising and have never been able to have a smear, and had refused all sweeps offered to date.

I have till Monday to try to go into labour spontaneously - though it's clear that consultant would have rather started induction yesterday - then have an appointment at the foetal welfare unit for BPP, CTG etc. Then I have to make a choice between starting induction immediately (initially as an outpatient, assuming baby still OK and my BP not sky-high) or going straight for a c-section.

Both consultant and midwife have said independently that even if I opt for induction, there is an approx. 50% chance I will end up having a c-section anyway, given various factors. Both of them have also said that I should consider the c-section without an induction attempt for psychological reasons alone, given how difficult I found yesterday's VE and failed sweep. Presumably an induction will involve lots of those...?

I'd be grateful for anyone's thoughts on this, as I just feel so low and frightened of both prospects, after having had a lovely, straightforward pregnancy, and can't sleep.

Also, what are the implications of either a traumatic induction or a c-section for bonding with my baby and breast-feeding? When I asked midwife, she suggested trying induction for a period of 12 hours for the oxytocin, which would help with that.

All thoughts gratefully received. Sorry about the doomy tone - I feel my body is letting me down and completely powerless.

I was induced with dd1 and I know there are good and bad stories. Mine was a bad one I'm afraid. I was 42 weeks too. I was in hospital for 5 days when they tried everything to induce ne but nothing worked. They then broke my waters, put me on the drip and to cut a long story short baby ended up in distress and I ended up having an emergency c section. I was 42 weeks with dd2 and went straight to planned c section. Very calms compared to first time. It takes longer for your milk to come in when you have a c section but I didn't have any issues with bonding. It is a such a hard decision isn't it but good luck whatever you decide. As long as baby's born safe and well that's what counts . I friend of mine went 45 weeks in the old days when they let you...

Thanks, nevercan. How was it they kept trying to induce for five whole days, though? That sounds horrible! And, as someone who's had a bad induction experience, what do you say to the idea of putting a strict time limit on induction attempts, and then proceeding to a c-section? I can't decide whether that would give my body a reasonable chance to do its thing, or whether it would mean that I was more exhausted than necessary before having the section...

i was induced at 40+12 and DS didn't arrive til 40+14. my cervix was firmly closed, not even admitting a fingertip when it started so had 2 doses of gel that day (max you can have in a day) and a third the following day, after which doc was able to break my waters, contractions started an hour later, had the drip that night and DS was born the following morning.

if i had my time again i'd think i'd try induction on the first day and if it didn't work then ask for a section. it defo didn't effect breastfeeding or bonding, although i was exhausted by the time i had him.

HardCheese On the basis of what you've said here I'd go for the ELCS.

Like QTPie says, a traumatic or difficult VB can affect BF and/or bonding more than an 'easy' ELCS, I struggled to BF and to bond with DD initially and I think it was because I found her delivery so hard (I very much feel she was delivered rather than born, even though she was a VB) to recover from mentally. I won't accept induction again.

But only you can make the decision. I think if they said perhaps there was a 30% chance of it going to EMCS I'd probably take my chances, but 50/50 would be too high for me personally :(

And by 'easy' ELCS I don't mean as in easy to recover from/easy way out, I just mean without the added exhaustion or sheer brutality or physical damage that can be involved in a VB!

don't feel your body is letting you down...

I was induced at 40+8 and it wasn't as traumatic as many say - I must point out however, I did end up with an EMCS. But, like I say the induction itself did work. We arrived at the hospital early am and had the gel (a vaginal pessary but nothing like a sweep - more like inserting a tampon) then I actually didn't get any examinations as they told me this would dislodge the pessary so they wouldn't even see if I was dilating, which seemed a bit bonkers to me but anyway by 9pm was admitted to delivery suite - as they finally did examine me and was dilated enough for them to have considered labour to have started. I then had to have the drip induction and I also opted for an epidural.. Labour proceeded very well during the night and I got some rest etc but was still contracting nicely.

I was pleased I got to 'experience' natural labour and to give it a damn good shot at having the baby vaginally. It was just a shame the baby didn't seem to want to play ball and full dilation, great midwives helping with the pushing she weren't budging so after an hour of trying the heartbeat dropped and they monitored her for wee while longer but upon examination the head wasn't moving anywhere so I was taken into theatre. I was pretty groggy, sick from drugs etc and couldn't feel limbs! BUT, it was amazing to have her out safely and she breast fed immediately in recovery and like someone else says it was calm and not horrendous at all - we had loads of skin to skin contact and certainly don't feel in anyway shape or form that bonding was any different to if I had had the vaginal birth.

Healing is a bit of a pain - but I left hospital the following day (at my wishes it was Christmas Day!) so perhaps too soon however I wasn't in agony or anything.

If you have medical complications like high blood pressure I would not risk ignoring doctors advice..go and get the induction underway and good luck! all you want at the end of the day is a healthy mum and healthy baby. Don't risk leaving it longer and longer as I don't want to panic you but my sister had a horrendous bleed as she went too far overdue and it was a mare of a labour as the placenta was stopping working.

All the best.

I had an CS but as it was an elective it was a very welcome, relaxed and pleasant experience. I had no trouble bonding with DD, we had skin to skin as soon as she was delivered and she bfed with no problems (still does at 10 months).

If CS is what you want it can be a positive experience. I imagine the worst birth experience is where you are forced by circumstances into a birth that is not what you wanted, so given your worries about internal exams a CS may give you more control and a better experience.

Thanks, everyone. Very much appreciated, especially as I seem to be going round and round pointlessly in my own mind.

Happy, can I ask why you feel it's worthwhile to try induction, rather than proceed straight to an ELCS, if that is still an option on Monday? Just trying to rationalise benefits of both approaches in my own mind. My blood pressure was completely normal for the entire pregnancy until yesterday, so it's hard to know whether the spike was in response to a stressful situation or not.

Fliss, I should have asked the consultant exactly what she was basing the figure of 50% likelihood of needing a CS after induction efforts - I think she said something about the unpromising state of my cervix, the fact it's my first baby, and the lateness of the induction - but I was shaking the whole time I was in there and not at my most rational. I'll try to get a clearer sense of the odds on Monday.

Can I ask you much the same question as I asked Happy - why would you consider induction if the odds of needing an EMCS were 30% rather than 50%, especially in view of your appalling past induction experience? (Or am I misunderstanding you, and you wouldn't induce again in any circumstances?)

My partner, who is being an absolute angel, is saying it's my decision, but I can see he favours the ELCS option as less potentially traumatic, given that our planned MLU hypnobirth is now off the cards, barring a miracle.

With my first baby I went into labour and then it stopped, so I was induced (not sure if this is the same as it would be for you). Labour was very long and painful, and I had PND after, although I can't say for sure that this was connected. I took a long time after the birth to feel physically well again.

When I had my second baby, I chose to have an elective caesarean, which was wonderful from the start. It was a bit scary walking into the operating theatre, and it was uncomfortable for a few seconds while they did the epidural. After that, it was fine. I had no pain, felt very positive, and seemed to feel normal again within a few days. I had no PND, although my second baby was much 'easier' than my first, which probably helped!

Everybody's experience is different, but for me, the planned caesarean was wonderful.

HardCheese The second one - I wouldn't consent to induction again under any circumstances, although I'd rather have an induction that ended in EMCS than chance one that ended in forceps and tearing and manual placenta removal again, and all of those things are unfortunately more likely with induction (I'm aware they can still happen with SVB though).

I've had a conversation about this with someone on either the April or the How long thread today (can't remember which one) in fact.

It's a decision that no-one can make for you unfortunately. Just because I or someone else would choose one thing, doesn't mean that's the right choice for someone else. You could find that you go into labour tonight, or that your cervix is favourable tomorrow - you just don't know.

WRT VEs - yes, induction generally will involve a few of those.

One to check your cervix before they start, then another one to put the prostaglandin in, and then every 6 hours whilst they're still putting more in (if needed) and then another one to do ARM (if you need your waters breaking), and then you're looking at routine VEs every four hours - which you can refuse of course - but if things aren't progressing once you've had your waters broken then the next step is the drip and again, you're looking at 4 hourly routine VEs there (which can be refused, but I don't know if the syntocinon means you'd be wiser to have them done even if you'd have refused with spontaneous labour)

The other thing to think about is could you have another scan to check fluid levels on Monday (amniotic fluid can replenish itself), and see if your BP is normal? Would you consider expectant management? Just wondering if Monday really has to be an induce-or-CS decision or if you could have induce-or-CS-or-wait as a choice instead?

To answer your question they tried a pessary and then waited 24 hours each time to see if it has any effect. However I had to stay in hospital so the waiting was v v boring and not much sleep at night. I would suggest a couple of goes but not as many as I ended up with.......

As far as I know there's no evidence to suggest that cs has any effect on breastfeeding, despite what one might intuitively think. Same with bonding - and with 25% of births being cs, if there was a compelling correlation I think we'd see far more societal problems. If despite induction you're 50/50 cs anyway, I'd go ELCS. But then I had excellent experiences both times.

Lot of VE with induction, I had a good induction but reading your history still makes me think c-section in your case. It is a big op but so much better if it is planned rather than emergency. Good luck.

I was 40+8 with signs of pre-eclampsia with DD1. Induction attempt 1, nothing happened 2nd attempt later that day had slight contractions but on exam cervix was still firmly closed.

By this stage I was soooo tired simply because I'd been in hospital for 4 days and had no sleep the previous night. I was given the option of attempting further induction with the drip (oxytocin) or opting for a c section.

My worst scenario was to go into labour, have hours of pain and then end up having a section anyway. I was also told that if labour did happen it was likely to be more painful as everything happened much faster (and I am a wimp).

So I decided to go for the section. It was calm and I had skin to skin immediately. I lost a fair amount of blood but was ok the next day. Milk seemed to take a little while to come in (but I've got nothing to compare it to) and I successfully bf for 14 months (the section made me more determined to stick at it when it was tough in the early days).

Anyway, I'm booked in for another section next week and feel very positive about it.

In your situation, it depends on how strongly you feel about "natural" birth. You could give induction a go like I did but be prepared for it not to work and if so that doesn't make you a failure. I did initially struggle with that but when I spoke to others who had had a section and found it was quite common, I realised that actually I HAD made a good choice as both me and my baby were healthy and bonded well.

Good luck!

Thanks from the heart to everyone who responded. I feel so defeated about it all, and I'm so tired of well-meaning advice about pineapples and curry and long walks, that I honestly don't feel like discussing it with anyone in real life other than my partner, who is the best person in the world and a tower of strength, but starting to get worried himself, about my mental welfare and the baby's health, though he won't admit it and backs me up 100% in everything.

Fliss, normally I would absolutely have opted to continue with expectant management and frequent monitoring, whether or not that's an accepted practice at my hospital after 42 weeks (it seems not), but to be honest, I am now worried about my baby's welfare and obsessing about his movements/fluid levels etc.

In essence, I've totally lost confidence in my own body, and am still very shaken after the VE and failed sweep on Thursday, as it's caused me to think about something I'd successfully not thought about in years. I managed to go through with it by thinking of my baby, and if it were the only way, I would manage it again, whatever the mental cost, because he deserves a mother who will put herself out for him, but it may be time to accept that any birth I now have will be heavily interventionist, and that I should choose something less traumatising for me, so that I'm in a better state to mother him when he arrives.

Thanks again, everyone - much appreciated.

Hardcheese, I'm so sorry you're going through this. I tend to agree with the majority of other posters, that an ELCS might be the less traumatic option, especially as it sounds as though you have a supportive DP. But only you can decide...

Aside from the CS/induction issue, it sounds like the best thing for you right now is to try and let it go, get some rest and do something totally unrelated for the weekend. (I know that's probably the most difficult thing in the world).

You sound pretty stressed, exhausted, and unhappy - none of which will help - and if you could rest, and relax perhaps it would help you to come back to this after a break, and then reach a decision. A bath/film/headrub/massage/bar of chocolate/sleep maybe?

After being pregnant for 42 weeks, you've earned a couple of hours of relaxation before your new arrival!

All the best: we'll be thinking of you!

I agreed, reluctantly, to induction at 42 wks, and had an emergency section at 42+5. I am not a big believer in induction - and in retrospect, I would have just gone straight for an elective section.

Forgive me if I'm speaking out of turn here -

I had an ELCS for my first DC. Have a history of sexual abuse and depression - was lucky enough to get an ELCS agreed by psychiatrist and consultant MW.

It was a great birth. DS was fully BF, never had
a drop of formula, was born healthy with an APGAR of 9 and 10 and I recovered quickly from a painless if weird birth! And was v grateful for it.

not a single VE, and had the catheter and suppository painkiller insertdf after anaesthetic and with the screen up.

I did a LOT better in terms of birth, recovery, and BF than
my contemporaries with traumatic VBs. By a long shot.

I hope you make the right decision for you. All the best.