Can you refuse an induction and ask for a CS instead?

[TribbleTuckandDismount]

I'm just wondering really, I had a fairly bad birth with ds and don't want to go through that again. I do want a vaginal birth (and there's nothing to suggest that I'll need induction).

But I was wanting to know if you can refuse induction (if it is needed) and ask for a section instead (I had very bad PND and was being treated for trauma surrounding ds's birth).

Thank you.

You can ask for anything! But are likely to be refused and bombarded with statistics about the risks of surgery. You'll receive scant information about the risks to mother and baby of induction and the relative merits of each mode of delivery.

CSection is moderately more expensive to the NHS if you exclude the cost of all necessary post-birth treatment/repair/surgery and as such you'll be ushered down the route of induction.

Do make the request and get it on record, push the issue to second opinion if you feel strongly. I know someone who was adamant that induction of her obviously large 2nd child would be a bad thing and saw a consultant to request CS which he refused. Her induction was awful and vaginal birth caused so much damage she needed colostomy and catheter for over 6 months post birth, several ops and treatment is still ongoing .

It's worth asking but I'd say be prepared to be told no
I was almost 2weeks overdue, due to be induced at th end of a week
Had already been told dc was 10lb+ and had to move to a different hospital as it was likely that a c-section was needed, yet I was still refused
Ended up having one anyway after 3 days of labour

I was told I could do this if I don't opt for an elective CS, but am having a VBAC
the consultant said that I can plan a VBAC but if I need any intervention, or go over due and need to be induced, I can opt for a semi-emergency CS instead of the other introventions

You can decline any treatment. If drs feel that you must have the baby soon & you decline induction, they will have to give you the cs or wait for spontaneous labour.

Mavis my understanding is the same - been a court case about it as well. (Sadly baby died, they tried to blame the mother but she had requested a c/s and they declined it so left her overdue for a long time.). Mother was awarded damages.

Worth pointing this out if they try to ignore NICE guidance and overrule you.

Good luck.

Tribble - So sorry to hear you had a bad birth with your first. I had a difficult, induced birth with DC1 resulting in complications for DC1 and me, and, in hindsight, a fair bit of mental trauma. My GP was supportive of ELCS but I was willing to try a vaginal birth if I went into labour spontaneously. I specified to the hospital that IF they felt they needed the baby to be born I would accept a CS but I would NOT accept induction (beyond a sweep). They might not have been happy but they accepted it. I think it helps if you demonstrate that you understand the relative risks of the different options.

As it happens DC2 was born after a spontaneous labour, with no interventions. It was utterly life-changing. I felt fully recovered from the birth within a week compared to 6 months with DC1. I wish you a similar experience

Columbo Thats very helpful thank you, although I did go into labour naturally with DS I had a bit of a cascade of intervention and ended up needing a lot of help and ended up in and out of hospital in the first week after DS was born. I really do not want to end up with that again. Mentally it's taken me a very long time to recover. Don't get me wrong, I've made my peace with it. I just feel that I don't want to place myself in a position where I could end up with a replica of DS's birth.

Ushy

Do you have the reference for that case?

Just in case anyone is reading this and is worried about induction I thought I'd offer my experience of it. I think we hear the stories about what went wrong more.

I was induced at +14 with gel, it kick-started straight away. The worse bit was early labour on the antenatal ward, rather than labouring at home, I felt very alone. The actual birth though was pretty normal, drip in the last hour but again bearable and only took me to normal contractions as they had gone. Ds was in a funny position (looking sideways, ear first) but after lots of pushing I gave birth naturally, not too much tearing (he was 9lb 3). It was an uncomfortable way to labour on the ward, but not much different in other ways to a normal birth. I would do it again over a cs as recovery was minimal beyond sleep catch-up.

My two bits of advice would be wait as long as the baby is safe and walk, walk, walk once you start to labour. I paced the stairs/ car park. IT both was pain relief and moved ds and stopped me feeling so cooped up.

My waters broke at 35 weeks and they asked me if I wanted induction or CS as I didn't go into labour. I decided on CS as I thought inducing a labour 5 weeks before my body thought it was ready would be awful. Hosp agreed and all was fine. Irrelevant really but consultant told me I would have had EmCS anyway as the cord was wrapped and wrapped round DD.

You can have an elective CS if you wish, all hospitals should offer you this as in accordance with nice guidelines. I've seen my consultant today who offered me one although I'm actually going to try for normal birth and see how I get on as am scared of a CS! Hope you get what you want in the end.

Could someone tell me please the risks associated with induction vs CS? Am interested as a result of reading this thread!

Tribble, I found having DC2 on a Midwife led unit great as I didn't feel 'pushed' into any interventions at all. In fact the midwife didn't even give me an internal at all as she was happy everything was happening as it should. I don't know if you've got MLU or if you were thinking of that as an option. Also, I put part of the good bits of DC2's birth down to Ina Mae Gaskin's book and a big bit of luck

smallgreenone Hospitals are not required to follow NICE guidelines though, so while you can request one there is no obligation to the hospital to consent to that, or to refer to you a consultant who will.

Tribble I had an induction with DD, which ended with several issues. I was very clear that I would refuse induction if I went to 40+14 with DS, and would take expectant management with a CS if that showed any problems - if the monitoring showed that he needed to come out NOW then I wasn't going to expose him to potentially days of induced labour. In the end I went into spontaneous labour anyway.

aamia With induction (as opposed to spontaneous vaginal delivery) there is a risk of hyperstimulation to the mother's uterus resulting in distress to the baby, the drugs used could cause distress to the baby, more chance of continuous foetal monitoring increases the likelihood of epidural - epidural carries its own risks to the mother, increased chance of instrumental delivery (which means an episiotomy or tear and therefore increased damage to the mother's pelvic floor) and an increased chance of CS. There is also an increased risk of PPH and retained placenta (resulting in manual removal) linked to instrumental delivery. Induction can last for days.

With CS, clearly that's major surgery and along with that go all the usual risks of surgery. The baby is more likely to need assistance breathing in the early moments as they don't get the same compression to clear fluid from their lungs as those born vaginally. There is an increased risk of PPH as compared to a spontaneous vaginal delivery.

I'm sure I've forgotten things. It's a personal decision though, the 'choice' of one over the other is right for one woman but not for another. You're never told of the risks of induction beforehand though. For me, suffering the damage I did following DD's birth (all the issues were 2nd/3rd stage related) was enough to make me determined to choose CS over induction if it was necessary second time around.

I had an emergency c section following a failed induction in march. I was given three gel pessaries over three days which gave mild contractions, but nothing major. On the third day, the mw on antenatal ward examined me and said baby's head wasn't engaged at all and so i should prepare myself for a section. When i went on the delivery ward and saw the consultant she was adamant i should be induced despite the unfavourable position of the baby. I stongly said that i didn't want to have a failed induction and would rather have a section, but was told i couldn't have one so i felt my only option was induction.
All this happened after the publication of the NICE guidelines, so went against the current guidance. I also felt scared and belittled by the consultant which wasn't fun.
That said, i didn't find the induction too bad apart from the constant fetal heart rate monitoring. I managed to get to 8 cm dilated with only tens and gas and air before my baby's heart rate started dipping and his head was still nowhere near engaged, hence the emcs.
My major regret is the stress the whole thing put my baby through. He was very poorly after the section having swallowed meconium and was in the neonatal unit for two weeks. I have no way of knowing whether the induction contributed to this, but still feel upset when i think of that conversation with the consultant as i wonder if my son might have had a healthy beginning if i had been given the option of a section then.
So in answer to your question, theoretically you can opt to have a section but in my experience the choice was not given.

I was induced at 40+10 with DS1(5) I ended up with complications resulting in him being born by emergency c-section at 40+12 and being taken to NSCU. I am currently pregnant with DS2 (was due today :() I was quite adament I would have an elective c-section with any future children after the 1st time, up until I actually fell pregnant. I discussed with my midwife very early on what my options were and I was sent to a VBAC session with a consultant, after talking it through I was told I would be allowed the section if it's what I wanted, I really was set on no induction and still am. The plan is to do this naturally, if nothing happens by next Tuesday (40+6) I will be booked for a c-section a few days later. I am really hoping things start by themself which seems likely but if not I will be having the caesarean instead of going through the process of induction.
I would definitely ask about it if that is what you want.

I'll speak to my MW at my next appointment about my fears.

Columbo I am booked into an MLU, and I'm quite happy about that. I just don't want to put myself in a position that makes intervention more likely. I was all over the place after DS and I just don't want to go through that again. I'm not really bothered about a perfect birth, just one in which I come through the other end with my sanity intact.

Big hugs Tribble. And just to let you know you can have a 'perfect birth' (or at least a birth where you and your baby are in charge) after a tough first one. DD's birth (due partly to the brilliant midwife and HCA) actually helped heal the emotional pain and fear I'd been carrying since DS's. I am an absolute bloody wuss and pushed out a ten pounder with water/gas and air and only a little bit of whimpering. I never would have believed that I would have been able to. I'm ignoring the fact that I was pathetic in the 3rd stage