ELCS V Induction, Big baby/small mother + previous complications

[Midgetm]

I am really struggling with making choices for my second DC and would appreciate your wisdom, especially those of you who have experienced both inductions and ELCS. First timer warning - do not read this if you only want to hear the good stuff.

History - 41, last DC at 36, history or recurrent miscarriage and EP. Managed to have a successful pregnancy, developed PET, baby had IUGR. Induced at 37 weeks - placenta failing, totally the right decision. Induction was pretty straightforward I suppose in the scheme of things but care was appalling. Told me I would not be left on my own as induction and this was dangerous (baby also back to back) and then was promptly left on my own for hours. I was not even given gas and air as lots of emergencies. A cleaner showed my husband how to use the gas and air by the time I was 8cms (I kid you not). Eventually got a midwife - and an epidural as by this time I was terrified and did not feel safe in their care at all, and just about managed to deliver a tiny 4lb baby unassisted but only just. they were waving forceps etc in my face just as I delivered Subsequent PPH, again discovered by the cleaner as I stood in a pool of blood like something out of Carrie blood transfusion and unpleasant PET issues (liver misbehaving, twitching, generally feeling a bit like I could die) meant I ended up in hospital for 2 weeks. This experience made me really want a homebirth as my fear was more from being just left and I know this would not happen with 1;1 midwife care. Been advised against this by both MW & Consultant. Due to my history of losses I would not do anything against their advice or put my DH in the same position as last time when he thought he may loose both me and the baby.

This pregnancy is so different. 35+3 No sign of PET yet, placenta seems to be an uber placenta as the baby is on 97 centile. Consultant wants to induce early because of previous history, age and size of baby and I do not have a problem with this but I am terrified of an induction with a baby that will be twice the size of DC1. I already have issues with my pelvic floor this time with VV's (they are gross and swell with any straining at all, feel like they prolapse a bit but not sure that they are - perineum in a right state already) and the dreaded piles. Having these so early in my pregnancy make me really fearful or prolapse which I know may be paranoia but I can't help thinking I may be more prone. The weight of this baby and the horrific constipation I have had this pregnancy is definitely putting pressure on my pelvic floor that I did not have with DC1. I am also very fearful of anything happening to the baby due to my history this is quite overwhelming. My worst scenario would be long labour - baby in distress, EMCS. I feel induction so early with a big one would end just like that.

My thoughts are: Take sweeps at 37 weeks and see if this starts naturally and then go for natural birth. I think I will only get this big baby out if I can have an active labour. If this doesn't work then request an ELCS. I know my consultant thinks I am capable of delivering this baby if induced but I am worried about the strain on the baby, my pelvic floor already in a mess my mental health and then likely emcs as induction with a big baby is rarely straight forward (I think 50% chance of EMCS which seems bad odds to me).

Crazily I am going to the same hospital again - I think these things can happen anywhere and it is all down to who else has priority at the time and they rightly concentrate on those babies who need it most. I have the same consultant who was spot on with her decisions with DC1 and who has done the growth scans all the way through the pregnancy so although I know they can be out, I trust her judgement. She will also support my decision but I know would prefer I took induction.

Sorry for the epic post - I just would really appreciate other peoples thoughts on this. Especially those who have had both inductions and ELCS. Some people tell me I am mad to think about surgery but I think if I may end up with it anyway I would rather it be calm and planned, yet don't want to do anything that may interfere with BF or bonding or recovery time as have DD1 to think about. Please help me wise Mumsnetters for I am running round in circles!

Sorry to hear you had such a bad experience first time.

Why do you have a 50% chance of an EMCS? That would probably hinge the decision for me: if that was a solid fact I'd probably go for an ELCS and stop the worrying.

Other bits: An 8lb baby isn't terribly big and definitely manageable to birth vaginally. 4lb is very diddy but having a small baby is actually quite difficult as there isn't as much 'oomph' behind them for gravity to work with.

I was also induced with DC1 as he had an IUGR and I had pre-eclampsia. It was a horrible experience ( also left for long periods, inadequate pain relief etc.) that I never want to repeat and I was seriously considering an ELCS this time. I'm now 36 weeks with DC2 with, finger crossed, a so far textbook pregnancy. My big fear was feeling as out of control and helpless as I did during the induction so I've been practising hypnotherapy techniques and am now quite looking forward to the birth

Waves at VQ who has already given sound advice.

Thanks SSP I think you hit the nail on the head with the out of control bit. That is very much how my first birth was. Chaotic and all a bit skin of the teeth dangerous. I have a hypnobirthing CD must take it out the amazon packet which I do need to use - I know my first experience would not have been so bad if the fear had been more manageable.

I think the 50% chance of EMCS stat comes from inductions for big babies before term. If I go to term I think the baby will be more like 10plus. I am tiny - although I know the pelvis is a magical thing.

Get it out of the packet! :o Honestly, I am not a 'woo' type person and kept snorting with laughter the first time I listened to the CD but I thought anything had to be worth a shot and now I feel a lot calmer, more positive and in control. It's yet to be put to the test but even the calm of the last few weeks has been worth it.

Just an anecdote: a friend who lives in the USA had her first baby earlier in the year and had an ELCS because growth scans showed that the baby would be massive and an MRI showed that her hips were too small to fit the baby's head through. Baby was not massive and in hindsight she would have been fine to have a normal delivery.

I have taken it out the package. I am listening to it now. I do think the big thing is spot on though. I am huge - and it is all bump. last time there was a lot of cake Every Dr or midwife that even feels it says that it is a big one. The consultant says yes measurements may be out but 'you only have to look at the scan images to know that it is big'. The same consultant was spot on with DD's weight prediction. I will give the CD a good go though as anything that will help is good with me. Off to lay on the sofa and let this mad lady soothe me.

Enjoy the warm golden light :o

The warm golden light was rather lovely and I had a nice snooze. will the warm golden light help me pass a bowling ball out my fanjo and stop me prolapsing?

Apparently so!

Just bumping a bit to see if anyone has anything to add re the prolapse, vv concerns.

Bumpity bump bump bump

I have had experience of induction (though that was incredibly traumatic - I was in inteisve care with severe PE at 26 weeks, HELLP and my baby had just died in utero) and ELCS.

I am probably therefore biased but even if my first induction baby had been ok I found the induction process very unpleasant (the tablets weren't doing much, the membrane rupture I had at 1cm dilated was horribly painful and hard to tolerate) though ultimately I guess "successful".

My ELCS was calm, more predictable, faster and I made a good recovery. I did not request it (I was willing to try induction again despite everything) but my DD2 was transverse at term. It wasn't totally straightforward (haemorrhage) but I was looked after well.

I don't have a great chance of a VBAC either (probably similar to yours) so have requested repeat ELCS (now 33 weeks). Also, the risks of uterine rupture are higher for older women with closely spaced pregnancies (I am 41, with only 23 months between DD2 and DD3).

For me, I think its the emotional side that is important. I might VBAC ok but the risks of it becoming an emergency situation are quite high and I might panic at this. I've had the most awful of obstetric emergencies with my baby dying and my own life at risk. My priority is to avoid the worst (a traumatic EMCS) rather than try to see if I can achieve the best (a straightforward VBAC).

I can't comment on your other concerns but maybe this helps a bit.

Midgetm my dd was induced on her due date. I am 5ft and they thought she would be big. I had 3 pessaries, my waters broken and then the drip and I had the most horrendous traumatic birth. 72 hr labour, she was born in theatre with shoulder dystochia. I was left with a 3rd degree tear (had an episiotomy too) had a big pph and then a blood transfusion. Followed by a fentons procedure a year later to repair the damage my 'natural' birth did me. I had pnd as a result it took me over a year to recover physically and mentally. Dd needed resuscitating was 9lbs.

When we decided to have number 2 I went to see the consultant before getting pregnant to ask for an elective section. He happily agreed and said it was my best option.

It was truly the most amazing experience of my life, it was brilliant - everything was calm and relaxed. I did still have a pph and need a blood transfusion, but they said that was just me. ds was 9lb 10. We are def not having any more but I wouldn't hesitate to have another section, the recovery time was so much quicker.

Happy to answer any questions x

Jules & Chiefowl Thanks so much for sharing your experiences. Jules I am so sorry that you have been through such horrendous loss. I know how much loss breaks your heart but mine have all been early - to carry so far and loose a child is unthinkable. I can only imagine the pain this must have caused you.

The more I think about this and the more I hear from others the more I think my strategy is right - if a sweep can get me started then I will give it my best shot but if this is not successful I do not want to be induced with anything in addition to this. I think no matter how hard I try and breathe in the light I will be haunted by my past experiences and lack of care at the hospital and freak out. Ending up with an EMCS is my number one fear and I feel I will start to head down this path by trying to deliver such a huge baby before he is ready to come out. You both made good points about recovery time. I was not up to speed until at least 6 weeks after my birth, despite the transfusion which did speed up my recovery. I want to avoid this at all costs.

I know for some to choose surgery seems crazy but I find it less daunting than the risk to my health and the baby. Thanks so much again for sharing your experiences. So may people talk about ELCS being peaceful and calm - if I could have a vaginal birth at home that was peaceful and calm I would take that option in a flash but for now ELCS seems the thinking woman's choice for me.

jules so very sorry to hear of your loss. I think you have hit it on the nail by saying your priority is to avoid the worst rather than trying to see if you can achieve the best. Very wise words, and I shall be quoting you no doubt.