Induction at 38 weeks versus opting for an ELCS?

[LexiLexi]

Hi all,

I have pre-eclampsia (2+ protein and mild hypertension) and have been advised that if my BP rises further I will be booked for an induction at 38 weeks (next Tues).

It's my first baby and am just wondering, given that I am already classed as high risk, how likely it is that induction will end in either EMCS or instrumental delivery (both of which I am terrified about)?

If BP is up, MW suggested I could ask for a membrane sweep when I go back to the hospital tomorrow and hope that helps move things along naturally.

If that doesn't speed things up, would I be better off asking for an ELCS?

Also would be great if someone could explain the Bishops Score. Would rather go in understanding my options a bit better.

thanks so much

I can't help you with percentage risks, etc but I can tell you my positive story.

I was induced at 38 weeks - at my request. I went to my consultant appt in the morning where they agreed to the induction and invited me back that afternoon. Before I went off to get my things from home, etc they also examined me to assess a Bishop's score and gave me a sweep. They didn't give me a number for my Bishop's score, but told me I was 'favourable' - 2cm dilated, cervix soft, but still posterior.

When I got back that afternoon I was already mildly contracting (though had been for weeks, though overnight, so can't be sure the sweep set me off). They gave me the induction pessary at 3pm, and immediately my contractions became stronger and more regular but still mild. This remained the same throughout the evening and they sent DH home at 9pm. At 10pm, I had a bath and they got stronger. At midnight I had some diamorphine as it was v uncomfortable and I wanted some sleep. When that wore off at 2am I was clearly in established labour, DH was called back, we went to delivery suite where I was found to be 9cm! DS was born at 5.14am with no interventions, no tearing, just grazing. I had an episiotomy scar from DS1 which I thought I would tear along but I didn't.

My induction worked but I had only one part of a 3 stage process if it doesn't - pessary, prostin gel and then IV syntocin. I would imagine you would be monitored thoroughly throughout and you could request a section if you didn't progress.

Thanks Flosshide, great to hear your positive story, my understanding was that at 38 weeks it's 30/70 whether induction will or won't work so delighted that you went on to have your DS without any intervention. That would be my ideal too (I was hoping for a water birth before pre-eclampsia crept up on me!)

Having spoken to the MW, unfortunately in my case, if my induction is due to raised BP that they will not be prepared to wait too long for pessaries, etc to work and I certainly won't be allowed home. Also I fear being confined to a bed for monitoring as I know that gravity helps :(

Would be good to hear from anyone else on here who is high risk and has had experience of induction.

I was scheduled for an early induction but I chose ELCS instead finally last week. I have a blood clotting disorder which was the reason for the induction. I was frightened about being confined to bed, and having had surgery before I feel more able to prepare for that than labour. I suppose my CS was granted for psychological reasons more than anything else.

For you things might be different because of your circumstances but I spent a few weeks researching both options and feel happier with things as they are decided now.

What do you feel happiest with? Are you comfortable with trying the induction and going straight to CS if it doesn't progress? There's no reason to think it won't progress quickly, it goes without a hitch for plenty of women. The only problem is babies are so unpredictable!

Best of luck whatever you decide x

I was induced at 36 weeks with pre-ecampsia. Sweep was horrible as I was nowhere near ready for one and synoticin made labour very painful - I had a epidural which helped and lowered my BP. I was also confined to a bed and had a very medical birth - no water birth (which wasn't a great experience).

Unfortunately DD was distressed by induction and eventually we needed an emergency C-section as she was getting oxygen deprived. I had to have a general anthestic as there wasn't time to top up the epidural. Unfortunately with induction comes more risks of intervention I think. I hope all goes well for you.

I was booked in to be induced this Tuesday just gone due to high blood pressure i was 38 weeks i had to propess at 12.45 started having pains at about 6 ish but when i was put back on monitoring baby was distressed and i had to have emergency section. It wasn't ideal but he is safe we both are and when they re examined me at 9.00 to see if they could break my waters my cervix was still completely closed.
Good luck remember it can take ages take plenty to do cos even tho i had my baby just before midnight the time before then went so slow x

I was induced due to high blood pressure (and a big bleed) at 40+1. The wouldn't induce me at 38 weeks as they said my cervix was all tight and closed and it would just end up in a section. I had a sweep at about 39+4, showed I was about 1cm dilated so they were happy to book an induction (I probably would've been scheduled section otherwise). Had some cramps, my mucus plug went that day but nothing else happened.

I went in to hospital at 8am on the Saturday (40+1), first prostin gel was given at 10am. Felt some bad period pains for an hour. They went away. They gave me a second gel in the late afternoon as there'd been good effacement but I wasn't dilated enough for them to break my waters.

After I few hours I thought I was going in to labour as had really really sore pains below belly button - one minute long, one minute apart. Lots of walking round hospital, TENS machine, midwive ran me a bath. Then she told me that I wasn't in labour, it was a side-effect of the prostin!!

I was getting a bit fed up by the late evening, and it was shortly before DH was going to be sent home. I was going to ask for diamorphine so I could get some sleep if it was going to carry on being on-off but I wasn't in labour.

Anyway then it all started moving very quickly. I suddenly felt a big drop/kick inside and my waters went (had meconinum in them, which can be caused by the prositin ie baby getting a bit distressed). I went from 0-100 on the pain scale in about 10 seconds. Speaking to other women it sounds like I went straight to transition, and I have also heard that induction can make things more intense/very fast. Absolutely horrific pain, I was climbing the bed like a feral cat and screaming my head off. DH was I wouldn't let them touch me unless they gave me G&A. My contractions were peaking and starting again too quickly for G&A to be much help. I was still only 1cm dilated but because I was very distressed (and terrifying the poor other women on the induction suite, no doubt!!) they got me an epidural straight away (it was all pointing towards an emergency section at that point). They also hooked me up to the syntocinin as a precaution but were only going to start it an hour after the epidural had taken effect and they'd examined me again.

Anyway my cervix went into sprint - between my staggering to the delivery suite from the induction annexe (20 metres) I went from 1 to 3 cm. Within the hour I was at 10cm (no syntocinin needed!). They gave DS's head an hour to descend once I was hooked up to the epidural (and I kept pushing the top up button ). It descended very well, textbook. Due to the meconium and because his heartrate kept dropping in different positions I was lying in, the midwife said I had one hour to push before they did ventouse and then forceps. 55 minutes of pushing, so I got him out on my own in the nick of time!

It was a little bit scary straight after he was born as he inhaled meconium on the way up to the suction table and his heartrate plummeted, so he needed CPR and it was like a scene out of ER straight after the birth with doctors running in and everyone yelling. I was in shock though wasn't actually upset at the time IYSWIM. But he recovered well and didn't need to go down to intensive care.

Second degree tear for me that took an hour of stitching, but I recovered well. BF didn't work from the get-go, but I don't think that was the induction I think DS would never latched no matter how he came out.

On balance I think it probably all went quite smoothly and I was only "in labour and giving birth" for 3 hours. But it was quite frightening how intense the pain was. I don't know if this is just how my body labours or if it was due to the prostin.

Around the same time friend of mine was induced at 37 weeks due to pre-eclampsia, had a long labour (and didn't get an epidural in the end as anaesthetist was busy! argh!), didn't need syntocinin and baby was fine. No forceps/ventouse.

Sorry that was quite long!!! Just wanted to give you a straight up account of what happened to me when I was in the same boat! :) Immediately after the birth I was quite shellshocked - but I think that was mainly because BF didn't work and I was very distraught about that. I had thought that if I got high blood pressure again or other complications I would definitely ask for an elective. Now I don't know what I would do second time around. The pain of labour was horrific (not trying to scare you, some women do just have very painful labours) and my tear was sore, but I was physically up and about with no problems. My fanjo is recovering well but I am not errrm as tight as I once was. On balance I think yes I would ask for a section second time around if I had complications.

Friends of mine who have had elective/scheduled sections have all said they were very calm and the recovery time was very good (much MUCH better than an emergency section where your body has been through labour too). However of course c-section is major surgery and carries its own risks.

Best of luck to you!! Sending you because I know how stressful it is in late pregnancy with high BP and PE etc xxx

As you're worried about whether you'll end up having a section, I'll tell you (based on chats to midwives and doctors) this is when it would've been likely I would've had a section:

• If a third dose of prostin hadn't worked
• If I hadn't dilated quickly and syntocinin hadn't helped - given the meconium in waters syntoncinin would've probably made DS even more distressed
• If DS's head hadn't descended so well on his own in that hour after I got to full dilation. When he had descended well the midwife said to me "ok that's good, you now only have a 10% chance of needing a section". So I think before then I was looking about 50/50.

• I had a massive bleed at 39 weeks. If baby's heartrate/movement was anything less than perfect I would've had a section.

Even if you are kept in hospital for the induction you can do lots of walking around, they encourage it. You are strapped to the bed for regular monitoring but between then you can be on ball, walking round the hospital etc.

TBH it all depends on how your body reacts to the induction drugs.

Sorry... one more post. Also even though giving birth on the bed with epidural etc is obv not as relaxing as water birth, there are things you can do to help.

I told them to turn off all the lights in the delivery room as the bright overhead lights were making me stressed (just the examination lamp was on) - it was nighttime so the whole room stayed quite nice and dark. After the epidural goes in successfully things are quite calm and quiet for a period before you start pushing. So that gives you some time to recollect yourself.