38 week ELCS or induction. Which would you choose?

[Purpleball]

I'm type 2 diabetic and have been told I will be having an ELCS or an induction at 38 weeks or sooner.

I'm 90% certain I want an ELCS. Almost everyone I know who's had an induction has ended up with an EMCS.

I'm also insulin dependent which adds further complications

My BMI is over 35 which is a further consideration although I'm currently lighter than when I fell pregnant

I mentioned to the consultant that I wanted an ELCS and he was non committal. I don't want a fight on my hands but I am prone to high anxiety and this is worrying me a lot. I'm currently nearly 20 weeks so there's time yet to decide

Bump

Hi, I've been induced with all 3 of my DC.
First was a pessary at 42 weeks, labour started quickly, gave birth standing up to a back to back 9lb 7oz baby. I had pethadine at 8cm for pain.
With DC2 I had exactly the same.
With DC3 they changed my dates due to a large baby-even though I knew my dates exactly, and DC2 was 10 11-my DH is massive!
I went in to see if the pessaries would work, after two days nothing.
Now, I don't mind a pessary, but absolutely do not want waters broken, drips, monitors,epidural etc. I feel this leads to more chance of an instrumental delivery,which I fear. I've never had stitches.
I refused all further treatment. Baby was happy as larry. I discharged myself.
Once I got home,relaxed etc my waters went naturally, and DC3 came along an hour later, naturally,10 12oz.
My advice is research, what are your 'no go' areas? What will you do, what won't you do.
I had no internals once in labour-midwives were very good, let you go with the flow-I would refuse monitoring, drips etc.
And if anyone came to me with an instrument they'd have my food in their face!
You don't ask your Consultant, you tell him what you'll be having. If you want a section, have it. If he refuses walk out and ask to see someone else.
It can be hard with your first as it is all so unknown.

If you aren't happy with things happening before you go into labour ask them why you're being started early?
You don't have to do what they say. Obviously they want things to go well, but you make the decisions, not them. Find out!
And good luck.

Thank you so much for the info. It is really scary trying to work out what to do. I didn't realise I could say no to examinations etc. I also didn't realise I could tell them what I want.

I think the major factor in not wanting induction is that it will be early - 38 weeks or sooner. Which means inducing a baby that isn't ready to be born from a body that isn't ready to give birth.

First baby or not? Previous normal birth or not?

I've been induced twice and may have it again.

The first was drawn out, but otherwise pretty standard even with drip.

The second was a straight to drip urgent induction at 36weeks. Start 10pm, born 8.30am but strong contractions only really got going half and hour before.

No assistance in each (though actively refusing a emcs first time as it was for 'exhaustion' and baby fine, was born very soon after)

I can't compare the pain to normal, but I did the second on gas and air and wouldn't change it last twenty min was rough without it but otherwise simply moving was fine. Couldn't cope on my back.

Conversely I know a lot of people who were induced but not one who it went to emcs, though one assisted.

Just seen you're 20 weeks now. So why are they saying 38 weeks already? Rcog guidelines is for elsc to be done from39 weeks unless there's a reason for doing it sooner.

Plenty of diabetics have a section at 39/40. So unless there's a concern over growth, or placenta, or another problem why are they saying they'd do it earlier than national recommendations? They should give you steroids to help mature the baby's lungs if it's prior to 39 weeks.

As a veteran of 1 emergency cs (following waters spontaneously breaking, then nothing, then induction by pessaries, syntocin drip and regular agonising 'rummages') then 2 elective cs, I'd say go for the induction.
BUT
Only on the proviso that you can be very firm on your limits and have a partner who will back you up.
I was adamant that I didn't want the syntocin drip, as no epidural (or even gas and air) was available (not UK) but my bastard ex shouted at me to 'just do what the doctor tells you' and it snowballed from there. If they'd taken me off for a section after all the pessaries and initial hours of useless contractions, it would have been a far calmer experience!

Hi Purpleball, I'm in very similar circumstance. insulin dependant didiabetic, need to be delivered by 39W. I had a Elcs with my first as he was breech. I have been offered either induction or Csection and have the same concerns as you about forcing the body into labour when not ready, so ending up with a EMCS,after hours of non progression and possibly a distressed baby! 98% going for Elcs, but still have a small desire to try naturally (as naturally as Induction can be).

123 delivery before 39w is recommended due to fragile placenta caused by the diabetes. Other can rupture easily after then. Also, continuous fetal monitoring is required (which I would accept as there must be history of distress in diabetics to offer as standard) and also a drip for sliding scale insulin. In addition to hourly sugar monitoring. I would struggle to eat as I can't tolerate any carbs or sugars at all. I need 30 units of insulin you have a piece of toast. I can't imagine easy access to my current diet when I need fuel to deliver at 3am in the hospital hospital.

Thanks for the replies. Yes it's my first. The booklet I was given by the diabetic clinic says ELCS or induction at 38 weeks

Bigfluffyhair that's exactly my thoughts too. I need to eat every 4-5 hours and take insulin 4x a day.

Had both.

Recovery from the induction was much easier, and that was after a forceps delivery and a very very generous episiotomy!

Mind you, both were hideous! Still bowel incontinent after that one, and still numb completely after my c section 12 months ago!

Kate Middleton I am not!!!

Purpleball a baby is considered term from 38 weeks, that is, it isn't considered premature from 38 weeks.
Re: Insulin, obviously you know best what you will need here.
If I was in your shoes, I would research and find out what is out there re: diabetic labour etc.
As I said, I would agree to pessaries but nothing else-that is just me. Or I'd go for section.
Bigfluffyhair We used to give insulin post op on sliding scale sub cut. Is this not possible? Venflon is so sore to get in and uncomfortable. (wimp!)

See Blazing88 this is why I would never let anyone near me with an instrument.
Of course I want a healthy baby, but that isnt all that matters! I don't want to shit myself for the rest of my life, and I bet there isn't a OB that is.
However, being a nurse and having had kids, I think that gives you confidence to speak up for yourself.
OP, just don't feel pressured to make a decision you aren't happy with. Yes, they are the experts, but it is your body, and you have to live with it for the rest of your life!
Good luck.

Would go for an induction, I had one. Had forceps & stitches but was walking same day, walking in local area 2 days later. No probs breast feeding, recovery was quick & straightforward.

MakI unfortunately waterbirths are not an option for diabetics. Even those who are diet controlled are advised against them.

I agree the best solution is spontaneous natural delivery (with added complication of insulin/blood monitoring/food availability) but unlikely to happen before the critical date.

After my CS I was sore for first 24hrs, but wasn't too bad thereafter. I have a fragile perineum and my DH has even said he thinks I'd struggle more with the tearing from natural delivery than csection. I have friends who have had multiple complications from tearing/bad stitches that have required ops months afterwards, but no one had issues after CS.
Maybe my experience was better due to Elcs rather than EMCS?

All weights and balances, I'm booking for the CS, if I go spontaneously prior, I'll run with it too.

And MakI you shouldn't be in pain! Please Tell them! I had a suppository in theatre beforehand and declofenic (sp?) for a few weeks afterwards. Not to much pain with those. And fine for Breastfeeding.

Anything between 37 and 42 weeks is a normal length of pregnancy.

My 'worst case scenario' is an instrumental delivery and an induction increases the chances of that so I'd pick an elcs, even though that is increasing my mortality rate.

It depends what's important to you.

Personally I'd have a section.

123 You're implying I didn't?!

OP, the point I was making is this. Not a lot of people realise that an induction leads to a higher chance of needing (possibly) to use instruments. As I'm not in the medical profession, I did not know this. After an hour of failed pushing, I was in distress and so was the baby, they used forceps. I wasn't offered the option, or offered a c-section. The doctors rushed in and just did it.

I also don't want to 'shit myself for the rest of my life'. Thanks for making me feel like a total failure!

Yes. I need an operation later this year.

Giving birth isn't easy. It isn't without risk. Personally, I would rather be dealing with what I'm dealing with now, than have risked the life of my baby. So actually, for me, at the time, the wellbeing of my baby was much higher than worrying about what could happen to me.

Ah, Blazing88,I'm so sorry if that sounded like I was picking on you. absolutely not my intention. Apologies.
I feel very strongly about this as with my 3rd induction,a doctor forced me to 2cm,then told me I was going upstairs to have my waters broken.
I put him is his place, but most don't realise that they have a voice,they just go along with what everyone says.
In the throws of labour it is extremely hard to go against what everyone is saying.
The 'shit myself' line I used is one I use often in relation to birth, I wasn't meaning to refer to you. Insenstive of me.

I would opt for an induction. I've had 3 & no instrumental deliveries or EMCS.

DC1 at 37 weeks for pre-eclampsia.

DC2 at 40+1 as BP was rising quite dramatically again.

DC3 at 38 weeks for pre-eclampsia & dodgy LFT results.

Waters were broken artificially each time & I had the drip to speed up contractions each time. Each labour was quicker than the last one (12 hrs, 6 hrs, 1.5 hrs), which is pretty normal for childbirth however it happens.

Personally, I wouldn't have a major abdominal operation if there was another way. Although I admit I'd probably feel differently had I experienced a nightmare induction.

Also, with the hospital I gave birth at, while the options for delivery may well be CS or induction, it would be the Consultant making the decision which one you should have! Sure, you can argue if you disagree, and you should, but it's not as simple as being asked which you'd like.

It's a tough decision. Also if it's early days in the pregnancy now things may look very different later on. I was induced at 38 weeks with my son. I had gestational diabetes (diet controlled) and there were concerns about how growth (not that he was too big but that he hadn't grown since a scan at 36 weeks) and placental blood flow. I was told that 90% inductions are successful but I no longer believe that to be true when your body isn't 'ready'. After 3 scary nights in hospital with his heart rate dropping low at times and no contractions and no sleep I had a caesarean. I don't know whether it counts as emergency of elective. It was calm though and a positive experience. I recovered well.

I want to have a casesaran this time (currently 23 weeks) but when I've mentioned this I've been sold the benefits of a natural birth. I have a VBAC appointment at 32 weeks. But no one can guarantee me a positive natural birth. What I don't want is an instrumental delivery and/or a frightening emergency caesarean. I would also never agree to induction again. Taking all that into account I want another caesarean. That's just me though.

By the way, do talk to the hospital in advance about food. They had virtually nothing suitable for me when I was trying to control my bold sugar levels. I remember being given a pie and having to pick out the filling and leave the pastry. Considering I live in an area with high levels of diabetes in pregnancy it was shocking.

Good luck whatever you decide.

Also - they couldn't break my waters or start a drip because I didn't dilate at all. No contractions. Just nothing happened at all.

I've had two inductions one for DS2at 40wks and one for DTDs at 36 weeks. Both of them just took a pessary to get started so no drip and that was with an unfavourable cervix. No instruments needed either. Really glad I went with induction with DTD's now 7 weeks as I had an easy recovery.

I'm not diabetic but had an emergency C-section when my waters broke at 38 weeks, DC2 was breech. For me, it was much less traumatic than DC1's natural birth, which ended up with an episiotomy, Ventouse, 3rd degree tear and a few hours in surgery having my tear fixed. In your position, I'd go for the section. Good luck.