Wwyd... planned section or induction?

[Witsender]

Back story is I had strep B earlier in pregnancy so will need intravenous antibiotics in labour, ideally for at least 2 hrs before a vaginal birth occurs.

However this is longer than my entire labour with #2, who took less than 1.5 hrs from.first contraction to placenta delivery.

He was also quite a big chap at 9lbs 11oz, and caused a severe 3rd degree tear and a 2.5litre blood loss.

All of these factors combined mean I am having consultant led care, and she wants me to have an induction at 40 wks. She feels this mitigates the risk of a mega speedy birth which could A) cause repeat damage and blood loss and B) mean i don't get the antibiotics.

However, given #2 was also quite big, she has booked me to be scanned at 38 wks to ensure this one isn't any bigger, and if he is then is suggesting a section.

No ironically #1 was small for her gestational age, and as such I have been having growth scans every 3 wks since about 20 wks. This one has a tummy that is off the centiles, and looks to be around 80th centile projected size at the moment. This has gone up from about the 50th last scan. Estimated weight at 34wks was 6lb4oz, but could be a pound either way apparently.

So #3 looks to be a decent size. I can't decide whether I prefer the idea of a section or an induction. Both pose different risks, and I can't decide how I feel about it.

What would you do if you were me?! Or any CS/induction stories or comparisons for me?

I had strep b, 2cm-born in 40 mins with forceps, 3c tear, year of physio, so pretty much the same as you! C section for me on 6 Nov :) Requested one at my booking appt!

WHen she says "strapped down" I expect she means that you will be hooked up to the monitor and drip (antibiotics and syntocin) so you probably will be stuck on the bed and not able to move around. Slightly strange way of putting it though!

Yes, she meant hooked up to monitoring stuff, antibiotics etc etc.

She said it may be that given my speedy labour with #2 that all they need to do is a sweep and maybe one pessary and then out he shoots (managed more hopefully to avoid the tearing again). But obviously they don't know.

Her way of putting it was that if I want 100% to avoid tearing the only way is a section. That odds of re-tearing to a 3rd/4th degree level are at worst 1 in 5, so if I am happy with an 80% chance of coming out intact then opt for the induction.

My worry is the 'maybes'. Obviously the induction may go well, not be too exhausting and overwhelming, not take too long etc etc. But then it might be all those things.

But equally a section may heal well, not be too hard, not get infected, not take 6 wks of nigh on immobility etc. But then it might!

"But equally a section may heal well, not be too hard, not get infected, not take 6 wks of nigh on immobility etc. But then it might!"

From what I've heard about sections (experiences of family, friends and people on MN), the ELCS tend to go more smoothly with easier recovery, and the EMCS don't. And you might end up with an EMCS if the induction doesn't work out.

Oh it’s a tough decision, especially with concerns surrounding strep B. Of course a section is more predictable but it is major surgery. Has your consultant advised you on which is the best option or is there truly no best option?

If there was a way for the vaginal birth to be made safer, and the meds administered appropriately, i would choose that every time over major surgery.

Perhaps you could be admitted to hospital and monitored regularly on the day of induction to avoid concerns surrounding a short labour and not being in the right place.

Is this likely to be your last child? If so I'd go for a section. If planning more I'd go for a vaginal birth.

Did you have any symptoms following the 3rd degree tear?

Oh I just read about the blood loss and speed of your labour. My induction was amazing and progressed quickly (1.5hrs of active labour) but the blood loss after floored me for several weeks after and I had an episiotomy. The effects of blood loss could be as detrimental as the effects of a section.. different of course, in terms of mobility and pain, but the toll is still there to be seen with blood loss. This is completely unhelpful. Sorry for ramblings.

"If there was a way for the vaginal birth to be made safer"

That's the whole point - there isn't a huge amount you can do to reduce the risks associated with a vaginal birth. You can plan for the worst in order to manage it appropriately, but you can't prevent birth injuries. It would be great if you could!

So true. Ignore my stupidity.

I think I meant safer in terms of the strep b risk (ie: close monitoring), not in terms of tearing but acknowledge that I sound like an absolute idiot.

Can they guarantee that you will have a senior midwife throughout your labour?

Lol no you don't sound like an idiot
I see what you're getting at re strep B but I think even that is difficult to manage isn't it? They just give antibiotics and hope baby doesn't get it!

I have had both and am a doctor so a good understanding of the risks. I don’t think there’s an absolute right answer. I went for Elcs with number 2 but that’s because I was crap at giving birth but for you vaginal labour might be ok. Try not to Agonise too much - so much can happen. In my case I went for the elcs because it was more of a known quantity ie I knew that it would be difficult recovery wise but at least I would not have awful complications (less risk to baby and my pelvic floor in tact) - so not the best but definitely not the worst outcome.

The consultant has promised that I hurt a good level of autonomy during the process, as in...start induction and if pessaries alone etc don't work I can say no the the drip and push for a section.

So as it stands am booked in to start on Wed at 39wks...still not convinced I have made the right decision but a decision needed to be made. If there was a perfect solution everyone would be doing it! 😂