Back to back, large baby induction - any advice?

[ALS17081982]

Hi,

I'm 40+6 today, I just had an appointment with a midwife today to try a sweep but she couldn't reach my cervix. I've been booked for an induction next Saturday when I'll be 41+5. My baby has been back to back since week 36 despite me trying everything to turn her. She's also measuring on the 82nd centile for size.

I'm very worried about being induced, especially with a larger back to back baby. I have 2 friends who were induced with back to back babies and both needed and emcs.

Has anyone got any advice or tips or suggestions?

Thanks!

Both my babies have been induced, and back to back. One small at 35 weeks and one on the 90th centile at 42 weeks! Both came out fine, no forceps or anything. I did need quite large episiotomies with both. The first healed fine, I'm only 3 weeks pp with the second. I'm not in any pain but the scar is still healing.

Listen to the midwives and stay flexible with pain relief so you're not too tired to push. My second I did with nothing as it was so quick but my first back to back labour was painful and I was glad I'd stayed on top of pain relief so had energy to push out the baby.

I had an induction and emcs with a large (11lb 9oz!) back to back baby. I don't actually think he started off labour back to back, I think he turned during it. Apparently most back to back babies do turn the right way during labour so hopefully it won't even be an issue for you. However, in case your baby doesn't turn and isn't descending, I would ask about whether or not your hospital uses rotational forceps and if so, how you would feel about their use as opposed to an emcs. There's a window of opportunity where either can be possible and I would recommend letting the medical staff know in advance if you have a preference.

I had 2 b2b following induction and didnt have emcs. The second time I was begging them to get the baby out after 6 hrs of pushing so they used the vacuum cup instead.

Thanks for the comments guys.

I know a lot of people will disagree with this but in weighing up the risks and potential complications involved in a back to back, big baby induction (e.g. forceps/ventouse/episiotomy/not being able to get an epidural if I want one/induction not working/emcs) versus a planned c section I think I would feel safer with a planned c section.

I understand that a c section can easily come with unexpected complications and problems and there is a guaranteed recovery period but I still feel like it's less of a gamble to the well-being and me and my baby - what do you think?

My preference is to have a natural birth and I think if I get to 42 weeks I would like to try expectant management up to the point the doctors tell me it is not safe for the baby to say in at which point I would ask for a c section as opposed to an induction. I'm sure the consultant would try to push me into an induction but I do know someone who has managed to agree this approach before.

DD was back to back. 60th centile so above average but not big, she was 98th centile for length though. The worst part was the shooting pains going down into my bum with each contraction, but once she was actually making her way out it was fine. Had a 2nd degree tear that stung a bit but healed like a dream in 2 weeks. No after pain.

My first dc was b2b and honestly labour was very long and painful and I only just avoided an ecs. She didn’t turn despite all efforts to persuade her too! For my second I had a planned cs and I recovered so much quicker.
Good luck!

@Freezingheart I've tried everything to turn the baby too but hasn't budged in 5 weeks!! Can I ask why you had a planned c section with your second? Was it elective after your first baby or for a specific complication?

Ds2 was b2b and was induced at 41+3. He was 9lb 13oz.
It was actually a much easier and quicker labour than with ds1, and I managed ok with gas and air. I felt all the pain in my back during contractions, which was totally different from the first time, but I don’t think it was worse really.
I had an episiotomy (did with ds1 too), but that healed ok, and I didn’t feel it at the time.

How many children would you like and how keen are you to have a natural delivery? This is important if you'd like to consider an ELCS. Personally I'd be thinking ELCS better than EMCS after induction or instruments after induction. When they say it's best to minimise interventions, for me that's what it means. I would seriously consider ELCS in your situation.

My induced back to back baby was my easiest birth tbh. She was a VBAC and consultant was pushing for an ELCS but I'd hated the one previously (ds was breech). I was 40 plus 9 and he agreed to give half a dose of prostin to kick things off and I agreed to an epidural and constant monitoring. Dd was born in six hours and three pushes which took the midwife by surprise as she was expecting it to take a while. I had a graze rather than a tear and I was home by lunchtime.

It's your choice whether to go for elcs. But I honestly don't think a back to back baby is necessarily a reason to panic, and it's not really a clinical indication for a section. It's a variation on normal. Same with induction. They often go very smoothly.

I had to be induced with a back to back baby but it was a little different as my waters had already gone so there was some time pressure. I had the drip, an epidural (which I completely recommend), an episiotomy (didn't feel it with the epidural although it was sore for a couple of weeks after) and two hours of pushing but we got there in the end. Without the time pressure i think it would have been a different experience and they wouldn't have gone for the drip as soon.

I ended up with shoulder dystocia with my first ( the one b2b). The doctors don’t really know why this occurs but there are various risk factors that make this more likely - she wasn’t a large baby (average size) but I do believe her position was a strong contributing factor. I was therefore strongly advised to have a planned c section with my second as have one child with SD increases the risk factor and dc2 was in a different but equally uncooperative position.

I would add even though my waters had gone too labour was progressing slowly (but surely) so they ended up giving me the drip too. I also had an epidural as I felt all the contractions in my spine and it was very painful.

I've had 2 big b2b babies. First - induction at 42 weeks- ended up EMCS after 34 hours labour. Second time I opted for ELCS as everything was looking for identical to the first time round.

ELCS was lovely and calm btw!

Malpositioned baby (b2b), big baby are both risk factors for forceps/severe tears. If this is your first baby, again, this is another risk factor. I'm really not trying to scare you, I'm just trying to make sure you make an informed decision. Personally I think you should give consideration to various scenarios and then decide. Unfortunately healthcare professionals generally are not very willing to discuss these risk factors. They should but they don't. Knowing why you choose or reject ELCS is important I think. All the best

I would never want to scare a pregnant lady either and what happened with me was relatively rare but I’d feel remiss if I didn’t share my experience.

What I would add is I recovered much quicker and with much less complications from my CS than my vaginal birth recovery. I was daunted at first by knowing I’d have a CS but really it was brilliant.

Sorry don’t mean to scare but If I had another back to back baby I would demand an epidural before I would agree to induction! DD was measuring on the 90th centile but was born 6lbs 7oz so not big at all!

For context the pain with my DD was excruciating and I was denied any pain relief as the midwives didn’t believe I was in labour Ended up with forceps and episiotomy. If I had another I would consider ELCS as wouldn’t want to end up with the damage and pain from the forceps

Having done back to back not induced, but with some augmentation when labour stalled, I'd have the ELCS.

My daughter was back to back and ended up with an emc she was on the 30th percentile but my son was back to back also and I was able to have a vbac he was also 6lb 15oz so it is possible to deliver back to back but the pushing is hard work! Good luck

My eldest was large (9lb11oz) and b2b. Very traumatic labour ending in an emcs. Second time I would have had a section rather than induction and had this agreed in advance. However...

Weight estimates are notoriously inaccurate. With my second child I was initially told he would be 11lb! Then when I had a last minute extra scan to check his size at 38 weeks they said he would be less than 8lb. In the end they were both way off and he was a rather nice 9lb. I wouldn't be too concerned about being told you are having a big baby unless you have a history of big babies as unfortunately I think the margin of accuracy is about a lb either way and more than that on late scans.

I would give it a go however I personally would refuse forceps (for my own reasons), so I would think through exactly what you do and do not want to happen in each scenario and think about exactly what you want so it can all be put in your notes. Also a sort of heirarchy of wants so if things start to change you know what the focus is. My one success of DS1's birth, other than us both surviving with no long term damage was avoiding an epidural. (I am needle phobic so the idea of a tube in my spine REALLY freaks me out.)