Section or Induction DC3?

[DC3dilemma]

This is long sorry...

Wonder if some of you could help me weigh up my choices (as much as choice exists) around the birth of my 3rd child.

I’m 39 weeks with DC3. Background is I have 2 DC, born at 39+3 and 38+4.

Both previous labours were spontaneous.

First, started with contractions. Waters only really broke with delivery. Long slow labour, stopping and starting, probably because he was firmly back-to-back. About 48 hours in, pain intolerable due to position and augmentation with induction type drugs, no real break between contractions, baby making no progress and looking tired. Several attempts at epidural failed, success after a couple of goes at a spinal, then delivered by forceps and episiotomy in theatre. Baby a little flat but recovered. Felt like my pelvic floor took a real hammering due to pushing with no sensation, episiotomy, forceps etc. Long recovery but ultimately we were both ok. Probably took around 12 months to feel like myself again though...

Second, started with show and regular contractions again waters only broke with delivery. Hypnobirthed at home till last minute then travelled in during transition and delivered within 30mins of arriving at hospital. No drugs, really straight forward, no sense that I had to actively push (felt like uterus and muscles were just doing it involuntary). Quick recovery, whole thing very text book and amazing. Notably, baby was in optimal position.

I’m now over 40 and given my age, the subject of induction keeps coming up. I haven’t needed an induction before. The reason given being that the placenta is likely to degrade earlier due to my age.

I am really concerned about induction. I didn’t get on well with the drugs during my first labour. The contractions were so much more painful and unmanageable than the natural ones I had with my second. As a result I needed an epidural and it was during attempts with this that it became clear that a cervical spinal condition I have had all my life has badly affected the rest of my spine. I was told by the anaesthetist that my spine is very complicated.

I have had a consultation with anaesthetics antenatally in which there was a lot of discussion about my technically difficult spine including advice to prepare that if a section became necessary I might need a general anaesthetic. I asked them, if that was the case, should we plan for a day time elective section rather than take risks out of hours -they agreed that might be better and we could select a day when the most experienced anaesthetist is available.

On the basis of these worries, each time the topic of induction comes up I have suggested elective section instead. But midwives/obstetrician always comment on my easy 2nd labour (very true, it was easy) and suggest these worries about unpredictable interventions are unduly negative. I don’t think they really appreciate the extent of my spinal issues however; I do have some lasting hidden disabilities.

Feel a bit like my head is mashed trying to weigh up the un-knowable, with HCPs who have their own biases rather than helping me weigh up my personal risks. Would really appreciate some help with thinking this through. So as not to drip feed, current baby is not engaged, still very mobile, including spending a lot of time in a back to back position. Growth scans and health of placenta showing no maternal age related complications. What would you do?

The other thing I should add is that even if epidural/spinal anaesthesia is administered successfully, i’ll definitely end up flat on my back for the rest of labour. I have pre-existing weakness in my upper body and anaesthetising my lower half leaves me utterly immobile no matter how “light”. This concerns me, with a baby tending to go back to back...

Inductions are more likely to result in interventions or emergency C-sections so your concerns are valid ones.

I was induced for my first as went 2 weeks overdue. It was not a good experience - like your first, my DS was also back to back, it was very painful and I ended up having an epidural and emergency c-section. I'm now pregnant with my second and have decided to book an elective section for two weeks after my due date as I'm 100% sure I do not want another induction. If I go into labour naturally before then and the positioning is good I'll try a VBAC, but if he's back to back like my first I'll have a section.

Obviously some people have inductions and it all goes fine, but I'd trust your instincts. If you feel an induction is likely to have a worse outcome than a section, then push for the section.

How long ago was previous birth?

Thanks ArialAnna that reflects my thinking...

KitchenFloor DC1 is 7, DC2 is 4, so quite some time ago...

If I were you, I would refuse induction. I did with both of mine, I was pressured to induce with them as they were both 'overdue'. (They weren't). However there is a small (but still present) increased risk of stillbirth, it would seem, so you do need to be happy with your choice, should the worst happen. (There is always the chance of stillbirth, no matter what age or gestation, though.)

I did go for the check of the placenta (done via ultrasound) while waiting.

This site is useful if you like statistics / research evidencebasedbirth.com/advanced-maternal-age/

I was like you bad first birth shot my pelvic floor. Now I want dc2 by elective c section for this reason.
I know the damage is done, but at the end the day another bad birth and tear could make it even worse. A c section eliminates this risk.
All I could advise you is to be very familiar with c section risks and weigh this up against what could go wrong with a vaginal delivery.
What feels more comfortable to you?
You will have to live with any consequences, so once you decide tell them what you want, and don’t back down.

Oh and good luck

Thanks for that link KitchenFloor. I do like stats and it helps clarify my thoughts. The main thing I am thinking so far that perhaps discussion about induction can be delayed a little. I am not concerned with delivering vaginally if it is a spontaneous labour- back to back babies seem to be very likely to turn in a natural labour in a non-1st timer who can remain mobile. My main concern is pain and immobility with induction, I think my general feeling is that if there is going to be intervention it should be the most controlled daytime intervention with the anaesthetist who is happy to deal with my spine, whether that is by spinal or the “waking intubation” GA I would need (my head doesn’t tilt back for standard GA methods).

Thanks ChocolatePraline. I know where you are coming from. My opinion is that it was all the strange artificial pushing that dame with DC1 that had the impact in my pelvic floor. DC2 was absolutely textbook with no pain relief and I can genuinely say I didn’t push. My uterus pushed him out and it didn’t feel like any of the pushes came from my pelvic floor at all. It really made me see and feel the difference between what our bodies are supposed to do, and what we are told to do by midwives and obstetricians, in stirrups, flat on our backs.