Should I ask for ELCS at 42?

[underthewestway]

I am due with second DC middle of July and have first consultant appointment at Chelsea and Westminster next week. I’m booked with the consultant because I am 42, no other apparent risks with pregnancy.

I had first DC at 40 and was induced at 39 weeks due to advanced maternal age. She was absolutely not ready to come and it was a pretty horrible experience. Nothing worked prior to going on the drip (breaking waters, pessary, couldn’t insert balloon catheter overnight because I bled so too risky). After 3 hours on the drip I was still only 1 cm so they cranked it right up - and it was hell. Had to have an epidural, developed a fever, 13 hours later had to push for 2 hours even though I couldn’t feel anything, had forceps and episiotomy (which subsequently became infected). All grim and I felt traumatised for a while afterwards.

I know this baby will need to come at 39 weeks if I am lucky enough to get that far. I wouldn’t risk going over that. I would love love love to go into labour at 38+6 and for the baby to come of his or her own accord - but I know that isn’t likely. I really don’t want to be induced again - particularly if I am likely to end up in an EMCS scenario - but I know it is better to have a vaginal delivery than a section.

I think if I do want a section I need to raise it as early as possible. Can anyone with experience help me work through the pros and cons?

Minus the infection and I'm late 30's I could have written this post although mine ended in an EMCS after DDs heart rate went up and didn't come back down again.
I'm planning a section this time; seeing the consultant on Thursday to discuss it.
I can't bare the thought of going through all that again to end up out of control again.
Do whatever you feel most comfortable doing.

My first was a emcs then I had 2 vbac currently pregnant with my 4th my 3rd like you was forceps and epiosomy when I saw my consultant at 12 weeks I told her I wanted a section and sterilised she said yes straight away and said I could get my date at 28 week appointment

Thanks both for replying. I think it does sound like an ELCS would be my best option (if I can persuade the consultant). I think it’s just in my head I’m thinking I’d prefer a spontaneous Labour but if course that’s not really on offer; it’s most likely either section or induction.

Can I ask how long you were in hospital for afterwards? DP can take a month off so I am less worried about toddler wrangling during recovery when I get home, but he will have to stay with DC so I will be doing overnights in hospital by myself.

All the best for your current pregnancies

My hospital considers anyone over 40 and above as a geriatric pregnancy & offers elcs from 38-39 weeks unless there are medical reasons not to. Just bear in mind that as you are older now, you may be more likely to have placental failure - so would suggest when you ask the consultant for a c-section you also ask them to do it from 38 weeks.

Thanks Grumpy. I’ll definitely raise that with the consultant. Can I ask which part of the country you are in? I thought I might struggle to get an ELCS but it doesn’t sound like it from the responses so far.

Absolutely yes. I was induced and it was the worst experience of my life, very similar to yours, with the added trauma of my babies heart rate plummeting.
Mine was for a blood condition that causes my placenta to fail in the later stages of pregnancy so will be the same next time around.
I don't actually know of anyone who has had a good induction experience, yet everyone who I've spoken to who's had a planned section says how straightforward it was.
Yes it's major surgery but less traumatic than a bad induction and for me certainly less healing time.
You shouldn't really have to convince your consultant, most are happy to go with a mothers choice these days. Definitely amongst my friends.

I am puzzled as to why it "needs to come" at 39 weeks. It needs to come when it is good and ready. All mine were two weeks overdue. All were fine. I was a bit pissed off though!

Why does your baby need to come at 39 weeks? Have you asked for the BRAIN? benefits, risks, alternatives(increased monitoring), your instincts and what happens if you do nothing.

I was 41 when I had my third and opted for an induction dead on 40 weeks, having had a horrendous induction previously. It was much easier than the first and fine.
I think either another induction or caesarean would be good in your circumstances and the hospital should back your choice (you can ask for a caesarean under Nice guidelines). But take into account the longer recovery.. you may find a second induction easier.
I also back having the baby around 40 weeks.. the risk of stillbirth past 40 weeks is too high in my opinion. Everybody differs on this point, but for me an induction and a healthy baby was preferable to the increased risks with going over 40 weeks at this age.

Thanks so much everyone.

As to the 39/40 weeks thing, in my last pregnancy I was told by the midwife all the way through I could go to 40 weeks at least, but when I saw a doctor at 38 weeks she wanted to induce me straightaway. I was very upset at the time and really had to persuade her to hang on to 39 weeks. She put the fear of god into me (and in fact more so DP) about the risk of stillbirth. I appreciate it is still a small risk post 38/39 weeks but the consequences are so devastating it’s not one I am prepared to take at my age - although I completely appreciate others may feel differently. DD was in excellent health when born at 39+3 so I’d be happy to get to 39 again.

I am in Bucks. It’s really easy for older mums to get an elcs here - only reason I couldn’t have one was because I wasn’t quite 40 yet and along with one of my conditions an induction was deemed better. It there’s a second pregnancy the complications that arose last time, plus my age, will mean I will definitely be able to get an elcs from 38 weeks.

I was in for 5 horrendous days prior to her eventual eviction and then had her at 238am on the Tuesday morning and home by teatime Wednesday.
Was very pleased to finally get home!

I’m not saying ignore what the doctor says at all but you don’t have to convince someone to wait for induction or to agree to a later c section. You are well within your rights to refuse treatment at any point and that does not effect if doctors will treat to later. So IF you wanted you can say I won’t accept an induction at 38 weeks but I’ll agree to a c section a 39 weeks.

Actually I’m not being accurate you are not refusing treatment you would be choosing to not consent.

Yes

Of course spontaneous is on offer. It's your body, they can't compel you to be induced or have a CS.

If you want CS then ask for it. But don't believe "they" control your options & that spontaneous wouldn't "be allowed."

I had a traumatising birth when I was 34, prepped for EMCS but managed to get him out with forceps, ventouse and episiotomy (aka wrecking my bits lol). I am now 42 and 7 months pregnant. I have been bricking it about labour especially as the midwives have said ‘they won’t let you go over 40weeks’ and I’ve heard not great stories about induction, especially that it can lead to assisted deliveries/EMCS in over 40s mums. So I requested a consultant appointment which I got at 28 weeks where I basically explained my previous difficult birth, my anxieties about upcoming labour and the added factor of my age (apparently our uteruses are less efficient which I saw as more evidence that I may end up needing assistance). I didn’t even need to ask for a ELCS (I had written down loads of reasons/research to back up a request) as he suggested within 5 minutes that I have an elective. I was like ‘yes please’. It has taken a weight off my mind. I am actually looking forward to the birth rather than dreading it. The risk of having another difficult birth, which did impact my bonding with my 1st child, was too much for me so I think I’ve made the right decision for me. Good luck with whatever you decide to do.

Hiya, I just wanted to say first of all I would definitely discuss making sure baby is delivered before 41 weeks and possibly 40 with the extra risk factor of your age.

However if you do go for induction, please know that not all of them are bad experiences. I went I to spontaneous labour with my first and was induced with my second, and my induced labour was a great experience, both by itself and compared to my first labour.

Good luck with whatever you choose!

Had my consultant’s appointment this morning and thought I’d update to say thanks to everyone who replied and just in case the info is helpful to anyone else.

Doctor is happy at this stage for me to go to 40 weeks (DD was first baby and IVF which was why it was 39 previously). She also agreed that after 20 week we could book ELCS for due date. And then do a sweep at 39 weeks and I could consider induction at that point instead if everything looked favourable. So that keeps the chance of spontaneous labour open as long as possible and at least I know I can have the CS if there’s no movement before then.

As expected she did go through the risks of CS and said is was very likely that induction would be much easier this time round - but she fully accepted my concerns.

Thanks so much again to everyone who replied.