Offered ELCS but do I want it?

[Rjd13]

Hi,

I had a previous difficult induction that resulted in forceps, episiotomy, tearing and subsequent pelvic floor issues. I had been induced early at 38 weeks due to GD.

I'm currently 40w and saw consultant yesterday as baby is measuring on 97th centile. They are happy to let me go until 40+12 as no GD this time or any other issues - just a big baby which they predicted already weights 8lb4 at 38 weeks (DS was born on 98th centile which was 8lb7 for me). They said they'd book an induction at that point to which I said no. I have been clear throughout this pregnancy that I won't be induced again. I asked if I could have a CS expecting to have to really fight for it but instead the consultant said 'yes no problem, you don't have to wait until 40+12 if you would rather have a section'. I was shocked as it was never even an option with previous labour.

I've left it at a CS at 40+12 if I don't go spontaneously before that. But I can't stop worrying about needing the same sort of intervention as my last birth. I will have to give birth on consultant led ward rather than MLU as baby is big. I also can't stop worrying about recovery and process of a CS.

Am I crazy for not jumping at the CS as soon as possible to avoid intervention? Anybody else had issues delivering a big baby on second birth?

I absolutely would have planned section over induction.

I am having a similar dilemma and need to decide whether or not to have a section. My current thinking is to opt for the section as the outcome is more predictable and controlled vs the unknowns with a vaginal.

I'd have the planned c section and I'd have it as soon as it was offered to ensure baby is out safely. I went to 40+10 in my last pregnancy before I was induced and by that time my placenta had degraded so baby had lost weight, had low blood sugar and was distressed in labour plus I had no water left. Ended up with an emergency c section. Recovery wasn't that bad given the emergent nature of the surgery and this time I am absolutely having a planned c section at 39 weeks. At 40 weeks your baby is totally ready to come out and you can save yourself all the pain and uncertainty of another difficult labour. Yes the pain after a c section is bad for a few days but after a week or so it really isn't that bad providing you look after yourself and keep on top of pain meds. In your situation I'd totally take the c section but have it as soon as possible x

Personally I would go for a cs over induction, but hold out for spontaneous labour as long as possible.
How are your pelvic floor issues now, has their been any discussion on how a vaginal birth Vs csection will affect?

I'd definitely take the section. The thought of getting a huge baby out vaginally at 40+12 after a difficult experience last time would terrify me.

Slightly biased as I had a great Elcs myself!

It's so difficult isn't it? I agree about wanting some control after my last birth. But even with the episiotomy and 2nd degree tear I still had a wander around Tesco on the way home from hospital and was out for a walk the next day. Don't get me wrong the recover was uncomfortable and I've been left with pelvic floor issues, but I worry about recovery time for CS especially with a toddler now.

I think the thought of opting for surgery, catheter, longer recovery time etc is difficult when it's possible I could have a straight forward spontaneous VB.

@Hopesakiller

Personally I would go for a cs over induction, but hold out for spontaneous labour as long as possible. How are your pelvic floor issues now, has their been any discussion on how a vaginal birth Vs csection will affect?

They've basically advised that both could have negative impact or both could be fine. And that pregnancy does a lot of the damage rather than birth.

I have made the decision to have a c section of the option is that or induction. Just bear I. Mind that the estimated weights have been shown to overestimate in most cases and you are not "over due" until 42 weeks. Induction is not recommended purely on baby estimated to be big.
Up to you as it should always be your choice but know you have got choices and can refuse the induction and c section and wait if you prefer.

It absolutely should have been an option with the first birth. The recent Ockenden report has made it clear that women must be given all the information needed to make an informed choice on place and mode of birth.

An elective caesarean is ALWAYS an alternative to induction if that’s what you’d prefer - recently got into an argument about this with some midwives producing a new induction leaflet that vaguely referred to “other options” rather than explicitly stating that the other options are waiting or an ELCS.

Personally I would opt for a CS over induction every day of the week, especially after what you went through before. And also at the moment many units have restrictions on how much time a partner can be present during induction and I wouldn’t handle induction mostly by myself.

I had an early EMCS under very scary circumstances but my recovery was a doddle compared to what I’ve heard from those who’ve had episiotomies/ severe tears and forceps deliveries. I would choose CS again if I were to have another. Obviously it’s major surgery so no walk in the park - assuming you have a partner to help with the baby and older child for the first couple of weeks I would go for it.

Sorry your first birth was so difficult

As a general rule, subsequent labours are often easier and more straightforward than firsts, because your body has done it before. So it is possible to have an uncomplicated spontaneous vaginal delivery after the first birth you had.

Growth scans are unreliable - the consultant midwife told me they're about 50% accurate! Your first DC was big but the GD was probably a factor. So DC2 might be big, might not. Even if baby is big, it doesn't necessarily mean a difficult labour - lots of women birth big babies without interventions or complications. (My two were born vaginally, 9lb4 and 9lb1.)

My advice is to do some research into the probabilities and risks of your various options.

For example:
"Most women (up to 9 in 10) who have an assisted vaginal birth have a vaginal birth next time round without needing assistance."
www.rcog.org.uk/en/patients/patient-leaflets/assisted-vaginal-birth-ventouse-or-forceps/

If it was me, I would hope for a spontaneous vaginal delivery, and would request extra monitoring from 41 weeks, and a c-section by 42 weeks, but would decline induction. However, it is a personal decision, and there is no wrong answer - you should do what feels right for you, whatever that is, including ELCS at an earlier date if that's what you choose.

Go for the ELCS. I was recommended to have one because my baby was breach. I really didn't want it and was terrified, but it was the best experience and I wouldn't have changed a thing about it. Recovery isn't the best if I'm honest, but as you know labour's no picnic either! And you could end up going through hours of labour only to need a EMCS anyway.

Thank you all, have some more things to speak to the midwife about on Friday regarding risks of VB in my situation before I decide whether to move ECLS sooner. I feel like I have time to wait as not one single sign that Labour is imminent and baby happily giving me lightening crotch every time they move

I had a planned section for my second for various reasons (but one of which was a 4day induced labour that ended in a csection and broke me )and even though it was brought forward my waters broke the morning of my section.
They offered me the choice to try if I wanted but still decided to go for the section. My recovery time wasn't too bad and I was up and about quicker than with my first. The main issue was not being able to drive but I knew that was going to happen so planned for it. My scar healed well and it's never caused an issue.
My planned section was quite relaxed and generally a good experience. I was handed baby as soon as he came out so got skin to skin quickly and my milk came in straight away with both my emergency and planned sections.

Hope whatever you choose goes well

I agree that there’s absolutely no reason to rush in if the monitoring is fine, no health concerns, no reduced movements.

As a PP said, having had an assisted delivery first time doesn’t mean you’ll have another. As someone with tokophobia, avoiding an instrumental delivery would be my priority but you might feel differently - obviously if you have a spontaneous VB that’s uncomplicated then great, but if it starts to go awry it may be too late for a section unless there’s no other way to get the baby out. But you may have no issues at all.

This is the biggest problem with childbirth - there’s just no way to predict it! For me that meant wanting a planned section as I could maybe just about handle an uncomplicated VB but could not handle an assisted one. The trade off for that for me was having a spinal (huge needle phobe and my spinal did not go well) and recovery time. It really depends on your feelings about the possibility of needing an assisted VB after what you went through last time - we all have different concerns.

An ELCS can be a lovely, calm birth which might feel quite healing after a traumatic experience first time. Or you might feel that you missed out on the possibility of a spontaneous VB. it’s all so personal.

I had an induction with a third degree tear plus episiotomy with a year of recovery gynae nurse and physio input first time around. This time requested an ELCS at my 8 week booking appointment, consultant in agreement at 20 week appointment.
ELCS has been a walk in the park in comparison. The first few days are very sore and they hurry you out of hospital within 24/48 hours but you heal quickly and baby is here safe and sound without the trauma of an induction and/ or assisted birth. Each person is different but I would not want another repeat of the first birth so would rather have baby out safe in a timely manner