Induction vs C-section at 37/38 weeks

[springingup]

Hi!

I have been advised it would be safest for baby to be out slightly earlier (between 37 & 38 weeks). The reason is due to a gestational allo-immune thing that is being treated but becomes more risky in those final weeks.

I'm was set against an induction but have since read about c-sections at this gestation and seen lots of scary stuff saying baby more likely to have respiratory distress due to not being able to get water off the lungs quickly, but if they go through a vaginal birth then this is a benefit to them from that point of view. I suppose they have a bit of time to adjust to coming out!

Would just like some thoughts on this. Everything I've read seems to be based on 'normal', uncomplicated pregnancies.

If anyone has any positive story's of induction or c-section at 37/38 weeks then I'd love to hear them.

Thanks!

I've had two 37 week inductions due to pre-eclampsia. I'm someone who won't entertain the thought of an elective C-section unless medically needed though.

First birth went fine. Gel pessaries were slow to get things dilated, ARM didn't start contractions, so had the drip. Drip got things going handily and was ramped up every half hour until I was contracting 3 in 10 and strongly enough. Drip went on at 5am, gas+air needed from ~6am, diamorphine at 11am (5cm). At 4pm I was 10cm. Started pushing at 4.20pm and baby was out a little more than 20 minutes later. 37+1. Minor second degree tear. Great birth.

Second birth went a bit askew. A single gel pessary dilated me to 2cm, but there wasn't room on delivery suite until 4 days later. No contractions after ARM again, so drip at ~11am. Did ok on just gas + air, but I wasn't dilating. I was really starting to struggle at 8pm (5cm, baby high on check), so had an epidural. As I knew I still had a way to go, Meptid probably wouldn't cut it, so epidural it was. Epidural went in around 10pm, drip stayed off, and had a sleep while we hoped for some passive descent. At midnight I was still 5cm and baby hadn't descended, so it was decided to have a C-section. I was a little disappointed, but I was accepting as I knew I had done all I could to try to get this baby out vaginally myself. Baby was born shortly after 2am. 37+6. The reason for the slow dilation was revealed to be baby being back to back (as suspected) and trying to come out brow first (not suspected). He was never going to be born vaginally. While the induction didn't go as planned, I was still happy I went through with it. Baby was a bit grunty, but didn't need any help breathing.

If I go on to have a third, I would still opt for induction over elective. I know it would be much more likely to convert to C-section, but I would still want the opportunity to try.

@Dyra thank you for taking the time to reply to me and share your experiences.

Part of me feels like as there is a chance of ending up with a section anyway, maybe just go for that in the first place, but like you, I think I want to give it a try.

My first birth was spontaneous, straightforward, no pain relief and I feel a bit put out that that has been taken away as an option this time, and the prospect of induction instead of that is really scary!

Lots for me to think about!

I had a c section at exactly 38 weeks. I had steroids a few days beforehand and DD was perfect.

On the other hand I also had a really great induction though not as early as you. DC born after a 3.5hr easy labour.

I've had three inductions at 37 or 38 weeks.

First two needed pessary, ARM and drip. Third one just needed pessary.

The first one was longer and more painful, had an epidural and episiotomy and forceps and 3rd degree tear. But this was due to the baby being unwell and having to be got out quickly, rather than the induction itself. I was also very unwell so didn't labour well.

Second two labours were very speedy (couple of hours of proper contractions and pain), had a 2nd degree tear with one and 1st with other one. And second babies both healthy and well when they came out.

Having experienced induction without a drip third time round, realised it is true that labour with a drip is more painful and intense. But I was fine with gas and air and TENs machine for my second labour with the drip, just needed to get a handle and a rhythm on the contractions.

I was offered a caesarean for the second and third, but preferred to have a vaginal delivery for lots of reasons: better for baby and me, quicker recovery etc. They said that at 37 weeks the baby is fully developed. And that after first labour body knows what it's doing. Both things were true for me. They also said that vaginal birth was better for the baby when it was coming out early.

Most things you read seem to say that induction is crazily painful, unnecessary, will lead to more interventions etc etc. This upset me when I didn't have a choice about the induction (pre eclampsia). But honestly this wasn't true for me. The interventions in my first birth were due to the baby being unwell. And the subsequent two births were manageable pain (crazily painful obviously but that's labour!) and good experiences and outcomes.

Hope you make the right decision for you!

@curiou thank you. No one's mentioned steroids so far so I might ask about that!

I had both these options and opted for section, however baby ended up being earlier section than planned due to having covid pneumonia and as I was ill, there was no choice but section, as I couldn't breathe, nevermind push. Baby was absolutely fine at 36+6, no breathing issues at all. NICU staff checked baby over when born and were happy and handed straight to my DH. Baby didn't have any specialist care and never had any breathing issues after. I was suprised how well baby was considering how ill i was! Nephew was born full term via section and very mucus baby, so think it just depends really. Section recovery was very good too.

@Aroundthelight thank you for your reply. Interesting about your body knowing what to do after the first time - I have given birth naturally once so that seems a promising aspect!

The (hopefully) easier recovery is also a positive for me and yeah, just the fact that the baby goes through the birth and gets the benefits of that.

At the moment I'm leaning towards giving induction a try I think.

I was induced. Never again. I won't bore you with the story but I ended up with an emergency c-section and a big bleed. I would have the c-section.

@Ginger1982 thank you for replying. I'm sorry you went through something traumatic. It's definitely the uncertainty of it that puts me off!

@121gigawatts thanks for that. Interesting point about the two different babies. There are just so many unknowns! I can't really get my head around it, my mind changes by the hour at the moment!

I had induction at 38 weeks. DS born at 38+3.

We were home about 14 hours after delivery 🥰. He was a bit jaundice but nothing major.

Also would like to add my induction was fine, no assisted delivery either. Didn't need the hormone drip. They're not all bad experiences.

Every case is uniquely different however..... in my case... I had an induction with DS1 due to growth (small). Had 3 pessaries over 24 hours then went onto the drip - 3 hours later increasingly worse contractions but no dilation which ended up with a cat 1 emergency section due to not being able to locate son's heartbeat and no oxygen, resulting in 4 weeks in special care. I was never given the option of induction or caesarian. Would have gone for the caesarian given the choice - but that's in retrospect. DS2 was a vaginal birth (vbac), the recovery from a section is initially harder in terms of mobility but I couldn't pee without crying for 12 weeks after the vaginal birth.

And I had the steroid injections at week 32 (I think?) to speed up lung development as the dr's thought he would need to be delivered early. Wishing you all the very best of luck!

I had an induction at 37+5 due to obstetric cholestasis. In the days prior to my induction I read online (and scared myself) about the drip and how it made labour more painful so I went in with an open mind as to what pain relief I may want. In the end I didn’t even need the drip (all that worry for nothing) and managed with gas and air as by the time I mentioned an epidural I was ready to push. It was quick once things got going. My condition is more likely to happen again in a next pregnancy and if I needed induction again I would over an ELCS especially as next time I’ll have a DS at home. Good luck OP.

Induction at 35+0 due to pre-eclampsia and I'd choose induction over section every time. Straight to drip, less than 4 hours from drip starting to baby being born, gas and air only, no instruments required and just a small graze needing a stitch.

I was booked for an induction for baby 2 at 37+0 but they arrived naturally beforehand.

No problemo!

Having had a successful vaginal birth already makes the odds more likely for having another. My body definitely handled the second induction much better. The single gel getting me to 2cm from the get go was great. Being on the max dose of the drip, but still moving around, changing position, and having conversations, compared to lying on my side, not moving, and occasionally saying ARGHHHHH as it was with my first. Baby's position was just an unlucky happenstance.

Good luck with whatever you decide. ❤

Hi @springingup

I had an ELCS at 37+2 due to breech and PPROM (at nearly 35 weeks). I wasn't given steroids at that point and I understand that there's some debate about it actually causing issues when you're classed as nearly or at term (there is definitely a benefit though if the baby will be premature).

We didn't have any problems at all with our baby due to the ELCS. We had a bit of jaundice which didn't need treatment but that was caused by feeding issues that were dismissed on the post natal ward, meaning he didn't get much milk at all for a good portion of day two (had harvested lots of colostrum which helped on day 1).

Good luck OP whatever you decide 🤞

I went for c section over induction. I had steroid injections at 37 weeks and baby was breathing just fine.

I opted for c section as I have a clotting disorder, was an older first time mum, overweight and had a history of miscarriage. My demographic odds for induction at 37 weeks were:

A. straightforward, unassisted 25% ish.
B. instrumental - 30% ish
C. emergency section just over 40%.

Induction at that gestation can take several days, and can have a high failure rate (not that this means it will fail - many people will be along to say they barely sneezed and out popped the baby!) I didn’t want to 1. Be off my blood thinners that long, 2. Increase my clotting risks with B and C. 3. Risk a long induction to end up with an EMCS anyway.

It’s worth understanding the risk factors for your demographic to help you make a decision. My ELCS was great, absolutely the right choice for me, and I’ll be doing the same next time.

@Weathergirl1 thank you for your reply. One of my thoughts about induction that early is that my body just won't be ready so it will take a long time or fail! And if it does take a long time that would potentially put the baby through unnecessary distress so I may as well just go straight for a section. Lots of weighing up to do!

@Littlegoth that's so helpful. Thank you.
Where did you get access to the specific figures for your demographic? Is that something my consultant can help with?

@Weathergirl1 need to do a bit of research re the steroids I think. Another question to add to the list for when I next see the consultant!

I’ve had one VB with drip and one cat 3 EMCS and if I was doing it again (I’m not) I would do literally anything to have a VB over a CS, all else being equal.

Should say the EMCS was at 36 weeks.

@springingup yes your consultant should have a rough idea, you can ask for your hospital’s annual data, studies and reports in the BMJ. It surprised me how much info I could get.