induction vs c section with a high risk pregnancy

[Amyjay19]

Apologies in advance for the long post!!
I'm currently 37+2 with my first baby, I've not had the easiest pregnancy with lots of complications along the way!
At 20 weeks baby was diagnosed with multi-cystic kidney so we've been monitored by the fetal medicine unit, at the same scan they told me I had a low lying placenta. I was then diagnosed with gestational diabetes afew weeks later. Then around 28 weeks I had severe itching that wouldn't go away I ended up being tested for cholestasis and was diagnosed immediately as my liver function test was very abnormal and my bile acids came back at 79 I've been on medication and monitored closely with twice weekly blood tests and ctgs.
Throughout all this I've not been happy with the way I've been treated by hospital staff and my consultant. I've been told it's not safe to go over 37 weeks due to increased risks of stillborn I was then told I'd have to have him by 38 weeks I saw a new consultant today who was very rude about the fact that I was scared to wait too long incase something goes wrong but she wants me to have him at 39 weeks, I've expressed my concerns about induction and not wanted to end up being rushed into and emergency c section and she's made me feel very bad about the choice I've made when all I want is my baby to be delivered in the SAFEST way possible I don't want to put him at any risk of stress or harm and I've heard some bad things about induction.. with having so many complications what is the best and safest option for me? I'd love to just wait it out and go naturally but that's not an option in my case. Please help a stressed first time mum ☹️

I flipped between induction and elcs with my DTs, and changed my mind on the day to an elcs. For us, it was the best decision I could have made. They were born 4 minutes apart, we each had our own little team of medics - my DD wasn’t breathing properly when she was born and the room filled up with additional medical staff to help her. She was ultimately fine (felt like a lifetime to me!) and I now joke how she was just pissed off she wasn’t the first born so wanted some added drama to her arrival to the world!

I shudder to think of what could have happened had I been induced and she’d had the same difficulties. Of course, they might not have happened at all, I’ll never know. I’ve never had a vaginal birth, but the feeling of being in control of the situation (until DD was born anyway!) was great, and knowing that there was an army of professionals to help us if things went wrong was what swayed me. If I ever have any more children I’ll go for an elcs again.

This is obviously just my personal experience, not saying this is the right choice for you!

While inductions carry increased risks of interventions, sometimes they are necessary. But you can also choose a CS.

no one can guarantee an easy induction. Mine was terrible, ended up with forceps. But it was necessary. And I chose it instead of CS. Second time now, I’m not sure, still thinking about it.

you and the baby have so many risks that I don’t think waiting is an option.

You could have an easy induction or a painful one, you can have an easy CS with a very hard recovery and some complications, or an easy one all the way through and beyond. Reading this forum showed me everything is possible.

you have to decide for one of these 2, induction or CS, knowing no one can tell you which one is going to be easier to have in your case.

I was due to be induced on my due date for various reasons. Ended up starting off without the induction but needed the drip induction to speed things along and ended up with an emergency section.
I'd asked for a planned section before we knew about any of the complications. Hindsight is wonderful but I would have felt more in control of a planned section and if I wanted to go ahead with the induction wouldn't be talked out of an epidural before the drip went in! Good luck, wishing you and baby all the best

Thankyou for your replies! I know everybody reacts differently to things I'm just trying to weigh out the pros and cons as I've been made to feel like I'm a bad person for leaning toward the idea of a c-section this was never my ideal situation when I found out I was pregnant but now I have two choices and neither of them would make me happy so safety is what is swaying my choice here.
I managed to get her to book a section for 39 weeks after she told me I'd make my baby ill and struggle to breathe if I went on previous advice of having him at 38 weeks.
Obviously I could still change my mind hence why I wanted real peoples experience to help me make a more informed decision as any question I asked the consultant I was just told "I don't know much about that so can't say"

Don’t let them feel bad for wanting a CS! Tell them it’s your body and your right, the baby is going to be perfectly fine with a CS, so why should you feel bad about?!

I know W who had CS bc of gestational diabetes at 37 weeks and their babies were fine. 37 is considered at term. Why would he baby automatically have problems with breathing at 38 weeks?! Unless there is some specific concern here, babies born at 38 weeks are absolutely fine.

if I were you I’d go for an earlier induction or CS at 37

1. bc your liver is in danger, it will take some time to recover, might get some permanent damage and liver is important!
2. your risk of diabetes 2 after pregnancy is greatly increased bc of the GD
3. a doctor told you the risk of still birth for your baby with their kidney issue is greater after 37 weeks

it seems like a decision easy to make to me. And frankly I’d go for a CS bc your body most likely won’t be ready at 37/38/39 weeks and the induction will be painful. Mine was at 40+1 and still extremely painful (but I recovered immediately after, up on my feet, no pain). Most stories with nice inductions were for W who were overdue, like a week or 2, very few were before 40 weeks.

good luck whatever you choose.

@CristinaNov182
It's not that I want a c section because I'm actually petrified of surgery!! it's that I want him here in the safest way and without causing him anymore stress than we both already been through throughout my pregnancy.. it's more the cholestasis that poses risks to him the later on I get in my pregnancy she was absolutely adamant I couldn't have him before 38 weeks but I know he would be fine at 38 as I am classed as full term and know people who had their babies two month premature and they are thriving.. I just don't think she's in the right job considering she is dealing with expecting mothers at the most vulnerable times of their life.
I do feel like I'm making the right choice for my baby by having an elective c-section as I wouldn't forgive myself if anything went wrong during an induction

It sounds like you’ve had a rough ride @Amyjay19, I can only imagine the stress and worry you’ve felt for the last 17 weeks. Been one thing after another hasn’t it? It’s ok to think “my mind and body has had enough, I just want him out now”, without the anxiety and more uncertainty of the induction process. I’ve known some people who’ve have very unremarkable inductions, but if your instincts are saying “section” it’s ok to admit you’re fucking exhausted and you don’t want to do it. That’s completely valid.

Full disclosure, I was induced at full term (my waters had gone themselves and contractions started but they wanted to speed things up because there was meconium in my waters) and it was shit. Ended in an emergency section, which was blissful in comparison. After four MC since I will brook no argument about another section. I just can’t be arsed, mentally or physically, after the last 18mos.

WTF is your new obstetrician on about.... induction/ section at 37 weeks is pretty standard for cholestasis due to the week known risks of waiting longer. Not to mention the other complications you are dealing with. Can you ask to speak to another consultant?

And FWIW - at 37/38 weeks I personally wouldn't be opting for an induction. If your body isn't ready there's a good chance of intervention and forceps or EMCS. An ELCS will be much more controlled. It is ABSOLUTELY your right to have one, even without medical reason, of which you have plenty!

*well known

@Mmmmpavlova This was a reason I changed hospitals as they weren't taking my concerns as serious as I was.. and the new one seems to be no better if not less medically trained I feel so disheartened that this is how my first pregnancy has gone☹️ I feel like I'm the only person who cares about my babies health!
I'm scared of waiting too long incase something goes wrong and I'm glad other people see my concerns about inducing when me and baby are high risk anyway!

I've had both CS and vaginal birth with syntocin drip, one with each of my high-risk pregnancies. I hate surgery too and I fought really damn hard for my VBAC with DC2.

In your case I would absolutely push for CS, you have low-lying placenta, you can't deliver that naturally, if the placenta ruptures in labour the child can die very quickly. If your child has kidney issues, I don't think all the additional chemicals whizzing around your body for induction will do them any favours.

You can be in early labour stuck on a ward for days with an induction if they're busy and I don't think it's a great idea if you have a high risk baby (induction is also more expensive for them, so IDK why so many UK hospitals offer them preferentially). Especially as you have no other children at home, go for the CS with a set date. You can always have a VBAC next time.

If they won't give you your right to a C-section get the charity Birthrights involved, they are AMAZINGLY helpful and intervened in my case to help me get my VBAC.

@PeekabooAtTheZoo I'm so glad I made this post now as I left my appointment feeling so guilty and drained about my decision and now I know my concerns are reasonable I don't know why they haven't been advocated by my consultant!
I appreciate you all sharing your experiences it's nice to know people who have had both procedures also agree with me.
I feel like they try to make you feel like you don't know what's best especially as a first time mum but I think that maternal instinct kicks in and we know what's best for our babies!

I have two DDs. First time around I had an induction for medical reasons which ended in an emcs. Second time around I had placenta praevia so I had to have an elcs.

With the first one the induction process just didn't work for me, so eventually (3 days in) they tried forceps which didn't work so I had to have an emcs. My DD has a permanent scar on her face from forceps damage.

Second time around the elcs was absolutely fine & text book.
Obviously you have to do what is right for you but given the choice between induction and elcs, based on my experience I'd go for elcs.

@Amyjay19 glad you feel better, you should.

I’d say don’t wait until 39 weeks for a CS, you can call them to reschedule for earlier. I think you and the baby have too many risks to wait that long. It’s not just one risk. And you can tell them the same.

if they start again with “breathing issues at 38 or 37” ask them to show you the stats

have the stats ready for your risks as well.

@Q2C4 oh no that sounds like an awful experience your first time too! I definitely feel like I've made the right choice now! It's crazy what we have to go through because a "professional" says we have to..

@CristinaNov182 that's a really good idea! I'm going to call my local midwife in the morning and discuss it with her too there isn't another consultant I can speak to as I've only just changed hospitals but I do think I need another opinion on waiting that late.. the risks are far higher with waiting and I know the breathing concerns aren't an issue it's just a scare tactic to push you to do what is convenient for them

my midwife told me she can’t schedule a CS, that I have to speak to a consultant.

But what she can do is arrange an app with the consultant or a registrar. She did this at my first app when I told her about the risks with my first pregnancy, I’m consultant led again for high risk, and she made the app for me and I had it within few weeks.

I was what, less than 12 weeks, so there was no great emergency to see one in a few days like it is for you. You need to get a slot booked it asap, as they might try to fob you that it is too late to schedule an earlier one (I don’t know what week you’re in, but just to preempt their excuses).

if a consultant is not available, ask for a registrar (a consultant in training). I had a call with one when my consultant wasn’t available. Someone must be available, don’t let them fob you off.

I had an induction at 38 weeks for GD, no other pregnancy issues. It was tough starting out from cold and making my body go into labour. I wish I'd asked for a CS instead but it was never mentioned and I didn't know I could make a choice. I was told they recommended induction and book it after 38 weeks, so I booked it at the earliest opportunity.

I later found out (we ended up in SCBU because of breastfeeding problems) that 37 weeks is classed as 'early term' so some babies born at that gestation do need a little more support. But in your case there's also a lot else going on!

Seems mad that the consultant wants you to wait with obstetric cholestasis. It's not going to get better until baby is out, and now you're term, there's no reason to wait.

It's entirely your choice about induction or C-section. Go with your gut. I agree with others in that you should try to talk to a different doctor.

For what its worth, I've had two high risk pregnancies. Both times pre-eclampsia, though mild. Felt like they couldn't wait to get things started once I hit 37 weeks. I went with induction both times, as I hated the idea of an elective C-section far more. DC1 was born vaginally at 37+1, and DC2 via emergency C-section (failure to progress due malposition) at 37+5. DC2, while very mucusy, had no breathing issues at all. If I had a third that needed to come early, I would still choose induction because it's what feels right for me.

I hope things get sorted for you, and you meet your baby soon.

It's the waiting that scares me.. I'm 37+3 and I am booked in for ELCS in 11 days but that will be exactly 39 weeks I did try to say to her that I didn't want to wait and risk something going wrong and she was very rude and said well I'll book it for 38 if you really want him out that quick and if he ends up in scbu and with breathing issues you will have to deal with that.. obviously as this is my first my pregnancy I don't know what the best thing to do is but she made me feel awful when I don't "want him out" I'd love to keep him in there for as long as safely possible but I do know the risks that come with that I'm just having the worst possible experience and I really don't want his birth to be like this either ☹️

Don’t let her shame you not do the best for you and your baby

see here

Advise women with isolated ICP and a singleton pregnancy that the risk of stillbirth only increases above population rate once their serum bile acid concentration is 100 micromol/L or more.

In women with peak bile acids 19–39 micromol/L (mild ICP) and no other risk factors, advise them that the risk of stillbirth is similar to the background risk. Consider options of planned birth by 40 weeks' gestation or ongoing antenatal care according to national guidance.

In women with peak bile acids 40–99 micromol/L (moderate ICP) and no other risk factors, advise them that the known risk of stillbirth is similar to the background risk until 38–39 weeks' gestation. Consider planned birth at 38–39 weeks' gestation.

In women with peak bile acids 100 micromol/L or more (severe ICP), advise them that the risk of stillbirth is higher than the background risk. Consider planned birth at 35–36 weeks' gestation. [Grade A]

Advise women with ICP and a twin pregnancy that the risk of stillbirth is higher compared with a twin pregnancy without ICP. [Grade D]

Clinicians should be aware that fetal ultrasound and/or cardiotocography (CTG) do not predict or prevent stillbirth in ICP. [Grade D]

Advise women with ICP that the presence of risk factors or co-morbidities (such as gestational diabetes and/or pre-eclampsia and/or multifetal pregnancy) appear to increase the risk of stillbirth and may influence decision-making around timing of planned birth. [Grade D]

Advise women that there are no treatments that improve pregnancy outcome (or raised bile acid concentrations) and treatments to improve maternal itching are of limited benefit. [Grade A]

obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.17206

Also

Are there any risks to my baby?
Breathing problems - the risk of your baby developing breathing problems is increased if your baby is born at less than 38 weeks. Therefore most Caesareans are done in the 39th week because at this time your baby will have fully developed lungs. Occasionally women who are having an elective Caesarean birth go into labour before the planned date.

www.nbt.nhs.uk/maternity-services/labour-birth/caesarean-birth/risks-having-a-caesarean-birth

You are not “most women”.

still birth or some breathing issues that can be addressed? And the greater risk is for under 38 weeks.

check your peak bile acids, if they did it, and see what risk you have. A doctor already told you 37 weeks, maybe based on some results?

I've had 4 indictions ok 2 took over 24 hours to do anything and needed ARM, unassisted delivery etc. Even went past 42 weeks and still didn't go into spontaneous labour 🙄

Bloody hell in your circumstances I would be insisting on a section and yes at 38 weeks - seems that your pregnancy is high risk, your baby and you could end up ill and no previous pregnancy or birth to compare things to.

I hope your midwife is supportive.

I've been on the medication for cholestais since 30 weeks my highest bile acid reading was just over 80 it came down with medication but my most recent blood results showed a bile acid result of 38 I told her I was concerned but she said they have new "guidelines" and aren't really concerned unless it goes over 100 which would be an immediate delivery.
I changed hospital as my first consultant "wasn't prepared to discuss a birth option with me" at 34 or 36 weeks so now I finally spoke about when I could have him it's all so last minute I just feel failed by every medical professional so far☹️
I've managed to keep the GD well under target with diet control so I'm hoping that won't cause me too much complications with regards to the baby but it obviously still poses a risk.

I am 37 weeks and due to complications, I will not be going past my due date. So if the baby has not come by the day before, I will be induced or have a section. I chose section as I just have heard so many bad things about inductions. I do not know anyone who had one without issues. So I thought that a section feels right for me.

@Snugglemonkey that's the same as me anyone I know who had an induction has a traumatic story or ended in a section anyway!
There are way more risks with an emergency compared to a planned section! they make sure everything is done calm and controlled compared to emergency where the baby is already stressed from failed induction and then rushing you into a major surgery.. I don't know why they are so against going with the safest option first time round and so many women don't feel like they have a choice in their own birth it's really sad!!