Induction vs c-section at 39 weeks

[PregnantQuestions]

I’m currently over 36 weeks and need to make the decision on whether I want to be induced or have an elective c-section at 39 weeks. This is due to the baby potentially being too big for me. I don’t have any other health conditions. I’ve been looking at pros and cons for both and I’m still unsure. I would love to hear your experiences!

You might want to take a read of: https://midwifethinking.com/2019/09/02/big-babies-the-risk-of-care-provider-fear/?amp

In general, NICE guidelines and the WHO say that women shouldn't be induced just because they have a big baby.

You might still want to go ahead (and maybe there are further complications that mean that you want to), but there shouldn't be any requirement for you to have either at 39 weeks.

@Recoba thanks for that but it’s not the baby’s weight that’s the issue. She’ll be too big for me personally if she goes to 40+ weeks. There are physical and psychological reasons for this decision, but the doctor isn’t forcing me. Have you had an induction or a c section?

Hi @PregnantQuestions, I was induced with my first at 41+5 via hormonal pessary. I had a very good experience (induced at 9.30am, baby arrived by 4pm that same day). After it was clear the pessary had worked I was able to labour on the attached midwife led unit in a birth pool, and although I had a complication right at the end of the birth (shoulder dystocia which was resolved by McRobert''s manoeuvre), the midwives all remained calm and both baby and I were fine (baby was about 4.3kg, I had minor tearing that didn't need stitches). I'm currently 31wks with my second and planning to give birth on the midwife led unit again.

However, I've also had friends who've had elective c-sections who recovered very well.

Because baby might be large, some active birth techniques might be helpful for getting baby into a good position for birth (if you go down the induction route). Birthing balls and yoga can help with opening up your pelvis.

I think there can be quite a difference in labours between ones that are induced "gently" (e.g. sweep or pessary) and ones that are induced more strongly (e.g. hormonal drip - most of the induction horror stories feature the drip), so it might be worth asking what the induction pathway they have for you is. For example, could you try having a hormonal pessary (or two) and then opting for an elective c-section if that didn't cause labour to start?

Hi!

I was considering an elective c-section during pregnancy due to gestational diabetes and was torn like you between the two so thought id share my experience (not sure it will help ha).

Baby was measuring big on all growth scans until the last scan at 38 weeks when her growth had dropped from the 70th to the 40th so a decision had to be made, me and the consultant agreed that if my body was showing positive signs of induction working id try vaginal and if not c-section would be booked. I had to go to the labour ward due to some complications in pregnancy with my own health and emergency surgery- my appendix ruptured at 30 weeks so had to be monitored closely through labour.
I was examined on the same day and was 3cm dilated and my waters were bulging (i had no pains or anything prior to this). I had a sweep on the same day and booked in for induction the following monday to give my body 5 extra days to see what happened. Unfortunately i had to attend MAU the following evening due to reduced movements so my induction was brought forward.

Saturday afternoon i was called into hospital and again asked if i was happy to go ahead with induction; i was still scared due to size of baby but agreed to try first and the agreement was any signs of struggling from me or baby and we would go to theatre.

My waters were broken at 10pm and the hormone drip started straight away, i asked for an epidural because id heard horror stories about the pain from the drip and got it straight away- I was one of the unlucky few and the epidural didn’t work for me, it half numbed one leg which made me immobile but still feeling every contraction!

Long story short, i was re-examined at 5am and was 10cm dilated, so from 10pm-5am i had fully dilated and didn’t even have extra pain relief; the contractions were strong but i just breathed through and took them one by one!
It came to pushing and babies heart rate dropped so after an hour of pushing she wasn’t born, i had to have forceps (which I really didn’t want but understood we needed baby out!) and had an episiotomy.

My little girl was born at 7am, she only weighed 5lbs which was miles off the estimated 8-9lbs from scans!
I needed stitches but recovered really well, only had pain relief immediately after birth but nothing at home and 8 week later im fully recovered; i was driving the following week and back to normal just tender.

Im not saying the drip wasn’t hard but it was nowhere near the horror stories i had read and heard, every labour is different but i had a really positive induction 🙂

I hope whatever you pick goes well! X

I was induced at 38+5 weeks due to potentially big baby. The pessary broke my waters but nothing else. I spent 14 hours on the drip which didn't do anything either so ended up with a c section anyway. I know other people who've had experience with being induced and it worked fine for them. I personally would choose being induced but just be prepared for the fact that it can take a long time and may not work at all which would mean a c section anyway. Take some good snacks and something to keep yourself entertained and just try not to worry too much. As long as you both are ok that's all that matters

I was induced with the pessary at 41+4 and had been warned in advance about the potentially long wait for it to progress so was ready to be hanging round for a while. The opposite happened in fact - I had hyperstimulation so the contractions started and intensified really quickly. The pessary was removed and I was given something to try and slow the contractions down to give my cervix the chance to catch up, but it didn't work. I was having almost constant (very painful) contractions but had only managed to get to 3cm dilated. The baby started to get distressed so I ended up having an emergency c-section 12 hours after the induction process started. I really didn't want a section as I was worried about having an epidural/spinal and about the recovery afterwards but it was fine in the end. The baby arrived safely and the recovery was nowhere near as bad as I'd feared. If I have another baby, I would seriously consider having a planned section (but don't think I would be allowed to be induced anyway). What happened to me is a relatively rare complication of induction but not something I had even considered as a possibility beforehand.

OP I've been induced and know others who have been with just the pessary, but one of my SILs had two C-sections for the exact reasons you are wondering whether to have one. Her first was emergency but the second was planned.

Personally having been on a shared postnatal ward and knowing why that SIL had two C-sections, I would suggest you have one.

I had an ELCS because of a predicted large baby. I understood that guidance was ELCS should be considered if the predicted birthweight is over 5kg, which it was. My first baby got stuck and was in distress leading to a crash delivery and I was very nervous of shoulder dystocia this time round after that experience. I decided I’d rather have the ELCS than risk it. The experience was fine - baby was under 5kg but had exceptionally broad shoulders / huge head. Was happy with the decision.

Very interesting to hear your different experiences with different methods - pessary and drip. I also know there’s a gel too. So scary that some of you had emcs but a relief that some of you had a fairly positive experience. I’m also still deciding what form of pain relief I want. I definitely want something!

I was induced for a few reasons at 39 weeks, baby measuring big, age, excess fluid. I was admitted on the Tuesday and had the pessary, it bought on contractions and because they were back to back they removed it around nine hours later. I had contractions for a further three hours and then they failed off to nothing. Next step was to wait for a bed on labour ward to have my waters broken. By Saturday I was still waiting and knackered from being kept awake by monitoring due to issues with heart rate and also noises from women successfully labouring around the ward. Sunday I was taken to labour ward as an emergency again due to issues with my baby's heart rate. I had my waters broken which took three attempts because my cervix was high, they offered me an epidural at that point which I declined. I was started on the drip, and after three hours asked for an epidural as wasn't coping with the pain. I was examined and found to be 3cm, five minutes later everything felt different, they examined me again and I was fully dilated, I'm hazy on this part, but think it took around an hour of pushing, I was advised at several points that I'd probably need an emergency c section, then it was forceps, then an episiotomy, but thanks to the midwives I was able to push her out without any of that.

Looking back, whilst recovery was good, I was absolutely exhausted and in hind sight wished I'd gone for the planned section. My first labour was worlds apart, midwife led unit, calm environment and more controlled.

I had two inductions for post dates and one section. First two babies 4.3 and 4.6 kg. Third had a elec section at 39 weeks and baby weighed 4.3 kg already.

I have permanent birth injuries after the first two and recovery took months nevermind the permanent effects.

From the section I have a small scar and still breastfeeding almost 3 years later. I went home the next day and I was pulling up my tomato plants 3 days after the section. It was an amazing birth. If I were you I would just go for it.

My induction story is on here if you search my name.

I really wouldn't recommend an induction to anyone personally and I wish I'd gone for a C-section, my epidurals failed and by the time I was screaming for a C-section, it was too late.

If I ever have number 2, I will be having C-section by choice. The hormone drip they put you on is no joke and you go from 0 pain to 100 pain in what feels like an hour.

Good luck OP x

I also had rods, 2 pessaries, a gel and finally they broke my waters and put me on the drip. By the time I gave birth I was exhausted.

I was induced and then had an emergency c-section. The induction was horrible from my perspective, and the c-section was a relief. If I could go back in time, I would have just gone straight for the c-section if given the option. I was very lucky though, as I had a very easy recovery after the operation.

I would add, I was in hospital for 3 days after they started the induction and before they went for the c-section, and I was in labour for nearly 30 hours before they decided to operate. Not pleasant!!

C Section - had 2 , wonderful. Much better than 'natural' child birth I had before.

My 1st baby was a long drawn out induction at 40+3, it ended in forceps delivery. I had an induction at 39wks with my 2nd baby, it was a long day after being put on a drip at 9am I was slowly progressing, waters broken at 2pm & they expected delivery by 6pm. That didn't happen, after adjusting the drip several times I was exhausted & baby was showing signs of distress so I ended up with an emergency section at 11.45pm. During the labour i wasn't allowed out of bed as I had a monitor strapped on for baby (later they put a clip thing on baby's head), I had morphine & gas/air for pain relief.

If I could do it over I'd of chosen the section, I had another baby 2.5 yrs later & had an elective section at 39wks, so much a better experience, calm controlled & stress free.
I won't lie recovery is a bit rough for some but I honestly felt so much better having the elective section

I was induced at 39 weeks due to being on blood thinners and high risk for blood clots.
The induction was via gels and failed and I had an emergency C Sec in the end.
But I wish I'd have just had an elective C sec to being with as it was an option.
But every one is different, what works for some won't work for others and vice versa

I’ve had both. An induction which lasted a week and ended up in c section. Had sweeps, pessaries, dilapan rods, artificial broken waters and the hormone drip. Over a week. All In hospital. All to end up 2cm dilated with no progress. Ended up in emergency c. If your baby/body is not ready to come - they’re not coming via induction I’m afraid!

My induction was at 38 weeks for an ongoing medical condition that put me the baby at serious risk. In your case I wouldn’t be choosing either. But if I had to choose it would be a planned c section. A baby actually being ‘too big’ is incredibly rare and If your baby actually IS too big an induction probably wouldn’t be effective!

I'm literally just recovering now from an unplanned section which ended to becoming extremely medically necessary due to a large baby. They predicted baby to be 'slightly' big but baby was much much bigger than predicted. I think there's lots of stories of babies being predicted to be big but coming out smaller and lots of people reminding you that there is some leeway in the scans and again that this means baby could be smaller, but few seem to consider and point out that it also means baby could be much bigger. So just make sure you would be comfortable giving birth to the maximum possible weight that baby could be and that your doctor/midwife has considered this fully also. My baby was nearly 11lb! There's no way I could have delivered vaginally and an induction in the end was just dangerous and a long painful labour for nothing. In hindsight I would have had a calm peaceful section at 39 weeks.
So that would be my advice to you because the risk of shoulder dystocia and birth trauma is not good the other way!

I was induced at 38 weeks due to a big baby and a previous shoulder dystocia. I'd had growth scans all the way through and actually when baby arrived he was nearly a pound heavier than they had expected!

I had a long long 5 day induction which was mental torture and ended up with a EMCS at 3am after getting to 10cm dilated and a lot of pushing - he just wouldn't (or couldn't? I have a very small pelvis as noted in two previous pregnancies where both babies were assisted deliveries).

if I had my time again I would have just opted for the CS. My recovery from CS was easy (apart from a slight infection) but I didn't feel a lot of pain, was up and about straightaway and back driving 2 weeks later.

During the labour i wasn't allowed out of bed as I had a monitor strapped on for baby

That was like my first induction @Alba82 but many hospitals have wireless monitoring now enabling you to move around. I had it during my labour. There was only one available through so I was lucky to get it!

This is true.

Midwife told us they cost £20,000 each, I had two on before I had my epidural. Then when I was screaming in agony when the epidural wouldn't go past my thighs and the midwife tried to move them I apparently swatted her hand away and chucked the monitor across the room 😰 I don't remember doing this and I was out of it from pain and gas & air and I'm so not an aggressive person but my DH nearly died of embarrassment knowing how much they cost 😂

I had an elective C section at 39 weeks for being large on scan having declined induction, and never once regretted my decision. Shoulder dystocia was my biggest fear and I’d also heard that around 40% of inductions in first time Mums where the indication is being large for dates end in section so decided I didn’t want to go through induction on my own, potentially for days, (it was peak Covid so husband only able to be there at the end) to then have a nearly 1:2 chance of needing a section anyway.
Baby was big and they struggled to get him out even at section. The Consultant who did it told me that they could have induced me for days and he’d not have come out. I was up and about taking the dog for a gentle walk the next evening and pain was well controlled on regular paracetamol and Ibuprofen.
Im now 36 weeks with number 2, who is also big and breech so have another section booked, hoping for the same experience.
One thing I will do differently this time is start hand expressing some milk from 37 weeks as there was definitely a delay in my milk coming in post elective section.
Good luck with whatever you decide!

I've had an induction on the drip and an elective c section with my 2nd due to her being breech (found out at 38weeks).
If I was to have another I would 1000% go for an elective.
It was night and day in comparison to the drip, it really is no joke.
This is coming from someone who was booked in for a home birth with both.