Elective section vs Induction

[Salacia]

Just been diagnosed with preeclampsia and all being well (e.g everything stays stable) we’ll be looking at delivery at 37 weeks (currently 35).

I’ve been offered the choice of an elective section or an induction. I honestly can’t decide.

I’ve never had a firm birth plan but was vaguely hoping to avoid a section as I’ve previously had lots of abdominal/pelvic surgery so it won’t necessarily be straightforward (and I don’t want to add to the adhesions). I’m also worried about recovery time vs a vaginal birth.

That said I’m also worried that an induction will end up with a section anyway and have heard more negative experiences of inductions vs planned sections. I don’t want to end up in the same position but having days of pain/being knackered leading up to it.

I don’t think there’s really a right or a wrong answer so I was just wondering if anyone has been in a similar circumstance, what choice they made and do they have any thoughts?

Hey I've had 4 inductions one at 42 weeks and rest at 37/38 weeks. 2 by the pessary and 2 by the drip. Coped with Gas & Air on all of them.
Was completely fine. Never had a c section so can't comment on that. But I liked my inductions. It's quite boring with the waiting around to get started and you could end up in for a few days to get things moving if pessary doesn't work first time, they'll try another etc. but with all of mine I went in either early morning or late at night and was always home within hours.
Didn't need forceps or any interventions. To be fair I don't know anyone that has or has been escalated to a section after induction. But on here I see some stories of that happening. And a lot of people are against inductions etc.

@TeaPleaseX - thank you for sharing your experience. I can cope with boredom (I’m stuck in hospital at the moment so getting pretty good at it). My gut feeling is induction due to my surgical history so it’s nice to hear some positive stories (obviously not negating anyone’s negative experiences!).

I was induced at 39 weeks and my body just wasn't ready and it didn't progress. I found the induction exams painful but I find exams painful anyway. I ended up with a section. This time I had an elective session

I'm not against inductions at all I was expecting one as all the women in my family have had successful ones. The recovery of my c section both times were painful but I just figure you've gotta have pain at some point and my section was nice and easy so.. I will say though I don't regret having my induction, I'm glad I tried just unfortunately it didn't work out for me

I've had two 37 week inductions for pre-eclampsia. The first ended in an unassisted vaginal birth, and the second in a C-section (baby got stuck). The first took 32 hours from gel to baby. The second a bit over 4 1/2 days from gel to baby.

Other than a few cramps after the gel with my second, I had no pain with either up until contractions were started on the drip. Though I will admit that the ARMs (managed, as neither baby had descended into my pelvis by that point) were deeply unpleasant. Gas+air got me through them. Otherwise I was very bored waiting for a space to become available on delivery suite, and done with all the 4 hour BP checks. I slept ok, but I work in the hospital anyway, so the surroundings didn't bother me.

Once labour got going I lasted as long as I could on just gas+air. At 5cm in both labours I needed stronger pain relief. I had diamorphine with my first (as I wanted to avoid having an epidural) and an epidural with my second (long labour with no end in sight). Total lengths of labour was 11.5 hours with my first (diamorphine 6 hours in) and 14 hours (epidural 11 hours in) after which a C-section was called, drip was stopped, and had baby extracted 2 hours later.

I have zero regrets choosing induction. It was important to me to try to have a vaginal birth first, and I would choose the same should we have a third. C-section recovery was much easier than I had anticipated, but I'd never had any abdominal surgery before. I was also way more tired leading up to vaginal birth than the C-section too. I had not slept well the night before, then I was taken down to delivery suite at 1am, then started on the drip at 5am. I was so tired I was sound asleep between contractions while I was on diamorphine!

Best of luck whichever you choose!

Hi there it's a labour ward midwife. We induce women for all sorts of reasons. How long the labour goes and the mode of delivery depends on the size and position of the baby and size and shape of the woman's pelvis. So the combinations are endless. Babies tend to be on a small side with pre-eclampsia. And you will be offered an early epidural to help with the blood pressure. I suggest you seriously consider induction

There are a couple of good books on induction on Amazon. They are written by research midwives Sarah Wickham and Rachel Reeves.

I went for the c section- best decision I’ve made - nice and calm and I recovered well. My concern with an induction was that I wouldn’t have been ready at 37 weeks and likely to end up in c section anyway which is what has happened to a lot of my friends

Thank you. I think I’m leaning towards induction but it’s really helpful to hear everyone’s perspectives and experiences.

I'm normally team ELCS but your specific medical history does sound worrying - I'd be too scared of adhesions not to go for VB if at all possible.

I had an induction using the drip, and I was shocked at how quickly (after the first few hours of nothing happening as the drip was being turned up) things got painful and I was having contractions with very little break in between it was quite overwhelming, and not being able to move much
But it ended in an unassisted vaginal birth followed a very quick pushing stage and fast recovery
Obviously this is just my experience but I'd only read negative things about inductions and I went into it feeling miserable about it but things worked out well in the end! And I was still hoping to avoid a c section due to the recovery time

As you say, there is no right or wrong and I believe our instincts are incredibly strong in the lead up to birth. I had an ELCS with DC2 but that was because they were so big! I strongly didn’t want an induction but this was based on my babies size and the risk of shoulder distoycia which is a different circumstance to yours. I had absolutely zero regrets but I do think that is because I sat with myself for a moment and really thought about what I wanted, all other opinions aside.

Sending you lots of love, it’s always an equally scary and exhilarating time this last hurdle before being with your baby. Take a moment to yourself and listen to what your instinct is telling you.

I had 2 inductions each ending in a section.
Our 3rd was an elective section at 36/7 weeks.
It was fantastic compared to having laboured for hours then having a section.
The baby was fine and I made a fast recovery.
Tough decision to make, good luck.

Thanks everyone who has shared their experiences. Really helpful. Having slept on it and seen my consultant this morning our plan is to try for an induction but with a low threshold for going for a section of things aren’t progressing as they should.

At that gestation a section. So unlikely your body or baby will cooperate / be ready and it will lead to a cascade of interventions and an emc which if you are already worried about adhesions you want to avoid an emergency one x

I had pre eclampsia with DS1 and he was induced at 35 weeks.

Due to a different issue with DS2 I had a planned C section at 38 weeks.

I'd have the induction over the C section any day. Recovery was much easier.

At your gestation i’d personally choose a c section. I was induced at 40 weeks for reduced movements and she just wasn’t ready to come so they tried everything, it took days and ended in forceps/PPH. If you do go with the induction, definitely request a c section if things aren’t progressing. I didn’t really realise I could and so just went along with it which I regret. Obviously some people have really positive and quick inductions but baby being ready is key I think, all my friends who have had c sections only have positive things to say about them.

Also ask your midwife for your bishops score, I think a higher score indicates if your cervix is favourable and if induction is more likely to be successful.

I have had both. First time induction , pessary did nothing , then drip . Had to have early epidural due to the induced contractions on drip being incredibly painful.
Got to 10cm, baby got stuck , meconium aspiration and crash section without proper working spinal/ epidural. Hideous.

Second time round had planned section . Much better. Good recovery.

I would worry given your history about what happens when your induction goes wrong. Emergency sections are much more likely to lead to Bowel injuries due to adhesions. In your shoes I would have a calm planned section done by a consultant surgeon.

Good luck with your induction! I was induced at 38+2 for reduced movements and slowing growth, and baby arrived six hours after the pessary went in. Only had gas and air, and once my waters were broken when I was 2cm I was holding her within 40 mins. Despite being "early" she was ready and my body responded well to the induction (cervix was unfavorable when the pessary went in!). Only a slight graze so recovery was easy - did a three mile walk two days later.

Thanks for the comments everyone. In a way it’s reassuring that there’s a range of views - makes me feel better about there not being a right answer!

Hi there I am a labour ward midwife with research experience. Research related to Caesarean section. I have not come across any evidence that an elective CS is protective against bowel or any abdominal adhesions. It's true bowel injury is more likely to happen during a crash emergency CS even though absolutely risk is rare. (I haven't seen one in my career despite seeing hundreds of emergency CSs). Adhesions happen once the body heals - the surgeons have no control over this process

Good luck. I hope your induction goes well!

@Kosenrufugirl can I ask if you know is an overhang if you are slim down to the skill of the surgeon whether you end up with a small ledge or not?

Hi I just had my baby at 38 weeks due to pre eclampsia via induction she was born on Sunday, my experience :

Given first gel at 11am
Given second gel at 5pm
Waters broke on there own otherwise they would Of broken them
I asked for petadine after the first gel in hindsight I could have held on it might have been more use when my waters went as I was in a lot of pain.
Used gas and air and my tens machine (worth the money)
I was out of it on gas and air and in a lot of pain but my partner tells me I was 2cm at 11pm I dont remember a lot of that time as I went to town on the gas and air I think the petadine would of been better here.
I was rushed down to delivery later and didn't have time
For an epidural as I was pushing and delivered using gas and air at 12.57am baby was 6.10lbs .

I have to say personally the contractions once my waters went were far worse than the actual delivery and having seen women in the ward after having sections I would deliver myself all over again if given the choice . If you have any questions just ask x