Second baby at 41 yr old - induction or c section

[TheSpoonyOtter]

Im 41 yrs old and pregnant with my second baby, due in December. I had a really long first labour where nearly all pain relief failed and i’m really anxious about the second labour, and I’m considering a planned c section. I’m scared recovery will be long with a section as I have a 2 year old to also take care of. Because i’m over 40, they said they will induce me at 39 weeks anyway, and Ive read that inductions can lead to emergency c sections which also worries me. I think i just want the planned section so i can take back some control, i wish they could guarantee that an epidural would work as i would opt for that. But would like to hear other 40+ women’s stories about their labours and whether you were induced/ had planned sections?

I totally understand your dilemma, it's really tough to decide isn't it. I was 39 when I had my DD and, after a lot of deliberation, research and discussion with a midwife friend of mine, I decided to opt for a planned C section if I went overdue. The initial hope was for a water birth if I could, but I was adamant after researching the pros and cons that I didn't want to be induced if I went overdue (main reasons were the statistics for interventions and emergency sections with an induction). Looking back I am so glad I made that decision and advocated for myself (first consultant accepted the decision, a second consultant questioned it and tried to push for an induction). Being planned was so calm and gentle, my recovery was good (of course painful initially as to be expected) but overall was easy and took just a few weeks. It's major surgery of course so not a decision to be taken lightly, but having spoken to many mums I met since who had difficult inductions I am so glad I had my planned section. Everyone's experience is different and I do think I was lucky with my recovery, but definitely easier than having an emergency c section! I wish you lots of luck whichever route you go down, but definitely do your research and also trust your instincts.

I had my second at 41, I went in for induction at 39 weeks, I was hoping it would be quick as my first was a spontaneous labour and 5 hours from start to finish. For me though, I had the pessary, then 12 hours of contractions pretty much back to back, so they took out the pessary as it was overstimulating me, then the contractions just stopped and I spent a further 4 days on the induction ward waiting for space on the labour ward to have my waters broken. Got rushed round there in the end due to problems with her heart rate and was prepped for a c section, but they instead broke my waters and started me on the drip. Hated the drip, started off nicely, but once it was ramped up I just couldn't handle it, the babies heart rate kept dipping, had a room full of people numerous times, but I did manage to deliver her without intervention 5 hours after they broke my waters. I was exhausted though due to lack of sleep on the induction ward with other labouring mothers and the issues on and off with her heart rate. Looking back if I had a choice again I'd probably have opted for a section, DD1 was 7 at the time and whilst it was hard being away from her for 5 days, she was ok, and we had my parents on hand to help out. It's a tough one, because the benefits were that I was home 5 hours after she was born and recovered well, most people I know that have planned c sections have said that compared to an emergency c section it's a much better experience, as more rested beforehand, and recovery has been good for them, even with a toddler in tow, but I don't have experience personally.

I would only have a c section if I had no other choice, a new baby and a 2 yo who dosnt understand your not able to do the things they are se to will be hard anyway without recovering from a c section.

i had babies at 36 induction, 38 shot of faster than a speeding bullet and 41+10m induction.

Hopefully your #2 will be like mine and give you no opportunity to make any decisions or allow time for pain relief anyway.

I had my second via CS at 40 (first at 39, vaginally) due to him being breech. It was an absolute breeze and I recovered really well. Only one word of warning if you're planning for any more - a CS can raise the risk of future problems. My third was a complete placenta previa and needed quite a complex CS (lots of blood loss) and she had time in SCBU. The surgeon waved her scalpel at my husband and said 'No more babies!' He was quite terrified that she might find out three years later when I became pregnant with our fourth! Happily had a third CS and had no problems recovering at all. Good luck with your decision x

I'd ask about alternatives to being induced at 39 weeks

(I was also over 40 1st time mum and had to have a planned c section but if I'd had a successful vaginal delivery for my 1st I'd be keen to explore avoiding a c section with a toddler.

I’ve had inductions for both by births - first at 38 was a long process, stop-start over 5 days before I was put on the drip and then around 12 hours including an hour and a half of pushing before baby arrived. Second at age 41 was much quicker- contractions started gradually and increased, was in active labour without need for hormone drip 18 hours after pessary inserted, active labour around 9 hours and baby out in 3 pushes. With both I asked for an epidural as soon as I was transferred to labour ward and it worked very well both times

i put the relative speed and ease of second Labour down to body having done it before, which I think is very typical, but of course lots of women will have had different experiences. I was very worried about having an emergency c-section first time round and almost asked for c-section to avoid this as heard so many positive planned c-section stories and it seemed like less of an unknown quantity. In hindsight I’m glad I didn’t go down that route as recovery was much quicker, and the experience wasn’t too bad

If you google and look at the ARRIVE trial, you’ll see that being induced at 39 weeks doesn’t increase the odds of c section vs expectant management.

I’ve just had my 3rd at 39, had an induction at 38 weeks because baby was growing small. Previous 2 were spontaneous labors and fairly straightforward, I wouldn’t have considered a planned CS myself. Induction was straightforward, balloon at 10pm, started contracting and balloon fell out, epidural about 3am, broke my waters at 4, baby at 830am. I think when your body has done it before induction can be very very straightforward in a lot of cases.

that said I totally get your situation is a little different. Can you ask to meet with an Anaesthetist to discuss pain relief options? They should be able to review notes from last time and see why they think things didn’t work for you, and talk through how things can be managed for you this time?

also the 39 week induction plan - as far as I am aware the evidence base for induction due to maternal age alone, applies mainly to women having their first babies over 40. Where I am we would offer induction at 40 weeks for a 40 year old with no other complications/risks, the actual risk increase beyond that is still quite small as well - perhaps spend some time thinking/talking that through with your midwife/Dr. you have options to do stretch and sweeps, you also have options to decide later (for example - an induction is likely to be more challenging if your cervix is still closed, but if you’re already 4cm then high high chance of smooth process). Or you could make a plan eg to aim for vaginal birth if you labor <40 weeks but to have a CS if you go beyond that for example.

all the best :)

Defo c section. Save your bits.

I had a planned section aged 42 - it was always going to be an elcs due to previous gynae history, but I was pleased to have it anyway. It was my third epidural and they've all worked perfectly on me. The operation itself was quick and went as planned. I was on my feet soon afterwards and was able to get out of bed to pick up and change the baby. Breastfeeding went smoothly. I liked that we were able to schedule the birth so that dc2 was in nursery (we had no other childcare so DH would have had to look after dcs if I'd gone to hospital at night).

I stayed in hospital for 2 nights and recovered well, but still had limitations on what I could do for six weeks. My younger dc was almost 4 and in pre-school so was able to understand, and DH was luckily not at work for six months so he was always around (and did all the nursery runs, which I would have found hard as it was a mile walk). Dc3 is 3 now and long term recovery has been fine - no ongoing issues.

I've had 3 sections and my bits are still knackered 🤣

a few thoughts...
-not all inductions are the same - it's often a bit more straightforward if you've had a vaginal delivery before.
-they would only offer you an induction, they can't insist on it. Once they've explained the pros and cons for you and your baby then you get to decide.
-they can often give you an idea about how 'favourable' things are looking for an induction - if your cervix is up round your tonsils and feels like a brick that's a bit less optimistic than if it's already 2cm and like a marshmallow for example.

-not all emergency sections are 'crashing through doors' emergencies. Quite often they still involve walking to theatre but just going a bit quicker than in an elective section. Even if it is a proper urgent section, quite often we still manage to make it a reasonably positive experience (music, photos, all that jazz).

-just because an epidural's been inadequate once doesn't always mean it would be again, but it depends a bit on why it might have failed (if they couldn't get the needle anywhere near then that's a bit different having one that worked a bit but just wasn't perfect). If it was that they couldn't get the needle anywhere near then that should probably prompt an anaesthetic clinic appointment ahead of this delivery.
-it may be worth asking about remifentanil as a pain relief option for labour if you decide to go for it (not available everywhere, but is sometimes useful for women for whom an epidural either isn't an option or doesn't work so well).
-the anaesthetic for a section is much more likely to be a spinal injection - completely different technique to an epidural.

Thank you this is super helpful, I spoke to a midwife today and she said that I can request an anaesthetist appointment at my growth scan next week. I mentioned about the failed epidural and she said that because the spinal tap worked on me last time (I had to go to theatre to have my placenta removed) then that means they had no trouble finding the right place and apparently they are the extract same procedure so her guess is the epidural failed because of the person administering it.

they're completely different techniques and that's quite a leap for the MW to make with not much info! There's a 1:8 chance of an epidural being inadequate and that can be for many reasons. The anaesthetist will be able to go through things properly.

Thank you, I managed to speak to a midwife today and she said that I can request an anaesthetist appointment at my growth scan next week. So i’m feeling more positive about discussing pain relief options now. Hopefully that will give me more clarity!

if you're interested/haven't seen it already, there's a website called labourpains.org that has a load of patient info resources re pain relief in labour and anaesthetic options (it's run by the Obstetric Anaesthetists Association).

C-section. No brainer
preserve your pelvis.
inductions often lead to c-sections anyway

I had my second baby at 41. I pushed back on induction at 39 weeks and was booked for induction on my due date - I went into labour with my first at 39+6 so was hopeful it wouldn't be needed. Induction was needed so the pessary was inserted and about 12 hours later baby was delivered. Much quicker delivery than the first and no need for stitches

Being 41 with a second baby isn't even much of a risk. Your risks go up by about half a percent. I'm 42 expecting my second and there's no way I'm having an induction.

Thanks just having a look at this now

Thanks for this, your thought process sounds so similar to mine, I’m finding it really difficult to decide! I’ve got my consultant app and a growth scan next week so I’ll speak to her then about my options for planned c section versus induction. I think the attitudes consultants have to planned sections varies massively so that’s really good you were able to advocate for yourself.

I had a planned c section at 38 (second child). The pain/recovery was nothing. I was able to do everything. The only ssue I had was being low in iron which they didn’t bother to tell me about for 2/3 weeks. It made me weepy etc. Once I got my iron levels up, I was fine.

I’d take the c section if I were you purely because you’ve got a good chance of having one after an induction and this way you can get all the pain relief you want.

Btw, I had an emergency section with my first after being induced. I insisted on a epidural before I let them put me on the induction drip as it is meant to be painful. Then I was able to doze through it.

Thanks for this, what pain relief did they send you home with after your section? i know it varies between hospital trusts

Hello 🙂
I’m in a similar position and saw your thread before starting my own.
I’m about to have my 2nd at 34. Had my first at 27,
I have opted for an elective c section due to my first birth being awful. A very long induced labour, realised baby was back to back in the end and needed emergency forceps delivery. They had to do the spinal twice for forceps because for some reason I could still feel contractions so I am nervous about this happening in a caesarean. I just couldn’t do that birth again. Everyone says it’s easier next time but for my mum her 2nd was worse and I don’t want to risk it.

Hi, I didn’t get any. I didn’t need it though.