Which method of delivery?? What would you do? Please advise...

[dubai71]

I am 41 and 35W with a long awaited DC

There are a few issues affecting the delivery method:

1. Because I am 41 they will not let me go beyond 40W.

1. I have had previous gynie surgery for endo which apparently means that there is a risk of that surgical scar rupturing in labour and this could be dangerous for DC and me. I think that this is the same risk as for those who have had a CS previously (c. 1 in 200).

1. Apparently the risk of scar rupture is greater if induced and so they will not "drug" induce me. However, they still could try and break my waters.

So, as far as I understand my options for delivery are as follows:

a) Forget the natural route and have a planned CS at 39W

b) Try the natural route- sweeps starting at 37W, medics break my waters at 40W. If for any reason labour does not progress, I would have to have an emergency CS as I cannot be induced

c) Compromise position- sweeps starting at 37W, if nothing happens by 40W then have CS booked in. I guess this could still end up in an emergency CS

I have to decide by next week and just do not know what is best so would be really grateful for some experienced advice. We have had a long and difficult journey to get to this stage with DC so just want the safest method but appreciate that nothing is without risk.

I am thinking that maybe the planned CS at 39W may be the most straightforward option but am concerned as to the recovery from a CS and bonding with DC. Will breast-feeding be more difficult? How long will I be in hospital? Is an elective CS less traumatic for DC? I was on steroids for quite a while to prevent miscarriage, if I have a CS will I have to wait for much longer to try and shift some of this steroid blubber? Mentally, which method is better for avoiding depression?

Thank you for taking the time to read this! If I haven't sent you to sleep, please let me know your views

Firstly Congratulations! I am 36 + 5 with my second DD.

Some points to consider?
What kind of family support do you have? Would you have plenty of help after a CSection? Someone to drive you around if needed?

Would it be much easier for your DP/DHs work to have a set date?

Is it 'just' your age that means they want to induce at 40 weeks, have you deter other options/closer monitoring and discussed this with your Consultant? Although to be honest I would accept induction at 40 weeks in your circumstances if you don't mind me saying.

They may not be able to 'do a sweep' at 37 weeks, if you're just not ready it won't be physically possible.

Your questions:
Bonding with your baby does not need to be affected after a Section, if you do go down the C Section route consider writing a detailed birth plan & discussing it with your Consultant:
You could maybe ask for your DH to tell you the sex (if you don't know), you might be able to have baby up into your chest, chose the music, if you can't do skin to skin immediately you can in recovery or DH can.

Your milk might take a bit longer to come in post Section but this might well be worse after a traumatic VB (& a bleed say) or after a EMCS. You will probably be in roughly 3 nights so will hopefully get plenty of help with BF.

In terms of weight loss, yes, a section will make it harder to exercise but you will be BF which will help and you can do gentle exercise such as walking with the pram. It sounds like you've waited so long for this baby so why not just relax and enjoy the first 6 weeks, eat sensibly and breastfeed these early days are so precious. Then after your 6 week check with your GP think about more serious weight loss/exercise if you want.

In terms of PND I think it's such an individual thing that there is no straight forward answer as to whether you are more likely to get it after a section. I think what is important is that YOU are happy with your choice and have realistic expectations not whether you have a VB or CS per se.

FWIW I think I would go for a sweep from 37 weeks if favourable otherwise have planned C Section at 39 weeks.

Are you on the April 2013 thread? Come & join us if you fancy a chat in antenatal clubs, we are very friendly.

There's no such thing as 'not allowed'.

You have another option, which is to wait and see if you go into labour naturally after 40 weeks. You could then opt for ELCS after 10, 12 or 14 days rather than induction, or you could opt for expectant management after that if you go past 42 weeks.

I'm not advising that you do this, but I am saying it is an option you are allowed to consider.

I had an elective c section as my baby was breech. It was useful in some ways as I booked for a Friday so was easier for dp and family. I stayed in 2 nights but they wanted to boot me out after 1 despite the vs being at 5.30pm. I insisted I stay as I wanted more help breastfeeding. I don't think I would have bonded more had I had a vb but I do feel a bit cheated of the experience. obviously I don't know the ins and outs of your situation but I would be keen to take the option that kept the baby inside me as long as possible.

Thank you ladies for your helpful replies. Much appreciated.

Flisspaps- I appreciate there is no such thing as "not allowed" but there is evidence of increased still birth when mothers who are 40+ go beyond 40W. Given the journey we have had to get here that's just not a risk I want to take.

Toobreathless- THANK YOU

A further point I forgot to mention is that if I have/try for a VD, the fetal heart rate and the contractions would have to be constantly monitored. I assume this means that I will have a fairly/very static bed bound delivery which I understand would be longer/more painful and also may mean that things stop and I end up with an emergency CS. It seems that all roads are leading to CS and I would rather go elective than emergency.

I do understand - it's just that unfortunately some women aren't presented with all of the available choices and the associated risk/benefit information, and are led to believe that there are things they are not 'allowed' to do. If it is an informed choice then that is an entirely different matter.

The very best of luck to you - I think in your shoes I'd go for ELCS rather than early induction; so many inductions end up in ELCS anyway and having had one induction at 42w, with various third stage complications I wouldn't have one again.

I'd go for an ELCS at 39 weeks. I wouldn't even consider the other options.

Having had a failed induction and EMCS I wouldn't want to have another EMCS as you are exhausted before you even begin. Everyone I know who has had a ELCS has a very positive experience.

If you are unlikely to have any more DCs I would go for the ELCS if they are offering tbh. With the restrictions (which you are free to decline BTW) on your labour the chances of a spontaneous VB are reduced and most of the risks of CS are related to secondary infertility and future labours etc, though breathing problems are increasing in babies when mum didn't labour. I've had 2 x EMCS and would choose ELCS if I had any more. Which I am not planning on!

It seems to me (and I have no experience to speak of) but an ELCS would give you some control and calm. The other scenarios might end in a more stressful delivery and stressful few weeks waiting to see what happens. You have lots of valid concerns over bonding etc. but if you know it's happening then you can plan for it. As mentioned already a detailed birth plan is a start, but also support and good discussions with your DH/DP. It means you can be prepared, relaxed (as much as possible) and enjoy it.

I had an emcs with DC1 and based on that experience am optigf for an elcs this time. The recovery for me was painfree and fine, though you will be a bit 'slow' during the first week. Since you don't have other DC to worry about/run around after, that shouldn't be a problem!

Forgot to say - so in your situation I'd go for an elcs to keep things less stressful and more straightforward.

another mumsnetter recommended this excellent book - you can download to ipad/kindle which is very interesting regarding ELCS and their safety. i really enjoyed it and feel much more in the know now. it might help...

www.amazon.co.uk/Choosing-Cesarean-Natural-Birth-Plan/dp/1616145110

Congratulations on your imminent arrival.

I would echo Toobreathless? wise words.

I was 39 and 40w when my waters broke and then I needed to be induced with my much longed for DD1. I was effectively bedbound for fetal monitoring for 19 hours and then had an emcs due to DD1?s heart rate dropping. Luckily I'd had a epidural so was able to be awake throughout the cs, however a lot of emcs need to be done under general anaesthetic.

DD2 I had a elcs, again with an epidural, and it was a much calmer process, infact I got to lie on the bed and read a book whilst waiting for the theatre ? a rare treat as DD1 was 22mths old .

I had no trouble bonding with either child, or BF both successfully,
I can?t tell you what to do, but remember that you?ll do whatever it takes to end up with a healthy child and births very rarely follow the birth plan (that was a big shock to discover).

I had an ELCS with my DS, who was breech. I felt that it helped me bond and to breastfeed successfully. It only takes about 1/2 an hour for them to sew you up, then you get skin to skin with the baby in recovery. Once I got home I also felt that I wasn't under pressure to rush around doing everything as I was recovering from surgery, so I just sat around cuddling him and feeding lots.
Recovery was way easier than I expected. You need to take it easy and not lift anything heavy, but tbh none of my friends who had natural births were exactly running marathons straight after birth!

THANK YOU ALL for your very helpful opinion.

Kelly's suggested reading matter arrived from Amazon today. Think we have decided on ELCS....

x

Late to your thread but that sounds like the best idea. (Speaking fronm experience of an horrendous EMCS, you don't want to end up there).
Good luck!

there is evidence of increased still birth when mothers who are 40+ go beyond 40W

The risks are still very small. Something like 1 in 450. But as you say, you have had a hard time getting to where you are and I can understand why you wouldn't want to go over. My health trust doesn't induce on an age basis alone (I'm 40) and some of the other mums on the 40+ thread aren't bring induced either so it's not universal policy.

At the end of the day you need to do what feels right for you. I have friends who have had ELCS and ECS and it hasn't affected breastfeeding. I had a natural birth last time and never produced milk. It really doesn't always follow that CS disrupts BFing or natural birth guarantees it.

Good luck in whatever you decide to do.