HELP - “planned” premature baby, should I have a C-section or an induction??

[MrsRose2018]

Hi ladies,

You may have been a previous post of mine saying that my waters broke at 25 weeks. I am now 26+3 and trundling on ok with no signs of infection or early labour!

I haven’t had a meeting with a consultant yet but am looking for advice as to what is “best” in terms of delivery? The hope is I can get to 34 weeks and then will induce me but I believe I also have the option of an elective cesarean as well!

My “birth plan” before all this happened was to go for a midwife led vaginal, non induced birth with a section as a last resort. I’ve accepted I will have a premature baby (just about) but I don’t know whether to go for a planned induction and have an emergency C section as a back up or to have a planned section!

Everything is giving me conflicting advice! Some resources say a planned section is better because it is “gentler” on a premature baby and reduces the risk of them getting into distress during labour - this risk is increased in my case due to having no amniotic fluid left!

Other resources say an induction is better as the vaginal birth gives them a “kickstart” and gets their lungs etc going.

A final consideration is that I could possibly get to 34 weeks, be fine and be able to carry on bit by bit with a maximum gestation if 36/37 weeks but that makes a planned section unlikely as I obviously can’t just shuffle that back.

I don’t care about myself - I’ll deal with the pain and difficulty of recovery post section if that’s what’s best for my baby but as this is my first I just don’t know...

Advice/perspectives would be greatly appreciated!

xx

I think that you should listen to the personalised advice of your medical team on this.

AFAIK Generally, in earlier births induction is preferred if it isn't likely to stress the baby too much due to the positive effects on the lungs of vaginal birth and the reduced likelihood of baby needing resus. But your medical team are the ones who can tell you the relative risks for you and for your baby.

A friend of mine 1st baby was very big, second induced at 38 weeks due to size and 3rd she had emergency c section for as baby stuck (even bigger).
Having to make decision between possible c section and induction for my second I asked her what she would do... Having had both. She really struggled to decide but eventually said prefered induction..although process was worse recovery was faster was her summary.... Not sure that'll help you in decision making...

it will be so specific to your circumstances that I think you just need to chat it all through with your medical team and be guided by them.

I was told that generally they prefer there to be at least some labour because it helps to avoid 'wet' lungs that can cause breathing issues, but I'm sure there are many factors that can push the decision either way.

Hi @ChainsawBear I'll absolutely listen to their advice, I just like going in with options/knowledge...

I don't have a date to speak to a consultant or anyone yet and theoretically I could give birth at any notice so i just want to be prepared

Listen to your team but usually they induce because natural birth has clinical advantages.

I'm in the same position and so confused! I've been 'pencilled in' for an elective section when I am 34 weeks as my placenta isn't working effectively and baby is measuring small.

When I spoke to my consultant, they said I could try for an induced vaginal birth first however there was a high likelihood it would end up in an emergency section anyway. Reason being labour was likely to not progress/wouldn't respond well to induction as it's so early. Also with baby being so tiny, would get distressed and not cope.

I kind of wished they had just ruled out that option and taken that decision away from me as I'm so conflicted now. The post surgery recovery puts me off in all honesty.. also recovering whilst also having a prem baby in special care is worrying me.

Sorry, can't offer advice but keen to see what experiences other people have had! Hope you make the best decision for you.

Oh also, I've been given steroids now to help babies lungs develop with the knowledge that baby will be delivered either way at 34 weeks. Has this been offered to you yet?

I was induced at full term but my 9lb15 giant was back to back and got very stuck and very distressed so it ended in EMCS and a week on NICU. Personally? Having laboured to fully dilated but for the last couple of hours having DS becoming more and more distressed I would rather have just gone straight for the section as I found it all very traumatic and the mad panic to get him out in the end was horrible. I completely understand you’ve got different risks with a preemie and lung function is going to be one of the likely reasons they encourage you to go for induction, however if I did it again I would want some clear lines drawn on when they would intervene and go to a section.

One of the main issues I had with DS’s birth was that he was sort of hovering around the threshold for a section for a long time, and because I didn’t know any better I didn’t know to insist enough was enough.

Anyway, that was longer than I intended! You never know what sort of labour you’re going to have until you have it, all you can do is weigh up risks according to the advice you’re given and make a choice which is right for you. Recovering from a section with a NICU baby is honestly fine, I was v sore but able to manage and you’re actually doing a lot less baby care like nappies etc so not the same amount of lifting, and there’s always nurses on hand to pass you baby etc so you’re actually probably better supported there than on postnatal ward!

Hi @greenemerald - I'm so sorry to hear about your situation! It's so scary isn't it! Yes I had the two steroid injections In my bum as soon as I was diagnosed with PROM! Jesus Christ I have never felt pain like that so far!!

I literally keep bouncing back between the two - ok vaginal birth/induction. let's give his lungs/body a kick start... oh wait no if he gets distressed during labour that will make him sicker

Ok c-section it's gentler on him and probably better in this Corona pandemic - oh wait no they don't thrive as well apparently and their lungs often suffer

I've been told a "consultant will be in touch/wait for an appointment" and I appreciate right now they are all stretched to breaking point but I'm just stuck in limbo! For ever pro there is a con etc and whilst I will totally go with their advice if I go into labour suddenly I feel my emotions may cloud things a bit and I won't make the "right decision"

@Badgerthebodger thank you that's really helpful to know!

I'm an only child and was a natural vaginal delivery but both my cousins had their 4 children through elective c section and have very positive (or at least no real negative) things to say about them!

If there wasn't any of this "evidence" that a section delivered baby doesn't thrive "as well" as ones delivered vaginally then I would go for it straight away but since his lungs will likely be shitty due to being preme I just feel stuck between a rock and a hard place!

I would wait and see what the consultant says. It’s hard for anyone here to advise you when they don’t know the specifics of your case and it may well end up with you not having to choose anyway. You might labour spontaneously and deliver without any problems. Or things might change and you might have to have a CS fairly urgently without any time for induction.

As above.. consultants will know best but my induced PPROM births were as follows...we were suggested natural deliveries due to it aiding babies lungs

dc1 induced Natural (36 weeks) - 3cm to 10cm and out in 21mins ..everyone was shocked .. mw said i got lucky and it was a reward for difficult pregnancy

DC 2 induced natural (34 weeks) took hours and hours on a drip with nothing happening... examined at 7pm by consultant due to concerns over distress ..he declared me 0cm /0.5 if I was lucky... baby arrived at 7.07pm

Dc3 EMCS 35.weeks - emcs as breech .. went smoothly

Dc3 induced vbac (34 weeks)... again super fast ...16mins from 3/4cm to delivery.

I think you need to take the advice of your Consultant in your case.

I had a baby at 34w and was recommended a section as baby not strong enough for a labour. It's so dependent on your circumstances.

I've also had a normal delivery and can see advantages of both types.

I’ve had those steroid injections...and fooking hell they hurt

(Dd tried to come at 28 weeks which is why I needed them but she stayed until 38 thank god)

My mum had a premature baby born via c-section after an induction failed and his heart rate struggled.

She had to keep syringing fluid from his mouth because the natural compression during labour never happened.

I would listen to what the professionals say, go with what they say but accept that plans change

An induction often won't work if you're not ready to go into labour anyway. I've had 4 inductions and 2 ended in emergency c section. A planned section is better for everyone all round than an emergency one. But you never know, the induction might work in which case a vaginal birth would be preferable. I really struggled with this choice myself, there's no right or wrong answer. Good luck.

I had my youngest son by planned csection. He was 34 weeks. I had the section because my other two children had been emergency csections due to labour not progressing. I had steroid injections for him but at the birth he really struggled to breath and was none responsive for nearly 15 minutes. He now has development delay and other SEN. I think a labour to get lungs working is always better (if at all possible)

I was induced at 36 weeks. Waters broken 1am, drip 5am. Steadily dilated until lunchtime until I went from 4cm to 10cm in 20 minutes. Baby born at 6pm by forceps as the pushing stage was a bit fruitless and I was exhausted.

The midwife said afterwards that it depends on how well your body labours, some people get induced and nothing happens or they only get to a few centimetres before it stalls.

I guess it depends whether you want to take the risk or not, I'm sure you know your own limits and whether you feel it is worth giving it a go.

In terms of baby, my daughter was 6lb 5oz and coped fine, APGAR of 10 when she came out. I'm sure they wouldn't offer it if it was unsafe for the baby. Good luck

I really relate to you completely as those are my concerns too. In my mind, I always planned to have a natural birth with skin to skin straight away and just a very flowery outlook lol. I've been doing hypnobirthing too. But as long as baby is delivered safely, that's the main thing. I think if baby is ok then doing skin to skin, delayed cord clamping etc is still possible even with a section. If that's something you'd want.

My delivery options were only just discussed and I'm now 32w! They've been reviewing me so regularly and just taking each week as it comes so it's hard to predict.

Ah nooo.. I've heard the injections are painful! I've been given pills instead to take. Apparently my hospital don't do the injections, so have two doses to take 12 hours apart.

It's such a tricky one but I guess we'll be guided by their recommendations. I'm leaning towards the planned section as my consultant said that was preferred, but will give it a lot of thought over the coming days. Because my baby is smaller than average I guess the chance of distress is even greater.

I hope we both get clarity in our decisions! Good luck :)

Hi ladies

just want to make it clear that I will absolutely listen to my consultant and that I know it is hard to advise without knowing my individual circs but as of yet I have had NO contact with a consultant, NO advice and NO idea when I will get any** at this time!

I'm not making a decision right now and I know it to really depends on how things play out but I don't think it would be sensible to not at least know my options and have some knowledge of respective risks and benefits - esp as I could go into labour any second

So yes, I will be guided by the professionals as you suggest but I would just appreciate personal experiences and opinions

Induction is a b and as some people have said, it often ends in EMCS as basically the baby isn't really ready to come out. I'd go straight to CS. That's what I did and best decision I ever made, but that's just me.

@greenemerald hypnobirthing helped me theiugh my section. :)

I had a section for medical reasons at 36+1. I was heavily monitored and at any point from 34 weeks they would have whipped her out if she was showing as anaemic.

I had a dream recovery, my pain was managed well, and 2 years on my scar has faded, with no raised tissue. I wouldn’t want to be induced and labour just to have a section anyway, save yourself energy.

Something I wasn’t prepared for, was after neonatal you go onto a transitional care ward. You stay there until they’re happy with feeding and weight gain. I was there 10 days and I wasn’t expecting it, so it was mentally tough.

Best wishes.

I had an attempted induction at 33+5. My body was over stimulated and contracted 8 times every 10 mins 🙈 baby panicked and heart rate plummeted. Ended with EMCS. I was strongly advised at the time that induction and vaginal birth was better for the lungs of the baby.

Now pregnant with DC2 and was talking options through with my new consultant. She suggested as DD was small for gestation an induction should not have been attempted as it was always likely to distress baby.

In honesty I think you need to ask your medical team about your situation. Get a second opinion and do what you feel comfortable with, please advocate for what you want.

Good luck 💐

Ladies thank you all so much for your input!

It's really helping me understand things better!

I am in hospital 2 x a week every week till it's go time for monitoring/CTG so I will ask to make an appointment with a consultant as soon as one is available!

Right now I'm poooooosibly leaning towards a planned section. If there are risks of baby's lungs with both an induction and a section, I think having "gentler" section with no risk of distress maybe tips the scales marginally!

I'll see what the Consultant says nearer the time and if it transpires that an induction is the better option then I'll go from there but I feel so much better having come to a vague personal decision.

I'm a bit of a type A and having lost every ounce of control over everything right now it's quite upsetting for me.

For me knowledge is power and knowledge is calming!

Thanks for all your help :) xx

I had a small 36 week baby via section. He has no fluid. I'd had previous section due to a 2 9 weeker previously. I was sad about the section until I got on the ward. There were other 36 who babies there who has been induced because of issues and most had ended up wit tug emergency sections as the babies struggled. My baby has no issues after I had him