Complicated pregnancy & can't decide between early induction & c sec - help!

[Evianfash40]

Wonder if anyone can offer any advice - I am 37 weeks pregnant - (2nd pregnancy but 1st child - lost my first at 15 weeks). Naturally I have been very anxious throughout this pregnancy after what happened with my first, I'm still terrified about something going wrong.

At 30 weeks I got diagnosed with a rare autoimmune disease called ITP - my body is destroying my blood platelets, so my platelet count at present is too low for me to have an epidural despite being prescribed steroids to try & boost them. The steroids just aren't working. At present the consultant has advised that they will induce at 38 weeks and try to boost the platelets with a higher dose of steroids or immunoglobulin therapy (bit like blood transfusion) so that I have the option of an epidural. I have already said that I will refuse the induction if I don't have the option of the epidural as I have heard inductions can be particularly painful - particularly early. The consultant said I could have a planned c sec if I wanted and they wouldn't make me do something I didn't want to do. Also I had a growth scan this week and baby is measuring in 95th centile. To make matters more complicated, they don't know if the baby has low blood platelets like me (cannot test until he is born) which can cause internal bleeding if they are very low so they have said that during delivery they will try to avoid using forceps/ventouse.

Here's my dilemma which is the best option for delivery - both will have to happen at 38 weeks as they will try to boost my platelets enough for me to have epidural/spinal - altho lower count needed for spinal vs epidural. Weighing up the options I am leaning to the c sec for being more controlled/less risk for both of us/avoids forceps & ventouse/baby is big and my partner can be there.
Despite this the consultant still thinks that induction is better but I don't know why. Because c sec is considered major surgery? I am not confident at 38 weeks that an induction will be successful, and will not lead to the intervention that I am supposed to be avoiding - forceps/ventouse. I am already worried for my baby having lost one before. I will also not be able to have my partner with me during the induction because of covid so he can only join when in active labour.

Any thoughts/advice on which direction to take?

Ooh I would defo go c section in those circumstances

I'm sorry for your previous loss abs the complications you're going through. If I were in your shoes I would opt for c section xx

I had ITP in pregnancy twice and had elective c-sections with a spinal. My platelets started to rise as soon as I had given birth and neither child is affected.
Wishing you all the best with the rest of your pregnancy and whatever decision you make xx

I was induced at 39 weeks and ended up with a section after nearly 5 miserable days in hospital. If I had to do it all over again I'd choose the csection every time. You'll have a planned time frame for the birth, you will be under the best care in surgery as it's all hands on deck rather than a single midwife during induction. Plus as long as you keep on top of the pain meds the recovery isn't too bad. And your partner can be there the whole time.

I had an induction at 38+ 2 without your added complications. Would you be happy with an induction with just pessary/breaking of waters, then go to C-section rather than use the drip? Low threshold for deciding it's not working as ideally want to avoid forceps/ventouse...

My induction only needed the pessary gel, water went on their own before there was "space" in the delivery ward - I jumped the queue...

Just being 38 weeks doesn't necessarily mean an induction will be difficult, especially with a bigger baby.

I had a planned section nearly two years ago, would absolutely have one in your circumstances where there are too many variables and anxieties around an induction.

Obviously all births are different but I recovered very quickly and was driving in three weeks and walking a good amount by day 3.

Put yourself front and center when making the decision, what will give you the calmer more controlled experience.

In those circumstances, I'd personally go with a section 100%. I was induced at term (baby measuring big - although they predicted 8lbs something - turned out to be 10lbs!) and it ended in a crash section anyway under general anaesthetic with severe complications. The induction process has its own risks and i was so exhausted from a long labour I was delirious by the time the section happened.

Basically, inductions, even at term, can fail or cause complications resulting in a section anyway. And, by that point, the experience may already be traumatic. Those I've spoken to who have also had severe complications tend to have been induced. Not saying it's inevitable, I'm sure there are some great induction experiences out there, but so early on I would be hesitant and choose the CS.

Of course it's entirely your choice and what's right for you and baby! Congratulations

With all the factors you mentioned I’d go for a c-section. Primarily because it sounds like that would be your preference and that’s a very important consideration. Oh and I too wouldn’t go near an induction without an epidural!! Good luck :)

Wishing you all the best.
In your position I would go for the elective c section. I had one for a breech presentation so different reasons but it was amazing - calm, planned (I know that that's fundamental but it still surprises me how 'planned' it felt - ordered, relaxed, if you know what I mean) and the recovery was great, I only took pain relief for 24 hours because I genuinely didn't need it.
If I have a second it will also be a c-section and that's fine with me.
Note - I was absolutely committed to a vaginal delivery, I hadn't considered it being any other way until he turned to breech at 36 weeks.
Good luck XX

Induced at 39 weeks. Got nowhere.

After five days requested a section. It was a delight.

Absolutely a planned section

Im sorry for your previous loss.

I would take a planned section over an emergency one which could happen if the induction doesnt work out.

@Evianfash40, very similar situation here. Itp, platlets are currently just high enough for epidural etc.
Baby also measuring 97th centile for weight - higher than 97th for abdominal circumference so chance of shoulder dystocia.
Was offered early induction or csection, both of which would be between 39-40 weeks.
I have opted for the section, a planned a section is supposed to be very calm etc so feel better knowing its planned.
Personally didn't like the idea of potential damage caused to baby if his platlets are low and forceps etc were needed (even though they would try to avoid them)...
I also figured there would be a high chance I'd end up with emergency section anyway!

I agree with pps C- section seems the most sensible under the circumstances, unless surgery itself might be more risky due to your platelet issue .

I have had an induction at 38 weeks because of having a medical condition .
I had 2 pessaries, my waters were broken, and I had a drip. I did not require forceps, or other interventions.
This was my second pregnancy. I did not have an induction for my first pregnancy, and for me, the two births were quite similar. I did not really find the induced birth to be more painful than the first birth. I had exactly the same pain relief for both births which was gas and air and diamorphine.
If I had another child I would have be happy to have an induction again, if it was advised.

C section but only because my induction resulted in a traumatic birth. I've had elective sections for my subsequent children

C section with spinal would be my choice in this scenario.

I usually am pro vaginal birth every time but in this case I would go with c section, mostly because of your anxiety . Good luck 😊

Planned section in your case

Thanks for all the advice ladies, really helped to sound it out with others.

I've found the whole birthing part to be one of the most subjective topics amongst friends & family and lots of opinions flying around. Mainly that the c sec was frowned upon but that also came from those who had uncomplicated pregnancies. I have mostly felt like I was being pushed into an induction which I don't believe is the right way to go in my case. In an ideal world I would have wanted the opportunity to go into natural labour but that isn't an option.

I had another hospital appointment today and my platelets have dropped again to 70 from 80 on Tuesday despite taking the steroids. The lowest they've been in pregnancy is 45. But normal range is 150-400. I need them to be at least 80 for an epidural but apparently only 50 required for a spinal.
They have asked me to double my dose of steroids from today and go back on Monday for another blood test. And if that doesn't work then they will try the immunoglobulin treatement. But trying to keep positive and I think either way they will be keen to get my baby out asap so hopefully by end of next week I will have him here with me safely!

Did the consultant say why they felt induction was the better option? Annoying if they stated that then didn’t actually back it up with anything to help inform your decision.

I’d probably be swaying towards c-section in your situation but it’s very personal. Try and get as much balanced info to inform your decision and remember it’s your body and your choice.

@picklecustard no they didn't say. I didn't see her today as she was too busy but I've requested to see her on Monday to discuss. I think there's a preference to vaginal birth over c sec, but not sure the reasons here. Also to note I'm in Switzerland not the UK, moved in March and found out I was pregnant, maybe they do things differently here.
I think my head is a bit fried from it all, I've been having 4 or 5 appts a week, but the end is in sight!

1000% a planned section all factors considered. I think the recovery period is heavily outweighed by the stress and unpredictability of the induction and you may end up needing a section anyway. Best wishes for you and your baby

Induction is seen as a better option because at the end of the day. Low platlets ane blood loss are not what you need to happen. Because then it turns into an emergency

Blood loss in surgery is not something you want. People can have life long. Life limiting problems with blood loss. It can cause problems with your brain and all sorts. Your hope it wouldn't happen. But major blood loss is much more likely. Than with a vaginal birth. That's why they try not to do surgery if they can avoid it.

I had a c section. I also had a big blood loss. I've now been left with a life long illness due to it

I would opt for a vaginal birth everytime.

However. It's a very personal choice.

Some ladies don't get out of bed for days after. It's major surgery. You can't drive for weeks after.

But you need to do what you feel right. ❤️