C-section or induction? Help please

[GrapefruitTsunami]

Hi,

I met with the consultant for the first time yesterday and she has offered me the choice of an elective c-section or an induction. Whichever I choose will take place at 39 weeks. I need help with this decision and would love to hear people's experiences of ELCS and inductions.

ELCS: What's the recovery and scarring like? Inductions: Do they tend to go on for days and end with instrumental births or EMCS? What else should I be thinking about wrt this decision?

Some context: I'm over 40 and in good health generally. I have had a previous "natural birth" that started spontaneously and was pretty straightforward with no complications but it was many years ago (I was in my 20s!) and I sadly lost the baby to Group B Strep a few weeks later. This time I will have to be on antibiotics for at least 6 hours to protect the baby and obviously am more anxious to ensure baby's health after that experience.

I'm only 20 weeks atm so still some time to think about this. WWYD?

Have you been offered a ELCS due to the previous Strep B?

Sorry for your loss!
I had an induction with my little one, I was in for a few days as I was induced at 37 weeks due to growth problems. My body wasn't ready so that's why it took longer. When my waters broke active labour only lasted a few hours and I was home within 24 hours. Managed on gas and air.
Up and about straight away and felt great. The thought of a c section or epidural terrified me obviously if I needed an emergency c section I would have to deal with it.

Sorry for your loss.

I would go for the section. Planned are usually very calm and recovery great. Scars tend to be neat and heal well.

I've had an emergency section for reference.

I would go elcs over induction.

I had an induction with our 1st. Started off at 39+3, taken to delivery at 39+6 5cm dilated. I hated the hormone drip, made me vomit and the contraction were much more intense than with my 2 natural births after her. Was high off my ass on G&A and asked dh to get the monkeys out of the room lol, midwife talked me in to epidural after than and I wax much calmer then as the pain was gone. She ended up in distress so they used vontouse and gave me an episiotomy cut, she had cord round neck and dh said she was blue. Once they sorted her out I got cuddles and was able to walk within an hour of delivery (bit wobbly though). My least favourite birth tbh, I hate lengthy stays in hospital and that was 6 nights in total. Had 2 vb's after that then elcs with breech twins. CS I had heavy blood loss but was walking within 12 hours and refused painkillers after spinal wore off. I only had 1 night in hospital, my vb's I spent 2 nights in after with each (all different reasons). I did get an infection after my cs but it was painless and sorted out with removal of undisolved stitches and antibiotics. Resumed most activities straight away, only difference to vb's was I avoided heavier lifting for the 1st few weeks. No driving while dh was home after all of them, he got 2 weeks paternity for vb's but 6 weeks for cs.

I've had two inductions due to GD and both times baby was born within 24 hrs of arriving at the hospital. First birth involved forceps but that was due to baby being back to back rather than the induction process. Second one just gas and air and no interventions.

Oh and my other 2 vb's I had unassisted deliveries despite them being much bigger than the induced one. 2nd over 3lb heavier than her and the 3rd over 2lb heavier, she was an average weight the others were just little beasties but then our twins were each heavier than her too and they were brought 2 weeks early lol.

I think you are being offered an Elective C-section to give your baby the safest way into this world. In your shoes I would go with that option and be very relaxed about it. It should be a calm experience.

@GrimDamnFanjo

Have you been offered a ELCS due to the previous Strep B?

Yes, that and my age.

@Metallicalover @Gabby82 Nice to hear some positive stories of inductions! Thanks. This is how I'd hope for it to go if I was to have an induction!

@Chelyanne

I would go elcs over induction.

I had an induction with our 1st. Started off at 39+3, taken to delivery at 39+6 5cm dilated. I hated the hormone drip, made me vomit and the contraction were much more intense than with my 2 natural births after her. Was high off my ass on G&A and asked dh to get the monkeys out of the room lol, midwife talked me in to epidural after than and I wax much calmer then as the pain was gone. She ended up in distress so they used vontouse and gave me an episiotomy cut, she had cord round neck and dh said she was blue. Once they sorted her out I got cuddles and was able to walk within an hour of delivery (bit wobbly though). My least favourite birth tbh, I hate lengthy stays in hospital and that was 6 nights in total. Had 2 vb's after that then elcs with breech twins. CS I had heavy blood loss but was walking within 12 hours and refused painkillers after spinal wore off. I only had 1 night in hospital, my vb's I spent 2 nights in after with each (all different reasons). I did get an infection after my cs but it was painless and sorted out with removal of undisolved stitches and antibiotics. Resumed most activities straight away, only difference to vb's was I avoided heavier lifting for the 1st few weeks. No driving while dh was home after all of them, he got 2 weeks paternity for vb's but 6 weeks for cs.

Omg That sounds like exactly what I fear from an induction - extended pain, distressed baby, instrumental intervention, long hospital stay...! Well done for getting through it! (The monkeys bit sounds cool though haha)

This definitely has me leaning towards ELCS

I opted for ELCS instead of induction. Baby needed to come at 37 weeks either way and I have APS. Went like a dream and if I’m lucky enough to be able to do it again I’ll make the same choice.

Forgot to say - I was 38, almost 39, overweight, and delivering at 37 weeks. I went for elcs as about 40% of women matching my demographic will end up having an emcs after a failed induction, which slightly raises the risk of a blood clot, and I felt recovery would be harder if I was already knackered from Labour, I didn’t want to be off blood thinners for so long if induction ran over several days, and spinal only was the best option for me due to previous non pregnancy related issue.

If I hadn’t had any of these I would have asked for a c section anyway, just as that would have been my preference.

I was induced at 39 weeks. It was really straightforward, I had the pessary at 9.30 in the morning and had the baby by 4am the next morning, no instrumental interventions, bit of gas and air for pain relief. So, it's not always inevitable that induction will lead to loads of interventions. Best of luck to you, whatever you go for; I wish you all the best.

Sorry for your loss

If it was me, I would firstly do some research into the risks of waiting to go into labour naturally, this would be my preferred option and there would have to be a significant increase in risk for me to discount that option.

Assuming it was discounted, I would ask about my Bishop score, and if it was high, I'd go for an induction (with low threshold for EMCS if it didn't progress well) but if it was low I'd go for an ELCS.

I've had a quick look at the RCOG guidelines and they don't say anything about induction for strep B - just that you will be given antibiotics when in labour.
www.rcog.org.uk/en/patients/patient-leaflets/group-b-streptococcus-gbs-infection-pregnancy-newborn-babies/

I would definitely choose the ELCS. It’s defiantly no fun undergoing an induction and then possibly ending up with a CS anyway should something go wrong with the Labour.

It’s a bit like Running a Marathon towards the Winning Post then being told You need to do a 12hour Nightshift straight afterwards without any previous rest or Planning!!

For this reason my Youngest DD was Born by ELCS and it was soo much better, Recovery time was quicker, Staff were well prepared and not tired from being ‘on call’ themselves, and l was able to plan my Childcare for my other DD with more certainty. I was also able to request to have a Sterilisation procedure carried out at the same time, without any further disruption, which they did.

Should I ask to be induced if I have had a positive test for GBS?

Our medical advisers do not recommend induction for anyone as a way of combating GBS infection in babies. Carrying GBS, or your baby being at raised risk of GBS infection is not a reason to be induced.

However, you should be offered immediate induction plus the intravenous antibiotics in labour if you are known to be carrying GBS and your waters break before labour starts, because of the increased risk of early-onset GBS infection developing in babies after prolonged rupture of membranes.

If you live a long way from the hospital or have a history of very fast labours, induction may be one way to try and ensure you get sufficient intravenous antibiotics in labour. However, induction is not without risk itself, especially before the due date. You should discuss the potential risks and benefits of induction with your obstetrician because they will vary dependent upon your personal circumstances.

If you need to be induced, the recommended intravenous antibiotics should be started as soon as possible once labour has started or waters have broken (naturally or artificially) and should be repeated 4-hourly (for penicillin) until your baby is born, and ideally for at least 4 hours before delivery.

Will a Caesarean prevent GBS infection in my baby?

Caesarean sections are not recommended as a method of preventing GBS infection in a baby. They reduce but do not eliminate the risk of GBS infection to the baby, since GBS can cross intact amniotic membranes to cause infection in the baby. There are also risks associated with Caesarean sections; plus the recommended intravenous antibiotics during labour are highly effective and low risk.

If however you are having a Caesarean section, our medical panel’s recommendations with regard to GBS are as follows:

Elective Caesareans
There is no evidence to show intravenous antibiotics are indicated against GBS when a woman is known to carry GBS or who previously had has a baby infected with GBS is having an elective Caesarean unless she is in labour or her membranes have ruptured. If a baby is at higher risk of developing GBS infection and the mother is having an elective Caesarean AND is in labour OR her waters have broken, she should be offered the recommended intravenous antibiotics as soon as possible after the start of labour.
The baby would only need intravenous antibiotics against GBS infection if born prematurely or if there are signs of possible infection in either the mother or the baby.

Emergency Caesareans
If a woman carries GBS or has previously had a baby infected with GBS and needs an emergency Caesarean, she should be treated as for an elective Caesarean – no intravenous antibiotics are indicated against GBS unless she is in labour. If she is in labour, she should be treated as for normal labour up until the time when an emergency Caesarean section becomes necessary, when she should be delivered immediately.

The treatment of the baby for GBS would follow the charity’s normal paediatric recommendations.

From gbss.org.uk/frequently-asked-questions/

Sorry for your loss, I'm sure this little baby will bring you so much joy. I had an unplanned section in January instead of an induction after my waters broke and my labour didn't progress quick enough. The consultant didn't want me to have the induction so i didn't argue! Anyway, despite not wanting a section and being slightly terrified of one all along, it was fine!! I felt great throughout the whole operation, they told me everything that was happening & I relaxed into it & even asked what organs they could see 🙈 the pain afterwards was manageable. the midwives kept pushing me on to see if I could avoid taking the opiates & I ended up not taking any, just diafine. I was up and walking the next morning and had a shower and all the day after. I started going for walks about a week later and walked 5km within 2 weeks. I assumed a section would be traumatic but it was a lovely calm birth and I felt normal again very quickly

I’m so sorry for your loss!

I was induced with my 1st due to concerns over growth and I wouldn’t choose it again.

I went into labour the same night of the induction but it was long and complicated. I ended up having an assisted delivery - forceps and episiotomy. I truly believe my body just wasn’t ready for labour which is what made it so difficult and my milk supply didn’t come in either.

This time around I’m having an ELCS and I’m very happy with that choice. Good luck With whatever you decide!

[quote NameChange30]Should I ask to be induced if I have had a positive test for GBS?

Our medical advisers do not recommend induction for anyone as a way of combating GBS infection in babies. Carrying GBS, or your baby being at raised risk of GBS infection is not a reason to be induced.

However, you should be offered immediate induction plus the intravenous antibiotics in labour if you are known to be carrying GBS and your waters break before labour starts, because of the increased risk of early-onset GBS infection developing in babies after prolonged rupture of membranes.

If you live a long way from the hospital or have a history of very fast labours, induction may be one way to try and ensure you get sufficient intravenous antibiotics in labour. However, induction is not without risk itself, especially before the due date. You should discuss the potential risks and benefits of induction with your obstetrician because they will vary dependent upon your personal circumstances.

If you need to be induced, the recommended intravenous antibiotics should be started as soon as possible once labour has started or waters have broken (naturally or artificially) and should be repeated 4-hourly (for penicillin) until your baby is born, and ideally for at least 4 hours before delivery.

Will a Caesarean prevent GBS infection in my baby?

Caesarean sections are not recommended as a method of preventing GBS infection in a baby. They reduce but do not eliminate the risk of GBS infection to the baby, since GBS can cross intact amniotic membranes to cause infection in the baby. There are also risks associated with Caesarean sections; plus the recommended intravenous antibiotics during labour are highly effective and low risk.

If however you are having a Caesarean section, our medical panel’s recommendations with regard to GBS are as follows:

Elective Caesareans
There is no evidence to show intravenous antibiotics are indicated against GBS when a woman is known to carry GBS or who previously had has a baby infected with GBS is having an elective Caesarean unless she is in labour or her membranes have ruptured. If a baby is at higher risk of developing GBS infection and the mother is having an elective Caesarean AND is in labour OR her waters have broken, she should be offered the recommended intravenous antibiotics as soon as possible after the start of labour.
The baby would only need intravenous antibiotics against GBS infection if born prematurely or if there are signs of possible infection in either the mother or the baby.

Emergency Caesareans
If a woman carries GBS or has previously had a baby infected with GBS and needs an emergency Caesarean, she should be treated as for an elective Caesarean – no intravenous antibiotics are indicated against GBS unless she is in labour. If she is in labour, she should be treated as for normal labour up until the time when an emergency Caesarean section becomes necessary, when she should be delivered immediately.

The treatment of the baby for GBS would follow the charity’s normal paediatric recommendations.

From gbss.org.uk/frequently-asked-questions/[/quote]
Thanks for this NameChange. I think the antibiotics treatment is one of the reasons for inducing me at 39 weeks. So that we can be better prepared and have time for it to take effect before birth whichever method I go with. The consultant said I should be on it at least 6 hours before and I guess that's harder to ensure with a spontaneous labour. I live almost an hour away from the hospital too so that would make it even trickier!

I had a horrific induction and a really positive one. No two are the same, but in your case, I'd opt for the ELCS. I wish you all the best

Thanks everyone for sharing your experiences. It's really helpful to hear about the realities of what can happen. Got to say that right now I feel like I'll be choosing ELCS..!

I was induced with DD at 37 weeks I had polyhydrammis ( too much water) they tried 3 pessaries was in for 6 days and nothing happened.
Had a c section at 38 weeks was brilliant, was up the next morning hardly any pain and home on day 3. You can’t even see my scar and I normally scar badly. I would recommend a c section and will go for one again this time.

I was induced and it was horrendous, sorry. Nearly ended up with a c section anyway due to complications and exhaustion.

Glad to hear some positive stories but I wouldn't do it again.

At least with elcs you'll know exactly what you're in for?

I had a very effective induction with baby #1. Cervix was not ready at all, but with a single pessary I gave birth within 11 hours of insertion.

My preference for the future would be to try the induction but to have a very serious discussion with the consultant at what point we would turn to C section of it wasn't working. Personally, I would try 24h of pessary, probably consent to having my waters broken, and if nothing was doing would refuse the drip and want to proceed to C section. You do actually continue to have choices all the way along the "induction pathway", despite what some HCPs imply.

If you've had a previous successful vaginal birth, I would go for the initial stages of induction with an absolute time limit on it to prevent you getting worn out by the whole process of it and a limit of what interventions you will consent to.