Induction or C-section at 37 weeks?

[RedPandaMama]

DD2 is due first week of December. However growth scans have shown her growth has dropped off and she's now very small - 3rd centile down from around 40th initially.

I have a final scan booked in a week where they will make the decision if she needs to come out asap due to possibly not growing properly.

Originally after a traumatic 3 day hospital birth with DD1 I had decided on a home birth. This is looking extremely unlikely now as I am under the consultant and baby is currently only 4lbs.

My options are:

1. Go against medical advice - refuse induction and keep her inside until natural labour occurs with twice weekly monitoring.
2. Agree to be induced at 37 weeks.
3. Opt for an elective C-section between 37-38 weeks.

If you had the choice, what would you do?

I want to do what is best for my baby but I'm really worried about the whole thing. My last labour was extremely painful and resulted in a bad tear which took 12 months to heal. Induction is likely to take at least 2-3 days for the baby to arrive, as they start with the 24h pessary and go from there plus may need a few days in hospital to check her over. I've been advised the average time from admittance to baby being born is 48h, plus whatever the stay would like afterwards with a possibly underdeveloped/low birth weight baby. My partner can't stay with me until I'm in active labour so I'll be on my own, and won't see DD1 who is only 4, for potentially a week, I'll miss her so much. But then I'm also terrified of the idea of surgery and how the recovery will be and how I'll manage with a newborn and 4 year old. I don't really like any of the choices! My partner has just started a new job so he won't get any paternity leave, though hopefully our family can help out as much as possible.

If anyone has any experience it'd be greatly appreciated, particularly if you've experienced an induction and/or C-section and would have a preference of the two.

I had an emcs first time round, second time round I will need a CS (planned) at 37 wks.

Technically it's term but from what you said they are monitoring your little one for growth - it may mean a short stay in scbu (although it's hard to say for sure)

With your eldest I would start by talking through the "mummy is going to have the baby and might stay in hospital" aspect and maybe find some age appropriate books. You can WhatsApp your DD as soon as you are well- keeping her in the loop will make it easier for her to understand.

I would aim for induction myself, as a labour is potentially better in terms of recovery times for you, and labour prepares the baby for being born. I was a mw and hv before I was a mummy and this would be my personal preference based on optimising out comes for you both, post-partum.

But only you and your mw team can make that call ultimately. Really sorry your first delivery was traumatic- I would make sure your team know, just incase it affects the decision making process.

Wishing you well xxx

@Whereismylatte thank you so much for the helpful response. It's good hearing it come from someone with professional experience too. I keep changing my mind daily about which option to take, I'm really uncertain.

3 without a doubt. Baby can be lifted out and seen to whilst your being sewn up. It also means that you'll probably be in and out in 24-48 hours. If baby is in SCBU then you will have the flexibility to see your older child and visit your new baby.

(But i am very pro c-sections and would choose that over an induction any day.)

My personal preference would be to opt for the elective section 100%.

I have now had 4 c sections, my most recent one being 8 weeks ago.

My first birth was induction that failed and ended in an emergency c section. The induction was for me, hell on earth. The most painful, traumatic thing I’ve been through.

My second, third and fourth pregnancies were all elective sections.

My fourth was done at 37+4. I was home the next day with each of my sections. Recovery was totally manageable. This time was slightly more difficult as I opted to be sterilised at the same time.

I’ve been through this recently (twins). I opted for starting with induction but having a section if things didn’t progress quickly (because in my understanding if your body isn’t near ready for labour when you start thw induction process, that’s when you get the very long drawn out pessary, another pessary, third pessary, ARM, drip, epidural, increased risk of intervention in for ages rah rah). And that’s what I did. Induction with pessary achieved fuck all over 24 h, I requested a section. It was in my birth plan and I reiterated it to every passing MW. It required more advocating. Than I’d have liked but was otherwise fine.

Sympathies - it feels a bit “shit sandwich”, but you do what you have to do.

What does the consultant advise? I was advised to be induced over section as it's better for baby's lungs and in general. I definitely wouldn't go for option 1. Induction was straight forward for me, second labour likely to be easier than first too.

I’d go for induction on the provisio that if labour isn’t forthcoming after 12-24 hours the induction process is to stop and it’d be a section.

I’m having an induction on Thursday at 39 weeks. If nothing is happening after 24 hours I’m stopping it all and requesting a c section.

I’ve had 2 spontaneous labours and 1 induced at 42 weeks which was great. I am though aware that if your body isn’t ready it’s pointless!

If baby is too small I think it’s safer to get them out sooner x

C-Section

I was induced at 38 weeks with DS1. I went into hospital on the Monday and he was born by EMCS on the Saturday. Horrible experience and I swore I would never be induced again.

DS2 was born last April by elective CS and it was great. We were out the following day and I recovered well.

Personally, I would not be induced again its your decision. Good luck with whichever you choose.

Absolutely option 3 with the way that maternity units are at the moment.

I've had the situation you're in with all three of mine but had different paths with them all. First was iugr and dropped from 50th centile to 5th. She was also breech and turning her failed so I had a semi elective section at 37+1. She was 5lb9 so actually 9th centile. Ended up with borderline fluid exchange jaundice and a 11 day stay in hospital. Second time around the same happened except Dd2 was 9th centile. I'd argued against a section as the first was a total shitshow. Was induced at 39+0 and failed to progress so ended up section on 39+1. The little sod was born on 44th centile at 7lb3. Yet she still fit into the early baby clothes her sister wore. They were both really petite- their leg measurements had always been the smallest on the scans- just Dd2 was fatter as she'd cooked longer. Section recovery was awful and I ended up back in theatre.

Third time around I was absolutely adamant I was going to be induced or have a section. Fought for a home birth. Growth scans again showed that Ds1 had gone from 50th centile to 8th.... Wasn't having it third time around so I chose expectant management. Twice weekly Doppler's/ctg and fortnightly growth scans from 38 weeks. Every appointment was constant pressure to go for section or induce including a three hour lecture from a consultant who wouldn't let me leave until I threatened to call security. Anyway. Ds1 born 41+6 at home weighing 8lb15.5 . Still short legged like his sister's and fit into newborn for ages despite his weight.

Obviously my situation and history is different to yours. In order to make my decision I read the rcog gtg33 (small baby guidelines), an absolute tonne of research on nice/Cochrane library, the positive birth book by Milli hill and then used the "brain" decision making tool to decide what to do. Ultrasound scans are not infallible. They can be up to 20% out depending on your gestation, the operator, position of baby and machine variations. Whatever you choose I hope you have a lovely birth and enjoy the cuddles with your newborn. Xxx

Should say third time around I was adamant I wasn't going to be induced or have a section. 🤦🏼‍♀️

C-section. I personally prefer natural waterbirths with whale music etc but I had an attempted induction at 36+5 with my youngest and it didn't work. Ended up with a crash section.

Personally I'd go for an induction.
My C section was in June, the recovery was horrific, I wish I'd d of had another vaginal birth even though I had a bad tear.

C section or trial induction and then c section in preference to having the oxytocin drip.

C section without a moments hesitation. This is from the point of view of an induction resulting in EMCS with DC1, followed by a lovely relaxed planned c section (on medical guidance) with DC2.

There was something really special about putting DC1 to bed the night before knowing it was going to be the last time with just us to think about.

I had the option with my DTs, although I didn’t quite make it to 37 weeks. I ummmed and aaaaaahed but chose elcs on the day they decided to deliver them due to severe pe.

Due to some very minor complications with DD (looking back, it was bloody terrifying at the time!) it was absolutely the best decision for us because she wasn’t breathing properly when she was born. The three of us each had our own medical team, and things got sticky with DD another team rushed in as well and whisked her off to scbu although she joined us in recovery later.

Whilst my journey is obviously different to yours, the faintest hint of higher risk would have me going for the elcs, which is ultimately what swayed me from my personal wish to have a vaginal birth (DD was breech/transverse and there was a pretty good chance she’d not turn downwards and I’d end up with an EMCS after a vaginal delivery with DS). I shudder when I think of what could have happened potentially without my elcs, especially after what happened with DD, but I have no way of knowing If the same thing could have happened if I’d had a vaginal birth iyswim!

They’re my only children so I didn’t have any others to worry about, but my recovery was relatively speedy (out at 5 days shopping, DH back at work after a week, driving after 2 weeks). My DTs are 3.5 now, and I would pick the elcs again if I were pregnant with another now. Partially because it’s all I know and I don’t know what birth injuries I could potentially suffer from a vaginal delivery, but also because I believe it would be a calmer and safer experience for us.

I don’t envy you your decision though, because it is a high pressure choice and none of the options are perfect. Good luck with the birth however you decide 💐

I had a baby with IUGR, delivered at 36w by section. I didn’t have a choice at that point but before then I had calculated my risk of an emergency section (there are online calculators) at over 50% so would have pushed for a section anyway since the chance of ending up there was so high.
Baby corrected his growth after birth and was on the 96th centile at 3 months! He was such a fat baby, nobody would ever believe his birth weight.

I thought smaller babies didn't cope as well with labour and were more likely to become distressed. Inductions are more likely to take a long time and in your situation I would guess you are more likely to have an emcs than most for this reason, also maybe to avoid instrumental delivery given previous bad tear.

I would definitely opt for a c section, but I was induced for first, very traumatic and had a c section 2nd time, will also be having c section again in January.

Recovery for planned sections is so much better than for emergency ones. I was home after 24h and going on walks within a few days. My friends who had emergency sections were a lot slower to recover.

I would want baby out without added stress of induction and possibility of emergency section.

2 emergency here and one elective here, worlds apart. When an elective you can plan other Childcare, be calm and relaxed and for my experience a speedy recovery. But also your baby delivered quickly and safely and looked after.

Thank you so so much for all the kind comments and helpful stories. It's so much appreciated. I feel like I'm going out of my mind with the options going around in my head. Thanks so much.

No direct experience here as one of my was SGA but only found at 40 weeks so was induced, the second was measuring SGA for ages but ended up putting on some chunk between scans and was normal-small in the end.

Two comments that were made to me relating to DD2- one the consultant said to me that very small babies tend to struggle with labour (in the context that she was 10th centile at the time so likely to cope ok with induction). And the second was the senior midwife when k went in for my induction who said there was very little chance I'd have gone into labour successfully if they'd had me in at 37 weeks rather than at 41 weeks (in the context that my Bishops score was still only 2, even at that stage!).

So just off those two random points I would opt for ELCS if it were me.