Csection preferable to induction even if you want a vagina birth?

[Rosekeeper]

Keen to get peoples views and /or experiences on induction vs csection when a planned spontaneous, no intervention delivery does not go to plan.

I’ve been reading a lot of birth stories where when given the option for induction (either to start labour or speed it up), women instead choose to opt for a csection.

I have no issue with this as everyone should make the best choice for themselves but maybe naively i would have presumed that for most women hoping for a vaginal birth, the option of opting for induction would be more appealing than a C-section.

Any ideas of what drives this decision? Just trying to work out if there is a reason that I should be thinking of avoiding induction and opting for a C-section instead if I don’t go into spontaneous labour/labour isn’t going fast enough.

Or equally if you had an induction do you wish you when straight for csection, or if you avoided induction via a csection are you happy with your choice?

Thanks for your thoughts!

I had an maternal request elective c section because I wanted to avoid an emergency c section at all costs and that was the only way to guarantee it.

That might sound silly but it’s the choice I made.

Do I regret it? Well that’s a difficult question. Yes if I could have had a trouble free natural birth, no if I would have ended with an emergency c after or during a long labour. Obviously I can never know so it is what it is.

Yeah I think that's right @LemonSwan

Elective is preferred to emergency after failed induction but you don't know if it's going to fail so it's hard one to call.

I had two elective and loved both if that helps!

With my first daughter I had a normal delivery planned, with a back up c-section booked at 42 weeks due to a back problem and wanting to ensure any epidural was done in a non-emergency situation as it was potentially a difficult one. I ended up going in at 38 weeks due to a heavy bleed which they couldn't work out the cause. Due to that, they advised induction of c-section immediately. I opted for induction to start with the view of c-section if it came to it. Unfortunately I found the induction process long (days) and hard, and made almost no progress. They said my cervix was just not ready for induction. It ended in an emergency c-section, so now with my current pregnancy I am opting for a planned cs.

I think if I'd been term, perhaps induction would have worked better for me. But it wasn't how it panned out.

Induction comes with increased risks of intervention and emergency c-section if interventions don’t work. Inductions can be a long process, several days. Women can have a horrible induction and still require a csection, so some take the option of a csection from the off.

FWIW I had a really positive induction after a failed sweep. I required no interventions and the induction worked fairly quickly. I still had in my mind a point at which I would request a csection if at that point I felt induction wasn’t working.

I had an induction at 37 weeks because of concerns about baby’s size/growth. I have several friends who also had inductions for medical reasons. So I can’t really comment on why people choose induction vs C-section as I didn’t really have that choice. But I wouldn’t have wanted a C-section if I could avoid it, because of the recovery time (on top of having to look after a new baby!).

However - I think a lot of people are put off inductions because of NCT bias/horror stories about long and painful labours (I certainly was). In my NCT classes inductions were presented as ‘a bad thing’ - they WILL take longer, they WILL be horribly painful, you WILL need additional interventions etc. So I can see why some people opt for C-section, because they’ve been scared off by stories about induction. I was definitely really worried when I was told I needed an induction - but in the end (although it was my first baby so nothing to compare it to!) I didn’t think the induction made for a longer/more painful labour, and didn’t need any further interventions. I’m not saying all inductions are straightforward, but IME they are not necessarily worse than spontaneous labour.

bit of a ramble but I think there’s basically a lot of anti-induction information presented to new mums and that leads to anxiety!

I had an induction which didn't work so ended up with a C-section anyway.

I'm pregnant again and would like a VBAC but wouldn't attempt another induction, I'd rather have a second section. The induction was pretty awful (far worse than the section, which I was terrified of, but which was actually very straightforward, and I recovered really easily), and given I've had one failed induction I feel like I'm more likely to have another. (There's also an increased risk of my scar rupturing, which I don't fancy!)

But obviously that's my decision based on my personal circumstances. Everyone would probably answer a little bit differently, based on theirs.

I was born via vaginal delivery after DM's labour was induced as I was 2 weeks + late. Every one/situation is different though. I was induced during long 1st labour, but had an epidural shortly after and delivered after 45 minutes of pushing.

Many women opt for csection in favour of induction because some inductions don’t succeed and they want to avoid the risk of an emergency C-section. It doesn’t help that the NICE guidelines of what NHS midwives should tell the patient don’t include what that risk of emergency C-section actually is.

There is a perception that the risk of emergency C-section is higher if you’re induced vs. going into labour spontaneously. This may have been true in the past, but recent evidence suggests improved or not worsened birth outcomes with nonmedically indicated induction of labor at 39 weeks gestation compared with expectant management.

“A total of 55,694 births were included in the study cohort: 4002 elective inductions at ≥39+0 weeks gestation and 51,692 births at 39+0-42+6 weeks gestation that were not electively induced. In nulliparous women, elective induction at 39 weeks gestation was associated with a decreased likelihood of cesarean birth (14.7% vs 23.2%; adjusted odds ratio, 0.61; 95% confidence interval, 0.41-0.89) and an increased rate of operative vaginal birth (18.5% vs 10.8%; adjusted odds ratio, 1.8; 95% confidence interval, 1.28-2.54) compared with on-going pregnancies. In multiparous women, cesarean birth rates were similar in the elective inductions and on-going pregnancies.”
pubmed.ncbi.nlm.nih.gov/30716284/

I had an induction with my first that didn't go to plan and ended in an emergency section, as meany do. Look up your hospitals stats but at mine about 1/3 of inductions result in 'natural' birth, 1/3 interventions like forceps and 1/3 end in section.

My second child was breach so couldn't have the vbac I'd wanted, and instead had a planned section. That was actually a really positive experience, obviously much calmer then the first and also much easier recovery. The two sections where like night and day.

If I ever have another and get the option between induction and section, I would 100% go for a planned section over the risk of an emergency on or intervention.

Induction can lead to instrumental delivery (which for me was a no) and emergency sections. Inductions also tend to come with an epidural as the contractions are 'unnatural' and so an epidural will help you manage them. Epidurals themselves are a higher risk of intervention- so faced with an induction which may very well lead to a (panicked exhausted) section, many choose section to feel more I control.

My 2nd baby had to be delivered at 38 weeks. The Dr and midwives all were pushing induction over elective c-section. I had heard lots of horror stories about inductions (very long and painful labours) but equally with a toddler and new born to look after I didn't fancy the c-section recovery. I agreed that I would be induced that night (8/9pm I think it was) but if we hadn't progressed significantly by the next day then I wanted a section. As it was, baby was in my arms less than 12 hours later. Delivery very quick and very painful but in retrospect I'm so glad I went with induction.

Thank you all so much for your responses, a lot to digest, think I have a better understanding.

Seens like common threads include wanting to avoid instrumental deliveries, feeling like you’re having more control over your birth, wanting to avoid emergency C-section (I’m guessing these feel more stressful). Will take it all in and have a think about what I would want to do in that scenario x

I had an induction that 'worked' pretty instantly in that my waters broke and I started contracting, but after nearly 3 days in labour and various other complications I ended up with an emergency section. Looking back I'd have rather just had the elective section, but then at the time I wanted to give myself the chance of a vaginal birth and to an extent I'm glad I don't have to regret not trying or wonder if it might have been possible. I do regret not declining or at least delaying induction for at least a few more days, particularly as it later transpired I'd been somewhat misled as to the pressing need for it.

If I had a second I'm pretty sure I'd go straight for a c-section, theyd definitely want to induce me due to age and I'm not sure I could face the whole thing again. I'd also prefer elective section to forceps or ventouse.

For me, it was about having control over the situation. Knowing a date and how it was likely to go was better than the unknown of an induction.
Had a v.positive ELCS experience
Everyone has differing priorities in terms of how they want their birth to be so there is no right or wrong :) xx

Just to add a c section doesn’t necessarily mean a non instrumental birth.

My boy was c section with forceps.

I went for an elective over a potential emergency if induction failed. 40% of inductions with my specific circumstances (first time mum, multiple previous miscarriages, BMI, age, and induction. At 37 weeks). Throw a blood clotting condition into the mix and I didn’t want to risk being off thinners so long and then having an emergency section which carries an elevated risk of clotting compared to planned.

I’ll do the same next time.

although if I’m honest, vaginal birth has never been appealing!

I'm pregnant again after an emergency C Section and was told they would not recommend having an induction if attempting a VBAC as the chances of success were much lower.

My priority would be avoiding an Emergency C Section, it isn't just more stressful, I ended up with a nasty infection and was told that would be less likely with an elective section.

I'm pregnant with my second and have been thinking about this after being induced with my son which ended in an emcs. I think I've decided that I'll have a section booked for 42 weeks if I haven't gone into labour naturally before that. I want to avoid induction at all costs because it's intense and felt like it forced my body to do something it wasn't ready for. I've read a lot of positive induction stories but for me, I'd much rather do C-section than induction again!

All inductions aren’t equal is the issue. If the baby is full term (eg induction is post dates) it’s a very different proposition to an induction at 37 weeks. And the gel/pessary is very different to the hormone drip.

In my birth plan I decided that if induction was necessary I’d try the pessary but if it hadn’t worked I’d go straight to elective c section. Most people I know who had the drip ended up with instrumental deliveries (probably because they had an epidural too) or emergency c sections.

as it happens I had 2 inductions, both just needed the pessary to get going and 2 lovely water births. One was 40+1 and the other 40+12.

I’ve been included which ended in emcs and had a natural birth. I would never opt to be induced again as the whole process was horrendous!

I was induced at 41+3, the whole process took about 4.5 hours and was completely straight forward with no intervention needed. It does seem from speaking to others that they seem to be more successful when overdue. My SIL had three induction attempts at 37 weeks which led to an eventual c section.

I had an induction. Was worried about it but it went fine. The pessary started the labour within hours (2nd labour which may have helped).
The only issue was a lack of midwives/beds on the labour ward!

It’s not about an emergency section being more stressful I don’t think - it’s about the fact that for many women, you’ve been in labour (= pain, no sleep) for a VERY long time before they do the section. Then they do the section under stressful circumstances - then your baby is born and you haven’t slept for a long time AND you’re on high doses of painkillers that make you sleepy. It’s a really hard start to motherhood, and no surprise that birth under these circumstances leads to higher instances of PND.

Not that all inductions end up like this -
mine didn’t - but you can understand why many women would rather avoid this scenario.

Re. Recovery, lots is said about c section recovery and nothing is said about natural birth recovery, which makes it seem like c sections are harder to recover from. Not necessarily the case. Lifting is harder but with an elective c section I think you’re less likely to end up with long term injury, pelvic floor damage etc. im convinced that a lot of the anti section propaganda comes from the NHS cost saving agenda.

I’d rather have a section than an induction.

I wasn’t given the choice, I was just scheduled for an induction which was incredibly painful and ended in a C-section because baby girls arms were up around her head causing an obstruction. Lots of medicine, 19 hours of labor, (3 of them pushing), I was a mess at the end of it. If given the choice in the beginning, I would have picked induction and hoped for the best. But now I’m grateful that my next delivery will be a scheduled c-section

The only women I know who were induced said it was awful, the body being forced into labour but also not wanting to labour. One of them laboured for five days before they agreed to do a c section (this was a while back).

Based on her experience I’d personally refuse induction and either go natural or c-section.