Considering ELCS instead of induction IF baby won't come

[Hoping4baby21]

Hey,

So I guess I have a very specific set of circumstances that have brought me to this. I'm currently 40+1. My preference is to have a vaginal and physiological birth (as few interventions as possible and no vaginal exams). I went through IVF to get pregnant and tried for over 2 years, I stopped counting at the 2 year mark. I've had a lot of vaginal and vaginal adjacent procedures due to IVF and now I struggle with the idea but also with intimacy with my husband. Hence the absolute no flex to consenting to vaginal exams.

Whilst an induction would or could still allow for a vaginal birth, it would require a lot of vaginal exams, as well as the increased risks of intervention etc.
I also have SPD, and cannot be confined to a bed for hours or have my legs in stirrups or pushed apart. There's no way I could tolerate an assisted delivery.

In light of all of this, as well as more but I'm trying to keep this short, the longer I go, the heavier I get, the lower baby gets my SPD gets worse and I'm finding it hard to have such little mobility and constant pain. I would love for baby to come spontenously but i feel I'm at the point I need to consider alternative options for my own mental and physical wellbeing.

So my question is, has anyone made a similar choice even if for different reasons? Would love to know your experience, any regrets, or tips (please no horror stories).

For all the reasons you've listed an ELCS seems to make more sense - with vaginal delivery you are at risk of tearing or episiotomy which could make your existing issues worse. I was induced with baby no.1 and ended up with forceps and v close to emergency CS which would have been worst of both worlds! Am going for an ELCS this time for various reasons but mainly to cut out the middle man! Best of luck however baby arrives!

I had in my birth plan no induction but a CS instead. Every induction I personally know of has ended in intervention and probably about 85% in an emergency CS anyway so I wanted to rule that out. She came naturally in the end so it was avoided. If you really cannot stand the thought of an internal I would be booking a CS as soon as possible if I'm honest with you.

You don't have to stay in bed when you're induced.
You should get up as much as you can.
You can also ask for no vaginal exams until you feel like pushing.

I had an induction and horrific recovery from EMCS.
Second time round I had an ELCS and it was so much better. I refused induction after the first one.

Interesting, if I had an epidural for example I may have to stay in bed. I was also told that the exams are needed for assessment of what drugs to give you to induce you and to figure out next steps.

I suppose ultimately whilst I understand things are possible, it's the risk of x, y and z that are a major problem and increase the chances of reinforcing the trauma I currently have. I can't really bank on a technicality of that makes sense.

Remember you never HAVE to have anything, vaginal examinations can only ever be carried out with your full permission and consent. You’re probably aware of this but I always feel like it’s worth mentioning!

I can definitely see why you’re leaning towards ELCS instead of induction. It’s worth looking at your hospitals statistics to see what percentage of inductions in first-time mothers result in an emergency caesarean anyway.

@Hercisback thanks for sharing your experience. Glad it was better for you the second time around.

@TheShellBeach my initial reply didn't tag you for some reason.

@OhhhhhhhhBiscuits I appreciate your perspective. I think a vaginal delivery could be quite healing so I am hesitant to completely jump to an ELCS. I'd like to do it and have been assured by multiple Midwives that I don't have to have vaginal exams. Tearing I hear you and have thought about as well, it's more about people doing things to me, so I feel my body tearing of its own accord wouldn't have the same effect. But of course I can't know for sure.

@Anyday thanks and good luck with your delivery. Re tearing I sort of address that above. An episiotomy is off the cards for me. I'd prefer to tear naturally. They also heal better than cuts so that is where I'm at with that.

I may be wrong but I believe most inductions start with vaginal inserts either pessary, rods or gels - if unsuccessful then may move on to the drip, but if they need to break your waters that would be a vaginal procedure.

Of course you can not consent to certain procedures but it may not be in your or the babies best interest (not that your trauma isn't valid, of course it is but I mean it may make things very tricky particularly if things aren't going well)

Don't mean to be negative there... A calm ELCS does sound like a good solution here, although of course it has a potentially lengthier recovery and other risks which you need to be aware of.

@TheShellBeach be careful about the information you are giving out. As this isn't necessarily true.

OP, VE's are always optional and require consent of course. However the nature of induction is that it does require VE's. If you decline them then that's absolutely fine, but they simply can't induce you.

Whether you're having a pessary, gel, balloon or rods, all of these require multiple VE's (unless you labour off one agent which I doubt but crazier things have certainly happened!) even if you went straight for an ARM... you'd need a VE to tell us we could do an ARM, then another VE to complete the ARM when you're on delivery suite. you're correct. If you really don't want VE's then induction won't be for you.

The only other thing I have to add is about your SPD, instrumental delivery and lithotomy position. For an instrumental in theatre you'd have either an epidural top up or spinal anaesthetic so you wouldn't feel SPD related pain.

I think you need to discuss your options with your midwife and consultant. Would love to hear an update about how you get on!

Best of luck!!!

You won't be able to be induced without vaginal exams or interventions. Especially if you want an epidural - you will be catheterised etc.

I had a spontaneous home birth with my first baby. No vaginal exams at all. I tore badly but it healed absolutely fine.

I'm due again in the Summer and I'm planning a home birth but with the back up of an ELCS at 41+ weeks.

I absolutely do not want to be induced for all the same reasons as you. I will do anything to avoid an instrumental delivery, or having to labour in hospital at all tbh.

@angelicaelizapeggy thanks I am aware of that. For an induction for example I don't see how it would be in my best interests to decline a VE to allow to determine my mefs. So it's about being put in that kind of position.

I'm due to give birth on the birth centre stats are pretty low for intervention.

I was induced at 41 weeks with my first due to baby growth spurt. I had no previous experience of vaginal examinations and was quite shocked at the v high level of pain and discomfort. My labour didnt progress after 3 days, and I was becoming increasingly distressed after each examination, so the consultant set out a number of options - c section being the one I went with as couldnt face any more examinations plus my body and baby just didnt seem ready for labour yet.

It is my understanding that examinations are required as part of induction process as they inform next step, eg additional gel required / dilation means waters can now be broken etc.

Based on your circumstances, the c section sounds like the most obvious choice if you dont start labour spontaneously.

I am 2 weeks post an elective csection and after 5 days I didn't need painkillers and currently can walk and move around absolutely normally (much more than I could in the last couple of months of pregnancy). My scar is healing very well.
The actual csection itself was amazing, very calm and also quite wierd. I found the staff to be amazing, reassuring and felt safe.

My circumstances are that my twins had to come at 33 weeks due to me developing incredibly severe Cholestasis which was making them unsafe due to bile levels in my blood. I wasn't going to go into natural labour so my choice was induction or csection . Given Cholestasis often causes fetal distress I didn't want to risk any further distress/meconium via an induction. My boys were born with meconium in their sacs from the pregnancy so I felt I had definitely made the right choice, although I do feel some sadness for not having a vaginal labour (which wouldve been option for me as the presenting twin was head down).
However had I had a traumatising induction experience having already had a very traumatic end to my pregnancy I would not have been in good mental or physical shape for the arrival of my preemies at all. As it is whilst I didn't have an "amazing birth" I believe I had the birth that has best allowed me to be in a good shape to become a mum for the first time.

Good luck making the right decision for you.

@NotAnAngelOrAHero thank you so much what you have said lines up with my conversation with the midwife. We have another appt in a week to discuss my options again.

Whilst I wouldn't feel SPD pain with ain relief that doesn't mean it wont impact me afterwards. Because it will be causing damage that I'll need physio to rectify afterwards and if I can't feel the pain I can't mitigate it so risk of greater damage is worse.

I assume my midwife will make a consultant appt once I confirm a c section is my plan b.

@HarrisonFifty thanks for sharing.

@Seaswimmings yes that's how I feel that the I'm looking for the most positive birth experience and if that ends up being a c-section so be it. I want to have the least amount of birth trauma given my specific service circumstances so that is what this decision is about it. I want a vaginal delivery but I need that to be a situation with the potential for the least amount of trauma/ long-term impact. Congrats on the birth of your twins

I had an emergency c- section with dc1 and really wanted a vaginal birth the second time.

I read this book and highly recommend it.

https://uk.bookshop.org/p/books/ina-may-s-guide-to-childbirth-ina-may-gaskin/3963262

I had an induction and really wanted a c section but was told no. I ended up with a c section anyway.

Given the opportunity I wish I had just had a c section to start with - it added 5 days to my birth experience

Book an elcs! In an elcs there are enough staff to get the job done quickly. If you go down the induction route nothing is in your control eg I had to be induced on a labour ward because there weren't enough staff for the induction ward to be open! It's cheaper for the hospital to induce but it puts you at risk of all the negatives you want to avoid. If I have another I will refuse induction point blank and get an elcs booked.

I would go for a C section.

I've had two difficult births ending in a forceps vaginal delivery and a crash emergency c section. Both started spontaneously but I ended up on the drip to induce to move things along.

There were so many interventions and so many vaginal exams, at one point with DS I'm pretty sure there were two different hands in there at the same time.

In your circumstances with the pain you are in already and wanting to avoid exams I would definitely go for the planned c section.

Irrelevant but my friend had a planned c section and asked grumpily how long I'd had to wait for mine as she'd had to wait for 6 hours for hers and it was very boring and inconvenient.

I had to nicely point out that I'd been in active labour for about 15 hours, had loads of things done to me and the baby and then had an actual emergency with a crowd of people running my bed down the hall to surgery, bumping another woman of the list as DS wasn't getting enough oxygen and I was losing an alarming amount of blood!

I would rather have been bored!

Personally, I would not be induced again and if I had my time again, I’d go for an elective.

Hi! I’m two weeks into recovery from my own ELCS. I had mine for different (although the same re no vaginal exams etc) reasons.

All I heard for weeks was how much pain I’ll be in. Or asked how I will cope alone (single parent, first baby) whilst healing and not much support (isolated area so alone a great deal and not much family or other support- dad isn’t interested in the least haven’t spoken in months). Told I won’t be able to cope. Or lift things. Or lift baby. On and on horror stories.

By day 10, I was only on paracetamol and ibuprofen only when needed. I had had days by that point, of very little pain. Every day was significantly easier than the last. No issues with picking up baby. Really it was only the first five days where I was in a lot of pain but with my baby to look after and the bond and love, the pain kind of doesn’t hit as hard. Then after those minimal days- I just got more and more mobile. Now I could do a dance and prance around if little one next to me would stop spitting out his dummy, then crying for it. Then spitting it out. Then crying for it. Repeatedly 🤦‍♀️😂😂😂😂😂

I have baby brain but I hope this makes sense- my point is that me alone after all the horror stories was shocked with the ease of my recovery. I’m only two weeks in and I “should” still be bedridden by the way people went on! Also my wound is healing beautifully- no issues with that they did dissolvable stitches and they take the dressing off when you leave. (Though I stayed two nights due to mental health). I could take a bath soon as I got home only no soap or anything is allowed Incase of infection. Oh and you’ll need to inject yourself for ten days with the blood thingy stuff to stop blood clotting- I couldn’t do my own I despise needles so I enlisted as many people as I could to do mine haha.

Be as prepared as you can re anything to make life easier when you return home. Batch cook meals etc. And the first night is the hardest. If you have a partner you will be fine.

Re the actual section- I wouldn’t change my decision for the world. I really wouldn’t. I won’t go into why I had it- but having my birth that way went exactly the way I needed it to in order to achieve the reason for having it. No pain, no discomfort. Apart from the local anaesthetic in my back (quick and easy) I didn’t feel anything- they did the spinal after that and I didn’t even realise they had done it haha. Only afterwards be prepared for the shaking (like as if you’re cold it’s odd but no issue doesn’t last long just feels weird!) and the itching. I could feel them moving around in there which was weird -but I was more amazed and excited to meet my boy- and I’m a super wimp so it must not be that weird haha.

I can’t think of anything else to say except it’s the best decision I have personally ever made. I wouldn’t change my birth for anything.

And not to buy into the horror story hype. We’re all different. I’m fine. Hope that covers everything and is legible. Baby brain is real 🙈😂

Oh and it’s SUPER quick and efficient! Re pain I didn’t even get past the “quickening” and into contractions (thank Christ) cos he came early. So I had mine booked, he came early, I had the pain of the quickenings (whatever they are!) which was worse than the entire elcs process beginning to end frankly! And it was done and in and out so super fast! Back into recovery for toast and a brew and a bit of breast feeding and monitoring me. Then to my own side room (again mental health and past trauma etc) in the actual ward.

I made the best decision for me. You have to make the best one for you and don’t let people scare you. With a vaginal birth a million things could go horribly wrong, and you end up needing an emergency section anyway, when the elective is booked it’s much safer as it’s all pre prepared. My point being that neither option is without pain and risks. You have to weigh them up and decide for yourself. Just don’t be scared by those never ending bleeding horror stories. I could have killed to not keep hearing them over and over. Very cruel and unfair to scare a mum to be like that. Wish you well!

I don’t know what you should do for your specific set of circumstances, but I wanted to share a couple of facets of my own experiences.

I suffer with severe SPD in each pregnancy and have never been offered induction or c-section due to this. I’ve also never been confined to a bed or had my legs forced apart.

I did not consent to vaginal examinations and have never had one, five pregnancies later. I have never had a c section but I believe there is a lot of nudity, vaginal and vaginal adjacent activity during or post surgery, eg catheter, needing to push baby upward vaginally, and post surgical intimate care with bleeding and pads. I wasn’t happy with the amount of nudity and people in the room with a c section so I wouldn’t elect for one. I understand your trauma

I had similar circumstances to yours and I wish I picked an elective c section as I ended up with an emergency one .
elective c sections can be amazing . I would certainly pick one over an induction. I’ve had 1 vaginal birth and 4 c sections .