Delivery at 37 weeks - induction or section?

[SkyBlue20]

My waters broke this weekend at 35 weeks, I’ve been in hospital for two nights having steroid injections and antibiotics and they’ve booked me in for an induction for the day I hit 37 weeks if baby doesn’t come of her own accord first, however I’m unsure whether to go induction or ELCS.

I had an induction with my daughter, which wasn’t a great experience (that’s an understatement) but did work. she was born via ventouse delivery and I had a second degree tear, episiotomy and I’d say a bit of birth trauma. It took 36hrs from start to her being here.

My reasons for considering an ELCS this time are:

• calmer, nicer birth experience to counteract the last one!
• less time away from my DD (I’ve been in the induction ward this weekend and some people had been there over a week and they kept hitting pause on inductions because delivery was so overwhelmed, though this is counteracted by the fact that I would go through as a priority - still imagine there’ll be quite a wait though!)
• I feel like there’s probably a higher chance of ending in section anyway as it’s so early (though my body has done it before)

my cons are:

• recovery with a two-year-old at home
• I believe being born vaginally is better for baby’s lungs, especially when early (but in contrast, would an induction be more distressing for baby)?

The hospital has told me they would do one gel then I’d go on the list to go down to delivery, where they’d break my waters and put me on the drip. I think at this point I’d ask for an epidural - I did it on gas and air last time, which was fine, but the drip is meant to be really quite painful, especially so early!

What would you do? I’m so, so confused. I’m changing my mind every two minutes! Any insights very welcomed. Thank you.

Never been induced so I can't compare. But I loved my ELCS!

Sorry it's been complicated and was tricky last time. I loved my elective section. No problems with DS's lungs - was maybe a bit mucusy when born but cleared very quickly! Pain free and very relaxed 😊 hope it goes well whatever you choose!

I was in a similarish situation with DC2.

Developed pre-eclampsia (again) so had a 37 week induction (again). Similar amount of time for DC1 to be born at 32 hours from first gel. No assistance needed, and thus no birth trauma though. Similarly, delivery suite was inundated at the time, which resulted in a 5 day wait even though I was ready to go after the 1 gel. Though if either of us had shown any signs of deteriorating we would have skipped the queue entirely.

Obviously I went for the induction. But since I had had a great induction first time around, there was no reason I would want an elective C-section. As it happens I wound up with a C-section anyway. Baby wound up in an undeliverable position (back to back + deflexed head), so progress was slow, eventually stalling, and baby started showing signs of distress. I don't blame the induction though. I believe even if things had run their course naturally the result would have been the same.

It's all well and good saying they'll do one gel then break your waters... you'll be 37 weeks so whose saying 1 gel will be enough? If your cervix is closed it's closed, aka not ARM'able.

If I was you I'd go for the IOL regardless because you're a para 1 and will probably be fine, but it's important you have correct information going into it otherwise you can't make an informed decision.

Unless they're saying if one gel doesn't work you'll go for a cat 3 section?

What's the reason for just the one gel?

Thank you for your feedback, everyone!

good to know that your DS didn’t have any lung issues. @arlequin - what gestation was he?

@Dyra that’s really helpful, thank you - it proves two of my main concerns that are that I’ll end up in hospital for ages before even birthing (so away from my DD) and that it could end up in a section anyway but obviously it’s impossible to know if that will happen!

@snuffles123 that’s a good point and a question for me to ask, I think. One gel was definitely not enough last time, I had to have all three. I’m at the hospital a couple of times this week for checks so will see if I can speak to anyone about what the plan would be.

I don't know if it helps any, but DC1 was brought to me every day so we could spend a few hours together. She couldn't enter the hospital at the time (Covid rule that was lifted a few weeks later), but there was nothing stopping me from leaving the ward to see her.

Regarding the gel, 1 was definitely enough to get me ARMable with DC2. I was just low down the triage list as I was otherwise well. With DC1, I had 2 gels, but should have had more as I was only 1cm at the ARM. It was just because they had an empty delivery suite, so rushed me through .

Hi @SkyBlue20 DS was 40 weeks so later than your baby

Good to know, thank you! Can I ask how you found recovery from the section with a little one at home? My DD very much wants picking up and to climb on me as much as possible!

Thank you xx

Would you consider trying the gel at 37 weeks to kick things off and see what happens? If nothing happens and they can't rupture the rest of your membranes (think you said they want to induce you because your membranes have ruptured?) then you could decline the synto drip and go for c section. I work in obstetric theatres and a fair amount of women opt for this. You may find with baby number 2 and waters already gone that 1 gel is enough on its own to get labour started.

@SkyBlue20 Truthfully, I don't really know. I was in hospital for two nights after. Then I only had DD (2yr 6mo at the time) for one night before she went to stay with my sister for just under a week. That night + day, she was very, very careful and gentle with me. She had a great time with her cousins, and in no way felt that she was being replaced by baby. They have an amazing bond at 15 months now. If you have the help, make full use of it should you have a C-section. I was nearly 2 weeks post partum before I had to look after the two of them, and by that point the worst of the recovery had passed.

Ive had both and I would say the section was by far better.

With the induction I was on the syntocinon drip for hours and it was ramped up to max, son went into distress and heart rate decelerated several times. He was born by vonteuse and in poor condition.

My daughter was born by emergency c section after failure to progress in an induction and as the pregnancy was IVF I think they were quicker to move to section. It was very early in the induction process so not too much harm was done. It was a calm, controlled and beautiful experience. A million times more enjoyable than the induction. I was dreading another induction and jumped at the chance of the emergency c section, didn’t know you could elect to have one, would definitely go for this if it’s an option for you!!

I'm 35 weeks too and considering a c section. Let us know what happens and take care x

Iv had 2 inductions at 37 weeks and both had pros and cons but they were pretty similar. 2 hour active labour and 1 hour active labour respectively following ARM. I had the drip second time and preferred that to the pessary. I had a tear stitched both time and manual placenta removal both times! However I was on my feet and had a 3 year old to look after so was glad to not have a csec. Good luck!

This could be a good compromise, thank you for the suggestion!

Good to know, thank you! My DH and my mum would definitely be around to do basically everything, so would be very well looked after - my mum is so helpful in terms of cooking and cleaning etc and is great with my DD.

Thank you for sharing your stories, I’m glad your DS and DD are ok. What happened with your DS is a concern of mine, too, especially with baby being a little early. So much to consider!

Personally I’d have the c-section.
I was induced with DC1 due to premature rupture of membranes, and it’s not an experience I’d willingly repeat. Don’t get me wrong, it was fast as inductions go once the drip had been started, but it was torturous compared to spontaneous labour. Gas and air made me vomit, and I had no time for narcotic pain relief or an epidural.
Anecdotally, I also have a friend who’s had one EMCS and one elective. She says her recovery from her elective csection was a lot gentler than her EMCS - I guess because they aren’t in a rush to get baby out the same way as they are in an emergency, so she was less battered and bruised afterwards 🤷🏻‍♀️

Thank you, good to hear the positive stories, too!

I’ve had three spontaneous, vaginal deliveries so I’m not afraid of delivering babies.
If I was in your situation, I’d be going for the section too.

I have had many, many friends have horrific experiences of inductions. Most of them being left in labour for days and days. I would refuse an induction point blank.

Thank you! I think I am leaning towards a section for the reasons that I know from experience that an induction can be pretty brutal, the induction ward was massively overrun when I was there at the weekend and I can just foresee being in there for ages before actually getting anywhere and that I worry induction could be distressing for baby, who is already quite early. I’m going to chat through with my midwife tomorrow but thank you everybody for your input, it’s been so so helpful xx

(Also, the fact that an induction could end in a section anyway!!)

My babies have to come at 37 weeks due to APS. I opted for c section rather than induction. This was because at 37 weeks it’s more likely for an induction to be prolonged and I didn’t want to be off blood thinners for days with a clotting disorder.

The odds for my demographic (37 weeks, geriatric mum, starting BMI 37+) gave me a 40% chance of an emergency section, 25% unassisted birth, and 35% some form of instrumental birth which I knew I didn’t want (I got these stats from my hospital). emcs again carries a higher clot risk than elective, plus recovery is harder being already knackered from induction so for me it was a coin toss.

You could ask for your bishop score when you go in - this isn’t foolproof but it’s an indicator of how successful induction might be - anything above 8 is favourable, below that you might want to consider other options.

good luck! X

With DS1 My waters broke at 36wks and after a few days of nothing they decided to induce me - 4 days of very painful and exhausting induced labour later I had an emergency section and he was born.
So with DS2 I decided to have a planned section, partially due to previous experience and drs happy to oblige due to my health conditions.
I was convinced my waters would break early again but I was constantly told I was wrong and they wouldn't book me in any earlier than 39wks for my planned section.
At 36wks I was clearly ready to pop and at a scan appointment my dr agreed and moved my section to 2days later - the morning I was due to go into theatre surprise solitaries my waters broke, they gave me the option of trying naturally or continuing with the section but went with the section - it being semi planned already meant it was a lovely calm experience and much nicer than my emergency one. They gave me steroids for his lungs.
Go with your gut feeling. My sections we the best way to get baby out and the planned one was a lovely experience. They lifted him out on to my chest immediately, he breastfed immediately and is now a very health happy 7yo.
My recovery was pretty good with both of them just had to be careful about carrying stuff for a bit & sitting up but with a bit of planning (having something next to the bed I could pull myself up on and have stuff in sensible places) it was a very doable.
DH went straight back to work 1hr after my section as because they were early he had no paternity leave booked and his dr rota had no slack.

*surprise surprise
Don't know where the solitaires came from