Induction vs C Section? (High pressure uterine artery)

[lenalove]

Hi all,

Just looking for some general advice please!

Currently 31 weeks pregnant with my first. At my 20 week scan I was told I had raised pressure in one of my uterine arteries, detected during the ultrasound. Apparently this usually doesn't come to anything, but in a small number of cases can an increase risk of pre-eclampsia or small birth weight. They are monitoring for these, so far no issues, next scan at 36 weeks.

Last week at my consultant appointment she advised that due to protocol, once a high reading has been detected even once, they do not want to let babies go past 40 weeks due to higher risk of still birth. She therefore told me I would be need to be induced around my due date (or earlier if anything untoward is detected between 36-40 weeks).

I have heard so many bad stories about inductions, particularly for first births, usually involving days spent on labour ward, instrumental deliveries etc. I raised this with the consultant as well as the possibility of an ELCS but she essentially dismissed this concern and wouldn't really entertain the possibility.

I am quite anxious about the whole thing - especially the idea of having an induction if everything is looking fine. I just want what is safest for my baby, so of course I am happy for them to come early if needed, but it's the method that is concerning me.

Any thoughts or advice would be much appreciated.

Thank you.

Best to do what is best for both of you. Pre eclampsia is not fun. Makes you very ill. See how it goes but if BP goes up then that's what is happening. You can have a stroke, kidney failure etc. I've had both induction and caesarea. Neither great but keep safe.

Just to clarify that they absolutely cannot force you to have an induction without your consent, so they need to offer you the option of a section if you decide what you feel most comfortable with.

Also worth finding out which method of induction they plan to use as it can be different at each hospital.

Hm I had high pressure at 31 weeks but it normalised by 34. I've had a couple of consultants review my results and no one has mentioned early delivery. Sometimes there can be a random high reading due to baby being very active or grabbing the cord. As I understand it, this can be a precursor to placenta issues but this would be evident via poor growth and a one off high pressure reading doesn't suggest an issue in itself.
If growth and cord pressure are fine at 36 weeks, Im not sure what the real risk would be. In your situation I would be inclined to push back and see what happens at the next scan. No bad thing to think about what you would do if an early delivery was necessary though. Personally, if there are issues towards the end and I really was behind the necessity to get baby out early, I would rather cut to the chase and go for a section than have a potentially drawn out induction, though plenty of people have ok experiences.

How much help do you have at home? Is there a partner on the scene or someone else who could help?

Thanks all for your answers so far - food for thought. I am definitely going to press for more information at my next appointment as I agree it seems potentially like jumping the gun if everything is looking normal.

@PoppingTomorrow - yes my DH is taking a month of paternity leave and both sets of our parents live locally, we are lucky in that regard.

With my first baby I was told that due to a health condition I had I would either need to be induced or have a planned section.

My Consultant also told me that a huge number of inductions usually end up with an emergency section needing to be done anyway so she told me I may as well just cut out the middle man (no pun intended).

I have heard many, many induction stories and I’m very glad I went straight to a planned section.

I had an induction. It took awhile. But it didn't hurt. I then had an emergency section.
I like trying to push. But it didn't work. So she came out the sunroof!

I had high uterine pressure with my first baby. I am also 34w pregnant with DC2 and having the same again.

With DD1, i accepted an induction for 39w but she made her arrival at 38w before the induction was needed. My BP was very high however and she was only 2.6kg so she was little. I was glad to get her out when we did.

With this one, im erring on the side of a section if i make it to 40w. Although i expect the recovery to be a lot harder when there is a toddler in the mix, when i had my birth options appointment with the consultant, we talked a lot about cascade of intervention that can result from induction. Its not an easy decision. Currently this baby's growth is looking ok, but my BP is starting to creep up again. I dont need to decide until after my 36w scan so trying to not think about it too much until then and see how things go.

i was given the choice of induction v csection for my first pregnancy. mum is a midwife and advised me to go with csection because of the amount of inductions that and in emergency csections anyway or traumatic births. i did and my elective csection was genuinely a great experience. obviously healing from a section is a bit more lengthy and difficult than a natural birth but electives are usually gentler as no need to rush it (also the case in my experience as second was an emergency). if i were you and being given the choice i’d go for an elective. your consultant can’t say no - you have a right to one through maternal choice alone. if she refuses you can switch consultants.

Had both for other reasons.
Elective section whilst major abdominal surgery was a much smoother recovery for me personally.

Do you have a desire to have a vaginal birth? When you get into that mindset it can be really hard to give up the idea and to want to experience it. But it’s also very overrated for most people and even the ‘perfect’ birth can have long term complications.

My c sections were absolutely fine and nice and calm. If there were genuine health concerns like you have, then I’d probably go with a section as I’d be anxious to get the baby out.

For balance, I had an induction with my first baby at 37 and 5. I had my waters broken and I was put on the drip. I had a really positive labour with just gas and air. My second child came naturally and I wouldn't say labour was much different. I too heard awful stories about induction, but it was the safest option for me and baby in the end.
I would personally be more apprehensive about a section. Recovery looks painful, long and hard work. Please don't read too many horror stories! Whatever you choose will be the right thing. Sending love for a positive birth.

Hello OP. I think I'm going to be encouraged to have an induction (for other reasons) so I've been doing a lot of research.

This Birth Ed podcast with Sara Wickham is a really good starting point: https://open.spotify.com/episode/5SWhW9QXe0lqDZilNoYUz9?si=KLw12jzlTtSgaNzI8h6qKA

It really helped me think about all the questions I need to ask my consultant. Don't let them fob you off with vague 'increased risk' comments - get specific numbers, and ask why an induction is being suggested for you specifically. From what I've read, the evidence base for inductions just doesn't exist and yet they're on the rise.

And as a PP says, if you want a caesarean you are absolutely entitled to one, as stated in the NICE guidelines.

Good luck.

I've had two early inductions. Both for pre-eclampsia, though I did have a raised PI reading with my first at the 20 week scan. I can't remember if it was still raised at the growth scans though. Never really came up again. My first ended in a vaginal birth, my second with a C-section. My second was back to back and got himself stuck, which could have happened in spontaneous labour anyway.

Truthfully they were both fine. An elective C-section would have been entirely wrong for me, and I'm glad I went through with the inductions.

I’d opt for the section. Inductions seem to be a bit like an experiment - some women are fine while others have horrendous experiences.

I had to have my little boy early and I had done research regarding inductions and planned sections and went ahead with a planned section.

Even though it is a major operation, the section was a very positive experience. It was calm and relaxing and took 6 minutes from the first cut to my baby being born. Afterwards, I was sore for a few days but apart from that recovery has been great.

Just adding for a bit of balance - I was induced on my due date for growth concerns, and whilst I totally admit that there were some tough times (the drip is intense, and they overstimulated me and it was not pleasant), once I had the epidural it really was a dream birth. And I was lucky that there wasn’t really any recovery time needed, and I could drive etc straight away, which I know I would find hard in those first few weeks.

I would say it depends how much trying for a vaginal birth means to you? If it doesn’t really matter and you’d rather take the unknown/risk out of it, there’s more “control” with a planned section. But just wanted to add my positive induction outcome in case you decide you’d like to try for a vaginal birth♥️

I'd dig into the statistics yourself in order to make your decision, your chance of a section being the outcome as a result of induction, while it varies slightly between 39-42 weeks, but is around 4/10 in the UK in recent years.

The experience of a planned section and an emergency section is vastly different. Personally, knowing what I know now I'd insist on a planned section, I asked but they wanted me to "try" an induction and I felt railroaded into going along with it in the moment. It did not end well, as I'd predicted. It's your body. Do your research, make your decision based on facts, out of the medical setting if possible, it's very easy to get swayed by the white coats once you're in there.

Hi,
Your options are wait and monitor, induction or c section.
I also had one high uterine artery measurement for my second pregnancy. In my first pregnancy they didn't do this measurement. I meant I had extra growth scans. I tried to find some info online about it and the only thing was issues if there was high pi on both sides. It meant I had extra growth scans. They did Doppler on the cord. I was recommended an induction at 37 weeks by one consultant as growtth scans showed a small drop in growth, sonographers had said everything was finished. I opted to be rescanned at 39 weeks. She did try and persuade me, and I agreed to be booked in for induction day after. I saw a different consultant at my next appointment and she didn't see the need for me to get an induction before 40 weeks so i had one booked for 40+4 and gave birth naturally just before.

To add I had no other complications or risk factors. To induce based on one measurement at one point in time, and very slightly under the curve growth (which the sonographer had said they don't worry unless you drop a percentile or two which I hadn't) didn't seen to fit. All consultant could said was baby might not be getting enough calories inside me and is full term so safer out. In my gut he felt safe in me. In my head the evidence wasn't there for induction.