Birth decisions - age 40, large baby

[CCrowe]

Wondering if other people have any experience of weighing up whether to try for a vaginal birth or have an elective caesarean with a similar risk profile to me?

I'm 40, we are planning to go ahead with the recommended induction at 39 / 40 weeks if we try for vaginal birth, the baby's head circumference is measuring big, in 97th percentile (all of which increases risk of tears, emergency caesarean and other complications) and we have an anterior placenta. If we try for a vaginal birth I've planned to have an epidural for a number of reasons.

I'm just not sure what to do. I don't have an ideological view one way or another, I just want to weigh up what might be likely to be the best option Last time we saw the consultant she still believed it would be better to try for vaginal birth but that was before we got the latest head measurement.

I would never choose an induction, knowing how they so often end in an emergency sections. Going straight to elective section would save you the ordeal of days of contractions etc. Also if it’s a large baby, I’d want to avoid an instrumental delivery and/or tears.

Recovering from an elective section is much easier than recovering from a difficult vaginal birth. I know because I’ve done both.

Elective section all the way.

For my first baby I had induction that led to EMCS - awful awful awful experience, can’t state this strongly enough.

My first, I tried for a VBAC. Went into labour naturally but she had pooed inside and her heart rate was all over the place so another EMCS!

if I have another I’m very happy that it will be an elective C-section. They are not that bad, yes the first week is very painful but I recovered much faster than my SIL who had induction leading to forceps and a 3rd degree tear.

If I was given the option my own stipulation would be I don’t wanna be induced. Really messed up my plans last time

I had a baby (my third) at 41. She was measuring really large in all the scans, so I was worrying over the same questions. Turns out that she was a perfectly normal size when born! You can't trust the scans too much. What really worried me was the risk of shoulder distocia which can be a real medical emergency. I opted for a vaginal birth though like my other DCs.

In any case, it ended up with an emergency C-section as the cord was stuck over her head. It was a really good experience overall - the staff were incredible and the recovery was surprisingly quick. I was back driving in 2 weeks! The long term recovery was much better too. With a vaginal birth you can still be recovering months down the line, this was much easier.

Hi OP. I was you a few years ago. 40 with a giant baby. I was actually induced early because of this (and previous shoulder dystocia) and it took five days before they broke my waters. I then got to 10cm dilated, with just gas and air, did lots of pushing but it became clear that Megamind was not going to come down and was starting to struggle so I ended up with an EMCS at 3am.

Honestly with hindsight, I wish I'd just had an elective c-section. I'd had two vaginal births before this and the recover from a c-section really wasn't that bad. I lost a lot of blood so that delayed things a bit afterwards but as soon as the spinal wore off, the catheter came out out and I was mobile and I stayed as mobile as possible which really helps. I had minimal pain, despite getting an infection and the only real downside is the mummy shelf that I've been left with but not everyone gets that.

PS He was born on the 99.6th centile and at least 1lb heavier than the growth scans had predicted!

Given the high chance of emergency c section and the other risk factors around stillbirth, I would choose an elective section in your position.

I had an emergency section after several days of induction/epidural. My recovery was good and it was the least "emergency" an emergency section could be. Baby was doing well and no one was worried about her.

BUT, I was absolutely exhausted. I could barely hold my baby for a few hours because I was so exhausted. The lead up to having the section was upsetting and emotionally draining. She ended up being born at night, so DH had to go home and leave us only a few hours after she was born.

If I'd realised the likelihood of ending up with an emergency section, I would have chosen an elective.

Any section of course comes with risks, but it sounds like are likely to face those risks anyway.

It's the worst isn't it @noodlesfortea On Day 5 of induction I was so exhausted after no sleep and no progress I actually had a fully meltdown/breakdown and was discharging myself and going home. They had to bring the Head of Midwifery who took me to a private room to sleep all day as the induction bay was on the postnatal ward and so noisy.

@Hoplolly absolutely the worst! I was the same with having a full meltdown. I'd say I'm a very resilient person, but I just couldn't do it anymore.

I was so worried about the potential pain of an induction (which was minimal and well managed at my hospital) but not prepared for how draining it was.

I'd never advise any women to have a pre-40 week induction unless already showing signs of readiness for labour. Sometimes babies need to come out earlier than term for good reason, but I don't think the mental wellbeing of women is properly considered when advising induction. At least not beyond the pessary stage.

I had my second at 41 and I was booked in for induction at 39 weeks, I was also told I was carrying a large baby and had an anterior placenta. I found it really hard being in hospital, kept being told about the risks of shoulder dystocia with large babies and the impact of that, and when I asked about c section they didn't seem keen to switch me to that either, I did have a vaginal birth in the end with no intervention and she arrived at just 7lbs 9oz, rather than the 9.5 they predicted. I will say though, that whilst the labour was quick in the end, it was stressful, and i stupidly declined an epidural, in hind sight I wish I'd pushed for a c section, but because I didn't I did have a quick recovery. I would recommend writing down all your questions and sitting with the midwives when you go in for induction and going through them, I found them very willing to sit and chat through. They won't try to sway you either way as they need to be neutral, but they will help with the facts

I can only say what. I was 41 with a big baby. I had already had a 9lb 9oz vaginally with no problems, and I wanted the same for my second. My consultant agreed that I could go for it- but I was monitored every 2 days for the last 2 weeks. He was born 3 days late, 10lb 6oz 45 minutes after I got to the hospital. Not sure what the purpose of this post is- just to say that it's not automatic that you need more interventions just because the baby is big.

ELCS is the least traumatic birth for you and baby. I had two ELCS and have never regretted that decision. The thought of labour and then an emergency CS is horrible 😕 My first was a vaginal birth and all fine but aged 30 and daughter average weight !

You could always have a loose plan where you book an ELCS but if you go into labour naturally before the ELCS date then you may be happy to continue with the labour? Avoiding IOL

Please update us!

ELCS every day of the week. I was a similar age. Most of my friends who were induced in their late 30s and 40s ended up with long labours followed by emergency sections. I'd choose the elective option again in a heartbeat.

Given what you've written, I would go for an elective c section. With all the interventions you have mentioned it could get very hectic , for example if you strongly want an epidural, what if they won't/ can't give you one in time?
If you book a c section, you could be going in to hospital pain free, have a relaxed, controlled birth , almost certainly without any damage to you pelvic floor (the surgeon do a vaginally examination before they start I'd imagine) and then post op pain relief given before you leave theatre.
Another thing to consider is that at 40, maybe you won't be having several more children so the risks of multiple c sections or vbacs wouldn't apply.
Good luck.
Both mine were emcs, I tried very hard to avoid the second one. He was predicted to be massive, but looking into the margins of that predicted the variation on those measurements if pretty big. He measured 98th gentile and was born on the 75th.

It’s so hard as you’ll be pressured not to let the baby come naturally - often they are one to two weeks overdue.
One outcome of induction is a long labour leading to a c-section and the risk of that doesn’t seem to be highlighted.
Due to the size of your baby I would consider going for the c-section as an elective one; it takes more of the uncertainty away and you can plan for the support you’ll need afterwards.
With a smaller baby then I’d probably delay induction and hope for a natural labour, keeping in close touch with midwives.
Good luck

Ask your midwifery team about their knowledge of the current process on your induction ward.

I say this as my first experience and many stories on here detail being induced and then trapped in limbo because there aren’t enough beds or staff on delivery suite. Ask them what happens if you are induced and then there are no beds on delivery suite.

I had an EMCS following induction and then an ELCS

ELCS for me was a lovely and relaxed experience with a brilliant recovery. I was literally back to normal (and in jeans!) at two weeks post op, no long term complications whatsoever. Only downside for me is that at my hospital they keep you in for 4 to 5 days after a section, but hoping on my 2nd baby I can get out faster.

I think if you go into labour naturally, then fair enough to give it a go, but after hearing so many awful induction stories, I personally would under no circumstances allow myself to be induced - ELCS all the way.

Personally I'd go for the ELCS for the predictability.

I was induced at 41 weeks on my first as the baby was measuring big and they didn't want me going any further over. On the day of the induction she was measured at 10lbs and they offered me the ELCS. I decided to proceed with the induction, but despite contracting like crazy on the monitor once I was on the drip (36 hours after being admitted) I didn't feel them and didn't dilate.

I had a very calm EMCS (bumped to second on the morning list as one of the ELCSs had diabetes) and DD was born without incident at 9lb 7oz and a head circumference over the 99th percentile. They had to use forceps in the section as she was so crammed in! My recovery was very straightforward. It wasn't a traumatic experience at all but if I'd been in pain on the drip that could've been very different.

One midwife said that she reckoned I never dilated as DD was too big to descend and put the pressure on my cervix but no idea if there's any truth in that.

Cut to the chase, take control of the situation and go for the ELCS. Let's face it, from what you've posted you're probably heading for a CS anyway.
I've had 2, one EMCS and one ELCs. Both fine. I've never felt that I missed out by not having a VB. You need to do what is safest for you & baby.

If you book a c section, you could be going in to hospital pain free, have a relaxed, controlled birth , almost certainly without any damage to you pelvic floor (the surgeon do a vaginally examination before they start I'd imagine)

What makes you think a surgeon would do a vaginal examination before a c section? There would be no need!

Cut to the chase, take control of the situation and go for the ELCS. Let's face it, from what you've posted you're probably heading for a CS anyway.

Thats the bottom line, I think.

They definitely do not do a vaginal examination before c-section.
What many women do not realise is that they clean out the vagina with a swab on a pair of forceps afterwards.

Really? What if the cervix hasn’t opened?

My first was delivered by c action after three inductions then 17 hours labour, turned out I have a tilted pelvis baby weighted 7lb 13oz . I opted for a planned c section second time age 37. Baby 9lb 3oz. No regrets.

Thanks so much again, this is all really helpful. I appreciate everyone taking the time to answer.

One thing I'm worried about is that it is too late to get an elective c section sorted. We asked for a consultant's appointment last week but we've still not got anything confirmed and our midwife warned us there may not be a space available by the time we try to book a c section if we choose that route.

Is that the case? I'm at 37 weeks and 4 days.

"I would recommend writing down all your questions and sitting with the midwives when you go in for induction and going through them, I found them very willing to sit and chat through."

But can you ask for a c section when you're on the ward? Would that be too late? I realise they have to prioritise emergencies.

I will update. We're so happy to be having this wee one, bit of a journey getting here. And yes, as some have said, we're probably not planning another child so some c section risks don't apply.