Birth plan after recurrent miscarriage

[Lily1990]

I'm 30 weeks pregnant after 5 early miscarriages in the past 2 years and treatment for high NK cells with Dr Shehata. I'm classed as high risk due to my history of miscarriages and my midwife has suggested an induction as the risk of stillbirth is higher for those who underwent fertility treatment. I'm not keen on an induction and feel I'd rather have an elective c section or wait for the baby to come when he is ready. However, they don't want me to go over 40 weeks.

I wondered what others with a history of recurrent miscarriage decided to do when giving birth? Were you also recommended an induction or c section instead of waiting for the baby to arrive in their own time? It seems to be recommended to have an induction/c-section if you have had IVF in the past but nothing seems to be mentioned for those with a history of miscarriage.

Would be grateful to hear others' experiences! Thanks xx

I had a c section with both of mine.

However, I had pre eclampsia and was a much older mum so very high risk so the decision was taken out of my hands.
Glad I did as I now have my 2 miracles safe and sound.

I'm 36 weeks, being induced at 38. I was never advised that I would need early induction/ c section due to ivf or previous miscarriages themselves as I think there's alot of debate and variation about evidence when doctors like to deliver with ivf. Some do suggest early/ others leave til 40. I did read there's a slight increase in stillbirth conpared to non fertility treatment but it seems to be after the 40 weeks, so induction would be offered if 40 weeks and no labour has begun.
Personally, I was offered induction / c section due to other complications such as uncontrolled diabetes / blood pressure rising / reduced movement episodes / ama but as I said ivf was never mentioned as a concern for early delivery by any of my consultants and I've seen about 4 of them. I'm not a medical professional, and have no idea why early delivery would be offered for recurrent miscarriages. Only for previous stillbirth is it mentioned as a reason.
It's really a personal decision. I chose induction due to the risks associated with c section for baby given my own circumstances. Good luck with whatever you decide

@Lily1990 no answers but going through similar. I had 3 1st trimester losses last year and then amazingly caught with our rainbow baby on a cycle when we weren't trying as were awaiting a referral to the fertility consultant. Currently 32+5 and being closely monitored due to small size (<3rd centile). We've been told they want to deliver 'by 37wks' - heightened still birth risk due to growth concerns etc I believe. As little man currently looks good aside from size, my consultant is happy to recommend induction, but after all we've been through, I'm seriously considering asking for the elective section. I certainly don't see it as the easy option, and I'm quite daunted as never had surgery of any kind... However, I think it feels more controlled and less risk of high stress for baby. I'm really in two minds as to what will be best. Part of it is I'm not convinced my body will willingly go into labour pre-term. I have a son already and he came at 41+1 after a sweep so doubtful I'd be good to go a month earlier this time!

Hi OP. I didn't give birth in the UK but have a similar story to you. I had five early losses before a full term healthy pregnancy.

My doctor said that once I was in the second trimester my pregnancy was no higher risk than anyone else's. But when it came down to giving birth, his appetite for risk was basically zero. I had one episode of reduced movements at 39+4 and he insisted on inducing me right away even though everything looked absolutely fine during monitoring. He basically implied that having made it all the way to term he didn't want to take even a tiny risk of it all going wrong at the last minute.

As far as I can tell, you're unlikely to actually be higher risk, it's just that it's been such a long, hard road for you to get to this point. It sounds absolutely awful but I think the logic is that someone who got pregnant and carried to term easily can probably just make another one, whereas someone who has lost multiple pregnancies may only have this one chance to have a baby.

My induction failed and I ended up having an emergency C-section. My baby was badly positioned, my cervix didn't dilate beyond 6cm, and my baby was in distress, so they decided to get him out. He turned out to be very small, so less able to withstand the syntocinon contractions. I suspect I had undiagnosed IUGR because he was borderline low birth weight.

An induction won't necessarily end in a C-section or other interventions. But I would do spinning babies exercises to try and get your baby to get into and stay in the most favourable position. Don't slouch on the couch, sit on a ball when you are watching TV. There'll be plenty of time for the couch once baby is here. And if you do have to get the syntocinon drip, ask for a lightly dosed epidural first.

Even though my experience with induction wasn't a very positive one, I think I would still opt for induction over an ELCS. I had a VBAC after my C-section and I found the recovery much better.

I would go for an induction.
I definitely won't risk it to go over 40 weeks - these medical advice are there for a very good reason. The baby's safe arrival is the most important.

I don't really see why choosing c section over induction would be better - they both carry risks.
I was induced and I had a good experience. I heard horror stories about induction, but I also heard bad ones about the c section.

Yes, induction hurts like hell, l but if you ask for an epidural straight after they break your waters, it will be fine.

I had a baby three weeks ago, after four recurrent miscarriages (one at 14 weeks and three at 7-9 weeks) and one child (12 years ago). This pregnancy was classed as high risk but also I developed gestational diabetes (metformin controlled), gestational hypertension (but not pre-eclampsia) and also I just turned 40, during growth scans baby was first measuring 90 percentile but came down to about 70 percentile and was born 8lbs 8 oz which was apparently 50 percentile. My consultant recommended induction at 38 weeks exactly which I accepted, although I was quite sceptical that it would work so early. I was keen to avoid a c-section and I’d had an induction with my first son but at 42 weeks previously. I went in for the induction at 38 weeks and baby was born 38+2. I had the pessary first for 24 hrs which didn’t progress much, I then had gel twice, 6 hours apart and after the second gel the following morning (after an amazingly well slept night on an empty ward!) they transferred me to the delivery suite and were able to break the waters. For the next few hours I had mild contractions which got me to 4 cm, and then my actual labour was very quick only 17 mins from 4cm to baby being born. I used gas an air (with first induction I was on the drip and had a low dose epidural) only. I’d had some monitoring during the induction but was able to move around in between and actually when my labour started the midwife was trying put the probe on baby’s head to check but instead I pushed him out. I was on my knees leaning on to the bed which I think was better than on my back when I had my first induction. I knew that there was a higher risk of emergency c section or assisted delivery with an induction so early, however I would’ve been happy with either too if it was needed to bring baby safely here. I know there may be negativity towards induction and if you’ve had a bad experience in the past then it would impact but I think the consultants make their recommendations based on risk and with my risk factors I was happy try what they recommended. I hope it goes well for you OP regardless of which option you choose and that you have your beautiful baby in your arms soon.

I had a planned induction at 39 weeks due to IVF/maternal age (and I did also have a history of miscarriages although that wasn't mentioned). I cannot overstate how completely fine it was. No 'cascade of interventions'. Minimal pain relief, because I wasn't in much pain. It was a genuinely good experience (despite being right at the beginning of the first lockdown!) and I'd absolutely do it again (maybe minus the lockdown). It's entirely your choice and you should choose what feels right to you, but I did want to share a positive experience because they do exist!

I wasn't treated any differently due to my miscarriages (I had 3 but with live births in between) I was surprised at that because I lost a lot of blood during my first one and had to go back into hospital 2 days later for fluids because my heartbeat was way too fast and I felt dizzy. I only had 150mls blood loss with each of my vaginal births and 500mls with each of my c-sections though so fairly standard. My 2nd miscarriage was early and happened spontaneously so I didn't get a choice but with my 3rd it was a missed miscarriage at 13 weeks so I chose a surgical one just in case.

Thanks all so much for kindly sharing your experiences and advice, I really appreciate it! It’s given me a lot to think about. Xx

Are you still seeing your Reproductive Immunologist? What does he recommend? As far as I know women with immune issues have higher risk with things going wrong and are mostly recommended to birth earlier.

After recurrent MC's if I had to be induced I would choose an elective C section. I've been through enough already as to risk injuries from natural birth or emergency C section.

Hi there it's a labour ward midwife. Lots of women who conceived via IVF go on to have a natural conception with their second. A Caesarean section will complicate the 2nd pregnancy and birth so it's worth bearing it in mind. How long a woman's labour is going to last and how the baby is born depends on the size and position of the baby and size and shape of the woman's pelvis. So combinations are endless. Yes you could end up with a Caesarean section in labour. Or you could have a very straightforward vaginal delivery. As for induction- I suggest you look up a book on induction by either Sarah Wickham or Rachel Reeve. Both are experienced research midwives. Both books are available on Amazon. I hope it helps

@Lily1990 how old are you? And how was your baby conceived? If this is a non IVF baby and you are under 40 I don’t think there is any basis for early induction.

I have had 2 kids thanks to Dr shehata (and now pregnant with no 3). DC1 was born when I was 31 and DC2 when I was 33. I had 4 mcs (3 before dc1 and 1 in between kids), all at about 6 weeks, and I was on the standard pred plan. I have hypothyroidism but no other health issues.

Once I was signed off from Dr Shehata in the second trimester I was treated no differently from any other patient by the nhs. Certainly no one ever suggested I couldn’t go over 40 weeks! I had normal, healthy pregnancies with both.

With DC1 I was induced at 40+12 because he showed no signs of coming by himself (though I knew when I ovulated as obvs had to test to time the pred and I was actually 40+6). With DC2 my waters broke at 40 weeks and I was then induced because labour didn’t start naturally. Contrary also to what pps have said, induction doesn’t have to be awful - I had 2 x inductions and 2 x quick lovely water births. Labour with dc 1 was 2hrs 45 and with dc2 was 1.5 hrs.

Have you read Dr Sara Wickham's book Inducing Labour, so helpful really recommend

The book talks about all the reasons for induction and the risks and benefits. It's honestly one of the best books I've ever read.

Also recommend Evidence Based Birth

evidencebasedbirth.com/evidence-on-inducing-labor-for-going-past-your-due-date/

I had three miscarriages before I had my daughter in May. I wasn't told the miscarriages made my risk any higher so I went into labour naturally and gave birth vaginally.

Hi ladies, thanks so much for all your answers and recommendations, I really appreciate it! What has stood out to me is that there is no consensus on the best option - some people recommend inductions, others recommend c-sections, others suggest waiting for the baby to come in their own time.

And as @Kosenrufugirl mentioned I appreciate there are lots of other variables too which might affect things, e.g size of the baby etc. I think I will have to carefully consider everything and what I feel most comfortable with, after finding out more information about inductions etc, discussions with the consultant and midwives, and later scans (showing baby's position and size).

To answer a few specific questions, @Olivie12 I'm not seeing my reproductive immunologist, but I'm sure I could ask them what they think on this.

@harrietm87 I remember you from the NK cells thread :) really helpful to hear your story and wonderful you have had 2 (and soon to be 3) children on Dr Shehata's plan. I'm 33 and the baby wasn't conceived via IVF, also don't have other risk factors (gestational diabetes, high BMI etc) so can see I'd be low risk in that sense. But I've done some research and there are several studies showing a higher risk of negative birth outcomes for women with recurrent miscarriages (after accounting for other risk factors), e.g. this study. So I'm inclined to err on the side of caution (e.g. accept the induction) at least for my first child.

Thank you again for the advice xx

Hi there further to my earlier message.... just to complicate things further, babies change position frequently in labour and growth scans aren't always accurate, especially if done after 36 weeks. I suppose you just need to decide whether you want an elective Caesarean section or try for vaginal delivery. I think an appointment with a Consultant obstetrician would be a really good idea. I hope it helps