Induction or Elective Csection

[TMI2000]

Okay, so a bit of back story.
I am currently 14 weeks pregnant with my second, my first will only be 18 months when this baby is due. I need to have a plan set at my 20 week appointment and I will either be requesting an induction at 38 weeks or an elective c-section at 38 weeks.

With my first baby, after spontaneous, vaginal birth (assisted by ventouse and episiotomy) was in labour for over 24 hours, didn't eat/drink or fuel my body in any way in the time due to nausea and was pushing for over 2 and a half hours. My body was exhausted.
After birth I had a major PPH, 4-4.5 litres of blood I lost, I had abnormally high levels of acid, potassium and carbon dioxide in my blood so I had to be put into an induced coma for 38 hours, woke up in the ICU Monday after giving birth on Saturday.

Safe to say, this has caused a lot of anxiety around the birth of my second so due to the risk of complications and the mental health aspect I now have surrounding birth I do not know which to request, induction or c-section? I have done plenty of research and you are more likely to bleed more and haemorrhage with a c-section and the thought of having major surgery, whilst having a toddler and a baby to manage and also getting married a month later worried me. I would prefer an induction as I loved the whole labour/birth but I know people have also have horrendous experiences and ended up in an emergency c-section anyway.

What would be people's suggestions/experiences?

I would go for induction as baby less likely to have complications if born vaginally as the fluid gets squeezed from their lungs as its supposed to, and you get the benefit of not having C section recovery to worry about with a newborn and a toddler!
Induction probably more likely to go well at 39weeks than at 38 though so worth thinking about the timing aspect and giving your body the best chance of success.
Best of luck!

@TMI2000 what a scary experience for you. I completely understand why this would be so difficult. First of all, I would highly recommend requesting a birth trauma review with a specialist midwife. I think all Trusts offer this experience. It gives chance to talk through your previous birth, what happened when, and why and helps you get some perspective on it and the likelihood of encountering similar issues again.

There are never any guarantees with birth of course, but I think, especially after an experience like yours, your care team will be fully on the ball with monitoring you etc and will be doing everything in their power to ensure no repeat. I imagine whichever option you go for they will likely want it to be quite controlled and with plenty of blood supplies close by.

It is ultimately a very personal decision. I had an elective section in July for different reasons. Very small baby, lots of close monitoring and previous losses. They wanted him out by 37wks. Despite having had my first by a very successful and positive vaginal delivery I had a feeling of overwhelm and possible impending doom with my second. I just wanted him out safely and felt there were too many unknowns and risks with the vaginal birth. I was also unsure how my body would respond to induction, especially early. I felt strongly that I wanted to take on the risks of the birthing process onto myself and away from him and this felt more controlled via the section. I also felt comforted that we were already in a surgical theatre if any further interventions etc were needed. I was very scared though as hadn't previously had surgery of any kind. Overall, I had a really positive experience and a doctor told me that given his small size it's likely he may have struggled with being induced anyway. It was easy to arrange childcare for my 3 year old as we had a specific day to work with and my recovery was thankfully really good. As long as you have decent support hopefully you should be ok if you go that route. Nearly 4 months on and I've been fully recovered for weeks. Back to all my usual activities and able to pick up my older boy etc. For me a section this time was absolutely the right choice and I have no regrets. The actual operation was really positive too and nowhere near as scary as I'd worried it might be.

In your situation I would ask to discuss all the risks etc and what kind of mitigating factors could be added to a birth plan etc for whichever route you choose. Talk it through. They understand how important this is, particularly after trauma like yours. Be as informed as you can and then see how you feel. I read a great (short) book called 'induction matters' as part of my decision making process and it was really helpful. In my situation I'm convinced it was the right call to go section but can see why it wouldn't be for everyone.

Wishing you a healthy ongoing pregnancy and a really positive birth experience to help with your healing from your previous experience. You are so brave to be having another child after going through that. I have every confidence that your experience this time will be very different 💗

What does your doctor recommend? What is the likelihood of you going into a coma again for both options?

Thank you all for your responses.

Yes, I am currently awaiting the Birth Trauma referral to go through so that I can speak to someone around this.

@Caipulli I haven't had a chance to speak to the consultant as of yet as the first consultant appointment is with your 20 week scan, this is however part of the questions I am planning to ask, I have just been doing as much research as I can into both options whilst I wait for the appointment.

@SnookyPook how soon after the c-section did you feel able to walk and stand normally and be on your feet for say the majority of the day? I have heard lots of positive things about elective c-sections I just do worry about the recovery time.

Poor you, that sounds horrible. I don't understand why induction would help, though?

Do you know why first labour went that way? My first was long labour ending in c section and not at all what I wanted tho without the pph and coma horrors you had. It was because baby's head was wedged in a funny position. Just wouldn't have come out that way.

Second baby - textbook vaginal delivery. They'd already have you flagged up for extra attention after previous pph I think. Second deliveries are usually much quicker. I found it way easier than cs recovery.

@Haroldwilson oh apologies I didn't mention, another reason that I believe I could have had the PPH was because my son was on the bigger side at nearly 9 pounds, so upon research and speaking to midwives, it can help your body to stop the bleeding as the womb doesn't have as much space to contract etc etc.

I don't think they're likely to offer either at 38 weeks, unless this baby has any issues. Either would likely be booked for 39+3 or later.

I've been told that a repeat section is the best thing for me; but I'm nervous of recovery. It's supposed to be a LOT different with an existing child to look after, and yours will be half the age of mine. DH will be around for at least the first 8 weeks, and I recovered really well the first time, but I'm nervous.

Is the wedding movable? There's no way I'd have a section if it's not - I recovered super well, was up and walking on the same day, didn't struggle too much with pain, and could do most things by 2 weeks later, but it's major surgery. My wound was still dressed until 3 weeks post-section, and I was incredibly swollen. You still have to sit down a lot - your muscles have all been cut - and although I could walk say half an hour away and back daily, it'd wipe you out physically.

Induction gets very mixed reviews too, but it's supposed to go a lot smoother if you've given birth before, and you bounce back from vaginal birth a lot faster, statistically. A friend of mine gave birth just over 3 weeks ago, and is pretty much back to normal, so I'd be a lot more confident about your wedding that way.

I'm really sorry that your birth was so traumatic. Mine was pretty awful too. I didn't find birth listening very helpful, personally, but time has helped a lot.

Given that medical history, I'd be going with whatever your consultant recommends as safest for you and baby, and then ask for support around managing your mental health in that scenario.

That said, I know consultants can sometimes think that physically, two options have fairly similar risks, and so whichever is better for the mother's mental health is better overall – I was in that situation with DD2, and my labour with DD1 was not as extreme as yours.

Things I'd think about are: Why 38 weeks? Could you go a bit later with regular monitoring to give yourself a better chance of spontaneous labour or an easier induction?

When did you go into labour with DC1? Induction is more likely to be successful if you're close to ready to go naturally. Each pregnancy is different, of course, but the odds are more in your favour if you went naturally at 39 weeks the first time than if DC1 was 41+4. (For me it was induction from 39 weeks, and that was only slightly before I'd gone into labour with DD1, so likely to be favourable – in the end, I went naturally then.)

How did you tolerate the pain (and nausea) of labour? How do you feel about the prospect of doing that again? What would the plan be to manage your nausea better and hence help you eat/drink? (I had a plan involving early antiemetics if needed, including potentially attending triage to get an injection in the early stages and then returning home until labour was fully established.)

Bleeding is an obvious concern for you with a c-section. Does the consultant think there's an extra physical risk for you there, or is it a mental health risk (which is completely valid), but not a physical one? Physical and mental risks need different management techniques.

Inductions can be very intense, especially if your body wasn't that close to spontaneous labour. Is there any reason to think that would be an extra risk for you (mentally or physically)?

C section. A planned c section is safe, quick and straightforward. Chances of having complications with a planned c section are miniscule. I’ve had one and was also a c section baby. I know many women who have had them, we were all out of hospital within 24 hours and able to do normal things within a few days.

the stuff people say about the benefits your baby gets through passing through the vagina is purely theoretical, there is a lack of evidence supporting this.

Planned c section is much easier than a complicated vaginal birth. I’ve had one and having another in a few months, feel free to ask me any questions x

@YouveGotAFastCar thank you for sharing. This is why my thoughts are leaning towards induction but I would happily be induced later so long as it is thought safe in my circumstances. My thought is 38 weeks now but that it just from what i've read can am really looking forward to speaking to the consultant to get this ironed out.

Ultimately, I will do what is best for the health of both myself and the baby.

@skkyelark this is exactly my thought process. With my son I went at 39 + 5 spontaneously so 39 weeks my body is much more likely to be ready for an induction or if not, I may even go into spontaneous labour again. The nausea was bad but I wasn't actually sick. This time I would eat more to fuel myself throughout it as I wouldn't eat or drink last time. I ended up getting an epidural last time but I was already 8cm and actually on hindsight I think I could do it on just gas and air so if the consultant would deem it safe for induction/vaginal birth I would go unmedicated apart from gas and air and see how it goes.

it's such a hard choice but I am ultimately going to be completely consultant led by what they feel is best.

@TMI2000 as mentioned my c-section recovery was really positive but even so, I was definitely up and about slower than after my vaginal birth (had an episiotomy too so that wasn't without additional physical aspects to consider but far easier). I managed to shuffle for a sat-down shower about 6 hours after surgery but it was hard. We were in hospital a week as my little one had jaundice and I think that enforced rest and time away from my 3yr old undoubtedly helped too. By the end of the week I could slowly walk around the outside of the hospital. Back home I was able to walk around more and more. However not sure I would have liked the deadline of 1 month to be ready for a wedding. Also, obviously some women do have complications such as infected scar etc so that is worth thinking about. As said, all things considered, it was the right route for me (also, my natural labour with my first didn't start until 40+6 - he was born at 41+1). In your case it does sound like there could be better hopes from induction but I deffo agree to talk it through with your team and see what makes most sense.

Ultimately the aim is for you and little one to be safe and I'm sure they will do everything they can to help that. 👍🏼

So I won’t weigh in on what you should choose as my first was an emergency c section and my second an elective c section but circumstances were very different to yours.
what I will say is that recovery was much harder the second time due to having a toddler. You are up and about the next day but you have to be so careful, if you keep up with your painkillers sometimes it can feel like you can do a lot more than you should be doing and the seriousness of the surgery you’ve had can slip your mind. The reality is that it’s seven layers of your body that have been completely opened and stitched back together, it can easily come open again even slightly and get infected and set your recovery back weeks. You can’t lift your toddler or anything heavier than the baby. With your first baby it’s okay because you just have a little newborn to care for, but it was hard the second time and I’d have rather avoided it.

Personally I'm going for an elective csection this time round. Also have an 18 month old. When I had my first baby I was induced but had no progress after 5 days and multiple induction methods & so went for a C-section in the end.

The problem is a lot of inductions end up as having to have c section anyway.