Elective c-section or a natural birth with induction

[feelingsuperlucky]

I've just had my 20 week scan and everything is looking good and baby looks healthy, with this being an IVF pregnancy the consultant has given me the option of a elective c-section at around 39 weeks or a natural birth with induction if at around 39+5 weeks if baby obviously hasn't already arrived. Please can anyone share their opinion on what they would do? I know it's personal preference and I'll do whatever is safest for baby but interested to know other peoples thoughts x

Yes and I actually think the first birth was more traumatic because of the hypnobirthing. Afterwards I read posts from women saying pain is all 'mind over matter' and if you suffered its because you had listened too much to society's portrayal of labour in the media. I think if someone had have told me that it would feel like I was being crushed by machinery, it wouldn't have been such a terrible shock. The c section by comparison was nothing, in my experience.

I had a similar decision to make last year, I finally decided to go for the c section as I didn’t want to end up with an emergency one like my previous experience after my induction first time round (this was due to waters breaking but nothing progressing so went on Pitocin drip.) Another thing I considered was that I would likely be in hospital less time with the c section (based on the induction plan they spoke about) so easier for my son to digest me being away. I ended up going to labour the night before my c section anyway and then it got brought forward 😂 so she was definitely ready to come regardless but it was an amazing experience to be so present and we had the drapes lowered to watch her being born and was able to get a video, I would do it all over again if we go again (just maybe without the going into labour part if possible!) I was concerned about the recovery with a toddler but I seemed to recover better and quicker this time round, or maybe it was just less of a shock to the system as I’d done it before.

you said ‘they won’t allow’ that’s not their decision to make. It’s your body, your baby, your pregnancy.

Also NICE guidelines were recently updated that IVF (with no other risk factors) is not a reason to induce.

Thank you all for your stories! I don't see the midwife for another few weeks so I've plenty of time to weigh up my options!

@Happymchappyface Maybe my wording wasn't fully correct but that was his advice for my options, I personally trust the medical guidance the consultant gave us, if there is even the slightest risk to baby by going over my due date after 4 years of IVF I'm not willing to take that risk 😊

I totally respect that and as a fellow infertility mum, completely understand not wanting to take any risks.

I would encourage you to check out the information on Sara Wickham, she is evidenced based and breaks down the studies and statistics so you can make an informed decision.

The change in NICE guidelines happened because the evidence doesn’t support routine induction / c section for IVF pregnancies.

Have a read and use that for conversations with your medical team. A third option is daily monitoring to keep an eye and then use that to support decision making.

@Happymchappyface I absolutely will do, thank you! 🙂

I had a vbac with my last baby via induction.

The pain was horrific (my first child was born vaginally), I genuinely felt i was dying, this wasn't down to low pain tolerance as I had my first child using just gas and air.

I also couldn't move around due to being constantly monitored, just laid on my back which was agony.

In hindsight I wish I'd of just ignore the midwife and walked around, it may of helped.

I'd recommend a c section.

I’m a lecturer in midwifery and mum of 3, nearly 4. First induction vaginal birth, second induction C-section (premature) and third induction VBAC. All three my waters went and the rest followed. I found the C-section worst by far but that is very anecdotal and prematurity won’t have helped. My last birth recovery was genuinely delightful

If IVF were my only risk factor I would not choose either of these options, I’d pick a gestation I was comfortable with being induced (maybe 41 weeks for a precious 4 year awaited baby, I imagine) and accept an induction at that point. Worth looking at the risks to you and baby associated with all options if you can - induction, elective and waiting it out. There’s a lot to think about

I had an awful experience with induction. I know people who have had successful inductions but for me, it just wasnt worth it and ended in an EMCS anyway. This time if I don't go into labour naturally I'll be opting for an elective.

I don't agree with the months of recovery after a cs . I've had 3 and was back to normal after 2 weeks . It took far longer and a repair op after a normal delivery . Cs every time !

Induction at 35 weeks with DC1 - straight to drip, waters broken by midwife, constant monitoring so had to just lie in bed. Only pan relief was gas and air and it was a quick and fairly straightforward delivery.

DC2 was high risk so booked induction at 37 weeks but arrived naturally before that. No difference from induction (possibly more painful as back to back). I was more than happy to book another induction and would have done all I could to avoid a c section, from mums on my ward after DC1 those with the c section seems far less mobile and I was terrified of the surgery tbh.

I think it's a really hard decision to make and you need to do what's best for you.

After 7 years of IVF I wanted to experience a spontaneous vaginal birth as it was the only chance I had, and to me it was an important part of wanting to be a mother.
I was pushed relentlessly to have an induction or C-section because it was IVF, despite having no other risk factors. I am very glad I didn't agree and my waters broke 39+5. I didn't go into labour straight away so was put on the drip but declined an epidural. I really enjoyed the experience of giving birth, and I didn't find the drip unbearable. I had a wonderful birth experience and the few minutes of pain felt so insignificant compared to the years of heartbreak battling through the IVF process.

Has your consultant discussed the risks and benefits of these options, and explained exactly why they want to induce at 39+5? Is there a clear clinical need for it? Or is it just ‘policy’ with no studies or science to back it up?

Induced labours can be brutal, with sudden intense contractions, no build up like in natural labour. As such they are often more intense and painful, with a high risk of fetal distress and emergency c-section as a result.

Ask your consultant to discuss these options again.

Another vote to
say wait it out with daily welfare checks- blood pressure, babies heart rate is a possible option if you want it

you may find that if you push back even slightly other options are suddenly on the table it’s worth asking as I found that though they said they wanted to book an induction for 41
+0 and then they said if i declined I would have to go into hospital and meet a consultant and so forth they just automatically moved me on so i could
go to 42 weeks and I never got there. So I am happy I did wait it out (I had no risk factors and this was a subsequent baby)

you could
also ask the consultant what they would
choose themselves in your position

I haven’t had either (two spontaneous vaginal births) however I did a fair amount of research around this with my first pregnancy as they decided it was best that DD was born by 38 weeks due to placental dysfunction. Thankfully, she decided to escape voluntarily at 37+4!

Essentially, my biggest fear was an emergency section. Lots of my friends have had sections (some multiple) and they have said that the difference between planned ones and emergency ones is night and day. Inductions can take a long time (up to a week on a ward!) and the thought of going through all that, only to end up with an emergency section anyway was not palatable for me. I decided that if an induction was medically necessary, I would have opted for a section.

I believe the success of inductions is improved in subsequent labours (if the previous births were vaginal) so if I’d have needed it with my second baby I’d have possibly chosen the induction, but only so far as a pessary and broken waters. If it didn’t start naturally at that point I don’t think I’d go for the drip.

Elective c section every time. Peace of mind knowing the plan, luckily my recovery was very smooth (eg out for solo walks with pram and dog by day 7 and driving by day 10). First DC, age 37.

I had 2 elective c-sections that were both great, smooth experiences. Breastfed within 40 mins, was up the next day. No pain at any point (during or after). I wouldn’t put myself in a position where any procedure might turn into an emergency c-section.

ELCS all the way - I ended up with a medical CS as DD was breech and not for turning (was quite glad of this!). When I was in one of my many stays during pregnancy in a 6 bed bay where 5 other ladies were being induced 5/6 of them ended up with EMCS. That definitely helped me decide on CS!

I've had 2 inductions. They've both been fine. Yes, I had a few days in hospital beforehand, and both needed the drip after my waters were broken. But both were fine. I had an epidural for both.

You need to weigh the risks and benefits in your personal situation. I would say that I would worry that with every uterine surgery, e.g. section, it will make future surgeries more difficult. For example, if you needed/wanted a hysterectomy in the future.

2x ELCS here.

recovery was quick (out and about by week 2), babies feeding within the hour, pain managed with paracetamol + ibuprofen. Would do again!

Do some research about your particular hospital and demographic (age + first birth) but when I did mine it was ELCS over induction very clearly for less risks of complication to mother and baby.

How is IVF a risk factor?

OP what is the rationale for offering induction or ELCS?

Please educate me as I don't understand?

I'm surprised you're not going to 40 weeks. Conception via IVF isn't (to my knowledge) a risk factor for birth?

My IVF pregnancy went to 40+11, then induction. Ended 24 hours later in EMCS, due to baby's head presentation making vaginal delivery impossible. Recovery from the C-section was absolutely fine, scar healed beautifully, happy days.

Second (natural) pregnancy I had dreadful mental health and chose elective C-section for that reason, baby born at 40+4. Physically I recovered just fine, but mentally I was not at all okay. Took me a year to be over the most acute depressive symptoms, and about seven years to actually feel like myself again.

If you choose elective C-section my advice would be to get everything down in writing and print it out before you turn up at the hospital: particularly what time/date they want you there. I was sent away like a naughty child for turning up on the date the consultant had booked me for - my due date - she'd done it wrong, but they blamed me. Not helpful to my already poor mental health!

Hope all goes well! IVF babies are a wonderful thing ❤️

Thank you all for your comments!

@LadyBrendaLast I believe there is concern that the placenta in IVF pregnancies deteriorate quicker and may not function optimally past full term. I'm not medical expert and obviously it's all new to me so I've still my own research to do but that's the information I got from the consultant.

I'd only ever consider induction if my cervix were pretty ripe. Would be an ELCS otherwise. Obviously you won't know at this point what state it'll be in!

Chat through it with your consultant, but a lot of people don't realise inductions aren't a one size fits all. If your body isn't ready, they're far less likely to be successful. Most people getting induced never discuss their bishop score - I didn't even know what it was! It's a marker for how responsive you'll be to induction. If you have a low bishop score, it's likely to be a shit show.

You also have options during an induction. If you're not responding well, or progressing as you want too, you can have it in your birth plan to call it and switch to a c section. You don't have to suffer through a slow progression just because you started the process.

If you do opt for induction, ask about indications for your bishop score + baby's lie in utero (are they in a good position) + early indicators of switching to a section.

C-sections have risks too, so weigh those up against vaginal delivery risks. Plus things like how many children you want, and how close together.