Induction or C-Section?

[EmmaMcMillion]

I'm not sure which forum to post this in, but here's my dilemma. I'm 40 and pregnant with my second baby, and I'll be 41 when I give birth. I had CVS done so I know its chromosomes are normal. I'm around 16 weeks pregnant. I had my first baby at age 37. I was 41 weeks so they induced labor with 3 cytotec pills around 2 hours apart and when my contractions seemed almost unbearable then they wanted to give me pitocin because my contractions were supposedly not strong enough, so I got the epidural at that point. I was only in labor like 4 or 5 hours from when my water broke to when I gave birth. When I was pushing, I started to bleed so they used a vacuum to get the baby out. He was 8 lbs 6 oz. The doctor couldn't find where the bleeding was coming from until they took me to the OR. They found the tear, which was a "sulcus" tear in the vaginal wall up near the cervix. They said it was only like an inch long but near lots of blood vessels. Because it was hard to find, I wound up hemorrhaging and needed a blood tranfusion. I also needed one the next day and was put in a lousy section of the hospital so I could be monitored, but they didn't allow the baby in that part of the hospital. So except for seeing him briefly the first day, I didn't see him for a few days. After I gave birth, my doctor said if I had another baby, she would just induce me 2 weeks earlier because I probably wouldn't have torn with a smaller baby. My family is convinced the cytotec caused it, because where the pills were placed were not far from where the tear was. However both doctors in the practice said the cytotec didn't cause it. They said there are no prostaglandin receptors in the vagina, only in the cervix, so the cytotec would not have affected the vagina, and that maybe because I'm older I'm less stretchy or maybe the baby's shoulders made me tear. I have told the doctors I'm afraid of tearing again, so they said I could get a c-section if I wanted. So basically I could either get induced at 39 weeks or get a c-section, and the choice is up to me. Both options seem bad to me, because if it was caused by the cytotec, I could tear again, or if it's because I'm older and not stretchy, I could tear again. In ways, a C section seems easier because I wouldn't need another episiotomy and I wouldn't have to go through labor, but I've heard the recovery is bad. I'm not sure it would be any worse than what I already went through. If I didn't tear, I think being induced would be better, but there's not guarantee I won't tear. I don't know which to choose, since it's like choosing between two evils.

 

[tristansmum]

hi... i'm prob not allowed in this forum cause i'm under 35 BUT i did have c section and next time will have the whole elective c section or VBAC decision. So similar to your predicament.

First remember labour second time round tends to be easier and quicker (not always ofcoarse but majority of the time it is). You have already dialated to 10cm and pushed a baby out so your body will remember this and so it happens much quicker. also your vagina should stretch easier the second time which is why many women who tear the first time round, don't second time.

If your doctor say the cytotec did not cause it then i think you should believe her. i'm sure your family are just trying to help but the doctor is the professional and i'm sure she knows what she is talking about. my understanding is the induction pessaries work on the cervix only.

i had eergency secion after failed forceps. I found the recovery hard. It was straight forward and i healed well but i was in pain of a good couple of weeks and i couldn't carry my son or look after him properly. this puts me off an elective because i didn't like how helpless i was last time. I couldn't even get off the sofa without someone helping me to stand. However, your own recovery from a tear sounds bad too so its hard to compare which is best.

i don't have an answer for you but just thought i'd reply.

 

[Nikki_d72]

Hi, the fact that you tore may have more to do with the pitocin causing such rapid contractions that your body did not have time to stretch naturally. As for beleiving everything the doctors tell you - don't. Much of it is for their own convenience not your good. I was told my baby was in distress to get me to give consent for a section, but I now have my surgical notes which are underlined "NO FETAL DISTRESS". Just to give you an example. Why can't they just let you get to term and try to birth naturally? I'll second what the lady above said about your body remembering what to do and the fact you've stretched already making things easier for you.

Pitocin does all sorts of disastrous things to natural labour, I would try to avoid if possible and yes, the recovery from a section isn't funny, especially if you have another child to look after. They can't make you do either one of these things, have a good read up and decide what YOU want to do and don't give in to their bullying. You only get one shot at each birth, glean as much knowledge as possible to empower yourself and insist on support, or switch your LMC. Have a look at "the business of being born" online and maybe have a rummage about the natural birth section here - there are a lot of very knowlegable and helpful ladies there who can point you towards lots of great reading material, even if you don't want to go the "natural" route entirely.

It makes me really angry that they are trying to force you to make this decision, that you're clearly not comfortable about. Best of luck, let us know how you get on? XXX

ETA, sorry, didn't mean this to sound as ranty as it came across, it just makes me mad that they treat women like this, trying to take away choice, sorry.

 

[seoj]

Maybe just have a more in depth discussion with your doctor? Ask about odds- and what they think may happen if you were induced and if you opted for the c-section, what you could expect there. Just having all the facts and odds may help? But you need to trust your care provider knows what is true as well.

Personally, if it meant less risk to me or baby, I would probably opt for the c-section (although that thought scares me!). BUT, I have several friends that needed a c-section, and yes, it took longer to recover-- but they all said the first week was the most difficult. Then it get's better week by week... I may need one myself if my placenta doesn't move upward (it's currently blocking my cervix).

It's a very personal choice hun. You have to do what makes the most sense for you. Period. I would just get all the info you can and decide what your most comfortable with.

Sorry I can't be more help... wishing you the best of luck!!!!

 

[Nikki_d72]

Just to let you know, C-section is not "less risky" than vaginal birth, it's 4 times more risky, the obstetricians often don't tout the risks or disadvantages of abdominal surgery.

Anyway, I found this article: https://www.bellybelly.com.au/birth/caesarean-section-or-vaginal-birth

It's a pretty well-balanced look at the pros and cons of C-section v's Vaginal birth, hope it is of some use to you in helping you decide.

 

[Fallen Angel]

I'm with Nikki - people think of C-Section as the easy option, but it is far from it.

I should find out in the next couple of weeks whether I'll be allowed a natural birth because I have a heart condition, a damanged pelvis after previously smashing it in a bike accident and the possibility of having a rather large baby, but I'm hoping and praying they don't push for me to have a c-section and I'm allowed to give birth naturally.

I couldn't do with the extended stay in hospital when I just want home with my hubby and newborn or the 6 week recovery thereafter - which is minimum dependant on whether you get any infections, etc.

Plus, you're not allowed to drive for a few weeks and it can be difficult to lift your baby and care for them in the way it would have been if you hadn't had a c-section.

No, sirreee, certainly natural for me if I get the choice - I'll be very disappointed if I have to have a c-section

 

[Nikki_d72]

Aw, I hope it goes your way, Fallen Angel.

Despite all the nonsense spouted about Cephalopelvic Disproportion, a damaged pelvis is one of the few reasons it can actually happen, but it surely depends on the extent of the damage, your pelvis can do amazing stretchy things in labour (pre-labour measurements aren't reliable, as it can move so much in the later stages, until then, no-one can know how well it will or won't open) so I hope they let you at least labour to see what happens.

Try not to get too down if it goes the surgery way - there are lots of things you can do to stay in control of the procedure and make it as good an experience as possible - Sarah Buckley MD wrote a good article on it where she says: "Issues that need to be considered include waiting for labour to begin to ensure baby's readiness for birth; epi or spinal rather than general; asking if the drapes can be lowered so you can see your baby's birth (me -this may sound hideous, but from experience, that feeling of being cut off and not knowing what's going on is worse, you're stuck there listening, you get shown the baby for a split second before it's taken and cleaned, checked etc and it feels like an eternity); requesting that the baby's cord be clamped late to allow the full amount of blood to go to the baby (it can be up to half the full amount of a newborn's total blood); asking to see, or even take home your baby's placenta; and allowing immediate skin-to skin contact between mother and newborn." I think the immediate contact bit would make a huge difference too - my DH was the forst to hold my DD, and while I don't grudge him that at all, I felt like a bystander, he brought her over to me and I stroked her face etc while I was being stitched and I was in a fairly baby-friendly hospital so they gave us skin-to-skin in the recovery room and didn't separate us at all, but I didn't feel like a participant in her birth - it was "done to me" if you know what I mean? The more you can feel like an active participant, the less it may bother you later.

Anyhoo, I'm rambling, but thought I'd post this for any ladies who genuinely HAVE to have a section, there are ways to get the best out of it and make it yours.

As I say though, FallenAngel, here's hoping they at least let you labour and give you a FAIR shot at it - maybe ask them in advance if that's the case what restraints you'll have, i.e. time limits, continuous fetal monitoring, drip in hand, push for epi etc as these are all things that will hinder you, that way you can negotiate the ones that are most important to you in advance and get it written down, from them too, if possible before the day.

Right, all the best, as you can see I've got a bit militant, sorry if it comes accross as uber bossy, I just hate to see ladies being pushed into corners by the doctors, just to cover their own bums!

 

[Fallen Angel]

Nikki, that was a very interesting read and helpful post - thanks

From my own personal viewpoint, I'm in agrement with you whereby I would like the screen down and be able to see our baby come into the world, I would also like to be handed the babe straight away also, for the very same reasons you explain.

I'm hoping that my appointment on 5th July will be positive and that when my obstetrician consultant has my previous x-rays from my smashed pelvis, it's good news. My worry is my pelvis was pretty badly smashed as it was fractured at the acetabulum, public remus, sacrum and somewhere else that I can never remember the name of

I have a heart condition also, but my cardiologist is happy for me to go into natural labour as he is happy that the structure of my heart is strong enough to cope with it - so that's good.

Just need to wait for the sizing scan on 5th July (I have PCOS and apparently run high risk of delivering a very large baby) and the information the consultant has gathered from my previous pelvic injury to decide.

I have a little concern that they will try and corner me in to having a c-section though, because my first appointment was about 13 weeks, and even then, before gathering further information, she was talking about inducing me 2 weeks early to avoid me going into natural labour and facing any potential complications.

I listened tentatively that time, but unless it's a definitive on my pelvis or baby size, I will certainly be pushing for a natural birth.

My ideal scenario would have been a water birth, I've accepted that's not possible due to possible complications and that's fine, but I won't give up the fight so easy on a natural birth.

Anyway, sorry for hi-jacking your thread Emma

 

[Nikki_d72]

Wow, FallenAngel, you've battled against a lot of things to get to where you are now, well done! It sounds like you are very well informed and won't be pushed around, I'm pleased to see that - I hate all the "just do what the doctors tell you" replies, it's so disempowered and so wrong. All the best, let us know how you go? xxx