talk to me about inductions and c-sections

[cricketwife]

I'm 39 w 5 d and just saw the OB this morning.  My cervix is still high and closed.  (This is all particularly upsetting b/c at 35 w he told me that he believed that I'd deliver early.  Grr.)  He did say that even though there's no sign of progress now, these things can change very quickly.  Statistically speaking, most women deliver between 39 and 41 weeks and I was in that range so don't panic, blah, blah. At about 41.5 weeks they will induce you, so 7-10 days after your due date. 

He said, you really want the baby to come on his on because inductions can take a long time, esp with the 1st,and they often end with C-sections. 

So, I feel like I'm going to have to make some sort of decision next Friday, at my next apt. I'm not sure what to do and I want to have thought it out beforehand as I really didn't expect to have to think about this.  I've heard that you should give the baby until 42 weeks to come on its on, but I'm also concerned about the whole pooping in the amniotic fluid thing and don't want that, of course.  I have 3 friends who all labored and then ended up with a C-section; 2 were inducted. To me, this seems like the worst possible scenario.  If inductions often end it C-section, wouldn't it be better for everybody to just schedule a C-section rather than an induction?  I don't want to labor for hours and hours and then have a c-section. That seems like so much wasted pain and energy. I also don't want a C-section, but I really don't want both!!!

Please just help me with some clear, reasonable thoughts and hopefully I won't need any of this advice in the end, anyway!

Thanks for reading this far.

[halfpint]

I was to be induced 11 days past my due date. You do want baby to come on his own - statistically, interventions tend to lead to more interventions - but there are many people who are induced and have successful "normal" deliveries. I ended up with a c-section even though I started contracting on my own the day I was to be induced (they did break my water, but I wasn't given pitocin). If I had it to do again, I would push harder to wait and not let them break my water, but I could have easily ended up with a c-section anyway.

Relax. There's still some time for things to progress.

I actually credit acupuncture with sending me into labor, so that might be something to look into if you're still worried in a few days.

[Deleted]

The most likely scenario is that you go into labour before you're 10 days over. I wouldn't make big waves over 10 vs. 14 days for being induced, but you could try to nudge it a day or two longer with NSTs.

If you do need to be induced, you may be more favorable in a week or so than you are now. FTM with inductions do have a high c-section rate, but it's well under 100%. There's a high chance you'll still deliver vaginally if induced. A c-section changes a lot of options for future pregnancies, as well as being a generally more complicated recovery this round.

[Brie]

I had a wonderful induction, no c-section necessary. I was induced at 41w1d, he was born at 41w2d. The whole process was 28 hours--started Cervadil at 6 pm, very mild contractions that I slept through all night, broke my water at 6 am, active labor from 7 am-4:30 pm, pushed from 4:30-8 pm, baby was born.

I was comfortable agreeing to an induction at 41w. The way my OB put it was that not a lot of good development occurs after that point, but a lot of bad can happen. It wasn't worth the risk for me, since I wasn't overly concerned with a med-free labor.

I would not want a c-section unless it was medically necessary--I would attempt an induction first. Yes, it would suck to have a c-section after laboring for a long time, but I would want to know I'd at least tried. A c-section is major abdominal surgery that shouldn't be taken lightly.

[cricketwife]

Jan 3, 2014 11:40:18 GMT -5 @tokenhoser said:

The most likely scenario is that you go into labour before you're 10 days over. I wouldn't make big waves over 10 vs. 14 days for being induced, but you could try to nudge it a day or two longer with NSTs.

If you do need to be induced, you may be more favorable in a week or so than you are now. FTM with inductions do have a high c-section rate, but it's well under 100%. There's a high chance you'll still deliver vaginally if induced. A c-section changes a lot of options for future pregnancies, as well as being a generally more complicated recovery this round.

What are NSTs?

[Deleted]

Non-stress tests - just checking on the baby and fluid levels to make sure everything is fine.

[barefootcontessa]

I never understand why some OBs tell people he/she thinks someone will go early ... it sets the patient up for some much frustration. My OB told me to plan on going over two weeks so I would not be disappointed/frustrated.

I agree with token on everything, especially complications for future pregnancies and the more difficult recovery w/ c-s after failed induction. I have had five c-s and by far my hardest recovery was my first after laboring for 24+ hours. I would try to push for as long as possible with favorable NST. GL.

[Deleted]

My water broke at about midnight and I didn't progress at all after laboring for about 8 hours, labored another 6 hours after an induction, then DS was an emergency c section due to his heart decils- basically low heart rate/distress. I think that your doctor is right that c sections after inductions are relatively common. DS had to be in the NICU for 4 days because he wasn't breathing at first but he's fine now and my recovery was relatively easy considering it's major surgery.

So yes, you would prefer to go on your own but it's not the end of the world if you don't.

[thebreakfastclub]

I was induced at 39.5 weeks due to pre-e. I was 2-3 cm and 75% effaced.

The pitocin began at 7:30am, and they broke my water around 11am. I got the epi at 11:30am (at 4cm), and I was ready to push by 1:30pm. 11am - 11:30am was the toughest time, as the pitocin making the contractions pretty strong. Once the epi kicked in, it was smooth sailing. I just watched TV until it was time to push.

Alas, I pushed for 2 hours but baby's head was swelled with a twist and he would not budge. So I did end up with a C/S, but for reasons unrelated to the induction.

Your dilation/effacement status could change quickly, and I am proof that not all inductions take forever. Most of the time is just hanging out anyway. Even though it didn't work out with a vaginal delivery, I am glad I had the opportunity to labor.

Stay positive, and try not to think about the C/S. I had a normal, uncomplicated one. I would not choose a C/S just because. However, I no longer think that every C/S is automatically worse than every vaginal delivery.

[zacksbride]

a vaginal delivery is definitely safer for mom and has benefits to mom and baby, so that is why people just dont schedule the c/s from the start typically. chances are you will go into labor before you need an induction. inductions are more likely to be successful if there is some progress (dilation/effacement) with the cervix - if i were you, i would be walking a TON, like an hour and a half a day at a brisk pace to try to get things moving. also, research evening primrose oil - it can be used to soften cervix (not induce labor, but possibly make cervix more favorable for induction). i had a very pleasant induction experience at 39 w 2 d, but it was with my 2nd baby. Pitocin was started at 6 AM, i was fully dilated by 10, and baby was born with 1 push. I was 2 cm dilated and 75% effaced when induction was started.

Good luck and here's to hoping you go into labor on your own!!

[cricketwife]

Jan 3, 2014 11:44:42 GMT -5 barefootcontessa said:

I never understand why some OBs tell people he/she thinks someone will go early ... it sets the patient up for some much frustration. My OB told me to plan on going over two weeks so I would not be disappointed/frustrated.

I agree with token on everything, especially complications for future pregnancies and the more difficult recovery w/ c-s after failed induction. I have had five c-s and by far my hardest recovery was my first after laboring for 24+ hours. I would try to push for as long as possible with favorable NST. GL.

Well, in his defense (because I LOVE him!), there was evidence of my cervix thinning at that point.  But I agree, it's been really disappointing and I wish that he hadn't said it, even if there was really good reason to believe that it was true.

Your point about the laboring and then having a C-section as being the hardest recovery is exactly why I don't want to go that route.  It really scares me.

I think what's so frustrating is that, in the end, this is really something over which I have not control. Welcome to parenthood, right??!?

[minzy]

I've had one successful induction and then one planned c-section (breech baby).  Both went pretty well, though the c-section was quicker, more efficient, and I recovered faster.

Maybe schedule the planned c-section to get on the calendar, and then cancel closer in time if you're looking more favorable for an induction.  That seems like it would give you the most options for the longest period of time. 

Good luck, and hopefully the decision won't be a real issue for you.

[countthestars]

Just chiming in to say that I went into labor naturally at 41w2d and delivered dd the next morning (the day or my scheduled induction, not needed). Big hugs, I know the waiting is the hardest part!

[djc315]

I would try for the induction instead of just scheduling a C/S. I had a failed induction turned C/S at 41w (born 41w1d). I was bummed, but he was having heart decels due to his head being positioned incorrectly & I wasn't making any progress. My recovery was not bad, but I imagine recovery from a vaginal birth would have been easier.

Good luck!

[faith194]

I was induced with Pit about 14 hours after my water broke(never went into labor on my own). 10 hours after induction, it was decided to do a c-section. I didn't progress past 6 cm, there were heart decels, and it was decided that DS was not in the ideal position(he was slightly turned, so he wasn't pushing on my cervix in an effective manner). I was really upset at the time, but everything went fine after the c-section. I was healthy. DS was healthy. I recovered.

I do hope you go into labor on your own, but I do know a lot of women have wonderful induction stories that lead to a vaginal birth!

[everafter07]

I had a C because my baby was breech. I was disappointed I didn't get to experience labor, but It was pretty awesome, looking back. Recovery was easy, though painful the first couple of days, but I'd guess the vag people would say the same. And I have to admit, I liked knowing when she was coming, and having time to get the dogs taken care of and the house picked up.

[dragonfly08]

Both of my kids were born via induction...#1 at 40w for medical reasons, #2 at 39w1d for a combo of medical and personal reasons.

I had no problems/complaints either time. They were normal vaginal deliveries with labor lasting about 10.5 and 5.5 hours, respectively, from start to finish. I did have a second degree tear with #1 but that really had nothing to do with the induction process. I'd absolutely try an induction before just scheduling a c-section...there's a very good chance it will go well which IMO is far preferable in many ways to surgery.

Good luck!

[pinkdutchtulips]

my ob doesn't let her patients go past 41 wks. i was induced at 41 wks - pictocin drip started at 8:45a, i got my epidural at 11:30a and dd was born at 3:50pm .. that day - no c-section.

[havarti]

I delivered my baby the day before I was supposed to be induced (10 days "overdue"). You still have time! It was frustrating when my midwives kept saying over the course of that week and a half, "Oh, we expect to see you back here tonight."

[satsuma]

I was induced 41w5d and delivered DS vaginally the next day. While women who are induced may be more likely to have a c-section than women who go into labor spontaneously, you seem to be under the impression that that means you will most likely end up with one, when the reality is that the odds are still in your favor for a vaginal birth.

[beefjerky]

Jan 3, 2014 11:34:19 GMT -5 cricketwife said:

I'm 39 w 5 d and just saw the OB this morning.  My cervix is still high and closed.  (This is all particularly upsetting b/c at 35 w he told me that he believed that I'd deliver early.  Grr.)  He did say that even though there's no sign of progress now, these things can change very quickly.  Statistically speaking, most women deliver between 39 and 41 weeks and I was in that range so don't panic, blah, blah. At about 41.5 weeks they will induce you, so 7-10 days after your due date. 

He said, you really want the baby to come on his on because inductions can take a long time, esp with the 1st,and they often end with C-sections. 

So, I feel like I'm going to have to make some sort of decision next Friday, at my next apt. I'm not sure what to do and I want to have thought it out beforehand as I really didn't expect to have to think about this.  I've heard that you should give the baby until 42 weeks to come on its on, but I'm also concerned about the whole pooping in the amniotic fluid thing and don't want that, of course.  I have 3 friends who all labored and then ended up with a C-section; 2 were inducted. To me, this seems like the worst possible scenario.  If inductions often end it C-section, wouldn't it be better for everybody to just schedule a C-section rather than an induction?  I don't want to labor for hours and hours and then have a c-section. That seems like so much wasted pain and energy. I also don't want a C-section, but I really don't want both!!!

Please just help me with some clear, reasonable thoughts and hopefully I won't need any of this advice in the end, anyway!

Thanks for reading this far.

Will your doctor schedule a section vs. an induction? I don't know of any OB's that would (or should) do that with no medical reason especially for a first time mom. That being said, I went 41w6d with my first, got induced, labored for 16ish hours and had an emergency section. Yes, it sucked and was the worst recovery out of my 3 sections (well, the third sucked too but I think that's because I got my tubes tied as well) but it all worked out. A LOT can change over a week or so, so start walking, having sex and whatever else you can -but not castor oil! - to get things moving. Good luck

[AmyRI]

I got to 40 weeks with DD, after having delivered DS at 39w3d. I was mad. We scheduled my 41 week appointment, a biophysical profile and NST for the same day, and got me on the schedule for an induction 3 days later.

DD came at 40w6d.

Make a plan. Don't stress about it. Learn about different induction methods and talk with your doc about what is appropriate for you so you are reducing the risk of c/s. Definitely push to go to 42 weeks if you want by agreeing to NSTs.

And he said that it increases your risk of c/s, he did NOT say that the majority of inductions end in c/s. I'll try to find numbers, but just as an example, he could be talking a 10% risk of c/s with natural labor and a 20% risk with an induction. That's still an 80% [eta: see actual statistic below - is really 75%] chance of successful vaginal delivery! Absolutely no reason to schedule a c/s.

ETA: "At term, elective induction in multiparas [Second or more time moms] was associated with a high vaginal delivery rate of 97% vs. 76.2% for nulliparas [FTMs]." www.ncbi.nlm.nih.gov/pmc/articles/PMC3361637/

[blindyswife]

First, the state of your cervix today tells you nothing about whether or not you're going to go into labor on your own. Some moms can be dilated for weeks and need induced, and some, like me, can have zero dilation and go into spontaneous labor that evening.

Second, although your chance for a c/s increases because of induction, I would still say that more inductions are successful than aren't. (I don't know stats to back that up.)

There are so many scenarios here. You could go into labor on your own and still need a c/s. You could be induced and deliver vaginally. And because scheduling a c/s now, for the sole purpose of avoiding incduction, limits your choices/increases your risks for subsequent pregnancies.

[coleyv]

I had a pretty good induction experience. I was induced at 38w1d due to high blood pressure. I was absolutely terrified of being induced because of the horror stories about more painful contractions and emergency c-sections.

Well all my worrying was for nothing. Labor was not very painful (I was able to get epidural pretty quickly) and it was fairly quick. Vaginal delivery with no complications and healthy baby.

Good luck! I hope you go into labor on your own but even if you have to be induced, it's not guarenteed that you'll have to get a c-section.

[satsuma]

And to be clear - an induction doesn't really increase your risk of c-section. You have no control over whether you go into spontaneous labor or not and women who are induced have the same c-section rate as women who are given the "wait and see" option.

[zarapipe]

Jan 3, 2014 12:19:59 GMT -5 blindyswife said:

First, the state of your cervix today tells you nothing about whether or not you're going to go into labor on your own. Some moms can be dilated for weeks and need induced, and some, like me, can have zero dilation and go into spontaneous labor that evening.

Second, although your chance for a c/s increases because of induction, I would still say that more inductions are successful than aren't. (I don't know stats to back that up.)

There are so many scenarios here. You could go into labor on your own and still need a c/s. You could be induced and deliver vaginally. And because scheduling a c/s now, for the sole purpose of avoiding incduction, limits your choices/increases your risks for subsequent pregnancies.

I agree 100%

I was induced at 39.5w due to high blood pressure. I was like 1cm dilated and still high. I just needed Pitocin, not cervadil. Idk why, but that is just what my doctor ordered.

Pitocin started- 7am

Began to feel contractions at Noon- got Epi

Started to push at 9pm

DD born just before midnight.

Pushing took the longest- 3 hours and she was born with the assist of a vacuum.

I would do an induction over a c/s any day.

[greycat]

I was unexpectedly induced after my 40 week appointment because of preeclampsia. My blood pressure was normal but I had extremely high protein in my urine. I went straight to the hospital from the appointment. My induction started around 11p and DS was born the next day just before 5p after an hour of pushing. I was worried about a possible ceserean too but my induction went smoothly. Try not to worry too much (easier said than done I know).

ETA - at my appointment I was not dialated at all.

[vanillacourage]

I understand that at 39w5d you're beyond ready for labor to start, but you still have PLENTY of time to go into labor on your own before jumping to induction or c/s.  What does your doctor typically do in terms of scheduling an induction (41w, 42w, or somewhere in-between?)?

I will say that with DS1, I was told he was a really big baby and had no sign of progress at just shy of 40w, and was also terrified of a long induction only to end in a c/s.  I let myself be guided into a planned c/s and while I don't regret it exactly, it did really limit my options for DS2 and he was ultimately a 2nd c/s. As much as you can I would try to avoid feeling like you have to make a decision right this second, and just take the next week as it comes.  Good luck! 

(also, as a PS, I really wish OBs would stop telling women they'll probably go early.  It seems to serve no point and I feel like it's only stressed out the people I've seen it happen to, when they get to their due date or beyond.  Ugh)

[Marmee]

My DD1 was induced at 37.5wks for :::shhh::: fetal size & my misery. I had Cervadil at 9pm, my water broke while getting my epidural (fun!) at 3am, I delivered at 9am. I never even had Pitocin or any other drugs. She was perfectly fine & aside from my episiotomy so was I.

I went on to have 3 more inductions preterm for cholestasis (which i had for my first as well which is why i was miserable but was undiagnosed) because there is an elevated risk of stillbirth with this condition. I was more than happy to have an early baby that was safer on outside. All my inductions were fine. DD2 & 3 were 6 hours each start to finish, DD4 I'm not even sure, but it was super easy. I have no regrets.

[vanillacourage]

Also FYI, a big reason for the fact that inductions lead more often to c/s is because of the "cascade of interventions".  When you're induced they usually break your water for you.  Once that happens, they want you to deliver within 24 hours due to the risk of infection, and you are on their timetable.  Sometimes "failure to progress" doesn't mean that the mom pushed for hours and it was just not going to happen - sometimes it means that her body didn't dilate to 10cm/pushing before that 24 hours was up, even if objectively things were still well in a safe zone.  This is why people who really want to avoid meds or interventions are told to stay at home (and on their own timetable) for as long as possible.