Induction v/s Cesarean- Pre-Eclampsia at 40 weeks
January 25, 2013 7:27 PM   Subscribe

I have been diagnosed with the dreaded pre-eclamsia. Good news is that we are 40 weeks! Bad news- my cervix didn't get the memo. I am being induced on Monday. Given my 'unfavorable' cervix, should I ask for a c-section or go ahead with the induction. We had originally planned a natural water birth at a birthing center, but all of that is out the window now. I just want the least stressful situation for the baby (and me).

I have severe pitting edema, way too much protein in my urine, sudden weight gain, and high for me blood pressure. Waiting it out past Monday is not an option. I am on bed rest for the weekend.

I was checked yesterday to see if I was dilated at all just in case we needed to induce (we were waiting for the 24 hr urine collection). Nothing. My midwife said my cervix was a little soft, but still high and closed. Baby is head down. The game plan is to force a foley bulb & cervadil then add pitocin once I have dilated to 4. The drip will be turned off once my body takes over contraction patterns.

I worry, given my 'unfavorable' cervix, that induction will not likely be successful. I am beginning to wonder if I shouldn't just ask for a c-section. My Dr. has no idea whether induction is likely to be successful. We are hoping for the best case, which would be labor starting on its own this weekend or at least some serious progress.

This is all so far away from the birth plan we had in mind, but we will not be messing around with pre-e!

I would love to hear pros/ cons/ personal experiences either way.
posted by MayNicholas to Health & Fitness (57 answers total) 5 users marked this as a favorite
Had a similar experience, ended up with c-section 48 hrs after induction. In my opinion you've already taken the most important step: You've let go of the "dream birth plan" scenario.

I'm no doc, but in my case I tried the induction and didn't regret it....and though I ended up with the opposite of my dream scenario I don't regret that, either. My only tip for you at this point is to make sure your partner is clear about your priorities. He/she will have to serve as your advocate going forward if you become too stressed/exhausted/whatever to advocate for yourself.

Lastly, a tiny anecdote: my best pal was pregnant at the same time and we gave birth just a few days apart. Her vaginal delivery left her groaning, "ouch, it hurts when I sit down." My cesarean left me groaning, "ouch, it hurts when I stand up." Separate but equal, and two healthy babies.
posted by BlahLaLa at 7:48 PM on January 25, 2013 [5 favorites]

Sorry to hear it. I was induced from 0 on cervadil, the foley, pitcon and ultimately ended up having a c-section after I got stuck at 4. In hindsight (and only in hindsight because I don't think it could have happened this way at the time), I wish I could have skipped the induction and gone straight to the c-section. Not because the induction itself was ultra painful or traumatic- it was more the emotional & physical upset of having to transition from "laboring" to "surgery". And FWIW, my recovery after surgery went very well. That said, what happened to me is only what happened to me- everyone is different, every mother/baby has different needs and birth is in many ways a great mystery. Talk to your doctor about it and see what she thinks.
posted by ThePinkSuperhero at 7:51 PM on January 25, 2013

Response by poster: There is nothing I can do to start labor on my own other than the old wives tales- which are just that. Yes, if the induction fails then we will have to have a c-section. The risk of laboring before c-section is my blood pressure getting too high or fetal distress. My midwife said the best thing we can do for both of you is to get that baby out. That is all she offered because at this point I am no longer under her care. I am now 'high risk'.

Blahlala & Pink- Thank you for the anecdotes. These are exactly the stories I need to hear. I will be having the conversation with my Dr. Monday morning depending on if there has been any progress over the weekend.

Keep the stories either way coming!
posted by MayNicholas at 7:56 PM on January 25, 2013

With my first child, I ended up having an emergency c section after 26 hours of labor, when the midwife refused to continue. My recovery was brutal, due to the pushing and the c-section. The actual c section was chaotic and scary, I ended up happy to have a healthy baby, but the process was profoundly unpleasant.

My second (who is right now 5 weeks old) was a planned c section, and was totally awesome. I knew what would happen, the whole thing was far more laid back. I went into the surgery with only a fraction of the stress that occurred the first time. I healed far faster, perhaps due to not having the primary stress of unproductive labor. Breastfeeding was exactly the same, I didn't seem to benefit from going into labor on my own. In short: the planned cesarean was a much better experience.

Pre-Eclampsia is nothing to mess around with, I'm so glad we live in a time with such amazing medical knowledge and technology. Wishing you and your new baby all the best!

Also! If you do have the c section, take the colace from the very beginning!
posted by Nickel Pickle at 7:56 PM on January 25, 2013 [2 favorites]

Hey, you're me! Sort of. I also had gestational diabetes as a complicating factor. I went ahead with the induction at 40+4 even though I was unfavorable. I didn't get the foley bulb or cervadil, just pitocin. I also had a magnesium drip because of the BP issues and was told I had to stay in bed because every time I sat up or walked, my BP would skyrocket, despite the mag drip. So I had a lot of things working against me. I spent 11-ish hours in labor with pitocin maxed out and never progressed past 2 cm dilated. So I ended up in the OR and had a c-section under general anesthesia (my platelet count was discovered to be too low for spinal anesthesia of any sort when I was admitted that morning). Being perfectly honest, I was sad when it didn't work out as planned, and it was scary being wheeled into the operating room. But I was glad to be able to say I tried to deliver vaginally. I wouldn't choose a c-section when I had the option and possibility of delivering without major surgery.

However, some people like to know exactly how things are going to happen and scheduling a c-section can put some of that fear of the unknown anxiety to rest. One thing that helped me greatly was having a doula to talk me through the craziness of being transferred into the OR. Mine was supplied by the hospital, so look into that if you haven't already. Hiring a private doula on such short notice might be an option too, but I imagine it would be difficult to figure something like that out in a day or two.

Good luck! And update with tiny baby pictures!
posted by chiababe at 7:58 PM on January 25, 2013

OMG YES COLACE! Seriously, take it for at least a month before you think of stopping. I stopped around two weeks and it was a huuuuuge mistake.
posted by ThePinkSuperhero at 7:59 PM on January 25, 2013 [5 favorites]

I'm sorry to hear that you're dealing with this turn of events.

I was in a less serious but somewhat similar situation, and I skipped the induction and had the C. (I can MeMail you with exact details.) It was a scenario where the baby really should come out sooner rather than later, and I showed zero signs of going into labor.

It was something of a letdown, you know? You're all geared up to do this THING that you've been preparing for and all the sudden ... it's totally different.

I never went into labor. I went into surgery after a good night of sleep, completely well-rested, and I knew exactly what was going to happen. I thought the first 24 hours of recovery sucked, but I had this amazing delicious baby to clutch to me, so that made the whole thing a lot more pleasant. After the first 24 hours, I was much, much more comfortable, and I personally think I had an easier recovery because I had not labored for X hours before the surgery.

I have no regrets about how things went, but I wasn't tied to any particular birth plan.

People sometimes say shitty things about C-sections, so I just want to mention how contrary my experience was: My milk came in right on time (a little early?) and I had no trouble breastfeeding. I held my son about 45 minutes after he was born, when I was in recovery; we bonded instantly (he stopped crying at the sound of my voice), and I fell in love just then. Sometimes natural birth advocates talk about how a vaginal birth causes bliss due to hormones that apparently only happen with pushing; after my son was born I was so happy, the happiest I have ever been. I didn't labor for one minute, and the days after he was born were the most absolutely euphoric I've ever had. Even if you end up with a C-section, giving birth can still be pretty amazing.

Good luck to you!
posted by purpleclover at 8:04 PM on January 25, 2013 [17 favorites]

My body just...doesn't go into labor naturally. However, I have had two successful VBAC foley bulb followed by pitocin inductions, both with a not particularly favorable cervix. I think induction is worth a try!

Pro-tip: ask for a shot of fentanyl when they insert the Foley bulb. That process is ouchy.
posted by Wavelet at 8:10 PM on January 25, 2013

Purpleclover's last paragraph is genius and totally correct. My experience exactly, post-c. So if that part if this is stressing you now when you have all this stuff to consider, you can let at least that much go.
posted by BlahLaLa at 8:18 PM on January 25, 2013

Another here with symptoms of pre eclampsia so scheduled c-sections for both. I never regretted a second. My experiences were both easy, recovery was fine and two healthy babes. I did have lots if support, all I had to do was hold the baby and nurse but I wouldn't change a thing. Good luck!!
posted by pearlybob at 8:21 PM on January 25, 2013

Seconding purpleclover's last paragraph. Except for the fact that we were separated a few hours because of the general anesthesia recovery, everything else went as planned. I was euphoric for weeks postpartum and had zero issues with my milk supply.
posted by chiababe at 8:22 PM on January 25, 2013

If your cervix isn't ripe I think I would go for the planned c-section. I have had an induction (my last baby) and mine went fine but I was ripe...otoh if your cervix isn't ripe an induction might not be the most pleasant for you or the baby. Both scenarios for you are kinda artificial so you might as well go for the most straightforward one. But the truth is it's really up to you.
posted by St. Alia of the Bunnies at 8:36 PM on January 25, 2013

Just another anecdote--I was induced at 39 weeks b/c my baby girl was on the verge of being classified as having growth restriction, and was only dialated to a 1. But the induction went very smoothly and she was born about 7 hours after they started the drip. I had wanted a natural birth but was unprepared for the pitocin contractions, and got an epidural when I hit around 6 centimeters (I was trying to tough it out to at least 5 because I had heard that epidural a can stall your labor if you get them before that--I don't know if its true). Anyway, I just wanted to give you a situation when an unexpected induction with no signs of labor went really well.
posted by Mimzy at 8:36 PM on January 25, 2013

Oooh, St. Alia is spot on about a ripe cervix. I forgot to mention that. If you spotted after a cervix check that's a good sign.
posted by Mimzy at 8:38 PM on January 25, 2013

Induction did not work and was the most painful thing I have ever experienced.

I will never ever agree to an induction ever again.

You might want to look up the statistics, I think they usually don't work?? I can't remember now.

In your shoes, I would jump straight to the c-section, I'd be grateful for my healthy child, and I would skip the useless and painful hours of artificially induced labor.

Congratulations and good luck!
posted by jbenben at 8:46 PM on January 25, 2013 [1 favorite]

I had one emergency c section after induction and then two planned c sections. They were all fine. I got to hold all of my babies in the delivery room for a few minutes while the doctor was sewing me up or whatever, and then got them back soon after they got cleaned and weighed. I was out doing stuff after a week each time. The babies were all fine and had little round unsquished heads.

Anesthesia was different each time - in the emergency one, they just upped my epidural. I could feel everything. It didn't hurt, but it was weird. The second one was planned, so they did a stronger epidural from the start. I couldn't feel anything and sort of felt totally disconnected from the experience. The third one was sort of in the middle. Didn't feel the cutting, but more awake.

With the emergency c section, there was urgency and "this is what we need to do to get the baby out now!" so it was scary, but out of my hands and happening quickly.
With the planned ones, everything's
calm and not rushed...which gave me a minute to think, "OMG, I picked this? I said hey doctor please cut me open?" But then I remember that it's gotta come out somehow.
My mom's had both and she said, "With a C Section you can hold onto your stitches when you walk around. Not so much with the other."
posted by artychoke at 9:20 PM on January 25, 2013 [1 favorite]

My first son was born at ~32 weeks due to pre-e. I went into the local hospital Sunday night / Monday morning and after an ambulance transfer to the larger regional hospital, I was monitored very closely and given the steroid shots for lung maturation until Thursday. My doctors did attempt an induction even though the chances of it working at that point were probably zero. That night Alex was born by c-sec with a spinal anesthetic. I may have gotten a glimpse of him at that point but I don't really remember. For reasons I never could get explained, I was kept on the recovery floor for 24 hours. My baby was in the nicu and could not be brought to me even though he was healthy and on oxygen only as a precaution.

Ask your doctors what the recovery procedures are for these high risk births in all the different scenarios assuming no problems with the baby? Would protocols be different after an emergent c-section after failed induction versus completely scheduled c-section? You know what is most important to you after healthy mom/baby is taken care of.
posted by Talia Devane at 9:33 PM on January 25, 2013

I also planned a water birth and went ahead with my plan even though the baby was posterior and ended up with a c-section. If I could do a redo, I'd just go straight to the c-section. The way it went was so stressful and I think I was thinking more about my birth plan than the stress on the baby. I'm lucky everything worked out great but again, I wish I could have been less exhausted physically and mentally to really enjoy and feel present during those first moments of birth. I was afraid of a c-section but truly, it was fine. I was amazed at the whole process. Friends who scheduled c-sections seemed to recover faster and just had an easier time. I ended up getting treated for an infection which is also a risk for women who labor before c-sections--just fyi.

Anyway, whatever you decide, I'm sending good wishes!
posted by biscuits at 9:38 PM on January 25, 2013

If you'd like to consider methods to make the induction more likely to succeed you might want to consider nipple stimulation (via breast pump, for several hours a day) for cervical ripening and labor induction. The studies on this are all quite small but there are some indications that it can work. I tried it in the hope of avoiding a medical induction and it successfully started labor for me. Even if it doesn't start labor it could ripen your cervix and make the medical induction more likely to work. You might want to look at some data:
When trials comparing breast stimulation with no intervention were analysed there was a significant reduction in the number of women not in labour at 72 hours (62.7% versus 93.6%, relative risk (RR) 0.67, 95% confidence interval (CI) 0.60 - 0.74). (from here)
Perhaps this study is particularly relevant to you: Breast stimulation--a new method for induction of cervical ripening in complicated term pregnancies. (link)
We have studied the use of breast stimulation as a method of cervical ripening in 75 patients who had complicated term pregnancies and who required induction of labour. The indications for induction were prolonged pregnancy greater than 42 weeks (N = 12), hypertensive disorders of pregnancy (N = 26), suspected intra-uterine growth retardation (N = 30) and a combination of two or more of the above (N = 7). All patients had a modified Bishop score of less than 5 before the start of nine hours of unilateral breast stimulation spread over three days. Twenty-nine out of the 75 patients went into labour during the three day period and, of the remainder, there was a significant improvement in the cervical score of 2.87 +/- 1.99. Three patients, all of whom had prolonged pregnancy, had exaggerated uterine activity. Two patients had foetal heart rate deceleration on antenatal cardiotocography during their first session of breast stimulation but this did not recur in any of their subsequent sessions. No patient had both exaggerated uterine activity and foetal heart rate deceleration. There was no case of perinatal mortality or morbidity.
posted by medusa at 10:18 PM on January 25, 2013

I was induced at 38.5 weeks for pre-e. They started on Saturday night and I finally started having productive contractions on TUESDAY morning. By then I was exhausted and annoyed and had no great energy for labor. 16 hours later I started pushing and pushed off and in for 5 hours and then had a c-section. Baby was just plain stuck. If I had it to do all over again I'd go straight for the C. After all that time in the induction and in labor I was just a wreck. I begged to be sedated for a hour or so after the operation and my husband stayed with the baby but I missed those first hours since I was so out of it.

The C recovery really wasn't too bad but I think not having a vaginal birth means your milk supply is delayed and that can lead to a cascade of other problems so keep that in mind.
posted by otherwordlyglow at 10:28 PM on January 25, 2013

I attended my best friend's son's birth, which was a 38 week induction due to pre-e. Her cervix was, to quote the OB, "as hard as a green apple and as tight as Fort Knox." The induction took three days and was not fun, but she ended up with a vaginal delivery of a healthy baby. So they can work, even with an unfavorable cervix. It was my friend's second delivery, though, and she is a professional singer with exceptionally strong abdominal muscles, which may have made delivery easier.
posted by KathrynT at 10:33 PM on January 25, 2013

Just do the C-section. Statistically you're going to end up there anyway so you might as well avoid the extra risk associated with pitocin induction. I'm sorry this hasn't worked out the way you had planned, but I'm glad you've got your eye on the prize. Order/find a Belly Bandit to put on the moment you have the cath pulled and you're allowe to walk - it will help you feel like your insides are inside where they belong. Speaking of, make sure you ask to have that cath pulled and get up and walk around as soon as you can because it makes a huge difference in terms of your recovery. Good luck and healthy baby to you!
posted by PorcineWithMe at 11:44 PM on January 25, 2013 [1 favorite]

Re: milk supply and c-section- ask for a hospital breast pump right away to help spur your body into production.
posted by PorcineWithMe at 11:45 PM on January 25, 2013

I had a dream induction (with epidural at the same time), so my vote is for induction.

However, it's YOUR choice, go with what you feel most comfortable with.
posted by Youremyworld at 12:46 AM on January 26, 2013

I was induced at 37+5 for high blood pressure with protein, glucose thanks to undiagnosed gestational diabetes and a 6 week long battle to lower my blood pressure and get rid of my goddamn headache. I cycled through bed rest, home rest and hospitalisation for the last three weeks. We induced with cervical gel at 6pm and my daughter was born at 1am - my cervix was ripe though and the ob. figured I probably would have gone into labour on my own that night or the next (as he phrased it "your body is done here, your baby is okay and you need to get her out to be okay yourself"). The labour snuck up on everyone, me included (totally posterior until about midnight - I just thought it was back pain for the first four hours...).

I only had cervical gel though - I never graduated to pitocin. If I'd gone the 'normal' route it would have been gel at 6pm, again in the morning, pit the next night and probable c-section the day after that. I am glad we tried the induction, particularly since it was the gel. If they went straight for pitocin here (Australia) I probably would have had a worse outcome. I didn't have an epidural, just some gas.
posted by geek anachronism at 2:49 AM on January 26, 2013

First of all; congratulations! You're going to be a mommy really soon! How exciting!

Sine you've gotten a fair amount of anecdotes here, I'll chime in with mine.

After 2 natural (no drugs at all) birth experiences, my third child decided he just wasn't going to come anywhere near his due date. But during my daily midwife checkup (2 weeks after my due date), she accidentally broke my water and because I carry strep-B, the baby had to come out within 24 hours, period.

Because my first two were so easy (I mean, relatively speaking), the midwives thought induction would be the smartest idea instead of a c-section since I handled the first 2 deliveries fine. Like you, the idea was to start slow and turn it off once my body took over. But remember, this kid needed to come out...stat.

And since I had already gone through the experience of feeling natural contractions and giving birth without any pain management, I thought I had a good understanding of what I was going to go through.

Dear reader, was I ever wrong.

After over 7 hours of an increasingly dialed up pitocin drip and pain like you couldn't believe (because nobody suggested an epidural and I didn't know better to ask), my cervix did nothing but soften slightly. My body never took over the contractins naturally, so they kept dialling me up.

For me, Pitocin contractions were NOTHING like natural ones. Basically, they were like getting simultaneously punched in the stomach, face and uterus while wanting to vomit.

I am NOT saying other inductions feel this way. But that's what happened to me.

Hour 8...still no movement...still no epidural...a doctor walked in, he looked me over, we chatted briefly and he ordered an epidural STAT and they rolled me into the operating room for a c-section.

Kinetic Jr. was out within 2 minutes. The doctors said they called those types of crash c-sections, "Skin to in in 2," and then was over.

What you want...what anyone a healthy mom and baby. If that means a c-section, then yeah, do it.

Best of luck.
posted by kinetic at 2:57 AM on January 26, 2013

I would go straight for the section if I had my time again - the induction was extremely stressful for me and my daughter, and just plain didn't work. My recovery was fine, and I had no issues at all with milk production.

Best of luck to you and your growing family!
posted by goo at 3:04 AM on January 26, 2013

You're in a great position, actually, with the weekend to think and plan. Anecdotally, the worst Cesarean births I've encountered have been the ones where the family was completely blindsided by them. It seems like you have three scenarios to imagine: an induction resulting in vaginal delivery, an induction resulting in a Cesarean delivery, and a belatedly planned Cesarean.

I was not induced with my son, but I had a long, exhausting labor that looked a lot like an induction. I ended with a vaginal delivery by sheer luck and cussedness - if my son's heart rate had dropped, that would have been it. The recovery involved two weeks of bed rest - for my non-surgical birth.

I suspect that with a body that's already stressed out, recovery from a surgical birth might go more smoothly than recovery from either a long labor or a long labor + Cesarean. But I am not remotely a doctor, and that's really just speculation. Frankly, a C-section seems like the least stressful option under the circumstances.

Take the time available to plan a bit for what you'd like the scenarios to look like, ideally. Figure out what aspects of your dream birth you might be able to keep - there was a really great discussion about planned Cesareans on the Offbeat Families blog this week that partially addressed that.
posted by linettasky at 3:07 AM on January 26, 2013

I had pre-e and started induction with cervadil the night before I hit 37 weeks. They started the pitocin the next day in the afternoon, and our son was finally born in the wee hours of the next morning. It ended with a fairly dramatic forceps delivery, but it was a successful induction from 0. I got an epidural when they started pitocin and wished I had gone for it sooner.
posted by banjo_and_the_pork at 3:21 AM on January 26, 2013

I've had "emergency" pitocin with a natural-ish childbirth (25mg of demerol near the end) and a real emergency c-section at 8cm (she was unexpectedly very breach because she'd turned over right after the week-before checkup).

I have a spinal situation that isn't friendly with epidurals, so I can't speak about being awake anywhere during or right after a c-section. I had general anesthetic with my second kid, and that was hard.

I wouldn't mess around with pre-eclampsia, though. You do what you feel is best.

If you are in good shape for an epidural, you have a lot of options.

For what it's worth, I don't think the side-effects of the pitocin did my eldest a lot of good. He was jaundiced and slow to gain weight. Granted, that could have happened anyway. My second kid came out lovely and hungry from the get-go.

The recovery from both was kinda equal but different. A lot of it depends on if you want to have more children in the future. One of the benefits of my c-section was, "While you're in there, I signed the release for a tubal ligation a week ago." If you aren't planning on having any more children, this is a good time for that.
posted by lilywing13 at 3:35 AM on January 26, 2013

Also, congratulations!!

Looking forward to new baby AskMe questions. :-)
posted by lilywing13 at 3:44 AM on January 26, 2013

Congratulations! You are almost there!

I had my daughter via scheduled c section at 39 weeks since she was breech. As a first time mother, I didn't have a vaginal birth to compare it to but I can tell you I had a fabulous experience.

It was scheduled so I never labored or had a single contraction (that I could feel anyway). I showed up at the hospital packed bags, calm, and buzzed the button on the maternity ward door and said "Hi, I am here to have a baby!" It was a very calm procedure. Because I wasn't in labor, and because it wasnt an emergency, I had the time to ask any questions that I thought of and casually talk to the staff. I never felt rushed or stressed. I knew when I was going to have my baby.

Post c section, I also saw my baby about 45 minutes after birth. Daddy held her close to me in the operating room so I was able to snuggle with her. I have never felt like we had an issue bonding. As for recovery, it was not as bad as I was expecting. I felt 85% about a week out. The last 15% to "normal" did take about 8 weeks post op but it didn't prevent me from doing much. I could drive, carry my baby and car seat, run errands, etc. I was just not quite well enough for strenuous movement and would get a bit sore if I over did it any given day. My husband did stay home for two weeks post baby and that was a big help. I was told to only go up and down stairs once per day so I could send him upstairs for things I had forgotten. For the first week, I was also nervous carrying the baby up and down the stairs while I was still sore so I had him do that as well. I am now 16 weeks post op and have kind of forgotten I had "major surgery" that long ago.

I can tell you that after my experience, if I ever found myself in the same position again, I would just schedule the c section. I had tried everything to turn her including a painful procedure at the hospital where they physically try to turn her and it was not worth it. While I have never been induced, if I was in your position next time, I would go the c section route.
posted by polkadot at 3:51 AM on January 26, 2013

My induction started at 7 am in the morning, and apparently I had contractions, but I don't remember. Twelve or so hours later, I had an emergency C-section, because my son's heartbeat was superfast. I do wish now that I had gone straight to the C-section, because the stress around getting the epidural and moving into surgery was quite overwhelming.

Also, it would have helped me avoid the complications that followed: the induction was planned because I have aortic stenosis and my heart couldn't handle the pressure of natural birth. But it also didn't deal well with the epidural and I ended up with a pulmonary edema. It could have been avoided by a general anesthetic and C-section.

I wish I'd spoken in more detail with the anesthetist, and I suggest you do this. Even if you are induced and it works, you may end up with an epidural.

But with all that, my milk started with no problem and my son "latched" thirty minutes after I was stitched up.

Very best of luck. Please let us know how you both are.
posted by bwonder2 at 3:54 AM on January 26, 2013

Response by poster: Wow! Thank you all for sharing so many stories! I am going to hunt down my Dr. and make her speak frankly with me about this. I haven't gotten to speak with her as I have just been dealing with the midwife. Up until last night a c-section was not even a consideration unless an emergency in my head. Now I am seriously considering it instead of the induction. I will have to see where my doc stands on this.
Thank you again to those who have responded so far & really given me a lot to think about.
posted by MayNicholas at 4:04 AM on January 26, 2013

Our first was induced and my wife was in extreme pain with no improvement for hours. When she finally got the epidural she had no energy left to push. Wound up with a C and healthy baby and easy recovery. Pitocin was a swear word in our house.

Fwiw, #2 was VBAC with just a little tearing, so a C now doesn't imply C next time.
posted by seanmpuckett at 4:05 AM on January 26, 2013

I think you should try the induction because it might work. I was induced for high blood pressure and t worked great. Find out what your bishop score is. I was 80% effaced but only 1 cm dilated when they placed the cervadil, which sent me into labor very quickly. Don't forget that preeclampsia adds a point to your bishop score. Also, even if you want to try to go natural, I would opt for an epidural. Epidurals reduce blood pressure and may help relax you so you dilate better (that's how it worked for me). And if you have the epidural in place, your attempt at labor will be less stressful and it will be easier to move on to a c-section if necessary. Ask for a "walking epidural" so you can push better. Good luck!
posted by yarly at 4:23 AM on January 26, 2013 [1 favorite]

I wouldn't do the c-section right away if you think you might have more children and would want a vaginal birth the next time (pre-e doesn't always repeat).

Here's the thing --- you don't know that you won't give birth vaginally, even with the induction, until you try. But if you have the c-section, there's no going back. If you attempt a labor, you can still have a c-section. At any point. Even two minutes into the induction. You don't have the choice of going back and trying to labor after you've had the c-section.

Pre-e is absolutely nothing to mess around with, but I will tell you two days before my daughter was born, nothing was going on with my cervix. It was slightly soft, but absolutely no effacement and no dilation. I was just about 41 weeks. I went home and cried --- because I had had a c-section previously, if I had to transfer to the hospital (I was having a homebirth VBAC), I'd almost certainly be pushed into a c-section since chemical induction was not a possibility.

Then the next day I cried and cried some more. My husband told me nothing had happened yet, and until something does, I shouldn't be so upset (hardly helpful in the moment, but from a practical standpoint he was right). Later that night my water broke and my daughter was born after an 8 hour labor the next morning.

I went from having my last pre-natal on Saturday around noon to having my daughter in my arms on Monday at 9:00 am. And my cervix wasn't any readier than yours. You clearly can't wait to have the baby because of the pre-e, but just because your cervix may be less ideal for an induction right now doesn't mean it's going to be that way tomorrow or Monday or stay that way once you are induced.

I had a friend who had pre-e. She was induced at 37 weeks. Her son was born in two hours. Her first child.

It's your decision, of course, but if you want a vaginal birth, I think you should go for the induction. As I said, you can change your mind during the course of labor and have the c-section. But you can't go the other way around.
posted by zizzle at 5:09 AM on January 26, 2013 [1 favorite]

I would also like to say that with my first, even though it was a 40 hour labor, I have no regrets about the labor. But I hated everything about the c-section. I hated the pain I was in during the c-section, the recovery time after the c-section (a year!), and I hated the way I was treated by the nursing staff and doctor for having a c-section. It was a terrible experience. And being in the hospital for four days sucked. I'd have left a lot sooner if I could do it again.

The only regret I don't have is having labored.
posted by zizzle at 5:22 AM on January 26, 2013

I work in labor and delivery, I've had preclampsia with both pregnanxcies and was induced both times with no problems except an extended stay for a few days. A c-section is a major surgery don't fool yourself there are risks with that itself...I can tell you that most couples who come in with an elaborate birth plan don't end up following it...I would at least try induction and if complications arise and a c-section is needed so be it, induction isn't a bad thing...good luck and keep us posted.
posted by irish01 at 5:27 AM on January 26, 2013 [2 favorites]

(Former L&D nurse, also had eclampsia with my first pregnancy): I would ask for the section and avoid the stress of labor. My first pregnancy I had an unfavorable cervix and the stress of induced labor caused my blood pressure to go higher and I ended up in full blown eclampsia and a resulting c/section. In my experience, inducing with a pretty unfavorable cervix is a long and tough road and more than half the time end up with an exhausted you going through major surgery.

Anecdotally, I far preferred having the subsequent scheduled c/sections over laboring. I was up and sitting in a chair later that same day and the pain was fairly easily controlled over the recovery period with Tylenol 3. I knew how long I was going to be uncomfortable afterwards, rather than being unsure how long I'd be laboring. (Just my own personal opinion).

Good luck!!
posted by hollygoheavy at 6:49 AM on January 26, 2013

I had 2 unplanned c-sections. The recovery after the second (3 hours of contractions, then discovered she was breach) was soooooo much easier than the recovery after the first (I was utterly exhausted after 60 hours of contractions, no sleep, then a sudden blood pressure spike).
posted by belladonna at 6:55 AM on January 26, 2013

My partner had an induction lasting 30 hours before they decided to go ahead with a c-section, which was the original plan anyway. Still, to this day, I have no idea why they bothered.

I honestly think if an induction's unlikely to work then you may as well save a lot of time and just cut straight to the c-section. By no means an easy option, but easier than doing both!
posted by welovelife at 8:33 AM on January 26, 2013

I gave birth to my son at 35 weeks, by C-section, when I was diagnosed with pre-eclampsia and HELLP syndrome during a routine checkup. The whole experience was alarming and surreal, partly because I was sick and terrified when I went directly to the hospital from the OB's office, and partly because I spent that night on an IV of magnesium sulfate to prevent seizures, which made me throw up and feel like I was burning from the inside out.

They tried to induce labor with cervadil followed by pitocin that night, to no effect; I think I went from 1 cm to 2 cm dilated over 12 hours. I am grateful that they didn't continue trying to induce labor after that -- by the time surgery happened the next morning, I was a floppy rag doll with no feeling in my limbs and no will of my own, and I have no idea how I would have managed labor.

I wish I had been more aware of everything after the c-section. I was so sick and exhausted -- by the next morning (after being on magnesium for another 24 hours) I couldn't lift my arms to hold my son, and I have no clear memories of anything that happened the day of the surgery. I guess it depends on what kind of shape you're in from the pre-eclampsia, but I would go for whatever birth strategy you think will leave you in the best shape to enjoy the moment your child is born, and the moments immediately afterwards, which I would think would be going directly to the c-section without induction that may or may not work.
posted by daisystomper at 9:07 AM on January 26, 2013

IAANM but IANYNM... (I am a nurse-midwife but not your nurse-midwife); this is more a few points from the other side of inductions for preeclampsia, which I somehow wound up doing a whole lot of... so, some considerations I suppose; (on preview, this wound up longer than planned)

1. being on magnesium sulfate, does, frankly, suck -- you're going to be on it probably 24 hours after you give birth, one way or the other, so there's no difference there with whatever route you choose.

2. I've certainly had successful inductions with vaginal births for preeclampsia - but if this is your first baby, it is a tough row to hoe (not everyone goes to a section with an induction, I swear!), and I've certainly also had women induced who went to a c-section ultimately. Your midwife's plan makes sense if you choose to go with induction, to ripen your cervix as much as possible before stimulating contractions - this is going to give you a much better chance of things working out. Using both foley bulb and cervidil is very reasonable to get things started as much as possible before using pitocin, and will help the odds of an induction being successful.

3. Preeclampsia makes having anything resembling a natural birth hard, though it sounds like you've very much accepted that's not in the cards. Frankly, I like it when women are using pain medication, because it helps keep blood pressure down when they're not in significant pain, even when coping well with it. It's really okay and fine to ask for an epidural with the induction, and if you go to a c-section, they can use the epidural for the surgery. You can always change your mind about the induction and go to a c-section at any point in the process. . Unless your doctor's a real jackass, I guess.

4! Another consideration is that you can, if you choose to have other children, attempt to have a VBAC [vaginal birth after cesarean] with your next baby. Having one c-section doesn't automatically mean you'll always have them for each baby.

5. With a c-section: it's going to take some more thinking about recovery. taking things easy, can't drive for a little while. don't lift stuff that weighs more than your baby for a while (that includes the dang car seat) -- so if you have family and good friends, and you decide to go for the c-section straight away (or if you wind up going to section), it's going to be really, really helpful to ask for their help in a more significant way and baby yourself after surgery. And everyone is right, take that colace....

**I'm sure everyone has told you this about 100000 times, but,** this weekend before Monday; if you get a headache that doesn't get better with Tylenol, if you stop peeing hardly at all or it gets very dark, if you start getting pain under your right ribs that hurts to push on, call your midwife and/or go to the labor and delivery triage floor of the hospital. These are symptoms of worsening disease.

and ps, either way, congratulations! one way or the other, you'll be meeting your baby next week!
posted by circle_b at 1:10 PM on January 26, 2013 [2 favorites]

Response by poster: I spoke with my midwife briefly today. She said we should wait until we see what is happening with my cervix Monday. If it is like it was the other day then we will be looking at a long long process. If we have progressed over the weekend, we have a much better chance. So we will just have to wait and see. I will update when we are through to the other side!
posted by MayNicholas at 4:39 PM on January 26, 2013

I was admitted to hospital for Pre-E a few days before my 'due' date. I presented with an abominable headache and feeling like I'd been kicked in the liver by a large horse, followed by 2 days of continuous vomiting. I was told I would need to be induced at 40+1. My cervix was high and closed. I went into labour - spontaneously - in the early hours of the induction morning and delivered my baby naturally 6 hours later, going from 0 to 10 cm in around 2-3 hours. First baby.

So it can happen quickly too; and it is possible that spontaneous labour may be another realistic option for you (to just wait and see if cervix and baby decide it's time, without intervention - obviously this depends on how the Pre-E is treating you too).

Also wanting to reinforce Zizzle's point that if you decide to have another baby down the track, it's much less likely statistically for you to deliver subsequent babies vaginally after a c-section than the other way around.
posted by metaphorical at 5:05 PM on January 26, 2013 [1 favorite]

I have had two successful inductions. The first was on a Mag drip for Pre-E. I had cervadil, slept overnight, then they started Pitocin around 9 AM. I pushed from 7-9:30 PM, which was tough and crappy, but it worked. I didn't get out of bed for at least 24 hours post-kid - I was a MESS.

Second boy wouldn't come out easily either. I had an induction that "failed" - I didn't progress, so they sent me home to try again a few days later. Even though I was on pitocin, nothing was so horrid that I couldn't hack it - like terrible period pains.

A few days later came, and that induction attempt worked well. The MOMENT I got the epidural, I dilated like a drunk schoolgirl and he was born in 5 minutes. I was up and at 'em within an hour - I almost felt like just leaving a few hours after birth with the kid and making some homemade mac and cheese at home. It was awesome.

I'm glad I labored because it was successful. Maybe I wouldn't be if it wasn't. It's one of those things you'll never really know until you're in it. I'd at least try, though.
posted by kpht at 6:06 PM on January 26, 2013

I had pre-eclampsia and a failed induction. My issue was that the induction (inducement?) was taking way too long, and I ended up developing class I HELLP Syndrome. I had an emergency c-section (which terrified me at the time, but which turned out to be a piece. of. cake). Yes, recovery was slow, but I was back to my usual schedule within 6 weeks time. My biggest problem from all of it was that I ended up with chronic hypertension for about 2 years. It is now resolved, but compared to dealing with that, the c-section was no big deal for me. I'm actually preparing for my 3rd c-section now, and while I realize that not everyone has an easy time of it, they aren't always horrible. Regardless though, I would just follow whatever advice your doc gives you under the circumstances. My doctor said I could have tried to continue inducing if I had wanted to, but she highly suggested against it. I tend to like to follow whatever advice they have, especially now that pre-eclampsia and HELLP are something I'm constantly on the lookout for. Oh, and if you want to have more kids, do not despair! My second pregnancy was textbook perfect, with no complications whatsoever. Hoping this third one is the same. Best of luck!! Congrats on your new little one. :-)
posted by Happydaz at 6:26 PM on January 26, 2013

How old are you? When I was pregnant at age 36, I looked into the risks of two conditions: (a) planned vaginal delivery (which included all emergency c-sections) and (b) planned c-section. The reason to include emergency c-sections in the (a) group is that you can't predict whether a planned vaginal birth will go all the way to an actual vaginal birth.

The literature at the time (2003) indicated that the risks were about even between these two groups for my age mother. They were lower for group (a) for younger mothers, and lower for group (b) for older mothers. I'm guessing that you'd have to assume you've got a higher risk of an emergency c-section, so if you're even close to age 36, I'd advise the planned c-section for you.

My point is, there is medical literature out there that can help you make a better decision than anecdata. Hopefully your OB can help you decide based on actual medical outcomes in the literature.

On another vein, my husband is an anesthesiologist, and from his stories I know that your presence at the delivery will be far better assured if the c-section planned than if it's emergent. In an emergency, you can be given general anesthesia if circumstances require it, and then you miss the fun part.

And finally, I loved my planned c-section. Loved every bit of it. I was delivered by a midwife, at home, and fully expected to have my own child naturally, but in the end planned a c-section and it was a wonderful experience. I wasn't tired, I was alert, my husband was by my side (photographing the surgery, can you believe it?), there was no pain or worry about the baby's health, and my friends were all there when I came back to the room with Caprietta. It was a wonderful experience.
posted by Capri at 7:02 PM on January 26, 2013 [3 favorites]

I had planned on a natural childbirth but even by 42 weeks, nothing! ("Natural" remedies to start labor did not work.) My cervix was soft but I was only dilated maybe .5 cm. Started with cervadil overnight, which did not do anything, then pitocin starting around 9 in the morning. By 2 pm I was completely dilated, then I pushed for an interminably long time, to deliver around 7 pm. Pitocin is no joke (when it works). BUT no pre-eclampsia or other complicating condition. I have no idea how I would have managed an emergency c-section after pushing as long as I did. I think this is something where you really need to do a medically informed cost-benefit analysis.
posted by stowaway at 9:58 AM on January 27, 2013

Response by poster: I know it is a month later but I thought I would update in case any one comes across this in the future...

I did indeed have a c-section. My nethers were highly unfavorable and my doc wasn't ever sure she would be able to get the foley bulb in to start the dilation process.

We have a happy healthy baby now and I do not regret my decision. If course I would have preferred natural birth, but in the end we got the same prize.
posted by MayNicholas at 9:14 AM on March 5, 2013 [14 favorites]

So glad all turned out well for you :)
posted by ThePinkSuperhero at 9:39 AM on March 5, 2013

Excellent, I'm so glad it turned out well in the end!
posted by KathrynT at 10:24 AM on March 5, 2013

Hooray for healthy baby and mom!
posted by chiababe at 1:02 PM on March 6, 2013

Mazel tov!
posted by BlahLaLa at 9:59 AM on March 14, 2013

posted by Nickel Pickle at 2:55 PM on March 17, 2013

posted by leahwrenn at 8:58 PM on May 26, 2013

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