C-section or induction!?

[merrohawk83]

Hello all

Merry Christmas!

I am nearing week 30 of my second pregnancy. Very briefly for those who don't know, my first pregnancy ended at 30 weeks due to placental abruption and my daughter was stillborn by emergency c section under General a anaesthetic. Many clots were found in the uterine cavity and I then had multiple pulmonary emboli, which lead to a diagnosis of APS (after testing positive for Lupus anticoagulant).

This pregnancy has been managed with clexane (120ml twice daily) and daily low dose aspirin and so far, so good.

I am coming to the time when I need to make a decision with my obstetric consultant about an exit strategy for this little one! We both have the same concerns:

1) elective c section at 39 weeks - clexane can be managed, but increases risk of clots. Recovery is harder and longer. However, a planned section would be far preferable to an emergency section.

2) induction at 38 weeks - if all goes accordingly then this would be preferred option. But if induction doesn't work, clexane may be more difficult to manage and also may then end up with emergency c section.

Does anyone else have any experience of having to make a similar decision, and what was the outcome!?

Any advice or guidance from those who have been in a similar situation very much welcomed!

Thanks all

Lucy

[lupus-support1 Administrator]

I am very sorry for your loss. This must have been a very traumatic experience for you. It is understandable you are anxious.

Every pregnancy is different and perhaps you should concentrate on what you and your consultant decide.

We all want to feel we have control but that may not be the reality.

My situation was different. I was 34 weeks, with twins, in hospital with pre-eclampsia, when my waters broke . . . thankfully, they were premature but were fine.

What I am saying is that it is good you and your consultant have a plan made together.

I wish you a good pregnancy and while this is impossible, try to relax.

With good wishes for a happy and healthy 2018.

Ros

[HollyHeski Administrator]

Hi, really sorry for your loss - you must be very anxious nearing the same time but hopeful and excited at the same time....

Nobody can advise, this is a decision only you, your partner and doctor can decide.

I can tell you my experiences it may or not may help, all 3 of my pregnancies were prior diagnoses and all 3 by ceasarean.

My first - I heameraged at 37 weeks, emergency ceasarean, he breathed for a few minutes but I was out of it, then sadly died.

My second - I chose to have a ceasarean, what ever happened I wanted to know about it as and when it happened. Beautiful healthy girl - now 29 years old.

My third - again ceasarean, this time no choice because of previous ceasarean's - wonderful baby boy (my blood pressure crashed) - hes now 27!!

All three births, despite all being ceasarean's were totally different experiences. If my third had been my first, (worse than first!!) - I would not have had any more....

What I'm trying to say - no ones experience will be the same, so proberly not helpful for you.

The fact you have been diagnosed and are being looked after is great, whatever you decide, your APS family here are really behind you and wishing you and babe well xxxx

[Ozchick]

My first was emergency caesar at term after18 hours labour.(bad position, couldn't push him out!) I was out of it and he was in NICU for obs so not a great birth experience. Second I had pre eclampsia so a planned caesar with epidural. Very different experience from the first! I was awake and able to see her straight away and recovery was OK.

Even though they have both driven me bonkers at times, I cherish all the moments I've had with them.

[INCR]

Hi! I'm so sorry for your loss I completely understand your anxiety. I also have APS and I'm 31 weeks pregnant at the moment. Taking aspirin and doing Lovenox 60 two times a day. Each case is different and I'm totally in favor of trusting our doctors, so just talk to him or her and see what makes you feel more safe!

I lost 2 babies before APS was diagnosed, but actually my first pregnancy was successful. I was already on medication at the time because I had a stroke in 2011 without explanation (now it all makes sense). In 2015, with my first pregnancy, I had induction at 39 weeks and 5 days. It all went well and I have a 2 year old girl No one can really predict or control how the birth will go, but I know that doctors are extremely careful with our condition and the likelihood of things going well is extremely high! I believe the majority of problems arise when the mother is not diagnosed yet...

Of course I'm also a bit anxious about the birth, but honestly this time I'm going to be very frank about what makes me feel safer and in more "in control". In my particular case, I don't wait to wait almost until 40 weeks, I prefer to schedule it sooner (as long it is safe for the baby).

So just talk it through with your doctor and let us both try and relax a little bit My due date would be around 24 february, and yours?

Take care!!

A.

[hardinse]

Sorry for your loss. I too had to make this decision. After weeks of agonising and torturing myself. I made the decision to have a elective c section at 38 weeks. My consultant supported my decision as he didn't want me to go any further than 38 weeks and either wanted to induce Me or c section at 38 weeks cause of aps. To be honest. I had herniated discs in my back and was told that this would have less risk of causing severe sciatica. I think looking back. After a loss, I don't think I would have been mentally strong enough to have tolerated an induced natural birth and a c section was the right decision for me at this time.

Good luck with your decision.

[glovebox]

Hi, I’m so sorry to hear of your loss. I had a total of nine pregnancies of which only three babies survived. I have a son who is now 21 (delivered naturally, no treatment during pregnancy) and twin daughters now 18 (delivered naturally, heparin and aspirin taken daily during pregnancy). I have since trained as a midwife and see many women like us coming through the doors who are unsure of processes and procedures. I chose not to induce my first successful pregnancy due to advice from Graham Hughes, however it is totally up to you. All I would say is that an untested cervix quite often is not ready at 38 weeks to begin labour and it might take more than one go to get you in to labour and more than one drug. Also it can end up with a medicalised birth of some variation which most people would say is worse than an elective caesarean. Talk to your midwife and your consultant in depth before making your decision. They can give you all the pros and cons and help you make an informed decision. Best wishes Emma

[Sara_A]

Hi, yes I was induced with both of mine at 38 wks now 5 and 22 months. Well my 1st I had a sweep at 38 wks and went into labour next day and then my 2nd had a pessary. I injected clexane til the day before induction I think. I think my obs didn't want to do a section as more risky with bleeding etc.

I was fine with both mine but had to inject for 3 months after x

Any other q's pls ask as I know it's a scary time x

[MaryF Administrator]

I had an induction with my first as it was clear my first baby was not well, all went well, the next two, just came early. I hope between yourself and the clinician that you make the right decision, a 38 week induction sounds like a good first step. MaryF

[merrohawk83]

ThanK you all for taking the time to reply.

I have a good relationship with my consultant - she is an APS specialist and is much more anxious than me! I know we will make the best decision at the time based on all the facts and likely outcomes, but it's very interesting to hear how decisions have been made by others who have had a similar predicament.

Thanks again all and I will let you know what we decide, and will update you when our baby girl arrives safely! She is due 13 March

X

[HollyHeski Administrator in reply to merrohawk83]

Whatever decision you make, I wish you and baby well xxxx

[merrohawk83]

Well the decision was taken out of my hands! I went to see my obstetrician on Wednesday only to find four specialists in the room - who had apparently been debating my case for a good 30 minutes before I went in! The obstetrician, cardiologist, anaesthetist and high risk specialist midwife!

The decision has been made to go for an elective c section at 37 weeks, so they can manage my anticoagulation and take away as many uncertainties as possible.

I'm happy to go with their recommendation although of course nervous about the risk of clotting - but I will do my meditations and prepare myself and my body as well as I can and let the universe do its thing!!!!

6 weeks to go!

[Wittycjt in reply to merrohawk83]

Best of wishes, best of care to you and your baby. It sounds as though you are in very capable hands, here’s to a smooth delivery by c section😘

[merrohawk83 in reply to Wittycjt]

Thank you!!!! 🤗

[Mrsdravenx]

Firstly, sorry for your loss I've had 4 losses myself :/

My first child was an emergency c section after a failed induction! I dilated to 3cm and stayed there for 32 hours, it was hurrendous! During my c section they told me it was because my son became stuck in my cervix and couldn't get out!

My second was an elective c section at 38+3 due to obstetric cholestatis which was diagnose at 30 weeks, the itching was something else! During that time I also was diagnosed with cyclomegalovirus which I think they said was something to do with the coldsore virus being dormant in my system for like 20 odd years and being pregnant has reactivated the virus! And then final diagnosis of gallstones! The consultant I was under did leave the decision up to me whether I wanted to be started off but I would be under extremely close monitoring due to all all my ailments and what happened to my son, I chose an elective c section because after what happened with my son i was only given a 70-80% chance of success giving birth naturally..i didn't fancy taking those odds and having another 32 hour labour 😂 but I loved my elective as everything was so chilled out! World's away from my emergency!