elective section - can I wait til 41 weeks?

(20 Posts)
brainonastick Mon 20-May-13 16:19:21

I think you definitely need to discuss the relative risks of pph - afaik the risk is higher with c section than vaginal birth. But higher with bigger babies, so an earlier c section could be better than a later vbac.

But also... the risk of scar rupture with vbac is quite a lot higher after 2 cs.

So hopefully the consultant can help you understand and balance the risks.

Personally, risks aside, I've done an emcs and a vbac. Vbac is vastly overrated unless you are lucky enough to have an easy birth with no fanjo damage, or you have a burning desire to have experienced 'natural' childbirth. Would def go for an elcs if there was to be a next time, especially if the ages of your older ones mean there isn't much lifting to consider.

Fuckwittery Mon 20-May-13 16:05:41

thank you both. quietly sorry for the delayed thanks, I read your post and have been thinking about things since then.
I had a conversation with a friend on sunday who recovered really well from an emergency section despite a loooong early labour and failed induction. We were talking about the operation and I mentioned how they had had to really yank both my babies out, and I felt so bashed around during the actual op. She said that despite her long early labour, her baby wasn't engaged at all. I wonder if my ops were difficult to recover from because the babies were so deeply engaged and I was more bruised internally as a result of the efforts needed to get them out. If this is the case can definitely see the case for an earlier elective to avoid the baby getting engaged too deeply.

It took definitely more than 2 to 4 minutes to get my babies out in the emergencies, it took ages to get my DD2 out who I got to 9 cm with

quietly, I'm pleased they let you stay in 3 nights, both times I've felt like they wanted to kick me out quickly with little regard to how I was actually feeling. I'm very surprised you managed with just panadol post op, I was begging for codeine and had to be sent home with a stash both times. I wouldn't have managed at home with just paracetamol etc. I barely could move with codeine.

Will def speak to consultant about having him do the actual op, and ask whether it makes a difference about the baby being engaged.

At the moment I am thinking that if the baby is in the optimal foetal position at 39 weeks and I go into labour by no more than about 3 days overdue then I would go with it, but I don't want the baby to get engaged in a bad position, so if e.g. baby was back to back at 38 weeks, I'd ask for an elective at 39 weeks.

oscarwilde Mon 20-May-13 15:33:37

As far as I know the reason to do the ELCS at 39 weeks is to avoid you going into labour spontaneously. Given that you have a history of going over term then it's possible that they'll be happy to schedule an ELCS at 41 weeks.

However, as you have had two CS's already [and complicated ones by the sound of it] you should and should insist on it be under the care of a consultant for the surgery. They will either do it or be there to supervise it in case of complications with scar tissue. They will therefore want to ensure that a consultant is free to operate on you, and will therefore want to ensure that you have a scheduled ELCS and not labour spontaneously, especially on a weekend when only one theatre may be open.

Have had a vbac - it's overrated imo grin Recovered from my first EMCS much faster. ELCS was planned but baby had other ideas and I had to get in line for the operating theatre on the weekend, so was in the final stages of labour or so I thought when the theatre was finally free.

Warning - when they say to you "you are nearly there", they don't mean you'll have a baby in the next 10 mins.

quietlysuggests Sun 19-May-13 19:00:17

You may have more power than you think, especially given the circumstances of your previous births. I mean, just request the consultant, and request a different anaestetist, and that your mum goes in for the setting up bit then swaps with DH for the baby bit.

Heres what happened with mine.
Very quick visit to clinic the day before to sign consent and be given a tablet to protect your stomach (ranitidine) which you take the night before or the morning off.
Day of section arrived at hospital early, c6am
(I arrived super early in hopes of being certain of a single room, dont know if this makes a difference)
Brought up to room and unpacked my back. Dh and I lay on bed playing scrabble and listening to music
Midwife popped in a few times to tell me how the list was going
(generally emergencies from the night before are done first, then extra-complicated ones like mother has diabetes so cannot fast, woman expecting twins etc)
Given robe to wear and wrist bands and hair net.
Time comes, ported called, all staff very relaxed and friendly.
DH walks beside bed as I sit up in bed and am wheeled down to theatre.
Bit of waiting around in theatre as you confirm your name chat to midwife etc
DH taken into side room to be given pair of scrubs to wear, at same time I am wheeled into the operating suite to meet the 2 theatre nurses, 1 anaesthetist, and 1midwife.
Lots of pleasant chatting, a drip is put in my hand.
Midwife holds my hand as spinal is put in.
I am told "this will sting a bit, like a bee sting"
Now believe me I AM A TOTAL WIMP and honestly it did NOT HURT. It was about as sore as a nettle sting. I asked the midwife to hug me as I was so nervous / sqeamish about that and she did!
It all happens quickly for a minute (as your legs are going numb but you are still sitting upright)
they lie you down on your back and put a wedge pillow under one hip
Midwife puts in catheter
(I cannot say what this was like as in all honesty I was totally numb down there from the spinal. So I scrunched up my eyes because you think "ick" but actually dont feel anything)
The anaesthetist is up at the head chatting the whole time "Do you know what you're having, any names picked out, wasn't it a lovely morning etc etc)
Nurses put on green drapes.
You are lying flat at this stage so you dont really see that they pull your gown up and put drapes around the edges of your bump and paint it with yellow iodine paint.
Husband is brought in and given a seat up beside my head.
I felt sick once and said "I feel sick" and anaesthetist said "Oh your blood pressure is a tiny bit low, I'll give you something for it, he added something into the bag of fluids I was on, and the sickness was gone in seconds.
Surgeon sweeps in all smiles chatting to me a husband.
within 2 - 4 minutes surgeon says "You'll feel a bit of pressure now" and I fell something swishing about.
I hear a baby cry.
My baby!
I am given an unwashed newborn to my chest
I cry.
Baby is taken to side to be rubbed and wrapped
Baby in my sight at all times.
I lie there as they close up and all agree that baby is the most beautiful they have ever seen.
Brought to recovery for an hour during which baby is put to breast by midwife.
Back to room.
Catheter out by 6pm, tea and toast
hobble into shower before DH goes home
panadol pain relief for few days
daily injections of clexane-type thing for 3 days (into abdomen, did not hurt)
Moving around ward before nighttime.
Stayed in 4 nights (this is hospital policy) with first then 3 nights with others

Well I hope that level of detail helps you.
If I have left anything out do let me know.
Off to put 4 children to bed and reminise over their births.

(you are allowed cameras in the delivery)
(once I had my DH and my sister, other times just my DH)

Fuckwittery Sun 19-May-13 13:56:54

thanks both. my second emergency was definitely better than my first in terms of care, apart from the haemorrhage.
do you think it would be possible to have 2 people in the operating theatre? as DH did not do well either time with watching it all and has never really understood the trauma I suffered first time round with the procedure I didn't consent to. I feel like I need a female to protect me, maybe they could swap with DH once the baby was safely out.

both times my sections have been done with a registrar I believe as they were emergencies, but perhaps I need to check that. they certainly hacked me about as my scars were not good either time.

quietly, that is kind of reassuring about the vaginal exams but the catheter and the fact i know they stick a suppository up as well is not! I guess could have the morphine suppository in another way, but i don't think the catheter could be optional.

yes please, I would like to hear about an elective. I'm thinking of starting another thread about length of stay in hospital post elective vs. emergency as I was totally amazed at the 2 women opposite me who left after 1 and 2 nights - I was in for 5 and 4 nights and hobbling out the hospital feeling like total shit at that, not able to do much at all at home for a good while after.

quietlysuggests Sun 19-May-13 11:30:44

Oh OP I am so sorry.
Firstly - having been through that, can you now request in writing that you have a different consultant, or that you will not have contact with the anaestetist (sp?) or that you will not have procedure X done or something like that?
Would that be possible?
Could you get assurances that it wont happen again, is it that sort of thing?
I dont know if it would help you if I described in detail what an elective is like? I will go through it if you want?
But the only bit my husband wasn't in for was the setting up bit - putting in the epidural/spinal and the catheter. I guessed that was more a modesty thing as he was just waiting outside.
But I could see no reason why, if you specifically asked, DH could not be in for those bits too.
Its hard to know what to suggest without knowing what horrible thing happened to you.
Is it useful to know that with my elective sections I had not one vaginal exam? So if your trauma is related to that area, then no-one goes near it.

quertas Sun 19-May-13 08:47:35

Yikes! Ok sorry I can see where you're coming from there- suggestion withdrawn! Sorry I thought it was the op situation itself that was worrying you. I can relate as I'm terrified of epidurals for the same reason, but with less justification than you have. Another possibly equally daft suggestion but a very detailed birth plan might give you a way to zero in on the exact things you're worried about and give you some control. Of ourselves this may not be any good from your point of view. Sympathies here at least

MrsHoolie Sun 19-May-13 08:37:58

Hello OP.
I have had to emcs for failure to progress.(only got to 4cm tho!)

When I was pregnant the 2nd time I could not decide whether to try for a vbac or go for the elective. The hospital were supportive either way. Decided eventually to try for a Vbac until my due date when I changed my mind!They booked me in for a section at 41 weeks but I then went into labour at 40+3 (1st baby was 11 days late). So I decided to give it a go.

However,my hospital (King's,London) are pro vbac and they were quite relaxed about the whole thing.I only saw a consultant right at the end when I had an extra scan due to my size.

Fuckwittery Sun 19-May-13 07:27:38

quertas, it's kind of not the operation itself but being out of control in hospital and the care I had during the section and stay in hospital previously, not being able to fend for myself. just prior to my first section an procedure was carried out without my consent, which I consider assault, and the anaesthetist was a complete bitch and didn't believe the anaesthetic wasn't working..... sorry, wasn't going to go into detail here but it's probably necessary to explain. I posted the full details of what happened once under a name change and unanimously people were utterly horrified. I think i would be scared of them doing more stuff to me under general, and DH wouldn't be allowed in to protect me sad

quertas Sun 19-May-13 01:03:03

Might be a dumb question but can you not ask for a GA?

Fuckwittery Sat 18-May-13 23:57:50

i just feel like i'm going to need hypnotherapy to voluntarily walk into an operating theatre after my last two experiences! i actually cannot see myself being able to <hyperventilating at the thought after dropping pretence of discussing options calmly!>

quietlysuggests Sat 18-May-13 23:47:03

Honestly an elective is just so vastly different from an emergency section!
It is peaceful, gentle, lovely, with a quick recovery.
A baby getting stuck puts massive stress on the baby.
The worst an elective regularly does is not squeeze out all the stuff from their lungs so they can be a bit frothy for the first 24 hours. But you dont get all that heart rate dropping with every contraction, being pulled out by forceps, being starved of oxygen malarky you get with delayed labours.

Fuckwittery Sat 18-May-13 23:43:17

quietly, it is also major surgery with risks, elective or emergency. I had a bad haemorrhage after my second section and want to discuss if thats likely again. i have also found the recovery both times v v tough and have little support and whilst i'm told elective recovery is likely to be easier there's no guarantees. I know recovery from a bad birth can be bad too, but because of previous sections, I think they would want to intervene quickly to section if not straightforward birth. I did regularly see an osteopath in my last pregnancy who thought i had no problem with my pelvis. I think i might have been unlikely in that I had two babies in bad positions for birth but who knows.

Fuckwittery Sat 18-May-13 23:38:16

sorry, topsmart, confused you there with nicknamegrief, i.e. thought you were her were answering my question to her.
my last post doesn't make much sense as a result!

how far along are you topsmart, have you spoken to the hosp yet about this time round?

quietlysuggests Sat 18-May-13 23:33:15

An elective section is a lovely birth and not something to try to avoid.
Perhaps there is a shape to your pelvis that prevents your babies from heading down?
After 2 sections it would be dangerous to have anything other than a very smooth and unusually easy birth, but I dont think that is likely after your past 2.
People sue Obstetricians all the time because they want to make all the decisions themselves, but have the consultant accept all the responsiblity and liability.

I think what you are requesting is foolish.
But I dont know, perhaps the experts will not (and I am no expert) and they will agree it is safe to try.
The very best of luck.

Fuckwittery Sat 18-May-13 23:26:39

brilliant, thanks, really good to know the hospital were supportive. i refused the elective at 10 days over with dd2 as i was so desperate to avoid section again, went to 18 days, laboured all day, got stuck for ages at 9cm and ended up with emergency section again. should have had the elective and easier recovery as i had to stay in for four nights, so amazed by people who can walk out of hosp 1 night post section after two emergencies with hideous recovery.

topsmart Sat 18-May-13 23:21:33

Yes here too. Guess it depends on hospital's policy etc?
DD1 was 10 days overdue, induced and resulted in emergency CS. Didn't want to be induced with DD2 if I went overdue, but wanted to give her the chance to crack on with things herself - would have loved to do things 'naturally' if I could, so didn't want elective at 39 wks as hospital suggested. Waited until week after due date but she had other ideas and decided she didn't want to come out grin.
So, elective CS it was - and am so pleased we did, was out after one night and healed quickly.
Hope this helps.

Fuckwittery Sat 18-May-13 23:18:24

thanks, good to know, was that vbac after one section though - i've had two.
the mws i have seen have been supportive but warned me that the consultant will be eye-rolling!

In my experience yes and the consultant was really keen. He did not want to induce and we decided for VBAC but ELCS at 40+10 as a back up.

Moved halfway during that pregnancy and following consultant also supported it.

Both consultants preferred VBACs but only if non induced.

Fuckwittery Sat 18-May-13 23:03:05

is there any medical reason why i should have an elective before 41 weeks? currently considering whether to have an elcs or try for a vbac after 2 previous sections both for failure to progress, no other problems with my pregnancies.
my first babies were 10 days and 18 days overdue, and I would like to wait to see if i labour naturally before 41 weeks.
I am seeing the consultant on tuesday and would like to have some facts before I get booked in. only 17 weeks but apparently i'll be offered an elective appointment now.

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