35 weeks- Still don't know if having natural birth or CS

(69 Posts)
gualsa Tue 06-May-14 19:43:06

I have placenta previa and the stubborn thing is taking its time moving out of the way. I have had 4 scans now and another next week. They keep making me wait hours while they hum and hah.
I am so fed up.
Baby is sometimes breech and sometimes head down. He is also rather large- already around 6 pounds so outside the "normal" range.
I dont particularly want to end up with all the pain of labour only to go for an EmCS anyway.
I have had 2 natural births before. Any thoughts or advice?

johull Wed 07-May-14 19:28:25

I am in exactly the same position! I'm 33 weeks with pp and the thing won't move. Mine is because my baby has slowed growth, and hasn't grown much since 25 weeks so is unlikely to move! I agree about the scans too, I've had so many now I wish they'd either book me in for a csec or decided I can go natural. Either way, I need to prepare as this is DD1. I have yet another appointment tomorrow to see about her growth and how much pp has moved. I think I'll tell them to book an elective if It still hasn't moved as I'm a very anxious person and the stress cannot be doing me any good :-( when's your next scan?

johull Wed 07-May-14 19:29:08

Also how many cm is yours and is it an terai or post? X

MetalLaLa Wed 07-May-14 19:35:09

I had this with my DD, PP was found on my 20 week scan, got referred for another scan around 30 weeks and they were adamant I would need a c section, needed an me emergency contact if I had bleeding (partial previa). However, they only scanned me abdominally, so at my final scan (36 weeks) the sonographer did ask me if I had been scanned vaginally before. Explained I hadn't, so I was scanned both ways and luckily she could clearly see it had moved well out of the range so I had a natural (induced) birth in the end! If you haven't already and feel comfortable with doing so, try to insist on a vaginal scan within the next week as it is far more accurate.

gualsa Wed 07-May-14 19:36:33

Hi johull. Went to bed early last night with rib and chest pain. Wish my baby would stop growing for a bit. Lol.
My next scan is a week away. How did you get on today? No, stress is no good. Especially as it's your first and you have nothing to compare it with. Mine is anterior so I know there is some risk w c-section but I think a natural birth may be stressful and messy. They say placenta needs to move another few mm so not much. Let me know how you get on x

TynesideBlonde Wed 07-May-14 19:46:00

I was admitted at 36 weeks with same. Ask for (insist on) transvaginal scan and then discuss results with consultant. You'll have a much clearer picture (forgive the pun). My placenta moved 2 days before planned elcs but there was only 1mm in it. 'Normal' scan did not show this. I proceeded with section in the end as high bleed risk. Although v disappointed at the time not to have a vaginal delivery am now super happy with decision as it was fully informed.

gualsa Wed 07-May-14 20:47:42

Thanks MetalLaLa and Tyneside Blonde. I did have both normal and vaginal scan last time and it's very close. Too close to make decision yet. However, they are cutting it fine. (Excuse the pun). My boss told me she was told to try a natural birth with PP which was just on the edge of acceptable distance away from OS. She ended up with abruption and emergency C-section. I don't really mind losing out on natural birth as I have had two already. I just don't want any more stress and worry. I spent all 2nd trimester terrified of bleeds as had grade 4 PP at 20 weeks and was told it would not move so this pregnancy has not been great.

johull Wed 07-May-14 21:47:51

Hello. I have scan tomorrow at 4 so will let you know the outcome. I'm pretty sure if pp is still present then it'll only be grade 3 at worse, hoping for grade 2. I shall keep you updated x

KnittedJimmyChoos Wed 07-May-14 22:04:07

can you not say you have had enough ad your stressed and worried and would just like the section as you are afraid and wouldnt labour well, worried about it.

TynesideBlonde Wed 07-May-14 22:13:30

If it's a close call so much so that they can't decide which way to go pushing for section may be wiser. A planned section with pravia is far better if higher chance of bleed etc as you need more folk in theatre. Planned section will get you all the right folks in the room at the right time!
Have they chatted through their rationale thus far?

johull Thu 08-May-14 19:04:54

After 3 hours In hospital good news and bad news, my placenta has moved so I'm safe! But, my waters DID BREAK In Sunday when I stared leaking! We know because Liv (DD) is only in 4cm of water and there should be more. Seeing consultant tomorrow morning to decided what we now do- midwife said it'll be an induction at 36 or 37 weeks. To top it off the little madam has decided to walk out- she's now BREECH! Therefore it'll be a c-section if she doesn't move back. She's still tiny but has/is growing which is great. All in all, an emotional visit. I'm now not under midwife lead care either, I'm under a consultant. Can anyone tell me the main difference between these two? I'm anxious to get her out now and just hope my consultant makes a decision.

gualsa Thu 08-May-14 22:23:19

Wow. It's all happening! I didn't think they likef keeping baby inside once waters broke? She can still turn many times before she comes along. My baby boy seems to change his mind all the time. I guess it's not easy fitting his head downwards with the placenta in the way. I think consultant led just means that the hospital and not your community midwife calls the shots and monitors your care. They take on all the high risk cases which frees midwife up to deal with the routine pregnancies.

And no T.B they have not discussed anything with me at all! It's so frustrating. They seem reluctant to give any kind of diagnosis or time scale or outcome or anything. I am not good with pain and hated my other two labours and I feel I need time to prepare mentally for either eventuality. Will let you know how I get on Wednesday.

Thanks KnittedJimmyChoo. I am planning to put up a bit of a fight. Problem is I just feel so low that I am likely to burst into tears..

Good luck with everything Johull. Keeping fingers crossed for you x x

johull Fri 09-May-14 23:26:25

Back in hospital this time admitted sad waters 100% not enough water for baby girl to swim around. Being induced at 34 weeks via section. Gutted.

gualsa Sat 10-May-14 10:08:26

At least you are in the best place and 34 weeks is fine for baby. Probably just needs to stay in neonatal for a few weeks. And look at it this way- you avoiding the last bit of 3rd trimester which is the worst as its so uncomfortable!! Have they given you a date? Sorry it's not what you wanted. Babies and pregnancy is so unpredictable. All the best with everything and good luck. You will have your baby soon x x

johull Sat 10-May-14 17:21:58

Gulsa, I have been told it's going to be 20th but that would make it 34 exactly. If I'm at risk of infection and she's swimming in a puddle rather than a pool then why can they not do it this Tuesday (33 weeks) is there really that much of a difference in safety? X

hotair Sat 10-May-14 17:28:24

If your waters are a 100% gone I would have a chat with them about infection risk. My waters went at 33+1 and they delayed delivery til 34+1 (weekday). I went into labour at 34 exactly and dc1 was born via a very emergency section, as she had developed a serious infection. She was very poorly for a while, although fine now.

johull Sat 10-May-14 17:54:34

Gual- she is your next scan??

johull Sat 10-May-14 17:56:22

Hot air- they have booked me in for section as she's breach. I have now been in hospital for 2 days, did this happen with you?? My mum thinks they won't let me out now until my section date becuSe of infection and because of her position. I'm keen to go home but obviously want the best for my little girl x

hotair Sat 10-May-14 20:34:59

No I came in for daiy monitoring, which is not sufficient, to be honest in my case they messed up big time. How often are they putting you on the ctg to monitor the baby? If you are being monitored very regularly and they've given you steroids then it's better to wait til 34 weeks when the lungs are more mature etc, but if they are not monitoring you properly and frequently then I would have a serious conversation with them.

johull Sat 10-May-14 22:20:43

Hot air- I'm on the monitoring machine every 2 hours and had two bloody massive shots of steroids. They check my temp every hour and pulse every hour too. I'm monitored really heavily. What I'm acted about is that there is 9 days between now and my section. 8 of these they want me to be at home, just be monitored. Do you think that's right? Alternatively should I really be in hospital for 2 weeks before the section? I really don't know what to ask my consultant?

gualsa Sun 11-May-14 08:24:13

I suppose they are keen to wait until steroids take effect. Specifically because as you said in your first post the baby has not grown much since 25 weeks. I think they are weighing up risk of infection versus risk of oxygen loss due to under developed lungs. At the moment you are breathing for her.
I am pleased they kept you in. They could bring forward your section at any time they decide and they may well do. Just hang in there. I am sure it will be fine.
My next scan is this Wed where I will be 35+6...if I can drag myself all the way up there. I am all bump and it's massive:-D.
Pls keep us updated Jo x

hotair Sun 11-May-14 12:24:49

So long as you're being properly monitored and you can get to hospital quickly and know to contact them if you have even the smallest concern then staying at home is acceptable. RCOG guidance is that in some instances of PPROM this is appropriate, but the decision should be made after consulting the patient and according to their wishes. However when you combine the fact that your baby is showing signs of poor growth, which can be a placental problem as well as the PPROM I would personally want to be in hospital
I would tell your consultant you're concerned and ask how/why they've decided it will be safe for you to wait at home before your section. How will they be monitoring you and how often, will they be getting you to monitor your own temperature at home etc to check for signs of infection? If you're not happy/ comfortable with these plans then you can discuss that you would be happier to wait it out in the hospital.
As far as 34 weeks go it is safer to wait til then unless you go into labour or your baby is distressed, or there are signs of infection. Especially if your baby is measuring small as this will mean they have less fat reserves when born and may not be as developed. If you know youre having a section at 34 weeks have they shown you the SCBU? it's likely your baby will spend sometime there and that will be easier if you know about it first...

johull Sun 11-May-14 16:12:46

The consultant came round this morning and asked me to stay another night which I have no problem with at all. He then said he doesn't want to book the section in without consulting with another dr about whether it should be 34 or 36 weeks. Why has he suddenly changed his mind?! It's crazy. I could go into natural labour by 36 weeks. I'm gutted!!

hotair Sun 11-May-14 16:32:57

That seems really foolish and I would not be happy. The RCOG guidelines are clear that 34 weeks is the optimum point for planned delivery and that statistically outcomes are worse for expectant management past this point (greater chance of infection being the main issue). The guidelines are here and I would ask your consultant to justify why they are not following them. The fact that they are conferring with a colleague suggests to me they may be not be a consultant but other level of hospital doctor- can you check? This maybe why he's second guessing himself.

johull Sun 11-May-14 21:49:28

Hot air- you are spot on!! Through investigating I found out he's not MY consultant, and therefore won't make a decision as I'm not 'his'! He told me that if I was he would section me at 34 weeks but he thinks 'she' my actual consultant will say hold off until 36 weeks. I want to cry just typing that! My work have been great and have said I can leave now. I now just sit/lay in hope that when the morning comes and I get to see her, she agrees with consultant #1. The same consultant let me go out this afternoon to get some lunch in the local town. It's a really small local town. I walked 200 yards and nearly fainted. I had to go straight back in to hospital again. We came back and baby heartbeat was baseline 180!!! Bloody crazy. I wish I could talk to her now About this. Fingers crossed for a women who listens and trusts her patients. X

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