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has anyone negotiated an elective c-section to be done AFTER going into labour?

(25 Posts)
ReshapeWhileDamp Thu 02-Dec-10 23:56:36

I have a breech baby and an ECV appt on tuesday. smile While we very much hope he'll turn for us, if he doesn't, we will have to consider an elective section as one of our options, and given the relative inexperience of my very lovely MW when it comes to breech births, and the likelihood of being messed about good and proper in hospital if I tried for a vaginal birth there, I think a planned section looks the best option from here.

So - I've read a bit about how it's much better for the baby to have been in labour for a few hours, as it primes him with the right sort of hormones to be able to breathe and adapt to life outside, as opposed to being hoiked out at 38 weeks when he might not be ready. And apparently the scar heals a lot better on a thinned uterus that's been contracting for a little while. So maybe we should wait until I go into labour naturally, and then proceed to a section.

But how easy is it to get the consultant team to agree to this? Has anyone here managed it? Obviously an 'emergency' section (calm or crash) is done when you've been in labour for a while, but that can't be foreseen. Is having a planned intrapartum c-section a good idea, even?

japhrimel Fri 03-Dec-10 06:50:34

You'd lose the advantages of having an ELCS, such as plenty of time to get the best team together, plenty of time for them to do the incision, etc. And you might go into labour at a time when they're really busy and/or short-staffed. confused

Maybe ask about it, but I can see the answer being "it's not sensible".

scotgirl Fri 03-Dec-10 07:08:26

I am not sure your hospital will let you.

I had a breach presentation and an elective section at 37+5. The only other date available was the day before my due date and THERE WAS NO WAY my consultant was letting me get that far along. They wanted to avoid an emergency section at all cost. They don't deliver breach babies vaginally as a rule at my hospital.

So 37+5 it was, a bit early but still classed as term and all was fine.

DS2 was over dates 40+2 and I did go into labour. Was 2 cm and had contractions for days - ended up having a semi elective section because of other things.

There was very little difference between the births DS1 was smaller was all. Both babies were health and gained loads of weight. First section was more painful, but I think that is because with a breach baby it is harder to get out (it comes out bum first with arms and legs trailing as opposed to a head down baby that comes out head first!).

onimolap Fri 03-Dec-10 07:09:18

There's a basic problem with the terminology.

An elective CS is one which is performed before the onset of labour. After labour has begun, then the procedure is known as an emergency CS.

So you can't have an elective CS after the onset of labour as there is simply no "window" for safe planning. No-one can accurately predict how your labour will proceed, and therefore whether there would be time for a calm procedure or if instead you face a hideous drama in the middle of the night.

MrsPickles Fri 03-Dec-10 07:16:16

Well, you can refuse to book in for an elective section and if you present yourself at hospital in labour with a breech baby I am fairly sure they will perform an emergency c-section - probably no-one would be too chuffed about it though!

IDontLikeDisciples Fri 03-Dec-10 07:17:02

Would it not be bested to try to turn the baby? As painful as it can be, has to be better thn a major operation.

I'm also surprised a hospital would refuse to deliver breech as a blanker policy, why would that be?

MrsPickles Fri 03-Dec-10 15:12:44

Idontlikedisciples, OP has an appt on Tues to try and turn the baby (ECV), think this is her plan if it does not work....

ReshapeWhileDamp Fri 03-Dec-10 15:56:38

I'm also surprised that a hospital would have a policy not to deliver breeches, as it simply does happen from time to time. Undiagnosed breeches happen at all maternity units and sometimes there isn't time or it isn't appropriate to do a section.

Yes, I'm certainly giving ECV a go - more than once if necessary! I've read about the possibility of 'intrapartum' sections in Benna Waites' book Breech Birth, as well as elsewhere, so I know they have been done. Obviously you can't tell how long a labour will last once started, but the book was talking about contracting for a couple of hours or so and then being sectioned. It seemed unlikely to me too, from a logistical point of view, which is why I asked if anyone had heard of this happening.

TruthSweet Fri 03-Dec-10 16:06:33

What kind of breech do you have? Footling/stargazer/soldier/frank/complet/incomplet e?

Cleofartra Fri 03-Dec-10 19:33:34

I know someone who did exactly this - refuse a section for breech until she'd gone into labour. She wanted the baby to be born at the right time - which as far as she was concerned was following the onset of spontaneous labour.

Yes - there are issues about theatre being full when you arrive in labour, but that might be a problem for any of us - not an unusual event surely given the incredibly high number of emergency c/s in the UK. Doesn't deter women from booking to give birth at hospitals with high c/s rates, whose theatres MUST be under more pressure, than those hospitals with similar numbers of births but much lower c/s rates.

As for whether they'll 'allow' you to do this - if you tell them you're going to wait until you go into spontaneous labour and then turn up at hospital they really have no option other than to agree to it. What else can they do? Refuse to let you in when you arrive?

Cleofartra Fri 03-Dec-10 19:37:50

"There's a basic problem with the terminology.

An elective CS is one which is performed before the onset of labour. After labour has begun, then the procedure is known as an emergency CS"

'Elective' simply means 'chosen'. The OP's doctor and the OP have chosen to have a c/s, it's just the timing that's the issue as far as I can see!

ReshapeWhileDamp Fri 03-Dec-10 23:00:22

Thanks, Cleofartra! As far as I'm concerned, letting the medical team know this is what we would want, and choosing a c-section after I'd gone into labour, makes it elective. And I understand that the proper term for a section that happens while labour is underway, is intrapartum.

Truthsweet, I don't think he's a stargazer. Nothing was said about an extended head at the 33 week growth scan, when we found out he was breech for sure. What's a 'soldier' breech? Have never heard of that one! He is, as far as I know, an extended/frank breech.

BUT - last night there was a real rumpus in there. I also had a lot of lower back and hip pain. Something definitely happened. He's been moving about a lot today and I now honestly can't tell if that's a bum or a head. I think I was only saying head before because I'd seen it on the scan, but his limbs do seem to be in a different pattern now. Fingers crossed. grin

onimolap Fri 03-Dec-10 23:17:30

Cleofatra: we'll have to agree to disagree. All CS involve a choice at some point that it is the best way to proceed. Elective is the normal term for a CS before the onset of labour; emergency for when labour has begun.

RWD's OP appears to be asking if she can refuse an elective CS - of course she can, and an emergency CS would then be performed as indicated during labour (though vaginal delivery of some breech presentations is also possible). Various other posters have noted that there may be downsides in preferring an emergency CS.

RWD: I hope you're right and these movements mean a more co-operative position!

mears Fri 03-Dec-10 23:41:23

Actually this isn't really a major issue. Just because labour has started, it doesn't make a CS harder. A breech baby can come out perfectly well vaginally. Some women opt to try labour and if the baby does not descend, or labour does not progress, then a CS is done. RWD - if your baby has not changed it's position from breech, you can discuss waiting for labour to start.

BTW - elective surgery is usually planned 24 hours in advance.

Technically a CS performed in labour is classed as an emergency however it doesn't mean it is an 'emergency' IYSWIM?

NonnoMum Fri 03-Dec-10 23:46:09

There is a website - spinningbabies.com - try that.
And try reflexology and swimming...

And good luck.

mazzystartled Fri 03-Dec-10 23:50:41

I asked my consultant about this when working out my plan of care for DC3.

Consultant was actually agreeable on the basis that I understood it was - very slightly - riskier for me and the baby than an elective. DS2 wasn't breech though. (Had a vba2C in the end)

thelittlestkiwi Fri 03-Dec-10 23:56:22

ReShapeWhileDamp - is this your first baby? My DD1 was breech and I was told that avoiding labour was a good idea as the baby could get stuck which would be very dangerous. You could be one of those people who doesn't realise they are in labour and ends up delivering on the bathroom floor.

Other factor is that elective C sections, done during the day with a rested team, are safer than emergency ones.

My elective C was a really good experience. It was done at 38+6 and DD had an APGAR score of 9/10. Lots of people commented on how well and pretty she looked on the day of her birth. Personally, I think it is a nice calm way to enter the world.

mears Sat 04-Dec-10 00:01:11

Emergency CS are done during the day too.

Since the introduction of working time regulations, staff working night shift have been rested too.

No need to worry on that score smile

mears Sat 04-Dec-10 00:03:00

If in the UK anyway

duchesse Sat 04-Dec-10 00:20:05

reshape, I think you should call your midwife ask tell about the ruckus today and see if they can do a scan to see if he's flipped over. That might just be it, worry sorted.

thelittlestkiwi Sat 04-Dec-10 09:11:20

mears- if the OP waits to go into labour she may have to have a C section at night as she may not be able to wait until day time.

duchesse Sat 04-Dec-10 10:24:26

I had a C section in the dead of night and it was fine. Obviously depends on how good your surgeon and team are at night. Would be interested to know what type of CS I had by these definitions though- I never technically went into labour (on syntocinon and having strong but painless contractions but never went into established labour) but they had to whip DD3 out v quickly when she started to become very distressed.

ReshapeWhileDamp Sat 04-Dec-10 11:10:26

Thanks for this discussion! Really, I wanted to weigh up the relative risks and benefits between what I'm most likely to be offered, an elective c-section before labour starts, and one done after I've been in labour a while. I'm beginning to think that a truly elective, pre-labour section might be a better bet, but I have read that an intrapartum one can benefit the baby.

Anyway, I have my ECV on tuesday, which will include a scan at the start, so I'm not sure there's much point in trying to get an earlier scan sorted. They won't do non-emergency ones over the weekend and I doubt they'd be able to fit me in on monday! I hope it won't be too inconvenient if I go to my appointment and they say he's already turned, but as far as I know, the clinic runs for several hours and they start the women on fetal monitoring at the same time, so I don't think I'll be pinching a slot from someone else who needs it, if he has flipped already. /hopes

Littlestkiwi, no, this is my second baby. DS was born vaginally, but induced and with an epidural. I'd really, really hoped to go ahead with my homebirth this time. Maybe I still will. smile

TruthSweet Sat 04-Dec-10 16:41:35

RWD - I got confused it's not solider but military presentation blush. It's where the baby is 'looking' straight forward not upward like stargazer or the normal tucked down chin to chest position.

mears Sat 04-Dec-10 17:01:08

thelittlestkiwi -I think I confused you. What I meant was that the staff who work at night are rested through the day. I am a midwife and work night shifts as well as days, and so do the medical staff. So yes, an emergency CS may well be at night but staff are equally rested.

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