elective c/s- when did you have it: 38 or 39 weeks?

[isidora]

I need to have an elective c section to avoid another 3rd degree tear. I had a very quick first labour which is why the tear happened. My hospital has a policy that elective c/s can be done only after 39 weeks, which makes me worried in case I get into labour early and it ends up being as fast as the last one. DD1 arrived exactly at 39 weeks. What has your experience been with arranging a date? Does this policy change from hospital to hospital? Does anyone know about babies readiness in terms of lung development etc at 38 vs 39 weeks?
I would feel less anxious if the date was closer to 38 rather than 39 weeks provided it's fine for the baby. Thanks a lot!

[chipkid]

I had a very similar experience to you. I had a third degree tear with ds who arrived at 39 weeks and 5 days. In booking my elective with dd, due to the days on which sections were done at the hospital I was scheduled for ...39 weks and 5 days!
I kicked up a fuss but was told that I could have the section at 38 weeks and 5 days (the only earlier alternative) but there was an increased risk of the baby having breathing difficulties.
I wasn't prepared to take the risk and managed to hold out until the scheduled day.
I was told that even if I had gone into labour earlier they would perform an immediate section which is not like a real emergency as the baby would not be in distress.
It is irritating-but you have to weigh up the risks to the baby of a 38 week section
hth

[KBear]

My DS was born by elective c-section at 38. He as perfectly fine, 8lb 6oz, lungs in perfect working order! I thought lung development was only a problem in the 20 and early 30 week stages but I'm not a medical professional. 38 def not a problem though. Good luck.

[chocciekookee]

At my local hospital an elective c-sect can be performed at either 38 or 39 weeks, dependent upon the consultant, but most tended to opt for 39 weeks.

I was due an elective c-sect with my 3rd baby and was booked in at 38wks+6 but my previous babies were early so I knew I wouldn't hold out until then. I ended up going into spontaneous labour at 35wks+5 and had an 'urgent' c-sect. I wasn't given any steriod injection for the baby's lungs since I was told that 34wks+ the lung function should be ok. I did have a scan though to assess how big the baby was.

If you were early with your previous baby I would be 'on standby' from 35wks onwards - don't stray too far from the hospital! Good luck with everything!

[fruitful]

This is what they base their policy on, I think:

RCOG.org.uk - \link{http://www.rcog.org.uk/index.asp?PageID=694\click on Full Guideline and go to page 51}

and this

NICE.org.uk - \link{http://www.nice.org.uk/pdf/CG013NICEguideline.pdf\page 14}

I had my first cs at 38.5 weeks; that was when they found out she was coming feet-first. They said if it had been before 38 weeks they'd have waited (with me in hospital!). DD breathed fine but didn't want to feed for about a week.

My second was at 34 weeks for placenta praevia; now that was too early! But he breathed ok as well, and started breastfeeding after a week in SCBU.

I'm interest in this as they said if I had another baby they'd want to do an early cs (had a bit of a scar problem last time too).

What does your consultant say about the risk of the baby coming early?

[fruitful]

The quick answer is:

at 37 weeks, 73 babies out of 1000 had problems breathing when born by cs

at 38 weeks, it was 42 babies

at 39 weeks, it was 18.

Have you considered lying about your due-date (evil emoticon)?

[kid]

I went into labour with DD at 39+3, I ended up having an emergency section at 39+5.

I asked for an elective section with DS as I didn't want to go through the same experience again. They booked me in for 38+5. I was convinced I would go into labour earlier but I didn't. He was a healthy 7lb 13oz.

[CristinaTheAstonishing]

Had DD by elective c/s at 38+0 (a number of factors, though). She did have breathing difficulties but I also had gestational diabetes so it may have been due to that (insulin may interfere with surfactant production). She was 7lb 13oz) and in SCBU for 2 weeks. She's 14 months old now and absolutely fine, if a bit small.

[isidora]

Hi all, I found your comments SO helpful! I'm amazed I haven't heard half of this from the consultant. Since the risk of respiratory problems for the baby seems a fair bit higher at 38 weeks I suppose it makes sense to wait until week 39, but to be ready to rush to the hospital at the first sign of spontaneous labour. My other worry is that the date they are offering me is the Friday before the Bank Holiday and I'm a bit concerned about availability of staff for the following three days. But hope that for a real emergency there is always going to be someone around. Anyway, once again, thanks a lot!

[pucca]

Isidora...I am in the exact same boat as you, i m having a elective c-section because of a previous 3rd degree tear, and i saw the consultant last week, she said it will be booked for 39 weeks i have to go and see her at 36 weeks and i will get my date then.

hth

[JanH]

I had 4 CSs - the first was at 41+ weeks because nothing was happening and baby was seeming distressed (she was OK though, and this was in US).

2nd was meant to be a trial of labour but we disagreed about dates and at what they said was 42 weeks by scan (40 by dates) they attempted to induce, but nothing was happening so that became a CS too (7.12, no probs but rubbish feeder).

3rd was scheduled at 38 weeks by scan - I think there was still a dispute about dates and he was certainly far from ready, terribly sleepy and another rubbish feeder, although a good size (8.3).

4th was scheduled at 37 weeks to be on the safe side - he was 7.4 and absolutely fine (still rubbish feeder though - this seemed to be a family thing ).

HTH. Good luck.

[eidsvold]

almost 42 weeks....but I wanted to try for vbac so consultant let me - by 41 weeks no sign of labour, movement or anything so we scheduled elective.

[nearlythree]

Hi, isidora, I'm going through a similar thing and have a thread going - I'm booked for my third section at 39.5 weeks' and getting worried for various reasons. Being a total technoidiot haven't mastered links yet but look at the 'Third Section Imminent - Scared I won't Make It That Far' thread. Btw I had dd2 by e/section at 39 weeks' and it was fine. HTH

[Poshtart]

I thought babies were considered term from 37 weeks? I would have thought in your case isidora that would indeed bring your ES forward to avoid you going into labour! What has happened to logic? My DD was born at 38+1 because of breech presentation and she was fine. Good luck ;)

[Gem13]

I had DD at 39 weeks. I wished I'd waited longer as she didn't feel ready to be born. She was a good size (8'3) but it took her a while to get to get to grips with feeding and I just feel she could have done with a bit longer.

She was another 3rd degree tear avoidance but DS was born 9 days after his due date so I didn't have the anxiety about an early labour.

[Uwila]

I had DS by elective section at 38+4. I live quite far from the hospital as what quite anxious about the possibility of going into labour and the logistics of getting to the hospital with toddler in tow and a husband who works two hours away from Mon-Thursday. I agreed with the consultant to take 39 weeks, but insisted on 39+0. Well that day was all booked up. That was a Friday and they don't schedule sections for Sat or Sun. The monday was all booked up too. So, he wanted to schedule for 39+4. And I said now way. That is only 3 days from the due date. Basically, I felt that the risks associated with going into labour before the scheduled section were far greater than the risks of breathing difficulties at 38+4.

He did however, have a bit of trouble with breathing because he was a bit mucusy (sp?). He also had a bit of jaundice. Nothing too serious, but enough that I worried. I don't know if this had anything to do with the dates. Interstingly, in case this happens with any of you, formula is better for clearing jaundice than breast milk. So I gave him some formula along with breast milk in the first week or so to help clear up the jaundice.

[RedZuleika]

Out of curiosity - has anyone had the experience of requesting an elective section, but refusing to consider it before their due date? And if so, what has been the reaction to that?

[Uwila]

I would expect that request to be well recieved. Unless of course the consultant was really worried that something bad might happen, like say you had placenta previa.

[RedZuleika]

Yes. Obviously that would be an indicator to do a Caesarean before there was the remotest chance of labour. Also - as people are discussing here - if you have a history of comparatively early labour, then you probably want to get the section in before it happens naturally.

If you know that you have a tendency to a long gestation though (say 42 weeks and +), then 38 / 39 weeks seems very early. I know that my daughter, for instance, put on a lot of weight during the last two weeks of my pregnancy and she wasn't huge at birth (7lbs 1oz @ 42+3).

[Jimjamskeepingoffvaxthreads]

I've had 2 in labour sections at 40 and 40 + 4 weeks, 1 elective at 38 + ? about 3 I think. Ds2 (38 week baby) had breathing problems. He was 8lb, but obviously not cooked.

Michel Odent is a big fan of in labour sections over electives, although I can see why you would be concerned if you have fast labours (I had the opposite problem :o)

[RedZuleika]

Yes - I've just been reading his book 'The Caesarean'. His idea is that with an in-labour section, the baby has sent a (hormonal) message across the placenta to say that it's ready, isn't it?

With me, they'd have had days to prepare... (and days and days... don't get me started...)

[Uwila]

I don't know if I suscribe to this theory (which I hear touted all over the place -- on and off of MN) that a woman goes into labour when the baby is ready. I tend to think a woman goes into labour when HER body is ready. And that may or may not be when the baby is ready.

However, I do generally agree that the longer they stay in the better (up to about 40-41 weeks). If I had lived near the hospital, I would have been happy to wait until 39+ weeks for the section.

[Jimjamskeepingoffvaxthreads]

I don't think its a wild theory uwila- I used to teach my A level Biology students exactly that 10 years ago. The process of birth is triggered by hormones released from the foetus.

[RedZuleika]

Because there is some evidence to suggest that the father has some input into average gestation. I read some research last year which looked at the average gestation of women who had children by one man, then further children by another. It wasn't a huge study group, but there was a difference in gestational length between the two groups.

As my mother delivered at 39 weeks and my mother-in-law at 37 weeks, I was all set to go from early on myself... and then sat there for another five weeks getting bigger and bigger and more and more grumpy