to think waiting to 39 weeks when labour would be dangerous is a bad idea?

[RainWildsGirl]

I'm 29 weeks (DC4) and I have a low lying placenta/borderline placenta previa. They will rescan me at 36 weeks to check position of the placenta and if I have less than 2cm clearance I will need a c/s.

My midwife has just told me that since my last birth (3.5 years) the recommendations have changed and that it is now 39 weeks for elective sections rather than the previous 38. Now considering the reason for the c/s is that it would be impossible for me to deliver naturally and that labour would be dangerous for me and the baby due to risk of bleeding it seems crazy to risk going to 39 weeks?

Also she says that even though 37 weeks is considered 'term' they will want me to have the steroid for baby's lungs if its before 39 weeks - my previous 2 DC were born at 38 weeks and clearly did not need this.

I live 45 mins from the hospital, not counting the time to get my other 3 DC to my parents and for DH to get to me to drive me in (I don't drive), realistically I'm at least an hour to an hour and a half away.

AIBU to think that being an hour away with high risk of bleeding and a need to avoid natural labour that waiting to 39 weeks is a bad idea? and WIBU to say this, strongly, to the consultant when I see her following the scan?

YANBU. They wanted to do this with my section, which wasn't for strict medical reasons but I have a family history of early labour, failure to progress and emergency interventions. I really didn't want to wait till 39 weeks.

I kicked off and got it moved to 38. I went into labour at 37 and DS stopped moving properly and because I never dialated past 1, they refused to move the section. By the time they got to DS at 38 weeks, he was blue, had aspirated on meconium, had suspected sepsis and nearly died. He now may have mild neurological issues from this.

If there is indication for a section, it should be done at 37/38 weeks IMO. I still get upset about what would have happened if I'd have left it at 39 weeks.

Just speak to the consultant about it and see what they say. The midwife might be referring to elective CS done for other reasons, rather than pp.

Then just ask if you can be booked at 38 weeks.

YANBU but I expect the consultant won't actually insist on you taking that risk, surely they'd have a medical negligence lawsuit on their hands potentialIy and theyd want to avoid that?

But if you placenta hasn't moved it won't be an elective cs will it?

Just because the guidelines say 39weeks doesn't mean that they will stick with that rigidly, they will assess as you go along.
I am having an elective section (hip problems) which at the moment is pencilled in for 39 weeks but knowing my previous history will more likely be 36/37weeks.

enjol well I wouldn't have thought so, not much 'elective' about it! but that is what the MW is saying.

tali what an awful thing to go through your poor DS. I hope he recovers well and has no lasting damage.

at least it seems I wouldn't BU to ask the question of the consultant.

I would have though that the guidelines are guidelines and the 36 week scan will decide what happens.

Try not to worry too much until then

Rain he will be fine, luckily nothing severe has happened, he has slight tremors which I've been told may get better with age or he may not.

Definitely speak to your consultant about it. Go armed with research and let them know your other children were born earlier. They may listen

I had both mine induced at 38 weeks and they were fine but I think new evidence does show on average worse outcomes when born at 37-38 weeks than 39-40.

I think this new policy is meant to be about looking at individual circumstances rather than inducing/elcs as a rule at 38 weeks for lots of conditions. I.e. they have to weigh the harm of birth at 37/38 weeks against the benefits whereas before they didn't think there was any harm at 38 weeks.

Speak to the consultant. I had placenta praevia and was in hospital from 35w as a precaution even though I'd had no bleeding and was scheduled for c sec at 37w.

tali so glad to hear that

sweetadaline that at least explains the reasoning a bit better for me, thank you.

ladydeirdre thank you for sharing - I really hope I don't have to be admitted that far ahead of time!

I know nothing is definite yet and I know labour and birth is never a guaranteed thing but this 'definite undefiniteness' of this one is making me more panicky about it all! plus the worry of potentially being stuck in hospital while DH tries to juggle 3 kids and work!

I have had praevia twice.

With dd2 the placenta did move out of the way.

With ds (dc3) it didn't. I also had placenta percreta and was in hospital from 26 weeks pregnant due to bleeding. They offered me a section at 37 weeks due to the very high risk to me and baby. In the end I pushed for it to be brought forward to 35 weeks. My reasoning was I was contracting and had relatively short labours with previous dc. I had steroids twice and ds didn't need to go to SCBU although he was observed for breathing.

Before my admissions for bleeding they had already agreed to do an ELCS at 38 weeks because my previous dc were born at 39 weeks and they didn't want to have to do an emergency cs with me as my case was more complicated than normal placenta praevia. I think if you have had your last 2 dc at 38 weeks you have a good case to have the csection at 37 weeks. Definitely speak to the consultant.

another thank you for sharing, its good to hear other people's experiences. reassuring to know that it isn't a black and white rule and that the individual situation will be considered.

maybe it will move out of the way and then all this worry will be for nothing!

I had exactly this happen with dc5. They wanted a section at 39 weeks, as I had had 2 others at 38+2 without a problem, they eventually agreed.

I do a bit of work around this, and I do agree that I've seen babies born at 38 weeks who have struggled. It's a tough call, but hard when you've had other do at that gestation.

Btw, I also had placenta previa with dc2. Main vein from placenta was 2cm from my cervix and it was a section for me.

I just want to add from a slightly different medical situation I honestly think the rules are not hard and fast, there may be guidelines but it's all based on how you and little one are doing.

Im 32 weeks with obstetric cholestasis and insulin dependant diabetes and my conversation with the consultant today was basically, we want to make it to 38, 37 if we have to but at the end of the day we are monitoring you twice a week and we will make weekly judgement calls.... I really got the impression it's a bout each different case if that makes sense

I , too am being told I will need the steroids and had to have them with ds1 who came at 37+1 but that does seem to be relatively standard unless there's a reason why not

I'm sure the doc will take into account your personal circumstances when discussing it.... My experience has been that mine does

Good luck

thank you imip and Euripides for sharing, it seems I am panicking needlessly as it seems the personal circumstance will be considered.

doesn't help that I've spent all of this pregnancy in denial over actually being pregnant! reality hit and brought a dose of panic with it!!

I've been offered an ELCS at 37 weeks for my twins. My consultant said that they will give me a steroid injection beforehand because it dramatically reduces the risk of the babies picking up an infection if they have to go to special care. He made it sound like it's a policy that has only recently been implemented, so perhaps that's why it wasn't done for your other children.

Good luck, whatever happens!

Not unreasonable. I have a permanent stitch so baby can't get out any other way other than c-section. If I labour, there's a high risk my uterus could rupture especially as I had two previous c-sections and a history of early and precipitous labour. We live 25-60 minutes from the hospital depending on traffic, and like you, we had three DC to find temporary "homes" for - which meant ringing round school mums as we have no family nearby.

Thankfully my doctor was brilliant. She agreed with me that 39 weeks was far too late, and was happy to overrule the guideline and make it 38 weeks. I was to have the steroids all the same which seemed bonkers to me as all my others had come earlier (35, 36 and 38 weeks) and were fine with no SCBU, but whatever.

DC4 had other ideas and came at 36+6, necessitating the panic we were hoping to avoid (thankfully the traffic was good at least, still took us 90 minutes from initial phone call to admittance to delivery suite!) but oh well, we're all good in the end!

I'm not allowed to have any more due to very thin scar tissue so goodness only knows what would happen if I got accidentally pregnant.

I had to have an ELCS due to risks to my health if I went into labour. They booked it for 40 weeks gestation. A few months further down the line, when I was about 36 weeks pregnant my CS was moved to 39 weeks because I was absolutely huge and one of my health conditions (heart retakes) started to destabilise.

However, two days before my ELCS they rang me and asked if they could push it back to 40 weeks again as the wards were busy

I said no as for the previous three days I had been in for monitoring and scans as I had been having reduced movements. When I explained this to the midwife over the phone she agreed to keep my appointment. I'm pretty sure though they if I hadn't have had reduced moments I would have been pushed back to having it at 40 weeks.

YANBU.

DD was breech and didn't turn so I needed an ELCS. I also had SPD and could hardly walk and was in agony, had to use a wheelchair and stick. I begged them to do it at 38 weeks but they refused because of the guildlines of 39 weeks. DS arrived (natural labour) at 38 and 3 and I had a 3rd degree tear and was told I shouldn't give birth naturally again. I was terrified of going in to labour after my previous experience and the fact she was breech and i was i agony and on strong painkillers but it didn't matter, they were sticking to their guildlines. Luckily it turned out ok and I didn't go into labour early that time but don't count on them doing to it before 39 weeks just because people are saying they are only guildlines.