WIBU to have an early elective c-section at 37 weeks

[beclev24]

Please be kind. This is really stressful. I am posting here for traffic as I have to make this decision really quickly and wonder if anyone has a view/ expertise.

I am 36 and a half weeks pregnant after several cycles of IVF. The pregnancy has been relatively uncomplicated so far but considered high risk- I am 43, had IVF and had low Papp-A which can indicate weaknesses with placenta and high risk for pre-eclampsia.

Earlier this week, I had v high blood pressure and some protein in my urine (levels considered borderline for pre-eclampsia)- they decided to deliver the baby the next day by c-section after giving steroids for his lungs etc. I was admitted to hospital. But then, my blood pressure came down, my blood results normalized and I was allowed to go home on bed rest. One doctor is telling me that I should get to 37 weeks and then have a c-section because the benefits will outweigh the risks/ there is a risk of stillbirth etc. Another doctor is telling me that 37 weeks is too early and it increases risk for all kinds of things- eg lung problems/ disease etc but also autism/ learning difficulties ADHD.

It's up to me to decide whether to try and go a little bit longer, to keep the baby inside as long as possible or to get him out now. WWYD?? I have no idea what to decide- feels like so much pressure and I'm filled with anxiety. Does anyone have any personal experience or knowledge on this? Please help if you can. Thank you.

My babies were born at 37+6 and were 7.5 & 6.4.
37 weeks isn't too early at all!

When I had my ELCS 18 yrs ago they routinely did them at 38 weeks , no steroid cover or anything extra , one assumes research has proven that waiting for 40weeks is better but I should imagine that there are thousands of people like me / my dc that we’re born at 38 weeks with no problems . Good luck whatever you decide .

Why are they telling you two different things? Tbh I'd be asking the pro 37 week delivery dr why the other dr is warning you not to deliver early?
Better to get the facts from people who know your history as we are just a group of Randoms on the internet!

37 weeks is full term so I’m not sure why one Doctor is telling you that is too early. 40 weeks just more often around when babies are born as due dates aren’t an exact science. And quite often babies are born at 41/42 weeeks and are considered ‘late’.

It’s not going to be good for you or the baby to spend potentially the next month filled with anxiety so I’d say sit down with the more syou bauble sounding risk / benefit Doctor and discuss the realities of the situation and what’s based.

Personally if I had any reason to be concerned about the health of my baby and I was full term then I would go for the ELCS.

Good luck. X

*sensible sounding

thanks v much for your responses:

grimdamnfanjo we are in the US and it's a complicated healthcare system- you see lots of different people and it all seems a bit less coordinated than in the Uk. I genuinely think on this question though it is a judgement call/ matter of opinion amongst doctors rather than there being one single right answer/ protocol. The 'keep going longer' doctor was more senior/ a consultant but I wont' get to see her again. My own doctor was the one who said deliver early- I see her on Monday and can ask her why the difference of opinion but it's hard to get clarity.

mimisunshine thank you! that's what I'm veering towards but then I keep googling and it's driving me crazy! I wish they would just decide for me tbh...which I know is silly but somehow having to make the decision myself is even harder.

Nearly all babies born at 37 weeks will be absolutely fine, might be a bit sleepy in the early days ( increased risk of jaundice etc) and CAN need minimal help with breathing. Are you hoping for a vaginal delivery (am a medic btw)

I was induced at 36.5 weeks, with my first child. It was because I had gained 5 stone and was starting to show signs of Pre-eclampsia. They did a scan which indicated that he was 10 pounds! They didn't give me any steroids for the lungs. I was in labour for 18 hours and things became a bit precarious, so I then had an emergency C section. My son was absolutely fine! And he wasn't 10lbs, he was 8lb3.5. My second child was also induced, at 39 weeks. Normal delivery and all fine. In your shoes, I'd be inclined to get the baby out safely, asap. Good luck!

Do you want a C-section? Is that highly advised for people with your conditions?

My take on this is...

They are monitoring you constantly for pre-eclampsia, I would leave that one in lap of gods if it forces a hasty induction or C-section.

They can do colour scans of the placenta which shows how big it is & how well blood is flowing thru it -- have you had such a scan? I'm reading online that low-PappA can mean lots of things or nothing, it's not a reliable indicator.

Yes ask on Monday - personally I'd be wanting a section at 37 weeks but I'm risk averse with babies as have had difficulties too and I just wanted them to be safe in case my body failed - slightly melodramatic on reflection but still I'd never have gone over my due date (37&40 at each birth)

i would have an elcs at 37 weeks - not worth the risk...as others have said it is term...all mine (also not in the UK) were born by elcs at 38 weeks..but other than being 41 with my 4th, I had no other health risks.

Good luck!

With my first (born 2012) I was induced at 38 weeks because of a medical condition. By the time my third was born (2016) they wouldn’t induce me before 39/40 weeks as research has shown there are small risks associated with early term delivery which outweigh the risks of my medical condition.

There are risks associated with being born at 37 weeks and there are risks associated with being born by C section, but there are also obviously risks with having a failing placenta, which can obviously have a catastrophic outcome.

There's not a "right" answer here and it is going to come down to your and the doctors' almost gut reaction about which side of the risk-benefit equation you come down on.

I can definitely see why it would be stressful to have to weigh this up and to feel responsible for this decision, and it isn't fair that the doctors (speaking as one) are playing "good cop, bad cop", rather than being united and honest and clear with you about all the risks of either option.

As a patient, (not speaking as a doctor, we don't have your full history and can't offer medical advice), I think I'd be inclined to get the baby out.

Hope all works out well for you.

I had mine electively at that stage for various reasons and they were fine.

I had my babies at 36.5 and 37.2 - I just went into labour both times. They were 8lbs 5oz and 8lbs 2oz respectively. No one even referred to them as early to be honest.

It sounds like you've waited a long time to have your baby, why delay any further?

Complete lay-person opinion on what I would do, if I were in the situation:
I would get the baby out, either start the induction process or c section. Other people I know have had no PE symptoms and all of a sudden developed it (you don't say how often they're monitoring you that I remember?) and I think that my brain would equate any tiny thing to PE so I would be in a near constant state of anxiety.
Plus there's lots they can do to the baby outside of the womb such as helping them breathe and sustain life that they can't do in the womb.

I don't think they've been fair to you in saying different things and it would have been easier if it was the more senior consultant saying get the baby out...

Hang in there until Monday OP and please let us know how it goes!

I would rather have a baby the week before Christmas as staff might be a bit more stretched over Christmas?

How confident are they about their ability to monitor you if you wait?

I'd be happy to have the baby at 37 weeks as that is full term.

One of mine was early term at the time you are now and does have some of the things you talk about.

37 weeks is not full term, it is considered early term.

My baby was born at 36+2. Not by CS or planned - my waters just broke for some reason! She had no breathing problems, didn't have to go into an incubator or anything. She was a bit slow to gain weight and has never gained well on breastmilk alone but that could just be her, and nothing to do with being early. She's only 6 months now so a bit early to tell about learning difficulties etc but so far she's meeting all her milestones.

There was some research recently that said there would be far fewer still births if more babies were delivered by (and I can't remember exactly but I think it said) 38 weeks.

Have you noticed any change in your baby's movements? Are the hospital happy with baby's size etc.?

www.nichd.nih.gov/ncmhep/initiatives/know-your-terms/Pages/health-care-providers.aspx

"Clinical evidence shows that a fetus goes through a significant amount of development and growth in the lungs, liver, and brain between 37 weeks and 39 weeks of gestation. An infant born prior to 39 weeks faces a 20% greater risk of significant medical consequences than those born after 39 weeks. Mortality rates are also higher among infants delivered in the early-term period compared with those born after 39 weeks, now called full-term births."