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.

37 week birth increases the risk of some things (though not autism and ADHD as far as I'm aware). It also reduces the risk of others, including stillbirth. Stillbirth rates increase every day after 37 weeks.

37 weeks is full term so I'd be happy enough to give birth then.

buffetfaced- yes they are saying 37 weeks is early term to me too. So sorry you have have had problems due to this. Would you mind sharing what kinds of problems you have enccountered with your DC? (no problem of course if this is too intrusive) . Thank you.

I'd go for it at 37 weeks.

My youngest was induced at 37 weeks due to slow heartbeat and distress. She was 7lb 14oz and looked full term to me. Absolutely no health problems at all and is 33 now!

I begged for my elcs (cs#3 1×emacs, 2xelcs) at 37 weeks as was absolutely massive (only 5ft and was about as wide as was tall) and in a lot of discomfort and pain with spd etc. Consultant reluctantly agreed on the proviso that I had the steroid injections, which seemed to have the added benefit of improving my lower back pain!
Baby extracted at 37+2, weighing in at 10lbs and an apgar of 10. Babies are considered 'term' if they arrive naturally at 37 weeks so I really didn't see what the problem was.

thanks for everyone's comments. I wont' be having a vaginal delivery- it will be c-section whatever happens (this is my 3rd DC- my first was born vaginally and I had terrible tears/ various longer term consequences which I never want to repeat. My 2nd was a planned c-section and the recovery was great. In this situation I have been advised against having a vaginal delivery even if I wanted one.

babyorsanta you sound like a lovely doctor. I agree with you. I wish in a way they would just use their expertise to make a plan and tell me about it rather than giving me the option and drive myself crazy!

I'm not a doctor so take this with a pinch of salt but I'm sure I read somewhere that 38 weeks was much better than 37.

Is there any reason you don't want to wait if your blood pressure has gone back to normal? Is it nerves as you had a fright?

In your situation I think I’d go for very very close monitoring (at least daily) and a low threshold for immediate procession to CS. Based on my experience which is hardly good evidence...
DS1 failed induction for reduced fluid, suboptimal dopplers and reduced movements at 39 weeks. I was in good shape with no issues of blood pressure/ pre-eclampsia or infection. EMCS, long recovery, excessively sleepy and jaundiced Baby.
DS2 semi- elective CS at 35+5 for same reasons. Steroids given prior but probably too early to be effective (28weeks). Great recovery for me, breathing and feeding problems and NICU stay for Baby.
DS3 semi-elective CS for same reasons, but I’d had weekly and then daily monitoring from 34 weeks) at 37+ 5 with steroids given 72hrs before. Amazing recovery, robust little baby.

Elective surgery: easier recovery (for me)
Delivery at optimal time: better outcome for my Baby. Consultant was very clear that without careful monitoring all 3 of mine would have been at significant risk of serious harm or still birth.

Yes 37 weeks is early term and while most babies born at 37 weeks have no complications whatsoever, there are a percentage that do.

If I were you I'd be speaking to the doctor again and asking why they recommend delivering at 37 weeks when another doctor is advising you to go as close to 40 weeks as possible.

As long as you are being monitored closely I see no reason for you to keep going unless you really don't want to.

These are not the standard accepted definitions. For example, the charity BLISS, for “babies born too soon”, defines full-term pregnancy as 37 weeks or more, moderately premature as 35-37 weeks, very premature as 29-34 weeks, and extremely premature as birth before 29 weeks

This is a quote I found on the NHS site. 37 is considered full term.

I had a CS due to developing pre-eclampsia at 38 weeks. I was not given the choice of a vaginal delivery as they said my blood pressure was too high to risk. DD is now 17 and fine.

OP, speak to your doctor on Monday, see if they explain why the other doctor had a different opinion.

These are not the standard accepted definitions. For example, the charity BLISS, for “babies born too soon”, defines full-term pregnancy as 37 weeks or more, moderately premature as 35-37 weeks, very premature as 29-34 weeks, and extremely premature as birth before 29 weeks

This is a quote I found on the NHS site. 37 is considered full term.

I had a CS due to developing pre-eclampsia at 38 weeks. I was not given the choice of a vaginal delivery as they said my blood pressure was too high to risk. DD is now 17 and fine.

OP, speak to your doctor on Monday, see if they explain why the other doctor had a different opinion.

My son was born by emergency section at 38 weeks. I was told he wouldn't have survived delivery and was flat when born. Within a few hours he was fine but I didn't know that until he was nearly two days old. Having a c section caused me many issues later on so I wouldn't chose one unless really necessary because for me it was worth it for DS but nearly cost DS his mum and sibling at a subsequent birth.

kaytee my blood pressure is still elevated and especially for me (I usually have low bp), although not in the pre-eclampsia range. my feet are v swollen and I still have some protein in my urine (borderline range)so there's obviously something going on. I guess I'm just nervous about waiting because obviously stillbirth seems so utterly catastrophic. But then all the other things do factor in too. ARGGGH!!!

All i have is my personal experiences OP. I was born at 36 weeks 6lb 4oz and was absolutely fine in the 70s. DS2 was born by c-section as i was bleeding heavily with placenta preavia at exactly 37weeks and he was 10lb! and completely perfect. He is now 3.3 and bright and lovely and no signs of anything concerning. DD was born c-section at 38wks and again fine.

As you still have symptoms of high BP I'd have the section, things can worsen very quickly and 37 weeks is term.

Are you having daily monitoring or 12 hourly??

anutteridiot- yes- irrelevant in this situaiton as I don't think they would let me delivery vaginally anyway now, but my c-section was a milion times easier than my vaginal birth and the recovery was so much better. But I know that this isn't the case for many. I guess it depends so much on the circumstances.

randommess i was in hospital for 3 nights having monitoring every few hours of bp and the baby. Now at home on bedrest with a home blood pressure cuff and monitoring twice a day....

I can give you my experience if that helps. I had symptoms of pre-eclampsia from 32 weeks but they nursed me along to 40 weeks then induced.

For that 8 weeks I had weekly checks in hospital where they would check BP, run blood tests, and monitor my baby for half an hour - I'd sit with a cup of tea and a magazine and listen to my baby's heartbeat. By the end of that session my BP would always have gone from worryingly high down to just a bit high.

In the last week of pregnancy I had my BP, urine, etc checked daily.

I'd encourage you to go back to your doctor and ask what they will be doing to check on yours and your baby's health in the time between now and the delivery. In your situation I'd want daily checks.

Both my younger children were elective c sections at 37 weeks (due to complications with first delivery which resulted in an emergency section).

They were both over 8lbs and have no physical issues or learning difficulties.

Dates aren't even always quite right (not in your case with IVF when they will be, but in pregnancies dated by last period and just one or two scans) so plenty of 38 weekers are actually 37 weekers, and 38 weeks is considered full term...

Earlier and you might be increasing risks, but at 37 weeks any risk increase must be minimal. Any actual causal links between prematurity and autism or ADHD are still quite sketchy I believe.

37 weeks is term. My DD was born by planned section at 37 weeks because of obstetric cholestasis. She was a healthy weight, no issues. Don’t fret!

Reading your latest update I would push for 37wks and not risk waiting longer.

I got pre eclampsia unusually in the last few weeks of pregnancy. I was sitting at home and my vision went weird, they did the c section that night. It was only a few days before my planned csection, which they'd planned at 39 weeks (am also in the US)

I'm currently pg with what will hopefully be DC2 and have also had IVF and various pregnancy problems. With DC1 I had problems with high blood pressure at the end of the pregnancy.

In the hospitals I've been at in the UK, the doctors won't let you go much over your due date with an IVF pregnancy because of the increased likelihood of having problems with the placenta.

There are increased risks for going early, but then there are risks for holding off! And just because there's a risk of a bad outcome doesn't mean it will happen, in either case.

If it was me, I'd be more worried about stillbirth than anything else and would go for a cs at 37 weeks.

I hope it works out ok and remember you can only ask yourself to make the best choice with the information you've got.

I had an emergency c section at 37 week as my placenta wasn't formed right and was failing. My baby was tiny because she stopped growing and had I left it any long I would have had a still born.
My logic was they could do more for dd outside the womb than her being in an hoping for the best.
It is a big decision and only you can make it. Don't let others force you into anything you don't want.
Ps my dd is 8 and the picture of health.
I hope whatever you choose everything goes well