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.

I was hospitalised at 34 weeks and induced and had a quick and problem free delivery with DD (now 6).

She has some very, very mild speech problems but otherwise her development was bang on. She reads at above average level for her age.

I had steroids at 34 weeks.

Adding to the above I didn’t have a choice. I was as close as they would let me get without getting to eclampsia.

I’m not sure what I would do in your case. I didn’t have any other problems, and I was also 10 years younger.

I've not RTFT but I requested my ELCS as 38+5 and was told by the consultant that's too early and they can't "justify the risks". It seems to vary so much depending on who you speak to. My friend was allowed an ELCS at 38 weeks, no questions asked.

What a tough decision. I've never had to make that choice so can only give my experience regarding your Asd, SEN etc concerns.
DD was born vaginally at 37 weeks exactly. Spontaneous labour. She is 5 now, no issues at all. She seems perfectly healthy, no developmental delays.
DS was born at 42 weeks. He has asd, adhd, dyspraxia, hypermobility, low muscle tone and spd. Currently on a trial of treatment for suspected asthma and his eye sight is not great either.

He had a whole extra 5 weeks inside me to develop and yet he's the one with all the issues. So whilst I know there may be studies and statistics I really don't believe that after 37 weeks the risks are that different.

Definitely speak to your Dr about the difference in opinion and see if that puts your mind at ease.

Coffee if you read that study, risks go up again at 42 weeks. OP I would hold on to 38+ weeks if at all possible

I'd maybe see if you can comprise and plan for 38 weeks? I think I would rather have the baby out where you can see and quickly act on any issues.

A ‘cold section’ at 37 weeks is very different to labouring at 37 weeks. Babies born by elective section earlier tend to be very shocked and they are more likely to need rescusitation with the potential for needing ongoing NICU support. If you can labour for even a little bit before having a section, even if it means starting the induction process and having a very low threshold for caesarian then that would be preferable in my opinion. Did you know that ACOG guidelines classify full term as 39 weeks? They recognise better outcomes at 39-41 weeks. 37-39 weeks is now considered ‘early term’.

My "early term" "cold section" boys were both over 8lb with APGAR scores of 9, and started breastfeeding in the recovery room.

The risks of early term are so small compared to the risk of eclampsia and stillbirth!

When I had dc2 and 3 the risk of leaving my older children without a mother outweighed the risks of early term delivery for us, as dc1's birth at 41 weeks (induction followed by long early labour followed by foetal distress almost being missed followed by emergency section followed by multiple blood transfusions and being taken back into theatre when she was a few hours old) nearly killed us both.

The cold sections were safer for all of us.

Would the op even be allowed to labour with preeclampsia?

DS was born 37+6 by elective after reduced movement and failed induction (i never got to the labour stage, so they halted the induction and booked me in for two days time so technically not an emergency).

Absolutely no problems. APGER score of 9 and breastfeeding 40 mins later. I had an infection but DS was fine apart from a little sleepy in the first few days - no intervention needed and came out 8lbs 6oz.

Best decision of my life as my surgeon said my cervix was high and long and my son was stuck right at the top and I'd have ended up with an emergency section (in her opinion) where he'd have likely been in distress by labour point. The decision was left to me and I took it and do not remotely regret it. I recovered quickly and do not have any issues 15 months on. DS is normal, albeit a bit lazy physically (choice rather that nature, he's perfectly strong enough) and developmentally he's hit all milestones thus far.

With medical advice as my pregnancy was also high- risk (twins), I had an ELCS at 37.4. They were tiny, both just shy of 5lb, and one had low blood glucose which was monitored throughout the first night, causing me much distress, but neither needed SCBU and have been healthy children and adolescents - no autism, ADHD or learning difficulties.

Their low birth weight was probably more attributable to them being twins than being delivered slightly early. At that time it was protocol to do ELCSs, if indicated, for twins at 37 weeks, to reduce the risk of emergency situations caused by spontaneous labour.

Good luck with your decision, OP. For what it's worth, in your situation I think I'd go for sooner rather than later. If for no other reason than your understandable stress being unhealthy for both you and baby.

Evelyn If pre-eclampsia can be controlled well with medication, a pregnancy is usually continued and there is no reason not to labour. Women who have pre-eclampsia are usually offered regular growth and placenta scans to assess fetal wellbeing. If concerns arise that the placenta is not functioning well of that baby’s growth has slowed, then an induction would be offered. Blood tests should also be undertaken at least weekly to assess kidney and liver function, clotting function and a full blood count - dependent upon these results and if they are getting worse, induction would also be considered. Women with pre-eclampsia tend to labour quickly.

Didntcome the OP has had serious birth injuries from a vaginal birth and a previous section though - a quick natural labour with pre-eclampsia would surely be very dangerous for her, and allowing her to go into labour would risk not being able to get her into hospital fast enough to intervene early, as she's at home on bed rest atm not in hospital.

Surely she would be ill advised to risk labouring in those circumstances?

Having a c-section & autism may have shared risk factors (so one doesn't cause the other but same things are linked to both).

I have experience of severe pre eclampsia and I started like you did however at 28 weeks given steroids at 31 weeks and settled until 32 weeks when dd1 was delivered by emcs. However she was also close to total placental abrubtion despite very close monitoring and many scans and dopplers. I was due to be sent home again having been in hospital for a week the day she was delivered only I just felt something was wrong and the fact that I was up and around at 6am when my whole pregnancy I couldn't move one midwife took me seriously. With subsequent pregnancies I was told any signs of preeclampsia and I wouldn't be going above 37 weeks. (Dd2 went to due date)

OP please speak again to your health care professionals. There is an incredible amount of misinformation on this thread. Also the well intentioned 'my baby is ok etc' does nothing to suggest how your baby will cope with an early delivery.

Everyone is assuming that you have PE yet no where have you said if this is so - have you actually had bloods done and urine sent off?

Also those using the word 'allowed' - of course op is allowed to labour/not labour as she chooses - it is her body and her baby. No doctor can 'not allow' her to labour!

OP this is a very personal and difficult decision. As a midwife, and also a mother of a child with ASD, I cannot speak medically without seeing your history, but I can say this - I am absolutely not convinced that delivery at 37 weeks increases the risk of ASD. I do suspect that there are a lot of things about birth that increase the risk - any kind of trauma including c/s perhaps - but this all needs weighed up with the risk of doing nothing. Ask for things like delayed cord clamping, a gentle peaceful environment for the birth, lots of skin to skin, bf if you can, etc and you are doing all you can to mitigate the 'risk'. Good luck

There is definitely an increased risk of TTN (respiratory distress)and nicu admission at 37 weeks if you have not laboured at all, but the staff will be prepared for this. The steroids will help prevent it. Each day you go beyond 37 weeks will make a difference. But only if your BP is stable.

OP is in USA. Her insurer might be able to drop her if she makes choices they don't agree with. There is a real element of "allowed" in her situation.

I hope you get some clarity tomorrow, OP.

OP is in USA. Her insurer might be able to drop her if she makes choices they don't agree with.

No they can't.

You're right, I said that wrong. But her doctors could drop her. Which could mean no alternative doctors that take that insurance within a reasonable travel distance.

My baby was born at 37weeks, due to pre-eclampsia I was induced but ended up with emergency c-section. She was 6lbs 10oz & a well baby. Had mild jaundice but has always been well & slightly ahead developmentally. I would go for 37week induction as at least on the outside you can help with feeding/health care and waiting incase your body fails them is horrendous (in my own experience). Best of luck!

I would 100% push for 37 weeks. Very low risks at 37 weeks especially as you have already had steroids. Far less serious than a risk of stillbirth. This should be your decision - go with your gut. I had dd1 at 37 weeks for similar reasons.

DS was elcs at 37 as I had a massive fibroid and his growth was slowing down. He was a bit smaller than the other babies & a slower feeder. Now aged 7 he is very tall wears aged 8-9 clothes.

If you are being monitored. Why not just have bed rest for a couple more weeks and book in a elcs for the new year?