Refuse C-section at 34weeks and revoke my consent to a sterilisation

[Twigsnroses]

Hi everyone

im currently 30+0 and today my consultant said she would schedule my delivery for 1st March. I’ll be 34+2. I am so scared of having a being unwell when I’ll be poorly too. The consultant repeatedly said baby while be fine, will be in special care 1 or 2 days. But this isn’t always the case obviously.

I have complete placenta previa and placenta accreta with possible bowel interference. So 34 weeks is for my benefit.
50% chance of hysterectomy, bladder repair, catheter in for 2 weeks, stents in urether, a sterilisation in the event that I keep my uterus, haemorrhage.
The section will be under GA due to all the work they need to do. So baby will come out poorly in terms of breathing anyway due to GA.

In the appointment today I didn’t object to the day even though I really would like to go to 35+2 which is just the following week. I did not object to a sterilisation if i was to keep my uterus even my partner would get a vasectomy or would be sure to not fall pregnant again. i even signed a consent form. Now I feel so stupid for just saying yes to these things.

Would it be silly to phone to question these again, revoke my consent for a sterilisation? And explore moving C-section to allow baby to bake more?
The consultant did mention that the entire team availability is also important, but i just feel that the outcome for me is grim and same anyway so I’d rather have her stay in longer.

im also shocked and disappointed at myself that i just nodded to everything. Absolutely everything.

Absolutely you can change your mind, it’s your body. Ask your consultant if you can discuss the options.

It wouldn't be silly at all - it sounds like you aren't convinced of the rationale for the plan so definitely worth asking for another conversation to explain. You can revoke consent at any time, including when you're naked on the operating table (I recently had my c section and sterilisation and that's how many times they kept checking my consent!)

I think it would be fair to make a list of questions and concerns, and to call them back with that list. You don't need to revoke your consent right now, but you should ask more questions to fully understand their views. A good way to question usually is: "What is the risk of delaying by one week? What is the risk of we delay by two?"
That way you can get a better idea of why timing (might) matter.

Hope this helps - hang in there, OP, it's hard to have to deal with uncertainty especially when it impacts not just you, but your baby as well.

Did you have someone with you? I find in some medical situations my sense goes out the wall and I revert to a people pleaser and want a gold star for most compliant patient. Or I'm so shocked and afraid that I don't take anything in. I find it easier if I have someone with me who can ask questions and take notes and then afterwards when I regain some sort of coherency with my thoughts I can ask why are we doing this that or the other and they can fill in the gaps.

I would ring and ask as soon as possible in case you have an accident and they can't ask you again cos you're unresponsive

A good way to question usually is: "What is the risk of delaying by one week? What is the risk of we delay by two?"
Thats brilliant advice. I'm writing that down somewhere.

Thanks for the responses so far. @Lovingitallnow I was alone. I fear that’s exactly what happened to me. I don’t even think I asked any questions either.

A good way to question usually is: "What is the risk of delaying by one week? What is the risk of we delay by two?"

@KentishMama thank you very much for this. This is brilliant advice.

You shouldn't beat yourself up about this. It's natural to be shocked about this and be second guessing yourself. It's a huge deal.

Ultimately the doctors will want what is best and safest for you but it's absolutely fine to go back to them with some questions and seek clarification, and take some time to think things through. It's your body and your decision, you just need to understand the risks properly to give informed consent.

This is a massive, and very difficult situation to be in. It's not surprising you're all over the place with it. Good luck when the time comes.

I’m not on obstetrics but sounds like you’re very high risk OP and a future pregnancy could be very dangerous. Of course you don’t have to agree but the consultant would only make recommendations for your benefit. And in terms of full team availability due to complexity I can see their view of wanting to do it sooner in a controlled way rather than risk you going into labour which could kill you both.
Id ask for another appointment and take an advocate but hear the doctor out.

You can change your mind of course, and it sounds like you'd benefit from talking it through again, but it doesn't sound as if you were wrong to agree the first time. Just because something's a big decision doesn't mean it needs to be a difficult one.

One thing you should probably double check if you do end up retaining your uterus is whether a sterilisation carried out as part of a CS is as reliable as a standalone one. Even under the best conditions, having your tubes clipped isn't 100% and maybe not good enough to rely upon if another pregnancy would be genuinely dangerous, which sounds as if might be the case for you.

Why would you not want to be steralised op? I'm guessing another pregnancy would be extremely dangerous

Definitely ask those questions and ask why that advice has been given.
I also had issues during pregnancy - not the same as yours but requiring a c section under general anaesthetic
They did not want me to go past 35 weeks in case I went into labour naturally
They wanted it done at 34 +5 as the consultant was on holiday the next day.
Baby handled the general anaesthetic no problems and, although both of us needed some short term oxygen she was back with me the same evening
Make sure you have a full understanding of why they are doing what they are doing

I felt pressured into a repeat CS I didn't want and I had a hell of a fight on my hands to get the (medically safe) birth I wanted. I think if you're not happy with the plan, you need to talk to them and remember to ask for more information about why it needs to be done right now not after 35w and also discuss the sterilisation situation as well.

Maybe make some bullet points. Obviously you know your consultant will have some strong medical reasoning but it sounds like you need to hear it, and I think you need to talk to someone and hash out the finer details that you're not happy with so you can come to a safe decision between you and your consultant.

Usually on these threads you get a pile on of "doctors are god and always know what they're talking about and why would you go against a qualified medical professional don't you want a safe baby?" but it's obviously not that simple (ever) and I think you need to filter that out, think clearly, and see if you can get to talk to someone who is a decision-maker. If the thread gets out of hand don't be scared to turn off notifications or ask MNHQ to take it down.

Good luck.

Correct to everyone that has said another pregnancy would be dangerous for me. Absolutely.

I have no plans to have another child so should be fine with the sterilisation..you’d think right?

It just feels I made a lot of decisions today, that I had not given much thought to if at all at any moment before I consented.

I have had one cs and had another planned and debated the sterilisation at the same time but apparently it’s more likely to fail. So might be worth doing more research

I had a placenta increta a few months ago and they definitely don't make the decision to deliver early lightly. I had my baby at 34+4 and that was with taking my baby's cardiac condition into consideration and allowing her to grow inside me as long as possible.
It's important to feel comfortable with your surgeon and team but placenta increta is very high risk and there is a greater risk of spontaneous haemorrhage as the pregnancy progresses.
What they tell as worst case scenario though doesn't have to happen. My placenta was adherent in two places and slightly stuck to my bladder but I had very minimal blood loss with no complications and was out of hospital 2 days later.
Good luck with it all.

I has my surgery with a spinal and epidural with the plan that they would switch to general if necessary.
Which part of the country are you in?

Have they suggested steroids for baby lung maturity

You poor thing. Make a list of all your questions and ask for another meeting (and more if you need it!). Asking - what's the risk of delaying another week. What's the risk of a planned section at 34 versus emergency later. What are the outcomes for a baby born at 34 versus 35. What other risks are they taking into account. They do steroid shots in these cases to help the lungs develop. Understand what restrictions you may have in the run up, e.g. I had some complications similar to yours and was admitted at 36 weeks for monitoring for a day to day risk assessment before delivery 10 days later, couldn't be alone for a while before that in case I had a bleed. That extra week could be spent in a hospital ward with constant monitoring. Doing the timing for their convenience may mean you both have the best access to the resources you need. Take care - this is so traumatic. Even afterwards when you're both home and well you'll feel traumatised from all the stress of a high risk pregnancy.

OP, continuing with the pregnancy past 34 weeks could be very high risk. If they are doing planned surgery, every
member of the team will know what is happening and make sure you and your baby are safe. I can’t answer your sterilisation question but given a future pregnancy could be extremely high risk, do you want to take the chance? Think it over for a few days

I’m south east London

I suspect that the earliness of the section is to avoid the extra 'stretch' and weight that further growth of the baby would place upon your uterus and placenta, and they're doing it so early because they cannot be sure it wouldn't be catastrophic for you both, especially if that then relies upon staff actually being available. Perhaps the coordination has required multiple people to clear their lists (and arrange additional cover for standard emergency interventions) to facilitate your surgery, along with ensuring there is a cot available for your baby where you are, rather than possibly having to travel away from you in case of rupture.

However, I would also want that spelled out to me to be able to say 'Yes, I understand and consent to this' because it's such a huge procedure and it's a lot to take in, even if they did say any of this at the time - your DH should definitely attend as well, as an extra pair of ears is so helpful when you've got so much to listen to, remember and consent to. He could bring a notepad with questions so that nothing is forgotten in the appointment.

I would contact the PA and ask for such an appointment for as soon as the consultant is available. They do tend to do this for their patients who are in clinically very significant situations.

i hope you get all your answers and you can post soon with your lovely baby, both of you safe and well.

Yes, steroids injections booked in for the 2 days before appointment. Will have two doses 24 hours apart. I hear these can be painful😃.

But they should massively help with the baby.

I had a complete previa and had it under GA so they could do emergency hysterectomy if I started to bleed. There are big blood vessels in the placenta so they need to be able to act super quick if a bleed begins. I would be more comfortable knowing that I was under so they can just get to work if needed. Having said that it all went really well - which is the most likely outcome, they just have to plan for the worst.