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.

I’m glad it went well.

For mine, she said it will probably take about an hour after GA before baby is out as they want to some prep work like the strents before starting. I do get that she’s giving worst case

Perfectly fine to say you want to talk it through again now you’ve had some time to reflect. I’m sure they must have that quite often as it’s so much to take in. All the best

I think when we’re pregnant we naturally think of baby above ourselves very often. Also we come across messages all the time saying it’s better for baby to go full term etc etc. And messages talking about patient choice. These messages are important to most people in most situations. BUT it’s v easy to prioritise these messages over the one we don’t want to hear with the bad news. Or at least feel conflicted, grieving the ‘normal’ experience we are supposed to have. It’s ok to feel all kinds of conflicted. I would also recommend asking for another conversation with your medical team and a list of questions. But remember that ‘normal birth’ messages don’t apply to you any more. Try to disregard them.

The steroids were so underwhelming I can't even remember them and my baby isn't even 6 months old yet, don't give them any worry!

I'm sorry you experience such scary pregnancy ❤

Having been in exactly the same position YABU. They know what they’re doing.

There is no scenario where this woman isn’t having a c section.

I had placenta percreta with bladder invasion and delivered at 34+5, carefully planned c section. My son did not need to go to special care at all and breastfed once I was able after coming out of surgery. I also had two steroid injections prior to delivery.

I was awake for his birth then went under general anaesthetic when it was clear that they were go to have to do a hysterectomy to stop the bleeding. Being awake at the time I have had issues dealing with the memories and in some ways it would have just been better to be under general anaesthetic from the beginning. It was touch and go with me. I had a massive transfusion and lost most of my blood volume, one of the cancer specialist surgeons (needed due to invasive nature of the placenta) that attended to me had to be called in as an emergency.

Having had the discussion with my consultant multiple times before surgery I had made it clear to her that I wanted her to do a hysterectomy quickly if it all started getting complicated to improve my outcomes. I wanted to be there for my children and I had done my reading and knew of cases of women who had ended up in intensive care very unwell or who sadly didn't make it. I was in surgery for hours, but I was able to go to high dependency rather than intensive care afterwards and have my baby with me.

Every cases risks are individual, your consultant knows the extent of your placental invasion and with their expert experience of having done this type of surgery has given their opinion. Possible bowel invasion is more complicated than bladder which is what I had. The risks of going longer is more chance of a heavy bleed and an emergency caesarian section without the full team of specialists needed and all the equipment such as a cell salvage machine and extra blood ready to go. I was up and down to labour ward contracting in the days running up to my planned c section and several consultants said to me that they hoped that they wouldn't have to take me to theatre as an emergency overnight as it would not have been the optimum team for the level of care I would require.

I know it is scary. PM me if you need to.

I have had full PP with suspected accreta. I bled a lot and delivered very prematurely. And even then he was home fully breastfeeding by 35+5 weeks. At 34 weeks the baby may not require support breathing (my baby didn’t after 30 weeks- and was very very premature).

The consequences of going into labour are serious for you and the baby. So the C section date will have been planned so that there is a full vascular team on stand by with the neonatal team. The minor risks to GA from your baby will be trumped by the much bigger risk if you have a catastrophic bleed etc. So please don’t push back your C section.

Of course you have to ask the questions that are on your mind, and know you're making the right decision. But if you went into labour spontaneously, prior to C section, and they were scrambling to assemble the team to cope with that, and doing everything in a tearing hurry...ignoring your outcome completely, I really would not fancy trying to resuscitate the baby in that situation. I'd far sooner be handed a slightly more undercooked baby, in a planned manner. I honestly believe they're thinking of the baby, as well as you.

Doctors want what is in the best interests of the hospital Trust, especially for maternity.

Ask yourself, is it worth a potential stillbirth or a child with lifelong disabilities to push this back?
sterilisation doesn’t need to be rushed. You can go back and have that done. But there will only be one opportunity to deliver your baby safely. No consultant decides to deliver at 34 weeks lightly.

It sounds terrible for your soul and sleep, but could you ask to be admitted from 34+2 with the intention of getting to 35+ weeks? If you're already at the hospital and you have a premature labour then it can be dealt with then. An acquaintance had a similar issue about six months ago and was admitted. Not sure if she asked or the consultant recommended it, tbh.

Are there any indicators that baby might labour early?

Hi OP, I think you need to speak to your consultant again about the care your baby is likely to receive. I don’t want to scare you but a 1-2 day stay in SCBU for a 34 weeker is absolutely best case scenario. I’m not saying that never happens, but lots of babies born at that gestation will require respiratory support and almost all of them will need NGT feeds to start with whilst they establish feeding.
When babies are admitted to the neonatal unit I work on, we never give an estimated length of stay as babies are so different. One baby born at 34 weeks may be discharged within a week (the unit I work on currently actually won’t consider discharge until 35 weeks corrected gestation but I am aware this may differ between trusts), another baby may be hospitalised for a month.
Again not to scare you, the vast majority of babies born at this gestation do very well without any major complications but establishing feeding is a common reason for a longer stay in SCBU. I worry that your consultant is giving you unrealistic expectations.

OP, you've phrased your post as if you only have 2 options: go along with the plan (and FWIW, as a medical professional working in maternity I would absolutely disagree with my colleague PP's advice upthread to "just go along with the plan" if you have misgivings about it!), or completely renege on the whole thing.
But the third option is to go back with a really open mind, with someone you trust, ask loads of questions, and be open about what exactly you're uneasy about. Depending which hospital you're at (I'm guessing Tommy's, Kings or George's) there might be the option to have a consultant midwife attend the appointment with you - they can be quite useful for translating some of the medical jargon if that would be helpful for you, or just advocating for you and ensuring that you're really giving fully informed consent.

I’m sorry you’re going through this OP and I hope that both you and baby are ok. I just wanted to add to the excellent advice KentishMama gave about questions to ask with something that I found really helpful. My hospital trust use the acronym BRAIN and encourage patients to question them using this structure to be fully informed about their treatment.

B - benefits (What are the benefits of doing…?)
R - risks (What are the risks of doing…?)
A - alternatives (are there any alternatives?)
I - Intuition (What does my gut say about…?)
N - nothing (What happens if we do nothing / wait a day, week etc?)

Does that apply to babies delivered by planned c section as much as premature natural labour or EMCS?

The thing is, in a premature labour situation, it might not just be "be able to be dealt with". The OP has an incredibly serious condition which will need a BIG team of incredibly skilled specialists. They won't just all be available at the drop of a hat. To give the best possible outcome for OP and baby, it needs careful planning.

You will (should) not be criticised for asking to speak to the consultant again or even another one for a second opinion

This is a major surgery and major decisions and you need to be comfortable. It seems very natural to want to absorb the information and then revisit the decisions.

I had a complete placenta previa which was undiagnosed. I went into spontaneous labour at 32 weeks. I ended up having a crash c-section under general anesthetic, seven minutes after arriving in hospital. I was in surgery for 7 hours, lost too much blood to discuss and spent three days in intensive care. My daughter was so poorly she was transferred by blue lights to the nearest specialist centre. I wish I had been given the option to have things done in a controlled manner, in my case things just spiraled and it all went horribly wrong. Luckily my 32 weeker is now 17, but I will never forget how close we came to loosing both me and her.

Yes it does. A baby delivered by planned C-section will likely be in better condition and have more developed lungs due to having had steroids, but most babies at this gestation require feeding support regardless of a planned C-SEC or spontaneous normal vaginal delivery. They also often have trouble maintaining their blood sugar or tolerating milk feeds so can need IV fluids in the early days.

For the OP, if you’d like to discuss this further with your consultant and want some “back up” so to speak. BLISS is a charity for premature and sick babies. https://www.bliss.org.uk/research-campaigns/neonatal-care-statistics/statistics-about-neonatal-care
They state the average length of stay in hospital for a 32-36 weeker is 12 days. Your consultant is misleading you saying it will most likely be a 1-2 day stay.

Hi I am so sorry to hear about your situation, it must have been so frightening to have so much information in one day.

My baby was born at 30+6 via c section and I was in hospital for the week prior. The steroid injections are painful but it passes quickly. I found the magnesium sulphate drip the night before my emergency section much worse.

I echo the others re trusting your consultants as much as possible. It sounds quite galling to hear about 'team availability' when thinking about your precious baby, but it is critical. I was about to have my spinal for my emergency (!!!!) section and I got rushed out the room before they put the needle in. Because a baby in NICU crashed and he took priority over my unborn baby. They didn't have sufficient specialists for both. Thankfully I had my section an hour or so later and the delay didn't impact my baby. But that is how critical a few key staff can be (this was in a major university hospital with a large level 3 NICU)

Agree with the comment re misleading on a 1-2 day stay. The rule of thumb tends to be until they reach term (37 weeks)

Contact an organisation outside of your local trust for an alternative perspective but still professional and experienced such as AIMS.
Being separated from your newborn is hugely traumatic for you and babe, if it can be avoided this would be the best way forward.

You can of course.
Just to reassure you my DD was delivered via c section under general anaesthetic and was absolutely fine x