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.

Doctors in maternity want what has the best chance of survival of Mum and Baby. This also happens to be the course of action that will be most easy to defend, should things go wrong. Do you have a problem with that?

It must be very worrying for you, and of course you need the opportunity to go through the pros and cons of various options in detail, and have all your questions answered. But I would be wary of pushing too much for delaying delivery.
I remember as a student an obstetric consultant visiting a patient at home who had a placenta previa and was refusing to come into hospital for a caesarean. She lined up a row of mugs of water and tipped them down the sink one after the other, and explained that that was the speed at which the patient could bleed if she went into natural labour. It really stayed with me.

Gosh Op, I’m not surprised you are feeling shocked and uncertain about facing this. But your consultant has recommended this course of action for a reason.
I agree with @MayThe4th, given your needs perhaps it’s best to take the plan that’s offered, you and your baby are going to need medical help. There’s nothing wrong with this, thank goodness we have the technology now to help when mothers and babies are facing these difficulties.
However I agree with the PP who said baby will likely be in hospital for a few days. My daughter just had her baby ( posterior position, large baby) by unplanned caesarean and they were both in hospital for five days because baby needed a course of antibiotics.

Just coming back on to say you might find it useful to connect with support groups if you haven't already. Kate Edwards, UK Global Ambassador for the National Accreta Foundation is on the group and may be of help as she has lots of connections to specialist consultants who are very experienced with looking after women with placenta accreta.

https://m.facebook.com/groups/114471105918970/?locale=en_GB

https://placenta-awareness-uk.co.uk/resources/

https://www.preventaccreta.org/support

My DS had to be delivered at 34 weeks due to placenta percreta in 2020. I was admitted to hospital from week 24 as no where in UK had 100% blood compatible with mines so risk where too high for me to be home. My DS had a short stay in NICU but he could breathe on his own, they wanted to monitor him for a few days and really to help look after him as we were restricted a lot with lockdown. I was in recovery for a few weeks in hospital. They will want to do it at 34 weeks as it’s a not a standard planned C-section where they will require various professionals to be there. I was told the risk for major bleed after 34 weeks becomes higher so this was best time for both me and my son to have the best chance. Please feel free to message me as I completely understand how you are feeling.

My daughter was born at 34 plus 2 and was in the NICU for less than 24 hours. She was 4 pounds 12 and was in hospital for about 4 weeks, growing and feeding but was totally fine. I personally would always go with medical advice but its your body and your decision and I wish you luck x

It sounds as if you were just told what would be happening, without being given any information about the procedures, the risks etc. This is unprofessional, and feedback should ideally be given to help prevent this from continuing to happen.

In maternity services, women are supposed to give "informed consent". Being talked at and told what they are doing and you nodding along in silence, being blindsided is NOT you giving informed consent.

You absolutely can go back and ask for someone to go through everything with you in more detail. You absolutely can revoke consent for the sterilisation, and at no point should the obstetrician have just told you that is what she'd be doing. That is utterly appalling, no matter how high-risk your situation is.

Please do ask anything you need to help you with understanding everything and to make sure you are as happy as you can be with the plans. You absolutely can put forward your own suggestions for consideration.

Good luck with it all.

Two issues here. C section - your priority should be the well being of your baby. I wouldnt be keen to agree to sterilisation unless it was for a life threatening condition. But when all is said and done it isnt usually wise to go completely against medical advice.

Hello, I had to deliver my baby at 27 +2, and I just wanted to reassure that he is absolutely fine now 4 years later. I would have loved to have got a few extra weeks, 34 is really quite far long and lungs will have developed.
I was amazed in the Neonatal ward, we have world-class specialists who can perform miracles, they deal with premature babies every day and I’m sure yours will be fine.
It is obviously incredibly stressful and worrying, the worst thing I’ve ever gone through, but honestly the only outcome now is that he needs to wear glasses as he is long-sighted. And I don’t even know if that is due to his prematurity!
so sending hugs and I’m sure all will be well. They have to do what is best for your and baby’s health x

When I was inpatient waiting to hit 34 weeks for delivery I met weekly with the maternity hospital psychiatrist to help process everything that was happening. It helped me process what was happening during my pregnancy, delivery and afterwards. It really helped to have someone to discuss everything with and she took my concerns and raised it with my consultant when I did feel I needed some support. Please ask your consultant if there is someone who could help you process everything that’s happening and have that extra support as it is really an overwhelming situation to deal with.

You need to speak with someone who isn't going to bulldoze you.
Ask to speak with the head of midwives, they are the best when it comes to rationalising what consultants say.

I'm so sorry OP to read your post. I've had two high risk pregnancies with extensive monitoring and hospital stays, and your situation sounds scary, but like you are being very pragmatic. To ease your mind a bit, the steroids did not hurt at all when I got them, though I think I was in hospital on an IV drip both times. My daughter came at 34.5 weeks and she was in the hospital for 3 weeks, not 2 nights as your consultant has mentioned, and that was with the steroids, her lung collapsed and it took 2-3 weeks for her to really start feeding solo. Generally the first 24 hours are a honeymoon period for premies, then they either go uphill very fast, or need extra care, and that was something that we were not mentally prepared for, or told in advance. The NICU staff told me that it is very unusual for babies to come in prior to 37 weeks and go straight home. If it is safe to do so, and your consultant will let you, 37 weeks is a huge cutoff for development and being able to breathe and eat independently. As a positive story, both of my children are healthy, happy and thriving. The 34.5 week one is a firecracker and has been a fighter since birth. Sending big virtual hugs and praise for how strong you are being. You're in the best place, and being monitored very closely it sounds like.

My mum had a complete placenta previa 38 years ago with my brother- she was in hospital from 24 weeks (I think) due to the risk of haemorrhage. She was sharing a room with another lady who also had a complete placenta previa- trust me you do not want risk a haemorrhage as her room mate had one and both her and baby nearly died. My mum has PTSD after witnessing it.

My mum was also sterilised during her c section but she was happy to have it done- I think thats a decision you can absolutely change your mind about.

I had placenta previa but without all of your other complications. I was also told i needed to have dc early albiet not as early as you but also under GA. I have healthcare through my work and pregnancy was covered where there were complications. I went to see a private consultant for a second opinion. She thought the whole plan by the nhs was a complete over reaction and i ended up transferring my entire care to her under my policy. I had the consultant on speed dial incase of any bleeding but i managed to hold out to 38 weeks and our agreed target date. DD was born by planned section and i didnt need a GA. I did lose quite a bit of blood but i was just under the transfusion threshold and after a couple of days i was fine. I am not saying you should be trying to get to 38 weeks op and for what its worth, my mil had pp and my dh was born at 34 weeks and was absolutely fine, but it may be worth trying to get a second opinion. If you have healthcare its worth calling them and asking if you are covered for a known case of placenta previa plus the other tbings. Good luck and whatever you do, feel confident in the decision you make x

Don’t be harsh on yourself, you have masses going on and it’s completely natural to digest the appointment hours / days later. It is your body and your baby. Ask about the implications of going for a further week: write down your concerns and points you need to raise so you can have a focussed discussion. Don’t worry about the whole team availability - they will have more availability than that one slot: they shouldn’t have put that pressure on you.
Wishing you all the best with the rest of your pregnancy and the birth

If the sterilisation bit is bothering you, could you ask for a contraceptive implant instead?They can easily put this in at the same time as the caesarean and the implant should provide secure contraception for about three years (unless you have it removed earlier) , at which point you could have full sterilisation if you preferred?
Or see what the consultant responds to this suggestion, if for example they really feel sterilisation is the best option because you really dare not risk another pregnancy they might explain this to you.
But it might be upsetting to hear.

OP, I have no idea what most of your opening post meant, but the key thing must be that you pay attention to the advice you are being given, but you then make the decision as to what happens to your body and your baby. Do not worry about inconveniencing anybody.

Lots of people with more experience that me have already commented so I am just throwing in my support.

But do listen to the doctors and be sure they are not giving the right advice.

Sending lots of positive energy that in a few weeks you will be home with your gorgeous healthy new baby and your family will be complete.

Risk of failure of sterilisation is higher at C-section, but modern techniques take a section of tube rather than just clip the juicy things so failure rates are lower than historically reported.
It sounds like a further pregnancy could be extremely dangerous for you and baby, so while it's reasonable to ask questions, I would probably trust the medical professional

As a former HCP consent is key and you can withdraw anytime.

Is 34 weeks due to everyones availability or based on medical urgency? Yes 1 weeks makes a massive difference for baby.

I would be sure to find out the rationale. Staff availability or baby safety.

I would be extremely surprised if there is a private obstetric facility in this country which would accept a placenta accreta case. Most NHS hospitals would refer to a specialist centre in their region.

I had my tubes cut (rather than clipped) during my 3rd CS. They send the segments off to confirm that they are fallopian tube material? (Admittedly that was 25 years ago)

You've had some great advice above. I'm the same, my head goes blank when I'm at an appointment. So I'd ask for a second consultation and write down everything you want to know. With my 25 week appointment 2 weeks ago I sat there with a list of questions and the midwife said it was a great idea.

My manager's daughter had a baby a few months ago, she was 7 weeks early and they were both out after 10 days. So don't panic about the baby. Look at all the pros and cons for the both of yous and then decide what is best. It's your body and your birth so it's up to you. Xxx

The teams availability is an important factor to consider during my DS delivery we had three obstetrician, two urologist, two paediatricians. Specialist doctors who deal with bloods, several nurses. They also got a female surgical oncologist in there to try do everything they could to help detached placenta from my uterus and bladder. Before I was put under GA they must have doing about 3 hours of prep work in theatre to get me ready for the c-section. It a massive surgery that they do need to plan and have the right team available for you and your baby. My DP wasn’t allowed to attend but I felt at ease and all of the team were lovely explained everything as they did it and it didn’t feel alone as room was full.

You should absolutely discuss this again.

However from 34 to 35 weeks is a negligible change in the length of SBU stay or outcomes for baby, but each week increases the risk of a catastrophic outcome for you both. Spontaneously haemorrhaging outside of hospital is what they are trying to avoid.

Some people on this thread clearly do not understand how serious your condition is.
I don't want to scare you and wish you the best.

It's natural to worry about your baby but your baby also needs a mum who is alive and kicking.

I had a close family member with placenta accreta. It can go very wrong, very fast. I’d take the docs advice tbh.