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.

My daughter went for a scan was told to go to another hospital the following day for a detailed scan by a consultant. We both went. The consultant said that one twin was taking the others nutrient both could die if they didn't remove them by CS two days later after a lot of steroids they were born at 31 weeks. Nine weeks in scibu later they finally came home.

So please listen to the consultant carefully. It's an awful shock at first but they will be doing it for very good reason. My daughter wanted to wait another day so that her husband on the other side of the world could be there. They couldn't wait even a day.

As a former HCP maybe you should be aware of spouting absolute falsehoods on the internet.
Nobody ever delivered a baby at 34 weeks for the sake of scheduling, it's because the OP's life is at risk of she starts haemorrhaging outside a theatre.
She should discuss her personal circumstances with her own team.

It isn't just the OP's life that would be at risk if she starts haemorrhaging. The baby's life would also be at serious risk if that happened.

Use the brain method...

What are the benefits of...
What are the risks of...
What are the alternatives of...
What does your intuition say..
What if you do nothing...

I couldn't give a flying one about the trust personally, but yes mea culpa I generally recommend the option that doesn't have me up in coroner's court...

oh op I am sorry about the complications you are facing and I do think seeing if there is counselling available is a good idea.

I also think look at the posts of those who have experienced and understand exactly what you are facing and how complicated it actually is because I suspect it is T about sterilisation but the consent to do things quickly if things go wrong because time is very much of the essence.

having the team you need together is far more vital then 4/5 days in terms of outcomes and making sure it is planned makes successful outcomes far more likely than risking something going wrong

I would wholeheartedly suggest asking for a further discussion with the team. And I'd take someone you trust along with you to listen and ask questions for you.

The BRAN mnemonic someone else has suggested is really useful to apply to both the timing and sterilisation decisions. You have to be happy with the plan if that is to dump the sterilisation option then do it.

Timing-wise I'd be guided strongly by your consultant as I've been the anaesthetic registrar scrabbling around late on a Sunday evening trying to assemble a team for someone with placenta acreta (so lower risk) who had presented in labour and was bleeding and needed to go to theatre for a section. The outcome was fine in the end but It was hugely stressful for everyone (including the patient and partner) and I can categorically say they didn't get the same level of expertise looking after them they would have if it had been a planned weekday event.

But you need to understand and agree with 34+2. Not me and not anyone else on this thread.

Another one here who had an accreta.
It was bloody terrifying at the time and I remember being utterly shell-shocked when I found out and they told me a similar plan. All I did was sob and say "I don't want this".

But I was assigned a midwife coordinator, who not only saw me every time I was in from then on, but arranged for me to meet all the (named) surgical and anaesthetic team beforehand, listened to what I wanted and advocated for me. She was awesome, utterly. I think they did this for all the accretas where I had mine, but worth asking about. That one face keeping everything in check was such a comfort.

I also had LOTS of consultant appointments to discuss things further, to make changes to things in the light of further scans, or just my panic. They absolutely didn't mind, so do ask to go back and talk further. It is your right to do so.

It all worked out ok in the end by the way. But mostly because they were all prepared with precautions taken, and they knew my wishes, and they'd all explained why they were doing what they were doing. So do ask if you don't understand.

Best of luck with it all.

This sounds like a lot of decisions to make in one go. My instinct is always to follow the advice I am given but you are absolutely entitled to go back over it with someone having thought about it and with support from someone you trust.

PS not the point of your post but I was really anxious about the steroid injections before my CS and I barely felt them - and it was all planned so not like I was distracted by labour!

And also - sorry to add - it is true that they are normally desperate to keep babies in utero as long as possible. I had a really complicated pregnancy where I was becoming quite ill. I wasn't worried about me but the stillbirth risk felt very high. My liver really had to go haywire befire they would deliver early - and even then it was at 37 weeks precisely, so just term. If they want to deliver you at 34 weeks, they must really feel it is absolutely necessary. I wouldn't take that lightly.

Arrange to go for another chat and take someone wurh you if possible.

Personally as someone who ended up having an emcs I'd rather a planned Cs.

My 34 + 5 weeker was 5.15 and didn't need nice at all, we were in hospital for 3 days

Ds 3 who was born at 32 weeks exactly and was born by emcs due to cord prolapse weighted 4lb 4 and spent 4 days in nicu then came up to the ward for 6 days before being discharged so it doesn't always mean a long stay ime

Second opinion sounds like it would give you more time to consider and have the why explained .
As a minimum call say you didn’t have time to think, can you bring your partner with you, discuss the options and why behind the consultant’s suggestion with the same consultant or see a private consultant appointment - kypros nicolaides, amazing
oxford john Radcliffe mr Impey is head of Fetal consultancy there, maybe email him?
get on forums for this Facebook somewhere will have people who have that specific wxpericne hopefully.

but maybe first call is go back to the doctor. Ask for more explination and go armed with a pad and some questions

i used to even ask a consultant - I find the amount of information understandable when I am in the appointment but when I leave I am unsure sometimes of the why, or what was said.
can I record your recommendations, so I can listen back and not feel I’ve misrembered something.
some docs are weary and say no, many said yes, good idea.
taking someone in to listen is a good idea.

prem baby Facebook groups, for advice on what to bring to hospital what to expect, sounds like your baby will be there, you’ll then be visiting, can you see the NICU, talk to a nurse there about what to expect and where you will be day and night etc
I think that would also be helpful for you.
some hospitals have a Ronald macdonald house on the grounds for this kind of situation.

what you have is risky for the baby and you I think, I’m not a doc, so it sounds like they are being cautious, the weeks and why will all be to do with your unique situation, so ask those questions and you’ll get the why behind the consultants thinking of not waiting, mine drew a chart this is where x weeks and best our come for (whatever) hits best outcome for the other issue I had. Then I understood their reasoning,

sterilisation - was egg donation discussed I don’t know your age, situation or thoughts but if you want more kids, is there anyway to add that into what is explained to you and options.

very best of luck with it all. Congratulations on the pregnancy, I’m sorry it isn’t all baby prep and worry free for you. But you aren’t alone in that if that helps.

Your consultant and her team want the very best possible outcome for you and your baby. It’s upon that premise that she’s made those recommendations to you. By all means talk to other people, including strangers on the internet who will tell you they had a healthy baby at 16 weeks and she’s now a top lawyer, etc., but your consultant has had decades of training and has seen it all. If you don’t want to follow her advice, make sure you a confident NO response.

I had placenta accreta 29 years ago. I was having a planned section under epidural. I had been admitted several times with pain, but at no point had this been spotted on any of the scans I had.

Immediately after my baby was born, I haemorrhaged. My DH was sent to the nursery with our baby while I fought for my life. I had a complete blood transfusion because I was losing it faster than they could replace it, that then increased to a further 6 litres.

I woke up in Intensive care 8 hours later having had a hysterectomy, I was in my mid 20’s.

Ask to delay it for a week if you want to but they don’t want to risk you going into labour, it can be fatal. I am very lucky to be here.

I would write a list of questions and ask for another chat. They are usually pretty good with statistics by week for specific conditions.

If I was in your situation, I would go along with what they have suggested. You're very high risk and the early delivery is for both of you.

My baby was in the NICU for 8 weeks. She was not premature, but had a postnatally diagnosed cardiopulmonary condition. It is a completely different world, I will never forget any of it. The nurses and doctors are amazing.

OP, I was in HDU from 32 weeks (different medical problem to yours) and it looked like I’d need a c section at 34 weeks. I kept reminding myself that DH was born in 1976 at 34 weeks, and with a blood disorder, and is now a healthy, physically active 6’2 man with a degree, a job and two perky children. 34 weeks is early, no doubt, but medicine can do amazing things for premature babies so try not to be afraid. Lots of love. x

I would go with what they recommended @Twigsnroses - it's their job and they know what they're doing. The benefits of a few extra days cooking for your LO don't outweigh the downside that it might risk them not having a mum.

My baby died essentially because the hospital was insufficiently cautious about delivering her soon enough.

The one question I would recommend asking is “what is the least risky timing for this delivery, to keep baby and me alive?” I expect it will line up with their current recommendation and then that is your answer.

Again, thank you very much. It has all been really helpful and getting me to figure out what I needed at that appointment.

I didn’t anticipate any of the decisions I had to make on the spot which ended with needing to read through the consent form on the computer screen and scribble a signature with a mouse.

I know, absolutely know, how dangerous accreta is. Because I have read up since the diagnosis. However, thinking back I do feel like I was told what is going to happen - procedure wise- but nothing about my case as an individual was discussed. If that makes sense. It may have been due to my silence. The consultant did say “I usually do this between 34-36 weeks”. But did not say why I’m on the lower end. This is where I could have asked, if there is a reason I cannot get closer to 36w for example. Perhaps my case is severe? I don’t know. She didn’t say and I didn’t ask. I have had no bleeds either, but she didn’t ask if I had these yet.

i need to read up about early babies, so thanks for this Bliss and group recommendations. The consultant did say only need 1-2 days, and I just remembered that I did ask if that meant baby would go home ahead of me.. to which she said no no, the baby will have to wait for you to get better. Silly question

I appreciate the responses, really. I am going to seek another conversation where I’ll simply be more prepared with questions. As many have said, there are likely clinical reasons for an early delivery and what not. I just need to hear it. The current plan will likely stay in place.

I was born six weeks early in 1977. DM had had issues throughout pregnancy and then I decided I wanted out! I spent, I think, about 8 days in SCBU. But I am fine! Passed my 11+ and went to grammar school ( if that even matters). I would honestly do what your medical team advise.

There was one doctor who had said I could go to 35/36 weeks but after the whole team met and discussed they went for 34+4.
This was with a baby with a known serious heart condition who would've definitely been better off inside for longer.
If they decided on 34 weeks in my case there I belive that there's definitely a good reason for that being the best time.
It seems that all of us on this thread who had accreta delivered at 34 weeks.
If you want a second opinion here in London then I would recommend seeing Pat O'Brien. He deals with most accreta cases in North London and surrounding areas. He also sees patients privately.

If you have placenta accreta with bowel involvement, please listen to your obstetricians - they will be trying to plan your delivery so they have not just obstetricians, but bowel surgeons and interventional radiologists present. The obstetricians will get your baby out safely, the bowel surgeons will make sure your bowel doesn't bleed and the interventional radiologists can use lots of techniques to embolise (block off) potential bleeding sites in both your bowel and uterus. If you go into labour out of hours, there will be obstetricians available. The on call general/bowel surgeons may well already be in theatre with a general surgical emergency and in some places, there's no interventional radiology on call rota (because there aren't enough interventional radiologists to staff an on call rota). This is why it needs to be planned before the risk of spontaneous labour outweighs the risk of early delivery to the baby. 34 weeks is about right

Placenta accreta is really high risk for bleeding. Please accept what your obstetrician is telling you for your own sake and that of your baby

The medical team are trying to keep you and baby as safe as possible. I had my DS at 34 weeks with preeclampsia and he was fine. We had the steroid shots first. He was in special care for about 12 hours then came in with me. He's now a tall and bright 3 year old.

As a professional who works in maternity care you should be much more concerned than you appear to be about patient consent. OP is absolutely correct to want to question such huge decisions and make sure she has time to think through all the options and risks.

What a strange comment. Obviously doctors want the best outcome for their patients? The fact that the outcome (especially in maternity) can be dubious is more often due to understaffing and filling posts with inexperienced and inadequate staff than the experienced staff providing inadequate care.