Elective section at 38 weeks - been advised will need steroids, anyone come across this?

[MrsZB]

Hiya,

I have finally made the decision (I think!!) to have an elective c section as I had an EMCS last time with a big baby in an awkward position.

This time I have gestational diabetes which limits my options regarding VBAC as they would prefer to get the baby out a bit earlier and I can't be properly induced due to previous section (I don't have strong feelings regarding VBAC anyway tbh).

Anyway so yesterday I was booked in for a section at 38 weeks and was advised I would need to go in 2 days early for steroid injections for the baby's lungs. I didn't query this at the time as was a bit overwhelmed with information but when I got home I realised that I assumed that usually steroid injections were given to premature babies, and I would consider 38 weeks full term?

I have done a search on MN and found a couple of threads which seem to think this is a new guideline produced this year, I just wondered if anyone knows anything more about this?

It's a pain as due to the G'diabetes it means I will be likely to have to stay in the hospital for the 2 days prior to the section as apparently they can make your blood sugars shoot up.

Anyway, if anyone can shed any light on this I would be really grateful, many thanks!

Sorry I don't know any official info but I have diabetes and was told this can mean the baby's lungs aren't as developed as they normally would be otherwise. So I guess it makes sense to give the steroids even at 38 weeks.

I'm currently researching vbac as I don't want one! And one of the papers goes into detail about respiratory risks in an elcs and that steroids should be given hold on whilst I dig it out.

Have had 4 sections , mostly around38 weeks and never had steroids. maybe related to the gestational diabetes??

Okay I can't link on my iPod. Google rcog green top vbac guideline. Page6 states vbac reduces risk of respiratory problems. 2-3% with vbac compared to 3-4% elcs. The risk reduces with each week gestation but you should be offered steroids from 37 weeks as it has a 50% reduction in respiratory morbidity by giving steroids. The stats to back it up are on page 7.

I thought steroids were offered before 37 weeks? I had a section at 37 weeks in 2008 for medical reasons and was not offered steroids.

It also states that the rate of respiratory morbidity reduces week on week fro
11% in week 37 to 1.5% by week 39. I'd say you are being offered steroids as you aren't having a c section at the ideal 39 weeks and so your risks are higher. 6.2% in fact.

I wasn't offered steroids and my elective section was at 36 weeks. My DS3 developed breathing problems (RDS) and then one of his lungs collapsed. I'm not saying this to scare you, just to say that I'd grab the steroids and inject them in my own bum even at 38 weeks.

He's a mad, bad, adorable 3 year old now with no problems due to his wheezy start.

Dd was born (VB) at 36 I was induced and am Diabetic, though type 1 on gestational. I wasn't given any steroids but there was talk of it before I ended up with an emergency induction. Dd was in SCBU for 9 days but there was never any problems with her breathing hth

I had steroids a few weeks ago as I'm expecting ID twins and they will be born by cs at 37w if they don't come beforehand. They basically told me that they would give everyone steroids as they're really good for the babies but funding issues mean it's not possible.

There are no risks for baby or mum so just go with it. xx

The rds risk isn't related to the diabetes but 'early' cs delivery. The thinking has changed in respect of this and routine electives are done as close to term as possible for this reason. This wasn't the case a couple of years ago. It us also about balancing the risk of rds and how urgent the need to deliver as tge steroids have to be administered 12-24 hrs apart.

Thanks very much everyone for the replies, it makes more sense now. I wasn't going to refuse them, I was just a bit confused about why I was going to be given them.

Really appreciate the replies, thanks again!

I think it must be slightly linked to the diabetes. I wasn't given steroids when I had DD at 37 weeks by ELCS however I was given them when I had DS by ELCS at 35 weeks. Good luck!

I had dd2 at 37+5 by ELCS, and she spent 5 days in SCBU with breathing difficulties. I am due another ELCS in a couple of months, and when I meet with the Consultant I am going to request steroid injections, just to try and avoid the unpleasant start in life that dd2 suffered.

I had DC3 at 38+2 in April and nobody mentioned steroids, he was fine btw. I'd had DC1 at 36+6 spontaneously with DC1, and with DC2 I had the steroids at 34 weeks due to PTL (she came at 35+5 with 10/10 apgars).

I'd heard that the steroids don't do much good past 34 weeks..? Unless there is new research.

I've had 4 sections:

dc1 - 36 weeks no steroids
dc2 - 38 weeks no steroids
dc3 - 38 weeks no steroids
dc4 - 37 weeks steroids.

None have had any breathing problems - my consultant was v. reluctant
to schedule a section pre-39 weeks without steroids, but previous consultants have had no problem doing this. A side effect of the steroids is that it can affect fetal movement - I spent 8 hours on a ctg monitor the day after the section with no fetal movements & v. abnormal traces.

Im down for ELCS at 39weeks. (In january). My consultant advised me it was now standard to give steroids beforehand so I will be having them. I don't have GD.

Thanks everyone! :)

doh I meant the day after the steroids not the section!

I had the steroid injections at 31 weeks as I was told there is a high chance my boy could arrive in the next two weeks, and I have type one diabetes but had it before the pregnancy