At 35 weeks, can I ask for a ELCS?

[ALovelyBunchOfCoconuts]

Bit of background,

I have DD who weighed 9lb 3. Not huge but sizeable and required episiotomy and ventouse to get her out. My pushing ability is obviously not up to scratch.

I am now pregnant with DC2, 35+3. I am measuring 4 weeks too big, have polyhydramnios, and baby is breech. I had to go in for monitoring after reduced movements two weeks ago and they also did a growth scan, which is where the above issues were picked up. They also said I am high risk for cord prolapse and SROM. I have my next growth scan and meet with consultant on Thursday where I will be 35+5.

Can I just ask at the appointment for a section? I'm worried about being left to go overdue and the baby potentially being so big that I cannot manage to push again resulting in more intervention, worst case EMCS. Also worried about just waiting it out, everyday wondering whether today will be the day my waters go.

Is it too late to book me in for a section? Or will they just tell me to get on with it?

I suppose Thursday will decide my fate for me depending on fluid levels, lie of baby etc. Does anyone have experience of this and was offered a section instead of a VB?

Thanks for reading :)

I think you have a case. Not because of your pushing being up to scratch - I'm sure it is!! But because of the cord prolapse risk.
If your baby is still breech I think you can opt for a section (?).
Make a list of all your concerns so you don't forget anything, make sure you do speak to the consultant not a senior midwife and don't be fobbed off if this is really what you want (O and if you can cry;-))
Congratulations by the way!! xxx

HI, I can't help with everything but hopefully someone can.

I wasn't officially given the all clear for ELCS until my 34 week appointment, and even then not given date, I will get more details at 38 week appointment apparently. So I don't think it is too late to ask.

Having an ELCS won't remove the worry of labouring early as here you can only get an ELCS at 39 weeks. And in my case if I am progressing if I labour early then I will be having a VBAC.

Sorry can't help with everything else though.

they will probably discuss it with you as an option anyway tbh. not because of the size (i had elcs for macrosomia with dc1 and then had to vbac 1 and 2 because there was no clinical necessity for cs.) with the breech and other complicating factors, i suspect they will prefer to cs.
in any case, you are completely reasonable to bring it up and make a request. i did ask for cs but was told no, but your circs are different. (i now have dc3 who suffered birth hypoxia and has cp as a result.)

definitely ask, particularly if psychologically you are starting to fret about risks.

Thanks both :)

I don't know if this is what I really want. Ideally I want a natural stress free birth but if baby won't keep its' position then then I'd rather have a date booked than have to be rushed in a mad panic.

It just feels like everything is against me and it is reallt stressing me out. Worried about it happening when there is nobody to have DD and I just feel that with everything added together that ELCS may be the best way forward.

Although I am petrified at the prospect of spinal/epi.

Gah, it's too much to consider!

Can't you have an ELCS under a general over there? My sister had two due to positioning of the baby.

I wouldn't want a general either tbh. If I had to choose I'd go for the spinal. The idea of not seeing my baby straight away would be awful for me.

The fear of spinal is just fear of the unknown I suppose and some horror stories I know I shouldn't listen to.

I had an epidural for DD (vaginal birth) and am petrified of needles. No physical side effects (eg headache, only working on one side etc)

I then had a spinal in theatre for a manual removal of placenta, and that too was absolutely fine - no different to the epidural other than the fact it didn't feel like iced water running down my back :)

I'd definitely prefer the spinal to a GA for a CS, far less risky :)

The size of the baby and your pushing ability are not of concern at all in terms of requiring an elcs appointment confirmed. I say this as somebody who had a PROM and couldn't push out a baby who was average size with an average amount of water. Cord prolapse/unstable lie caused by the polyhydramnios IS a concern. I assume from the sounds of it they're keeping a v close eye on you which is right for now. I'd get them to discuss further with you exactly how they will proceed from now on. Of course if your baby remains unstable in its lie then it's right that they book an elcs in good time. I'm a more straightforward case in that I'm a VBACer but this pregnancy isn't high risk in itself. But they are very clear on what we're doing/what will happen/where we are on a week by week basis (I'm 37/38 weeks atm).

You know what to do in the event of a PROM, yes?

And a spinal is just fine. I promise you I'd do that bit again in a heartbeat.

I had a spinal both for my miscarriage op and my EMCS, plus an epidural before the EMCS for the labour. When the needle goes in it stings a little, but then it is pure pain free bliss.

Things going wrong are extremely rare, especially in the calm setting of an ELCS or other planned surgery.

I wouldn't have had a GA either though have had to have several since (for other stuff) and realised it was nothing to be scared of either. But spinals are safer AFAIK

I'm not even scared of needles so I know my fear of spinal is just an anxiety rather than a 'omg I can't do it' thing.

Saulgood - Yes I think so. Call my labour ward and get there asap. (?)

They are keeping an eye on me yes. I had the growth scan two weeks ago and as I said the next one is thurs so depending on what this point out will depend on what they do next.

I'm just driving myself crazy, trying to imagine the different outcomes and what they'll say/decide. either the fluid has reduced, stayed the same or increased. I would sat it hasn't reduced as baby is floating about in there changing position on an hourly basis!

It's good to hear I can ask at least and that it may even be on their agenda to offer me one. :)

oh, you know, there doesn't have to be any mad last minute panic necessarily. my elcs was only decided the day before i had it at 39 weeks - i popped back in the afternoon to discuss with the anaesthetist, and then had to be back there by 9pm as i was going to be the first into surgery the following morning. i had a spinal -it was very weird but not painful at all.

i think saul has some good advice though. i would discuss all aspects with the cons, you need to know what his/ her feelings are about likelihood of elcs anyway tbh.

If your waters break get on your hands and knees and call an ambulance. Or get somebody else to.

The spinal I think you worry about because it's somebody switching off a part of you which you take for granted ie sensation/movement.

But it's not like an epidural where you've got time to lie there with no movement. I had mine sited (didn't feel it, they give you a local first) and then they checked it had worked, did a bit of prep and within about 10 minutes dd was out. The half hour max it takes to stitch up is taken up with them weighing the baby/having a cuddle/looking up the anaesthetist's nose. And by the time you're in recovery you will find that you have sensation again. Your toes and feet and then ankles etc will be normal before you've even realised it. By the time I was wheeled onto the ward with dd tucked up beside me, I had full movement back and was discharged 12hrs later.

I know as soon as I get there that my mind will go blank so if anyone has any advice on any questions I need to ask I'd be grateful. I tend to go into these things planning to ask x, y and z then get all emotional and it goes out the window!

Saul - Really!? That sounds great. I don't think I quite understand the difference between that and the epi though?

An epidural is sited and left there. So they then top it up and rely on it for pain relief. The downside being that you're not mobile at all. The spinal block is a single injection and it wears off quite quickly. I remember saying to the surgeon stitching me up that I could move my feet and he said 'yes that's normal, I'll be done before you can feel anything else'. It's probable that if you have an elcs, it will be a spinal anyway.

Write down as many questions as you can think of. How long do they leave unstable lies for before intervening. Do they attempt ecv with polyhdramnios. How often will you be scanned from here on in. How far post dates are they comfortable with etc etc.

Thanks Saul - you've been very helpful :)

I vaguely remember someone saying to me that evc is not an option as he just floats freely in and out of position so he'll just go back again. Estimated weight at 33weeks was 6lb already so god knows how big he'll be by 40 weeks!!

I will write those questions down in my notes so I don't forget them.

Of course you can ask. You have genuine concerns that need addressing & should have adequate information about risk management & pros & cons shared with you. Whether you then wish to discuss ELCS further is up to you. Consultants are not in the business of putting babies at risk.