Is it normal to do an elcs before 39 weeks?

[laward]

I'm booked for a elcs at 39 weeks but I'm worried the baby will arrive naturally before that time.

Anyone know if 39 weeks is the usual time (its a recommendation by paediatrics at the Royal Free) or do other places allow an earlier option?

Depends what it's for. mine was at 38 but labour would have been dangerous.

I had my section booked for 38 weeks, doctor did tell me she would prefer to wait until 39 weeks.

However ds decided to make an earlier appearance ad I went into labour at 37 weeks, i was fully dilated and ready to push just as I was wheeled in to theatre. Ds was breech and cord around neck so there was no way of natural labour.

What makes you think you will go early?

I am considering a section as well and my consultant explained that he does 38+3-4 if it's a simple breech and 38 if the baby is transverse. Apparently with transverse lie there's an increased risk of cord incident if waters break. He made it sound like he would always prefer to do 38 weeks, but that the paediatricians like to leave the baby in as long as possible.

Sounds like it varies from hospital to hospital, and of course on the reason for the CS.

This is my second child and feels very different.

My DS was 40 weeks + 2 days so no history of early labour.

My last was a very fast damaging labour that was not managed at all.
Left alone all night on a post natal ward, MW's assuming it would take ages and would not let my husband stay.

Very unpleasant treatment by midwives before & after. Made it to the Labour Ward at last minute as my DH & DM arrived, saw me & insisted midwives leave the nurses station and do something.

Under Consultant MW now, she's lovely but said there was nothing she could put in place to ensure I had epidural this time as labour unlikely to take more than 3 to 3.5 hours.

I can't face going through that again and really fear worsening of current prolapse symptoms, so they gave me the option of elcs although they said my pelvic floor could take another natural childbirth.

I think the new NICS guidelines are that c-sections should only be before 39 weeks for good clinical reasons. Earlier than 39 weeks the risk of immature lungs still exists.

39/40 weeks are the nice guidelines.

Better for baby. I was told if I had any signs if contractions to come down within an hour and they would do the section straightaway.

Before 39 weeks there's a higher chance of admission to NICU with breathing problems - because the baby isn't 'forced out' like with a natural delivery the baby could have wet lungs; the incidence of this is reduced after 39 weeks so unless it is more dangerous to keep the baby in utero for some reason a planned section will only very rarely be offered prior to this.

I was booked in for an ELCS at 39 weeks but went into labour at 37, my section date was brought forward. I was in labour but not progressing very quickly, plus they wanted to wait for 'fresh eyes' so it was done at 9am rather than me be rushed to theatre in the early hours but had I been labouring quicker I would have just gone straight to theatre. (It was a section due to previous section, I was also given the option to try for a VBAC but I didn't want to)

My ELCS was 39+1, they said they don't like to do them earlier as it gives the baby's lungs the best chance of being fully developed.

Thank you so much for your posts, really helpful.

I will ask at my next appointment whether I can have a c-section if I go into labour early and there is time. It's not an issue that's been brought up so far. I'm 32 weeks +4 days so there's time.

My prolapse symptoms do worry me, it feels horible.
However, a pelvic floor consultant did't seem to see it as such a big issue. I was told they can always give it a nip & tuck later on, but that if I have more than one c-section my abdominal wall may be shot and they couldn't help with that.

I've found NCT less than helpful, at times they're dogmatic in their positivity about non-intervention.

I am having an elective c section and my consultant told me he would do it around 38 and a half weeks. I also saw an NHS consultant and he wanted to do it at 39 as he said is better for the baby . Have been worrying about going into labour early though and what will happen!

I wasn't allowed my elcs (after emcs) until 39 weeks either, as not serious enough medical reasons, despite suspected gd and extra fluid. Am so glad I wussed out of vbac now, as she came out at 4 kilos. Dread to think how big she'd have been if I'd gone overdue and attempted vb.

Hello

As an NCT volunteer can I assure you that if you ring the NCT helpline, what you should get is a listening ear and evidence-based information.

C-sections have risks - as does everything. Sometimes we don't want to think about the risks of something becaus in our hearts we've already decided what we want to do, so someone explaining the risks can sound like they're trying to put us off our intended course of action.

You need to make a decision which is right for you - never mind what anyone else would do - this is about you. Reading your posts I think you know what you want!

ELCS is scheduled for 39 weeks because that reduces the chances of your baby having respiratory distress and also tries to avoid you going into labour.

If you went into labour, you go to hospital and the section should be done then - it would be classed as "emergency" -ie, unplanned rather than the planned one you're hoping for but there shouldn't be any issues with that. If you arrived at hospital fully dilated and with the baby's head on your perineum then you'd be better of pushing because it would be much riskier for the baby at this point to go into theatre.

If you've had a less than positive experience with NCT I would suggest you complain - you can do so through the website I think.

I had an elcs with ds, and was told that if I went into labour before, then I would have an 'emergency' c section.

Ds was born at 39 weeks, and had respiratory distress, he was in nicu for 2 days and scbu for 8. If it is possible to keep them in for longer (as near to due date), then it is better for their lungs.

My elcs (for exactly the same reasons as yours, funnily enough) was booked this morning for 38+5. I'm getting steroid injections to help with the lungs x

Snowsquonk,

Thank you for your imput. I have no problem discussing risks with any intervention. I'm honest with myself and I am capable of making an informed decision.

Aspects of NCT have been helpful however, there is never any talk of the risks or downsides of natural childbirth. This fluffy view is unrealistic.

I mentioned in a private discussion (in earshot of the teacher) that I believed my negative experience of natural childbirth left me unwell and delayed bonding with my son. I received a phonecall from the teacher a couple of days later requesting that I not speak in class as whilst my comments are valuble and relevant, they do not fit with the positivity she wants to create in class.

NCT classes promote an agenda that casts medical intervention, not as progress that has led to falls in maternal and infant mortality rates but as unnecessary interference. It is doubtful that such an agenda is evidence based in any balanced way.

Most people go to NCT classes as it is a good way to meet people who are also having children. Most information NCT provide can be found on google.

I m a bit buffled because my midwife just told me the opposite of what everyone seems to say here... That they fix elcs early to help babies breathing as the more they stay in the womb the more their lungs get filled with fluid and due to lack of labour squeezing this out, they might have respiratory issues.... .... I wonder maybe I should change midwife....

I totally agree with laward on the NCT agenda... It was my experience too.... And all women in my group felt the same.... risks of natural childbirth were completely ignored together with issues with breastfeeding.... And making any medical intervention look evil... It felt like being pushed into joining some sort of cult.... Great for networking though!

Hi Laward,
Sounds like you are keen on the elcs which is fine. If you do reconsider vb, I just thought I would add that I had a slight prolapse after a vb with dc1. Had a straightforward homebirth with dc2 which was actually longer than the first birth (he was 1.5lb heavier!). I had a "nip and tuck" as you put it, at 4 months after dc2. Three months later I don't have any prolapse problems or incontinence and although my foofoo is still a bit sore and tight from the stitches inside (which don't dissolve for three months) I now feel I'm coming out the other side and can get back to being me again.
I think if I ever got pregnant again (hope not) I would ask for elcs, now I have had the repair job.

Hi thing2andthing2,

Pleased to hear you're recovering well and surgery has been successful.

I'm sorry if I sounded at all flippant by using the term "nip & tuck", I was directly quoting the surgeon. She was lovely but she had a certain way of putting things that made me cringe a bit given it's such a personal thing!

I would prefer a elcs as I had a dreadful experience first time round, however if I do end up having a vb I know thephysical damage can be repaired.

Take care

Hey it's ok, my surgeon totally minimised the surgery as well to be honest and I wasn't really prepared for the recovery but hey-ho.
To be honest I think vaginal birth is way over rated and I think everyone should be offered a straight choice of vb or elcs whatever their circumstances, but I know that lots of people would disagree with me!
Good luck with your cs and I hope your baby plays ball.

Hi Laward

You're absolutely justified in your reasons for section, youve got to remember that they wouldn't have offered you one if there wasn't clinical reason & nobody else can put themselves in your position and judge your choice!

National guidelines are to do ELCS after 39 weeks because there is an increased risk of respiratory distress before this. This isn't a problem with emergency sections because usually your waters have broken or you've started to labour and this stresses baby a bit causing them to produce some of their own steroid to help the lungs and also contractions help clear some f the fluid from the lungs. There are various indications for doing electives before 39 weeks but if you do this the mum should have steroids to help babies lungs and decease the risk of needing to go to SCBU.

If you went into labour before then you should ring LW & they'd get you to go in ASAP. If you weren't in established labour & it was under 39 weeks they'd probably hold off until you were. If you went in in labour they would aim to do an emergency section but if there were other emergencies that needed to go to theatre before you (distressed babies or unwell mums) they would take priority and they would then have to let you labour. The only time they'd say no to doing a section is if you were in advanced labour & the head was low because the risks of pushing a baby back up to deliver them by section would outweigh the benefits.

Hope that helps. X