Third section imminent - scared I won't make it that far

[nearlythree]

My third section in four and a half years' is due at the end of the month. I am the size of a small family car and my g.p. doesn't think I'll make it - it's booked for 39 and a half weeks. He says if I go into labour I'll probably need a g.a. as I'll be too far gone for an epidural, and as our dd1 nearly died during my first section with a g.a. I'm keen to avoid this. Now my scar is pulling for the first time this pregnancy and I'm terrified I'll go into labour and my womb will rupture and the baby will die. This is our first ds and I love him so much. I've already been in hospital a few weeks' ago with a virus and still have fatigue, anaemia and loads of silly niggles and I have had enough. We live 45 mins from the hospital and have no family nearby and I am really scared.

Can anyone offer help or advice?

Won't they bring the section forwards given the circumstances?

I don't know, I last saw my consultant at 20 weeks. I'm hoping to see her next week but need a referral from my g.p. which could take a while, and I need reassurance now.

At least ds is giving me a good kicking!

Was your gp trying to reassure you because it seems like he has just scared you loads! Why did you need a GA with your first section? Was it because of an emergency? It may be that your dd1 was already distressed before that section or perhaps she just got a bit knocked out because of some of the effects of the GA? Its quite common for babies who are born by GA section to need a little bit of help with their breathing immediately after birth. It doesn't necessarily mean that they are having breathing /other probs in themselves but just that they are being affected by the GA in the same way that you are. How was your second section and why does your gp think that you will be too far gone for an epidural? What does your midwife/obstetrician think?

Sorry but I think GP is not the best person to ask in these matters, if you are concerned ask your midwife or OB...
I don't think the fact that you look big is an issue... scar pulling is probably not an issue at 36 weeks.
Scar rupture is very rare.... especially if you are not induced... think positively and make an appointment with a MW or OB

Yes... "why does your gp think that you will be too far gone for an epidural? "

And also if you are in labour and about to give birth is there a reason why it must be a section?

I had a third section (and was huge), after a trial of labour with my third pregnancy. Rupture is very unlikely. If you go into labour they can give you a c-section. Mine was done under spinal. TBH it was the best section of the 3. My scar was very thin, but I spent 7 hours in labour and had no problems.

Good luck- and I do know how you feel I was in a right panicky state- it was fine.

Your midwife can refer you to a consultant tomorrow. If they are concerned they will suggest doing the cs early, and IME they tend to be over-cautious rather than not.

Your doctor is an idiot to scare you like that and not do anything more!

A "scar rupture" isn't always a huge bang kind of thing either. I had something they called a scar rupture with ds - one end of my scar had come apart a bit. It wasn't bothering ds one bit. They only found it when they did the cs.

fruitful, that's a scar dehiscence and it is not dangerous as you just explained... and very common.

i had an elective c/s at 37 weeks to ensure I didnt go into labour. I was huge and had a previous c/s. 39.5 weeks is surely quite late

Scar rupture is NOT very rare and have varing degrees sort of like burns. winning the lottery when you buy a lottery ticket is (chance is 1 in 13million) and yet so many still buy. A midwife is not the best person to ask about surgery and neither is the GP.

I'll be having my third cs in three years as well but the consultant I'm with has done fifth cs ops on women (he was the third consultant that I questioned) and he doesnt think it's a problem. I would advice you to ask as many questions as you need to and get a second opinion if it sounds all doom and gloom.

Have you been classed as high risk? I was told something about the additional risk of having a BMI of 31.5 at the start of the pregnancy so I am being refered to a dietician. don't see the point but I'd rather err on the side of caution.
maybe the anas...? anesthe...? you know, the guy who gives the epidural decided that I'm so fat he wont be able to feel my backbone.

Fine - anyone having had a section before is classed high risk.

My local hospital has midwives trained and experienced in vbac and didnt class me as high risk for that. they were keen to supervise vbac for which surprised me so i assumed they had stopped that practice.

how many weeks are you now?? im sure if you spoke honestly to the midwife/consultent taht they would consider getting over sooner...based on your size that is. i was offered an induction at 34 weeks due to size but i held out andother two after that and i was soooo uncomfortable..best of luck XX

The proof that previous sections is considered High Risk is that you are asked (though you can decline it) to be fully monitored... if you are not high risk they don't make that request.

When you say your scar is pulling, what do you mean?? Rupture is very rare even after 2 previous c/s, so I really wouldn't worry, unless you have an ongoing condition that would link problems in all your pregnancies.

If you go into labour, stay calm, and call the hospital, you're bound to recognise what's happening in time to make it for a nice calm section with a spinal. Can you call a community MW in the morning?

"For women whose labors begin spontaneously, uterine rupture is reported to be less than 1% and the risks similar to or less than the risk of any other unpredictable complication of labor and delivery.

Medical experts state that the risk of a uterine rupture with one prior low-horizontal incision is not higher than any other unforeseen complication that can occur in labor such as fetal distress, maternal hemorrhage from a premature separation of the placenta or a prolapsed umbilical cord.

Respected studies have concluded that the probability of any woman needing to have an emergency cesarean those other complications is approximately 2.7% or up to 30 times as high as the risk of uterine rupture."

She's had two not one. and none of you have been to a SANDS meeting when those rare, almost none-existent ruptures have shatterred lives obviously. try going there to trivialise the risk.

less than 1% is 1 in 101. that not rare or low. That's over 10,000 times more than my chances of winning the lottery. it's closer than you think. once the cs has been done twice, it's significantly higher. The literature I got put the risk at 3%. it's further complicated by my weight amount of excess fat on my stomach. I'm not in the least bit worried but to not be aware of the risk and is foolhardy.

It's relatively improbable that the scar will ruputure but IT'S NOT IMPOSSIBLE. And if you haven't physically examined someone, read thier notes or followed thier history, you are in no position to assure them that thier particular case doesn't lean towards the 1%.

Nearlythree needs to be optimistic and know that there are a lot of good outcomes but she need to be well informed by her OB not us. I just think she needs to grill an expert.

A friend of mine went into labour ward with complaints every other day. I took castor oil to induce labour and have have my cs same day which was a week earlier that schedule. I was initially scheduled for 7/7 at st thomas'. I was so glad i tokk the castor oil. dont try this at home though.

1% with augmentation of labour or not? That sort of thing makes a huge difference. Before trialing labour I insisted that there was to be no induction, no use of syntocinon, and early move to c-section. In nearlythree's case she's not asking for a trial of labour, so there's very little risk of rupture- that is in the literature.

I'm not trying to trivialise the risk (we already have 1 severely disabled child, we were very keen to do anything to avoid having another), just trying to reassure her that it is unlikely, and therefore not worth getting in a blind panic about at the end of pregnancy (and I did begin to feel like that at times, I was terrified of another section, but also terrified of labour).

nearlythree I think you need to see your consultant and explain your fears- I did that and was very pleased with the care I receieved. Also ask why you can;'t have a spinal or epidural. When it was decided to switch to c-section I was absolutely terrified and and the anaesthetist was fantastic, stayed on shift for an extra hour and half to see me in and give me the spinal rather than pass me over to someone else.

I was terrified of having a 3rd section/of having a rupture etc etc, so I know exactly how you feel, but in the end it all went very smoothly and ds3's birth was a lovely experience.

BTW I read Michel Odent's book caesarian (on pupuce's recommendation) when pregnant with ds3 and found it really reassured and calmed me about the whole thing. Seriously I was terrified - spent the first few weeks of pregnancy in tears convinced I was going to die. Did calm down during the pregnancy but had flashes throughout of impending doom. The reality wasn't like that at all.

1% is still 1 in 100. While I agree with you and don't see the need for panic, 1% is not small or rare. That's the fine point for me. and the general 'it turned out to be untrue in my case so your doctors are just lying' message that seems to come across.

I think it's the lack of proper balanced information that causes us so much panic.

Jimjam, What's a vaxthread?

nearlythree - have you spoken to your midwife? Do you see one? I cannot understand why your GP has said this to you. How far did you get in labour first time? I presume you had an elective C/S last time? Just because this is your third baby, it does not mean you will go into labour without warning and progress quickly.
You can have a spinal anaesthetic at any time during labour and be awake for a C/S. There is no need for you to have to have GA if you labour.
It is extremely unlikely that your uterus will rupture if you go into labour on your own.
It is much better for your baby to be delivered as close to term as possible. If you are very concerned then your midwife can arrange for you to speak to your consultant - there is no need for GP referral.

The figure I found out (in more than one source) for scar rupture in non-induced birth was 0.02%, which is much better than 1%.

But I agree with everyone else, nearly3. You should try to talk to your consultant asap, and certainly not wait for your GP to refer you. I'm sure you could ask for an earlier cs. I had an elective cs at 36 weeks (for placenta praevia, so they couldn't risk me going into labour). Baby was small (but placenta very dodgy, so she had been undernourished) but otherwise absolutely fine. Good luck with everything. I hope it goes smoothly.

Yes but nearlythree is perceiving it as a much bigger risk than 1% (which is also the "official" figure given for the risk of losing a pregnancy from having an amnio- and is a risk many are prepared to take). I am not trying to downplay risk, or say that doctors are useless (although I do not understand for one moment what her GP has told her- but a consultant will be able to give a clearer more reliable picture) but just to reassure nearlythree that she is overestimating it in her mind. I can understand how she feels as reading her opening post I felt the same, I was convinced that I was going to die. I didn't think I had a 1% chance of rupture I was sure I was going to not make it.

One thing I did find out from reading nearlythree was if rupture occurs it is most likely to occur during birth, rather than labour. Even if you went into labour there's no reason why you couldn't have a section then (Michel Odent's book is very reassuring about that- and is the main reason I chose to trial labour rather than have an elective- even though I thought I was very likely to need a section, and did.).

I'll put a link to ds3's birth announcement- there you'll see that even though my scar was very thin (they really commented on it, and said if I ever had another (no way!) then I was to have an elective)- and even though I had 7 hours of labour- there was no rupture. I'm not downplaying the risk, just wanting to reassure you that it doesn't have to happen (even though I was convinced it would):
\link{http://www.mumsnet.com/Talk?topicid=1370&threadid=52051&stamp=050214234021\ds3's birth announcement here}