elective c/s- when did you have it: 38 or 39 weeks?

[isidora]

I need to have an elective c section to avoid another 3rd degree tear. I had a very quick first labour which is why the tear happened. My hospital has a policy that elective c/s can be done only after 39 weeks, which makes me worried in case I get into labour early and it ends up being as fast as the last one. DD1 arrived exactly at 39 weeks. What has your experience been with arranging a date? Does this policy change from hospital to hospital? Does anyone know about babies readiness in terms of lung development etc at 38 vs 39 weeks?
I would feel less anxious if the date was closer to 38 rather than 39 weeks provided it's fine for the baby. Thanks a lot!

[jeanini]

im 37 wks preg today and im booked in for a planned c-sect friday. they said that they wouldve preferred to do it next wk but they are fully booked. i had ds1 at 38 wks naturally. reading this thread i hope my baby is ok. i have gest diab and they have said the baby is about 8lb already. as im only a shortarse they were worried i wouldnt be able to get baby out naturally.the consultant did say that the baby might have to go to scbu. im r worried.:(

[RedZuleika]

Doesn't the NICE guideline just say not before 39 weeks....?

[nearlythree]

I hope so! Am seeing my consultant tomorrow.

[Uwila]

I thought everyone did them at 39 weeks as standard (as that is the nice guideline). SO, I wouldn't expect you'd have to argue much for 39 weeks.

[Jimjamskeepingoffvaxthreads]

nearlythree I'm sure you'll be able to argue a good case for 39 weeks- my local hospital does elective sections at 39 weeks standardly (which was xmas day in ds3's case so I was pleased to wait to go into labour :o).

[nearlythree]

The whole thing's so scarey, isn't it? I followed the 'best practise' advice with dd1 (leave it to 42 weeks', go for a vaginal delivery over a section etc.) and she nearly died. But if I do have ds early (I'd like 39 weeks' if poss.) I am putting him at risk.

I had to see a different GP today and she raised her eyebrows over the 39.5 thing, too.

[Jimjamskeepingoffvaxthreads]

god no you didn't offend me at all. I don't know much about it, I just had a baby born at 38 weeks with breathing problems, which was quite scary (and not something I'd really considered before it happened). I think towards the end of pregnancy there tends to be this strong feeling that you want to get the birth over and done with and know that everything is ok (that's how I felt each time anyway), but ds2 would definitely had benefitted from extra cooking.

[Uwila]

Yes, Jimjams. I agree that all other things being equal, it is better to wait until 39 weeks. But, if going into labour presents it's own set of risk than those too should enter the equation. But they don't -- not in the nice guideline anyway.

Hope I didn't offend you. I'm sure you know more on the topic than I do.

[RedZuleika]

Mary Cronk may be bonkers - but it's an idea that I've seen her express - and a perfectly reasonable one on which to build a more evidenced-based conclusion. No on is making sweeping statements.

nearlythree: To my knowledge, Mary Cronk hasn't said anything about the gene pool - that was my extrapolation.

[Jimjamskeepingoffvaxthreads]

But uwila- the stats also show that leaving the baby an extra week from 38-39 weeks more than halves the incidence of breathing problems. That's why the guidelines take account of that.

Anyway very boring, far too boring to put here but the hormone pathways are pretty well sussed out now and the initial trigger is from the baby. Of course the pathway is quite complicated and things can go wrong (dpends on mothers hormone receptors as well), but the process is triggered by the foetus.

IIRC Michel Odent's book talked about a test that could be done on the amniotic fluid which could give a better idea of whether the baby was ready to be born or not.

[Twiglett]

39 weeks .. St Georges and Kings

[Uwila]

vax=vaccination

[muppety]

El c sections at 39 weeks here. I wouldn't worry too much about the timing. With ds1 I went into labour at 39 weeks and with ds2 was absolutely certain he would be even earlier. In the end had an election section at term for various reasons and I am quite sure he would have stayed for longer as although he was huge was much more dopey than ds1 had been! IN other words your second could be much later!

ps what is a vax thread??!!

[nearlythree]

Dd1 was certainly ready but wouldn't come at 42 weeks'. No doubt Mary whateverhernameis would think it better for the gene pool if she wasn't around to pass her faulty ones on, but she is! (Sorry, but I have never heard such a load of cobblers.) I felt a total fraud in Nicu as dd1 was about 8lbs bigger than every other baby in there, and am firmly of the opinion that it was my body that was 'at fault'. Also think in-labour sections are appalling if you have been having contractions for 48 hrs like I had with loads of drugs to try and stimulate everything and then needed a g.a. because dd1's condition had deteriorated so quickly. My planned one was a dream.

[Uwila]

I have a theory that Mary Cronk is bonkers. Lots of things can go wrong. It isn't just down to faulty babies. I'm no doctor, but I'm generally skeptical of such broad sweeping statements.

The truth is we don't know everything about how labour is started and why it sometimes doesn't start. Lots of theories. Some are certainly credible. But we just don't know for sure which ones are right.

[RedZuleika]

"sometimes mums don't go into labour even after baby is well and truly cooked"

Mary Cronk has a theory that those babies who become post-mature without labour starting are in some way 'faulty' though (for want of a better term). That they lack the capacity to trigger labour. Presumably they would be (in a pre-medical / surgical time) selected out of the gene pool in the same way that chromosomal abnormalities are, or my own clotty problem (which inhibits implantation).

[Uwila]

wrong thread.....

I hate when that happens.

[Uwila]

So, do you think senior school should set guidelines on bedtimes?

If my 13 year old's teacher came to me and said "DD seems very tired by the time she gets to maths in the afternoon and I think her performance might benefit if she got m ore sleep." now I would appreciate that feedback. But if the school sent out a general guideline on what time all 13 year olds are to go to bed and when they should get up, I'd throw it in the bin.

[Uwila]

I didn't say it was a wild theory Jimjam. And, as you know, I have a lot of respect for your words (on and off the vax threads). I just think labour is a bit more complicated and while it is certainly a factor. I'm just not convinced that the whole process is as simple as baby ready therfore labour activated.

I think sometimes babies are born too early because mum's body decided it was ready. and sometimes mums don't go into labour even after baby is well and truly cooked.

[RedZuleika]

Because there is some evidence to suggest that the father has some input into average gestation. I read some research last year which looked at the average gestation of women who had children by one man, then further children by another. It wasn't a huge study group, but there was a difference in gestational length between the two groups.

As my mother delivered at 39 weeks and my mother-in-law at 37 weeks, I was all set to go from early on myself... and then sat there for another five weeks getting bigger and bigger and more and more grumpy

[Jimjamskeepingoffvaxthreads]

I don't think its a wild theory uwila- I used to teach my A level Biology students exactly that 10 years ago. The process of birth is triggered by hormones released from the foetus.

[Uwila]

I don't know if I suscribe to this theory (which I hear touted all over the place -- on and off of MN) that a woman goes into labour when the baby is ready. I tend to think a woman goes into labour when HER body is ready. And that may or may not be when the baby is ready.

However, I do generally agree that the longer they stay in the better (up to about 40-41 weeks). If I had lived near the hospital, I would have been happy to wait until 39+ weeks for the section.

[RedZuleika]

Yes - I've just been reading his book 'The Caesarean'. His idea is that with an in-labour section, the baby has sent a (hormonal) message across the placenta to say that it's ready, isn't it?

With me, they'd have had days to prepare... (and days and days... don't get me started...)

[Jimjamskeepingoffvaxthreads]

I've had 2 in labour sections at 40 and 40 + 4 weeks, 1 elective at 38 + ? about 3 I think. Ds2 (38 week baby) had breathing problems. He was 8lb, but obviously not cooked.

Michel Odent is a big fan of in labour sections over electives, although I can see why you would be concerned if you have fast labours (I had the opposite problem :o)

[RedZuleika]

Yes. Obviously that would be an indicator to do a Caesarean before there was the remotest chance of labour. Also - as people are discussing here - if you have a history of comparatively early labour, then you probably want to get the section in before it happens naturally.

If you know that you have a tendency to a long gestation though (say 42 weeks and +), then 38 / 39 weeks seems very early. I know that my daughter, for instance, put on a lot of weight during the last two weeks of my pregnancy and she wasn't huge at birth (7lbs 1oz @ 42+3).