Fibroid and consultant

[monniemae]

I've been referred to a consultant at 28 weeks to discuss my fibroid. The one I'm seeing doesn't have particular expertise re fibroids but is the only one who was available.

I'd love any advice on what I should be asking please! It's a large (11 x 10 x 10cm) subseral anterior fibroid ie towards my cervix. It was partially blocking although I know they can move out of the way during my pregnancy. However it is also in a place that would make c section difficult so I can see them advising me to try for v birth..

My anxiety is that even if it moves and they advise I can "try" for vaginal birth it may still be so big, and located in such a place, as to make exit difficult and I'll end up with a c section anyway - I'd much rather go for ELCS if that's the case (letting go of waterbirth/homebirth dreams...)

The only stats I've found suggest that while 13% of VBirths normally end in C section, 48% of those involving fibroids do! Which sounds astonishing. But to date any questions to midwives about increased risks, or prem labour etc have been waved away...

Would really appreciate any feedback from others who've been through this, or could tell me what to be asking the consultant

Thanks!

I should have been in your position, but my fibroids were undiagnosed so I attempted a vaginal birth and ended up with an emcs. I was told afterwards that I could never have given birth naturally, as although they weren't directly blocking the exit, they were diagonally under the baby's head and made it impossible for the cervix to contract properly.

In your position I would be wanting an elcs given the statistics, but of course it all depends on the exact location of your fibroid.

Also bear in mind that fibroids carry a large risk of post partum haemorrhage, even if you do manage to achieve a vb. I had one after a very long labour, lost a lot of blood and it took a long time to recover.

I had a similar case to you with DS1. Same sized fibroid said to be blocking cervix & I was told I needed a vertical incision CS when I was 14wks pregnant. I agonised over that, as otherwise I too would have been a water-birth type. But then about 3wks before due date fibroid/baby had moved/grown so his shoulder was past the fibroid which was the deciding factor for trying for a vb. I was not at all prepared mentally or physically so one thing I would say is prepare for both options if there is any uncertainty about what will happen.

I did end up with a vb but it wasn't great, which I believe was more to do with DS1 being back-to-back (possibly he was in this position due to the fibroid though? who knows?) So if going for vb check baby's position as it can make quite a difference, esp for a first birth.

I had a massive pph, which in hindsight was horrendous but at the time I just got on with it. For DS2 I was told risk of bleeing is greater with a CS as the body's own mechanisms for preventing bleeding are not employed. I had a smaller bleed with DS2, also vb - fibroids were not an issue with the second pregnancy.

If you think you may want surgery to remove the fibroid later on, check if there are any implications wrt the CS scar & further pregnancies afterwards if you are planning more.

I'm sure you will be fine. I know what you mean about no-one appearing to be that interested! I was often introduced to midwives etc as the lady with the "huge fibroid" but getting proper information was impossible!

I'm almost 24 weeks and have a similar size fibroid which is blocking the way out, got an appt with obstetrician next week which I think is to discuss whether I'll need an ELCS. They haven't told me much about it, just constantly told me that my fibroids (I have about 5 more, two of which are also 10x10x10ish) are really big. OK - thanks, and what now?!
I'm very interested in your stats, I didn't realise that. I'd much rather schedule in a CS rather than hoping it magically moves out the way and VB is possible, but equally I think I'll be guided by what the obs/mw tell me is best.
On a similar note, is it true that ELCS are generally a couple of weeks earlier than the due date? For maternity leave planning etc it would be good to know.
Good luck with it all, and keep us updated - I'd like to know what happens as it seems you're a few weeks ahead of me so can give me some warning about what might happen to me!!

I'm placeholding, if you don't mind.

I'm only 9 weeks, but early scans have picked up 3 approx 5x5x5 fibroids. Already my longed-for home birth is definitely out :(

All I know for now is that they'll keep an eye on them and scan me more later in the pregnancy to check if they've grown or if they're in the way.

I dread the thought of a CS, but definitely agree that if it's on the cards, I'd rather have an ELCS than a possible EMCS halfway through labour.

Kikoi shack, elcs are usually done 7 days before your due date.

Tobylerone, don't dread the thought of a cs, I went into my first birth thinking the same but it was actually much easier and less painful than first stage labour!

So I'm told. I'm not the least bit afraid of labour, though! This will be DC3, so I've done it before. When I was in labour with DC2, they threatened me with a CS and I cried like a child until my mum reminded me I was 23

Thanks everyone! Really helpful. Tutti Frutti - sorry you went through that :( Great tips idlevice; and yes I got a shock at 22 week scan when they said might be having v birth, so I can imagine at 37 weeks the idea was stunning...

Kikshack, this is the link I read and if you search for the labour section you'll find the sentence about c section rates www.ncbi.nlm.nih.gov/pmc/articles/PMC2876319/ - "In a systematic review, women with fibroids were at a 3.7-fold increased risk of cesarean delivery (48.8% vs 13.3%, respectively)."

Tobylerone, the midwife at my booking in appointment said if the consultants decided my fibroid did not after all make me high risk - ie, vbirth likely to be straightforward - a homebirth could still be an option. Maybe she was just being nice but depending on the fibroid it's my understanding HB is still possible, though you'd be urged to have a managed third stage ie injection to assist placenta coming out ok and reduce risk of PPH.

hth

Hmmm. The MW at the EPU told me that a HB is definitely out of the window immediately, although the MLU might still be a possibility.

I hope you're right and I'm wrong :o

This is at Kings / KCH in Denmark Hill, v homebirth friendly area, high rate of hb.

My friend was booked in at Lewisham and told it was out of the question for her to use their new (and thus especially strict) MLU, but when she was eventually signed off the high risk books by a consultant at 28 weeks (because her fibroid was high up), she got into the MLU. The Consultant said yes you can go there; the midwives there said no you can't but referred her to the head of the MLU who said yes you can.

And her birth was fine! So fingers crossed for you. (she did have a small bleed but was kept under control and she was home the same day.)

Thank you. Excellent info!

I had a homebirth with a fibroid but it wasn't in the way and was external to the womb...cant remember what thats called. No one mentioned increased risk of pph or any issue related to it but I guess it may depend on the type.

My 3 fibroids were diagnosed at my 20 week scan, couldn't have the water birth I had hoped for and was told I couldn't use the home from home birth centre at tommy's. I ended up having an emcs due to ds' heart rate dropping at each contraction. Don't know if fibroids had an impact.
Had great monitoring and care throoughout my hospital stay, did lose ' more than normal' amount of blood though.

good luck OP

Hello, just to update for whoever 's interested - my 32 week scan showed the fibroid has moved up and shrunk and the baby's head is fully descended past the fibroid and partly engaged.

Consultant did say the fibroid probably hasn't actually shrunk and it's just harder to measure now. He said go for vaginal birth with some precautions in case of PPH - eg actively managed 3rd stage (syntocinon injection to deliver placenta) and a canula inserted during labour in case they need to get drugs into me quickly. He said this will not stop me having active / waterbirth etc and wrote this in my notes.

They did not want me to have a homebirth (the first consultant said "homebirth is out of the question"), but it was clear if I did insist I would be able to discuss it further and I do know women who've had homebirths with fibroids in my area. However my partner doesn't support me having homebirth and I'm not dead set on it (his sister almost died of PPH then delayed PPH 10days afterwards, earlier this year).

I'm actually now going to try and transfer to another hospital which has a lovely birth centre instead!

In terms of the research I did - I was too embarrassed to say "but I've read this..." about risks - I did ask if I was increased risk for c section etc but he just said no.... He couldn't give me any statistics about the increased risk for PPH or anything...

But ultimately, the baby is measuring average-sized, it's already in the right place and well past the fibroid, I'm no longer freaking out that it will all end in EMCS so I'm willing to go with what they say!

Hope all goes well for you guys.