ELCS at 34 weeks

[elliejjtiny]

This is a hypothetical question as I'm not pregnant or ttc but I get nightmares about this so I thought it would help to work this through in my mind if that makes sense. I'm not planning on having anymore babies but I've had unplanned pregnancies before so despite lots of contraception there is that worry in the back of my mind that it might happen anyway.

I have Ehlers Danlos Syndrome which means my waters tend to break early (35 weeks the last 2 times). After 3 normal, term births DS4 was born by C-section due to unstable lie after my waters broke. I tried to vbac with DS5 but I ended up with a ruptured womb (more common with ehlers danlos syndrome apparently but I didn't know that then) a crash c-section and we both had sepsis. DS5 was very poorly at birth and was very close to needing a ventilator. I was in HDU for 3 days, DS5 was in NICU for 5 days.

With DS3 my induction for prolonged rupture of membranes was delayed because labour ward was busy, which worked out well for me because I went into labour naturally while I was waiting. With DS4 my C-section was delayed because the operating theatre was busy. Both times I ended up with my waters broken for more than 48 hours. With DS5 I was offered induction twice but warned that it would be a long wait and if my baby needed scbu he would be transferred to another hospital 90 minutes drive away as the scbu at my local hospital was full. My consultant recommended not being induced to maximise chance of vbac so I had twice weekly monitoring and antibiotics for 9 days until I got an infection.

If I got pregnant again I think the safest thing for me and baby would be an ELCS at 34 weeks. I've been told that a VBA2C is out of the question because of my previous rupture but I know they don't normally do elcs that early. I know this would mean the baby would be in scbu/nicu with a feeding tube and maybe CPAP as well for 4-6 weeks or so but he would probably be a lot better off than DS5 was. And with a planned cs they will be expecting him and there will be more likely to have a cot ready in our local neonatal unit. I know it would be a longer stay in neonatal but it would be considerably calmer and without the trauma that me and DS5 experienced.

I'm worried that it will be recommended that I have an elcs at 39 weeks, but my waters will break at 35 again and I will end up waiting for more than 48 hours, risking infection and my baby will end up in a different hospital. Under these circumstances would I be allowed to have an elcs at 34 weeks.

Hi Ellie
I'm sorry it sounds like youve had a rough time with your previous pregnancies. Hope you LOs are all okay now.
I would probably do some reading around the guidance on c-section (see the NICE website and RCOG green top guidelines), and then make an appointment with your consultant as it will probably come down to thier decision. The usual advice is not to do a planned c-section before 38 weeks as theres an increased likelyhood of babies developing breathing difficulties (particularly TTN) after birth, but in your case this obvously has to be balanced against your risks of continuing pregnancy until that point. I would think that either way they would probably advise you to have the steriod injections to develop baby's lungs prior to delivery given that there's an increased possibility of pre-term delivery.
I'm sorry that it doesn't really answer your question, but there isn't a black and white textbook answer for these things, it has to be judged on an individual basis. You can call your hospital to arrange a meeting wih your obstetric consultant.
All the best x

This is all really hypothetical, but obviously a big worry for you. Have you considered you or your partner getting sterilised to minimise the worry of an unplanned pregnancy?

also if you check the guidelines on management of pre-term rupture of membranes, once you are over 34 weeks i dont think they delay delivery anymore unless its to give steroids (in which case would just be for 48 hours and you'd get antibiotics)

Not sure they would encourage elcs at 34 weeks for any reason unless the baby was distressed or in danger.... There are many other risks associated with early babies which I don't think would be worth taking. It may be less stressful for you, but not necessarily better for the baby. DS1 was born at 33+5 after a placental abruption and needed to be in neonatal for 4 weeks. I wouldn't recommend that to anyone. DS2 was full term, but I've now had 3 bleeds with DS3 and a low placenta, but they won't even consider me for cs until at least 37 weeks and will do all they can to keep the baby in there as long as possible.

Thankyou for the replies. I've started this post several times since yesterday and had to stop and deal with crying babies, fighting children etc so hopefully I will make it to the end this time. DH has been sterilized already and we use condoms but still I worry. DS4 was born at 35 weeks and was in the neonatal unit for 4 weeks. It was horrible being apart from him but he was never in danger of losing his life like DS5 was. I've been trying to get a birth debrief sorted out for DS5's birth and I think then would be a good time to address my hypothetical next birth questions.

Hmm. My ds was born at 34 weeks by cs (classed as emergency but I wasn't in labour, so more like elcs) as I had severe pre eclampsia. He was a really good weight but had respiratory distress syndrome, was in NICU on a ventilator for 5 days, had severe reflux, got aspiration pneumonia as a result and bounced back from SCBU to HDU, spent about 4 weeks in SCBU on low flow oxygen trying to learn how to breathe properly, and finally came home after 8 very long weeks.

I am not trying to frighten or scaremonger but think it would be a good idea to have a proper chat about relative risks with a consultant. It may be that they would not agree to do the cs at 34 weeks anyway. Everyone told me before I went into theatre that all 34 weekers need to do is fatten up - unfortunately I found out later that there is still plenty of risk associated with this level of prem birth and cs is also an additional risk factor for breathing problems like ds's.

Sorry just twigged this is a hypothetical question! If it's really something that keeps you up at night you may be able to access a pre conception consultant appt (I was offered one for my second pg due to disastrous first one) where you could discuss what would happen in any subsequent pg.

I wonder whether this isn't a symptom of some general anxiety issues you might have? Because if your DH has had a vasectomy AND you use condoms, and you're still hugely worried about falling pregnant, then perhaps this has more to do with the traumatic experience you had last time, and not so much to do with a real likelihood of you getting pregnant.

Thanks. I think it is all anxiety/trauma related. I just thought that if I could find out what would happen if I ever got pregnant again then I'd stop worrying about it.

Just to let you know I had an elective c section booked for 34 weeks baby was healthy pregnancy healthy but I needed surgery but it wasn't exactly life threatening but I ended up having an emergency csection at 33 +5 but if this happend again I would ask to wait till 35 for elective csection as a 34 weeker can have many problems I now know and 35 weekers do better mostly.