Can I insist on this at 38 weeks

[fizzingmum]

Hi all, after some advice. A bit long as I don't want to drip feed. I'm 39 years old and 36 weeks pregnant. I am under consultant due to my age. On first appointment she quite casually mentioned the high risk associated with my age group if I go over 38 weeks. She suggested I go home and google it to get more information and then decide if I would like to be induced at 38 weeks. I was at how blasé she was and proceeded to terrify myself with horror stories and statistics of still birth etc. I decided that I would go with her advice of being induced at 38 weeks. I arranged for my children to stay with their Dad for a week at 38 weeks, dog in kennels etc so I can be induced with no worries. So my last appointment at 34 weeks she asked if I had googled it ( again) and I said yes let's go for induction at 38 weeks. And she says, sorry I wasn't clear but we don't induce until your actual due date. As the dating scan can be out by up to 2 weeks and we wouldn't To induce at 36 weeks!! So after putting the fear of God into me about what can happen in those last 2 weeks at my age, she wouldn't book any earlier than 40 weeks. Which by her reckoning could also be 42 weeks. I was so upset, and practically I can't change the plans for my other children. EXP has to give lots of notice to have the week off and cannot change it now. Dog isn't a problem to change. I will really struggle with what to do with children now as I don't have any family support. On top of all this I now discover (but only after reading my notes as no one has told me) that baby is breach. This makes sense as baby feels so different to my other two pregnancies. So this could potentially mean a CS.
I am seeing a midwife on Wednesday. Can I insist on booking induction/CS at 38 weeks for both health and practical reasons? I am feeling very anxious about it all and need some courage to stand my ground. Thanks if you got this far and for any advice.

Id be requesting a change in consultant in all honesty! I'm getting induced at 37+4 as I have severe PGP and for social reasons, so me and DH can arrange proper care of DS who has autism. My consultant arranged this at 28 weeks for me
They should happily induce at 38 weeks (you'll have people here telling you otherwise) you have valid concerns, especially considering what you were told so early on. I'd be requesting one on social and personal grounds.
Midwives themselves can be a bit iffy with inductions/sections (maybe that's just mine!) if you have no joy with her, I'd ring to see another consultant if possible.
Congratulations on the pregnancy though! Try not to panic, and try to remember that medical professionals won't ever put you or baby at risk

100% ask for a section! And good luck!

You can request a c-section, but it's very unlikely they'll book you in before 39 weeks unless there is a reason to get the baby out early. My daughter had health issues in utero and the earliest date I was given was 38w4d. But it is still worth asking of course.

I think you will have a better chance of pushing for an induction from 38 weeks onwards, given your circumstances and what you have been led to believe.

The key to getting what you want is to be confident and really push for it. Ask for a second opinion with a different consultant, and get your argument written down on paper, so you know exactly what to say.

I know nothing about breach but I did have an induction.

I'm surprised you want an induction with breach, wouldn't you want to give the baby a chance to turn?

I had an induction. It was tough going. I can't imagine adding breach to the process.

But as I said I know nothing about breach, maybe that's what people do?!

Contact the supervisor of midwives, talk about your concerns with her. She should help you set up a plan of action for your circumstances.

Hi blink owl! Induction is booked based on her turning before 40 weeks. (tbh not sure if the consultant even read the notes from scan saying baby was breach as she never mentioned it). I am seeing midwife tomorrow and if still breach would like CS at 38. If she has turned induction at 38. My midwife is great. I should say I haven't seen my assigned consultant in person, the woman was her registrar. I would have thought her to be qualified though.

C section babies are at risk of TTN and associated complications, most of which are minimised by having delivery by CS no earlier than 39 weeks ( I had my baby at 39 weeks and he had TTN and then a pneumothorax, and what gave him a good outcome in the end was the fact he had not been delivered even a day earlier.) Obviously many babies are born pre 39 weeks and are ok but (unfortunately like so much in pregnancy and birth) it is a gamble, and unless you go into labour before then, I cannot imagine why you would take that risk and I doubt you'll find a consultant who will agree anyway tbh. In my case, my section had originally been booked for 39+1 but, two days prior, they moved it forward a day to ease some scheduling issues as they were a theatre down. We will never know whether that extra day in utero could have saved my child from a week in NICU, and scars all over his chest from the chest drains he had to have in place to save his life, but the hospital obviously realised the significance, and there was an investigation into my dates and why they had moved the section forward - my consultant said had I been 38+6 they would have been in big trouble for bringing my procedure forward into that week.
I appreciate my view on this is hugely coloured by my own experience of being a parent of one of the 1.5% of children who has these problems after elcs and I do not wish to add to your anxiety around statistics, as I also appreciate your concerns about still birth in older mothers (I had my son at 40 btw and had he not been breech, I would have had a vaginal delivery with indiction if I went past 40 weeks. 39/40 is def at the lower end of what they consider old now). However I do think you need to consider the risks in the round, which includes the very real risk of having your baby too early just to minimise a far smaller risk.
I understand how vexing this must be for you but, if I was you, I would plan for elcs or induction at 39w onwards and look into alternative childcare arrangements for the following week (there are numerous agencies who will provide nannies if family cannot help). If you are anxious, you can ask for growth scans in the last weeks, to check that the placenta and cord are still functioning well. I hope you get a plan together soon

My understanding was that the lungs only develop properly in the last few weeks before birth. So if you kick the baby out before it's ready you risk the lungs not being fully developed and then the baby will need to be in special care. My DC were born very late and still very small. They'd definitely have ended up in nicu if born at 39 weeks as wouldnt have been ready and would have been very small. I understand how annoying it must be but I would make alternative childcare arrangements.

I am having my first baby at age 42. 32 weeks at the moment. All they have said to me is that they would not want me to go over 40 weeks but no actual plan has been suggested yet. I am bemused as to why you would not have known the baby was breech- at ever single midwife appointment and at my fortnightly growth scans (precautionary only, just due to age) the midwife or sonographer has talked in great detail about the baby's position. In fact there's not usually a whole lot else to talk about. I can't imagine a sonographer would observe a breech baby and not tell you. Apart from anything else they would be wanting you to tell the midwife at your next appt (as well as putting it in your notes of course).

The evidence has been reviewed recently and they know much more about the possible negative effects on breathing of being born at 38 weeks as opposed to 40 weeks (they used to assume no difference). Dd and ds (4 and 2) were both induced at 38 weeks because I am diabetic but for this pregnancy they won't induce before 39 because it's safer.

You're absolutely not going to get a c-section at 38 weeks, unless there is a dire medical need to remove the baby early. Your best bet is asking for one, and agreeing to the date that they give you, which will almost certainly be at 39 weeks +.

Jessie - breach has never been mentioned once. Had I not Seen it on my notes I would not have any clue. I saw my midwife this week and mentioned it. She said it wouldn't have been mentioned as there was plenty of time for baby to move. I feel completely uninformed and in the dark. She told me on Wednesday that I needed a scan to check current position as she couldn't tell. Told I would be phoned and go in by the end of the week. I've heard nothing so continue to feel frustrated, scared and in pain. The sciatica is so bad now that I can barely walk. I will be 37 weeks on Monday and really don't know how I can do another 2-3 weeks like this. This is my 3rd child so I am not new to this. But this is so much worse than my earlier pregnancies.

I have a chronic pain condition, at my last appointment the consultant offered to move my ELCS to 38 weeks. This is due to my pain levels increasing and my mobility decreasing, potentially meaning I would need to start in blood thinners, though the baby's growth has also started to slow a bit, so it is a combination of both.

There is a risk with the lungs not being developed enough, but steroids can help that

I'm amazed they haven't mentioned an ECV. I thought it was normal practice at 36 weeks to offer an ecv for anyone who is breech.

You will not get a section prior to 39 weeks. I really don't think you'd get an induction at 38 weeks. Having an induction decreases your chance of a vaginal birth and as you have an increased chance of ending up with a section again I don't think they will induce at 38 weeks.

Why would you have made all those plans for 38 weeks when babies are due 40+ weeks?

Simon, they have not even mentioned breach. I read it in my notes and has to bring it up. Midwife had a feel and said she wasn't sure so is sending me for a scan that I am still waiting on. . However I would not have ECV if offered as the risks seem to outweigh any benefit IMO.
Artandco - I arranged for 38 weeks as at my first appointment with consultant she said that is when they would induce me as high risk of still birth if I go past 38 weeks at my age. She told me to google it! It was only when I went back and said yes to induction at 38 weeks that she explained that although she said 38 weeks As the dating scan would be out by up to 2 weeks they wouldn't actually book induction until 40 weeks. She put the fear of God in me about still birth and brain damage for my baby after 38 weeks only to say she hadn't explained herself
Properly. And by her logic I could also be as far as 42 weeks if daring scan is out.