Would a Caesarian be safer??

[Rose138]

Hi everyone,

I'm expecting my second baby. 22 weeks now. My midwife last week said by bump measurement is larger than what is expected at this point and when she felt my stomach she said 'that's a big baby'. I've got to have another scan at 28 weeks.

Members of my family have started to comment about whether it would be safer for me to have a Caesarian- due to the difficulties I had having my first child- induced, he got stuck, I had a PPH of 1600ml and therefore had a blood transfusion. Midwives commented that him becoming stuck and my PPH could have been because he was what they consider a baby with a 'big' birth weight.

This has just got me thinking- when is a decision made for a planned Caesarian? Would they base this on the size of the baby- they may believe baby is big but can they be sure? No one commented on my son being a big baby until he was born. Has anyone requested a Caesarian due to your own concerns (I don't know if you can request one)?

Thank you so much in advance

Mostly this is a conversation you need to be having with your midwife in the first instance. Growth scans and measurements are not always reliable (within 3 days at 30 weeks I had a fundal height measurement above the 90th percentile and a growth scan on the 10th percentile), but on the basis of your history and current concerns my approach would be to write a list of questions to go through with your midwife. Once you have her answers you should have a cleared idea of whether your labour will be managed any differently this time and whether she feels a CS is worth considering.

In general, depending on the circumstances, a decision for a CS seems to be in the second/early third trimester. A consultant needs to approve an ELCS so your midwife would need to refer you if you decided to go down that route. The NICE guidelines state that maternal request is a valid reason for a CS and one should be granted if requested.

Thank you Duggeehugs.

I am under a consultant due to my previous PPH but my midwife said I am not likely to see the consultant until about 36 weeks.

I wasn't aware of those guidelines so that's really helpful, thank you.

I don't know why but the thought of a Caesarian really scares me so definitely a lot to think about and I like your suggestion about the questions, thank you.xx

Birth choice is a very personal thing - most women probably have a preference one way or the other but the reasons will be vastly different. Each method carries risk so it very much depends which risks are more acceptable/appropriate for you. At the moment it sounds like your preference is VB. If your midwife and consultant agree this is safest then hopefully all will be well

The guidance I mentioned is 1.2.9 here: www.nice.org.uk/guidance/cg132/chapter/1-Guidance#planned-cs
Useful to read through so you know the process while considering your options.

Some women deliver big babies easily, others deliver small babies with difficulty - it's true that obstetricians should discuss the increased risk of shoulder dystocia (I'm guessing this is what you mean by "got stuck"?) when babies are estimated at 4.5kg or above but the best indicator is how you delivered your last baby.

The PPH itself wouldn't be a reason to go for CS - you tend to bleed more during a caesarean. But if it was a significant shoulder dystocia, you are at increased risk of it happening again and if this baby feels bigger, a CS is something that should at least be discussed, particularly if you found it traumatic.

Given that 36 weeks is generally when CS's need to be booked, this gives you no time at all to think about it after a discussion - IMHO you need to see your consultant ASAP to talk this through.

Thank you Duggeehugs!

Doctormonty, thank you for your reply. You are completely right. I had a perfect pregnancy but then it all went wrong at the birth lol. He was 9.8 and yes I found it all very traumatic- struggled with it for quite a while after. I know that sounds silly. I thought that too about 36 weeks being a little late! My midwife last week said that she would chase the consultant to be in contact with me so hopefully will be sooner! xx