Elective CS or Natural?

[JlouiseR]

Hoping someone can offer me some advice! I am currently 35 weeks with my second baby boy. Due mid November and mid pandemic. I suffer with very bad anxiety among other things and I am contemplating an elective c-section.

My first birth wasn't straight forward in any sense. Planned a midwife unit let birth with just G&A however I ended up stuck at 8.5cm (transition stage and also one of the most painful stages) for over 12 hours with very strong contractions coming very close together. I didn't receive an epidural till I was 9cm and 10 hours into transition stage (one of the most terrifying experiences of my life getting it done between constant 9cm contractions) I also had involuntary pushing for about 6 hours which was exhausting.
My son ended up getting distressed and had Meconium (required additional monitoring)
My front waters didn't break so they had to assist there. They gave me the induction hormones right at the end to kick start that last cm and get him out.
I was literally minutes off an emergency c-section and was given 5 minutes for things to progress. Thankfully they did and my son arrived shortly after. He wasn't small and weighed in at over 8.5lbs
I ended up in ketosis, tachycardia, had excessive bleeding and a jagged placenta.

Overall not at all what I had planned but at least he arrived and was healthy. This time round I planned to have the birth in labour ward (rather than Midwife led) as I want the support from the beginning if I needed it.

HOWEVER,
I have my concerns about labouring naturally with my second son due in a few weeks. He was on the 97th percentile line up until I hit about 30 weeks and now he has jumped well above the 97th percentile line. I am 35 weeks and he is already estimated to be 8lbs!! Midwife said she wont offer a sweep until 41 weeks or an induction till 42 weeks. If I go to my due date he is estimated to be between 13-15lbs based on his accelerated growth?! (I cant even get my head round that).
Obviously I have my concerns about this and especially so because of my previous labour. However my midwife doesn't seem at all concerned. She believes I should try to labour naturally and "what will be will be" . She is also not giving me any growth scans due to COVID although has said several times "if covid wasn't about I would have sent you for one weeks ago" just adds annoyance more than anything.

I am questioning whether to request an elective CS due to previous complications and also the fact I could well be growing the Incredible Hulk. Although midwife doesn't seem to even acknowledge CS as an option.

Just to add I am only 5ft1 average build, my husband is 6ft 4 (not sure if it makes any difference)

Looking for some advice on what other people would do in my situation, try natural and risk complications and a possible emergency CS or try and request an elective based on previous experience?

p.s sorry for the life story ;)

I'd go elective CS - I was in a similar position with my 2nd but less excitement with my first labour, although I did have what felt like tight stitches after tearing with the ventouse I needed for 6lb 13 DC1. DC2 was measuring big, especially abdomen on serial growth scans (thanks to low pappA) and after a couple of reduced movements episodes and the next scan suggesting DC was going off the scale, the consultant offered induction 2 days later at 38+2.

Needed episiotomy and easy ventouse at 38w for an 8lb baby. He does have pretty substantial shoulders though - his chest measurement at not quite 2 is bigger than that of his 5 year old sister.

Bump measurements are notoriously inaccurate so I very much doubt baby is anywhere near as big as your GAP chart makes you look. However, I would insist on a growth scan if you have had sudden accelerated growth. You may also need blood glucose monitoring to check for gestational diabetes. This is basic care, not nice extras. If they aren’t going to act on their findings, they shouldn’t be measuring at all.

Also your first delivery sounds like it was very badly mismanaged... is this the same trust? It doesn’t sound great.

I would opt for the c section. I hope all goes well whatever you decide

@PolarBearStrength

Bump measurements are notoriously inaccurate so I very much doubt baby is anywhere near as big as your GAP chart makes you look. However, I would insist on a growth scan if you have had sudden accelerated growth. You may also need blood glucose monitoring to check for gestational diabetes. This is basic care, not nice extras. If they aren’t going to act on their findings, they shouldn’t be measuring at all.

Thanks for the reply, yeah she keeps telling me they can be way out. Doesn't help reassure me much because it was spot on to the OZ with my first son =/ but here's hoping!

Ive asked over and over for the growth scan she's just saying its not a concern to her because its accelerated growth rather than slowed. She has now agreed to send a referral for one but thinks it will be rejected (and also mentioned I wont be told if i'm getting rejected so no real way of knowing if she sent a referral or not)
She said i'm not eligible for a GTT because my BMI was okay before pregnancy and no close family has it (although grandparents do she said its not close enough).

The care this pregnancy hasn't been great. I was only seen at 18 weeks, and then not seen again until 29 weeks and then 35 weeks. Now she's having to do them 2 weekly because i'm close to full term so has no choice but to see me more.

Its all in the same trust and same hospital for that matter, so I cant say i'm hugely possitive its going to go as planned.

As it currently stands I have no additional growth scans, no GTT testing and planned to have a natural labour (as midwife doesn't think CS will be needed)

There's no way they will have his weight right I wish they would stop giving estimate weights and scaring women stuff!
Mine was 'estimated ' 7.7lb at 36 weeks so o worked out on average if I went over due she would be over 10lb
She was over due and weighed 6.12lb!!
I think due to your first experience perhaps a planned section is best

I had an emcs after a long labour first time for failure to progress for a big baby. Planned a cs second time she arrived earlier was smaller and I had a VBAC instead. In terms of recovery it was a doddle compared to the cs and I did have stitches.
In your position i would say to your midwife you want an elective cs then she has to refer you to a consultant. From there you will hopefully get a growth scan can decide how to give birth E.g. cs or try natural labour but if it stalls straight to cs or cs rather than induction, however you want.
My labour was good second time but if I were to have a third my birth plan would read more like a flow chart with a cs for the slightest issue.

Good lord, complain to someone! PALS, the pregnancy assessment unit at hospital, another midwife- someone! Say you want a second opinion and do not rest until you've got one. You need to be your own advocate here, I'm afraid. Have you had a glucose tolerance test?

As for them saying you are not having a glucose test because of your BMI, do you know anyone who has diabetes who has a finger prick test that you could do?

I'm in the same boat with a baby off the scale and the midwife totally dismissed a glucose test for me until I told her my home done blood test came out at 14.5. She had a heart attack and couldn't book me into hospital fast enough.

You can buy them on amazon even.

Thank you for the replies everyone, its a really weird situation to be in. This time round I feel like the midwife is really lovely and just trying to do her job under the current COVID restrictions. Just frustrating for me as someone with a traumatic first birth experience and then having all the uncertainty around the second.
She has said that the baby doesn't "feel big" just measuring huge =/ I am a bit concerned because when she was on the phone to the other midwife she mentioned he was above the 90th percentile line. Which was incorrect hes measuring above the 97th percentile line (by quite a bit) So I am worried its been dismissed by the ultrasound department as it doesn't sound as bad.

Regarding the referral for a growth scan, its now Friday and ive not heard anything from them so im assuming she was right in saying they would probably reject the referral =/.

@FourPlasticRings no she's not referring me for a Glucose tolerance test, she was going to and then she said because my mum/dad/brother/sister don't have it and my BMI was fine before pregnancy I don't tick the boxes/don't need one.

@footprintsintheslow thank you! I do but they live too far away so may have to order one online that's a good idea :) . Did they do the GTT? and change the care plan etc to reflect it? planned cs or early induction etc?

@Itllbeaninterestingchristmas do they always have to refer you to a consultant when you ask for an elective? Im wondering if its now getting too close to due date to go down that route? full term in 1+1/2 weeks and due a month today.

I got a GTT for measuring above, OP, despite being a normal weight. And that was after passing one earlier in pregnancy that had been triggered due to family history (aunt and grandmother). A friend of mine got sent for one for measuring above way back in May, at the height of restrictions. COVID should not be affecting routine maternity services and your midwife is letting you down here.

@FourPlasticRings Thats so frustrating =/ . My grandparents have a history of it and great grandparents but she said it had to be parents/siblings.
She wasn't going to refer at all but I think she could tell I was anxious about it so she phoned another midwife who said to send for a referral anyway and just see what they say.
I was told if I don't hear anything back within a week then its a no from them. Just seems so odd to me that there not even checking, surely its quicker/easier/less stressful for all involved to carry out a quick scan and check rather than risk possible complications further down the line

Book a private growth scan, OP, if at all possible. I used ultrasound direct for one and the sonographer also worked for the NHS. Expensive (about £90) but for peace of mind it might be worth it?

Your midwife sounds very dismissive and unhelpful. See a different one if you can. Ask for an appointment with the consultant midwife at the maternity hospital (will probably be a phone appt), your midwife should refer you if you ask and if she doesn't you should kick up a fuss.

I don't see how on earth she can estimate your baby's weight without a growth scan?! Growth scans themselves have limited accuracy (I was told only 50%) but they are the only way to estimate weight.

The other option is booking into to talk to your GP.

My glucose test is Monday so I'll let you know how it goes and what happens as a result.

I'm very concerned about the lack of glucose test.

I had GD and it was diagnosed after 1 slightly elevated sugar level in urine

Underweight BMI/no indicators etc

I would be pushing for a test

This sounds really concerning. I’m the same stage as you and have had 6 appts so far. I would agree with someone who posted above, pay for a private scan, I also found ultrasound direct VeRY professional and using NHS scanners only. I’d also send off to amazon for the blood sugar test kit and test myself. It does sound like your midwife is under a lot of pressure, it’s left so many women having to advocate for themselves these last months. In terms of the birth, of also be considering asking for an elcs. That sounds so traumatic. I have friends who has similar situations and we’re allowed sections after discussing with the consultant. You may just have to be super pushy but if you’ve got evidence of size from the growth scan and evidence of glucose tolerance from home testing, those should help support your case. Wish you so much luck x

There's nothing stopping you OP saying that you've done a home test with a higher result to push them to give you a test. 😈

I've not been in your exact situation, but I did have a similar experience in that I was told to expect a 14lb baby. This was due to growth scans but did seem entirely plausible given I was a 12lb baby myself.

In the end my son was 10lb at 39 weeks. I went for the section. Thankfully they agreed to this due to family history of massive babies. You should definitely ask if this is what you would prefer. I am so grateful for the elective section because he would have got stuck (also ended up being breech)

Yes the request for a cs has to be referred to a consultant.

Thanks again all, ive had to have a couple of extra triage visits for reduced movements etc. So thankfully they checked blood pressure etc there but there was still a break of about 10+ weeks a couple of times. Was halfway through before I met my midwife, a mixture of covid and her annual leave/not seeing my messages/calls etc has meant it feels like few and far between. She did tell me that with second pregnancies they see you less. Ive gotten used to that now.

My next appointment isn't until 37+2, so im going to have to mention an elective then and see what she says closer to the time. Hopefully I wont get the same "we have a good few weeks left yet" discussion. I don't want to leave everything till last minute as sometimes these babies can have a mind of their own for their chosen birthday!

My main concern is that they aren't checking WHY the baby is measuring so big. I wasn't a big baby, despite my husband being a giant he wasn't a big baby either, Im only 5ft 1.
And I think the fact that she hasn't mentioned c-section once really confuses me, I understand the want for a natural birth (It would be my preferred method) but if there are possible complications that could arise I feel like it should be discussed so im at least prepared for it. I would much rather go in clued up than completely In the dark not expecting it because she's so sure ill labour ok and then be told ill need an EMCS because it stalls again.

I have done some home glucose tests, they don't seem the most reliable because the readings vary so much (when testing a couple of times at the same time to get an accurate reading). But from what I can tell its within the realms of normal I think.

Never got a phone call from the Scan department so they clearly didn't deem it to be essential to check babies size despite accelerated growth and must have rejected the referral. My first son had restricted growth (turned out to just be a shorty like his mum haha) but still I was sent for a growth scan at first sign something was off and he came out over 8.5lbs in the end.

@NameChange30 she's based this on fundal height, it was really consistent on the 97th line and then spiked at 30 weeks to well above 97th. Then its calculated into weight, so as of last week he was estimated to be 8lbs at 35 weeks based on fundal (which I know can be well and truly off, but was spot on with my last son =/ ) . and to give an idea of how accelerated his growth is, hes putting on about 1lb a week based on measurements.

I have my 37 week appointment on the 27th so im going to have to see what she says then about it all. I keep getting told its okay I wont make a baby bigger than I can push out. But im not so sure!!

@JlouiseR I've had the diabetes test and it's come back all clear, no diabetes. So just a randomly big baby for me.

Any news with you?

@footprintsintheslow that's great news on the GD test!! nothing new here. I did a home blood test and it was bordering low if anything so I think its okay. I have a 37 week appointment next week so just trying to come up with questions I want answers to at the moment.

Think i'm going to really push a sweep for 40 weeks. Midwife has said 41 and no earlier because its my second (they do 40 weeks with first) . I don't see why they don't want to, especially if he's big, surely it benefits them to get him out as close to the due date and reduce need for CS but we'll see =/ .
Also never heard anything from the Growth scan referral so that's a definite no to that, which is really frustrating.
When are you due :) ?

Hi OP I had a very traumatic first birth and went for an elective section with my second for that reason. When the consultant for my 2nd reviewed my notes she also advised a section based on it being psychologically better for me but also could foresee I would have similar issues again (shoulder dystocia) due to my build/pelvis. Personally I found recovery from my ELCS a breeze compared to a 3 day back to back labour, episiotomy, SD and forceps. Having a positive experience was also very healing. With regards to Bump measurements I was off the charts And had accelerated growth so had 2gestational diabetes tests and growth scans. Based on bump measurements I was having a giant, growth scan suggested a 90th centile baby, she arrived via ELCS at 39 weeks 7lb just below the 50th. You would be well within your rights to request a second opinion if you feel policies are not being followed.

@Itsalwayssunnyupnorth thank you for sharing your experience! That sounds so eventful! but nice to hear a positive outcome from an elective.

Unfortunately I wouldn't know where to start with a second opinion, my midwife contacted another (whilst I was there at an appointment) that midwife suggested referring for the growth scan so my midwife did. However it appears to be the scan department that has refused it based on Covid =/ . My midwife said she would send the growth scan referral and if I didn't hear from them within a week then they have rejected it.
I will get measured again next week and see where he's predicted to be at now.
At 35weeks he was estimated to be 8lbs off of fundal height and well over the 97th percentile line with an average gain of 1lb a week. So I think if he's measuring near the 10lb mark at 37 (where hes predicted if he continues on this curve) then im seriously considering mentioning a CS.

I was really against a CS for my first and wanted to avoid it at all costs but the closer and closer I get to my due date with this one and the bigger his size appears to be the more i'm starting to come round to it. It was mainly the 3-4 day hospital stay that has put me off (I HATE hospitals) and had a terrible time on the post natal ward last time (actually pretty sure if was one of the starting triggers for my PND).