Anyone successful scheduling a CSection for 38 Weeks?

[MissingCoffeeandWine]

HI all, hoping you can help me. I’m 22 weeks pregnant, due (my second) late May 2021. I had a consultants appointment this morning that I found hard, she was rushed and didn’t listen to any of my questions/worries.

I had my daughter in December 2019. My waters broke naturally at 37 weeks, 3+ days of labour, failed induction, EMCS asI failed to dilate past 7cm. Midwives supporting me felt it was an “odd presentation” and connected it (potentially) to scar tissue failing to stretch (I’ve had lots of previous cervical treatment for CIN cells). It made me sad, but made sense to me. Baba was born safely, but needed time in NICU un-expectedly.

This time around, I was considering an ELCS. The consultant pushed hard for VBAC. I was told that they will not schedule an ELCS prior to 39 weeks at all. I understand that it is better for baby, but have a family history of late loss (including babies born sleeping at term) and of preterm labour. With my previous pregnancy, they wanted to induce me at 38 weeks and didn’t want me going any further (different hospital but they were insistent, hence I was induced). I had a sweep at 37 weeks! So I am totally confused as to why barely a year later, they are now saying its safer to wait and (likely) be an emergency patient?

I’m so confused. I know its better for pregnancies to be as close to due as possible, but how come I needed a plan to deliver early last time, but not this time? When if anything, its now confirmed, that I am likely to give birth prior to 39 weeks. Why would they prefer me to be an emergency, than a planned section? It makes no sense to me to wait - given my particular circumstances.

I asked and just got old “thats not how we do it”.

From reading NICE guidelines - it seems I can request that a date be scheduled at 38 weeks. Has anyone achieved this? Who did you have to involve?

So much about the whole process doesn't make sense!

My ELCS was at 38+6. This was because the consultant preferred to do CSs on a Thursday and she didn't want me going to 39+6. I should add this was NHS, not private.

It's honestly bizarre how some consultants explain themselves. Frankly, getting the guidelines adhered to with electives seems to be a combination of fighting for a sensible outcome and pot luck.

Thanks @DuggeeHugs at least I know it’s not just me that can’t make sense of it! Luckily I have time on my side to arm myself up to do battle 🤞

I have cared for many, many babies born at 37-38 weeks often by c-section who ended up unexpectedly in SCBU (as seems happened with your first pregnancy). The evidence is overwhelming that babies do best if delivered at 39 weeks. If I were your consultant I would also be encouraging you to have a V-BAC and if not then suggest a date at 39 weeks. If you do go into labour before that this will help your baby even if you end up with a C-Section in the end.

I was told that the risk of SCBU admission after a CS at 38 weeks is 6%, whereas it drops to 1% at 39 weeks. Are you sure the consultant had read your notes? Because what she said would make sense if it weren't for your family history. You've still got aaaaages as well, though I understand you wanting some clarity.

www.ncbi.nlm.nih.gov/pmc/articles/PMC6957045/

bmjopen.bmj.com/content/10/3/e033154

I had an elective c section at bob on 38 weeks. I just kept on saying that I understood the risks and felt on balance that the benefits far outweighed them and I wanted a c section. I'd had a late loss the previous year and the subsequent pregnancy was very difficult both physically and mentally, I had reached my limit and 38 weeks was as far as I was prepared to go, mostly to preserve my mental health which was flagging by that point. The thought of a spontaneous labour filled me with dread.

I stood my ground, I got the date set, DD was and is absolutely fine, no issues, no stay in SCBU, she's a very rambunctious 4 year old now.

You have a way to go yet, they may not want to discuss it till 35 weeks or so but if it's what you want I would make sure they know it and give yourself time to get referred to another consultant if needs be.

4 sections. 1st emergency 2nd booked at 38 weeks as was 3rd. Last one at 39 weeks

I had my last c section at 37 weeks. It was elective and because I didn’t want to stay pregnant longer. I had steroids and the consultant (NHS) was quite happy to deliver then.

Sorry for the brevity I was serving tea. However my children are adults now. The 2 born at 38 weeks were booked in because that was the guidelines then in early 2000s. My youngest was born a few years later at 39 weeks because evidence dictated that it is safer. When I had my eldest, they delivered the lady opposite me at 38 weeks. Her baby ended up in scbu due to breathing difficulties. After a couple of days they decided she was acting more like a 36 weeker. If your baby is delivered at 39 weeks, issues such as these are far less likely

Thanks all. I do thoroughly understand the advantages for baby of being 39 weeks. It’s just that I am incredibly unlikely to make it that far.

And am confused as to why - given that it was decided my family history in my last pregnancy meant I was given a maximum induction date of 38 weeks (they wanted 37, I pushed for longer and was on daily monitoring at that point). I tried to be kept on a medication free pathway - did 40+ hours of labour without any pain relief, and ended up with a very much unwanted but necessary EMCS.

Hence my confusion. As it feels like this time I am saying “ok, I’ll try it your way” and now they've changed their tune. Telling me it could be later. And encouraging VBAC. Surely the risks from last time haven’t just vanished? And if they have, I’d love that to be explained to me.

Especially as my baby had extra monitoring and to all extents appeared fine, and still needed support when born.

I’m generally quite calm in pregnancy, but can’t imagine that I’d be anything but anxious, without understanding Why the recommendations seem to have changed so much in 12 months.

As someone said - I’ve lots of time luckily to chat to the team. I did try to ask questions: but got told “every pregnancy is different” and while I understand that, it’s not exactly reassuring.

In ideal circumstances I’d 100% wait as long as possible, but in my specific case, I’m just not sure it’s probable.

Really naive here but what is the evidence to support VBAC over ELCS? Genuine question, benefits to mum?baby? Etc? Why is bag birth pushed so much over section? Sorry may be jumping on your thread there

Bag birth = vag birth 😆

@Notthissticky

I was told that the risk of SCBU admission after a CS at 38 weeks is 6%, whereas it drops to 1% at 39 weeks. Are you sure the consultant had read your notes? Because what she said would make sense if it weren't for your family history. You've still got aaaaages as well, though I understand you wanting some clarity.

@Notthissticky Thanks for this. I did direct her to it, but perhaps it’s too early for her to have access to my full history. I’ve only had a phone booking appointment so far. And it’s a different hospital to last time. So could we’ll just be a lack of information. It was a 7-10 minute appointment, which is possibly why I felt so hurried!

@SnowFields and @DeadButDelicious
thank you. Glad your LO’s are safe and that you both felt heard.

In my trust, although they encourage getting to 39 weeks, they balance the mental health of the mother against other factors, so worth highlighting if you feel you wouldn't cope from that point of view being left any longer.

I would recommend asking for a VBAC or Birth Choices clinic appointment - there a midwife will talk you through all the risks and benefits and look at your history.

When I was pregnant with twins and had severe tokophobia which caused debilitating anxiety, I found consultants absolutely useless and would not even entertain discussion of a c section. I literally had to take my DH to my 32 week appointment and have him insist that we weren’t leaving until they agreed. As it happens those same consultants had also overlooked some serious findings on my last two ultrasounds and I ended up with an EMCS at 35+1

If you do want an ELCS and that’s your decision, whenever you go into labour the CS should then be done. And while it wouldn’t be a scheduled section, it wouldn’t be like an emergency section after a 40 hour labour either. So if a CS is what you decide, you can still have it even if you go into labour before it’s booked.

@SlB09 jump away! I’m NO expert. I will say that honestly, I didn’t hate the labour process. I wouldn’t do it for fun, but the contractions felt purposeful and for me, the pain manageable (but I know it’s very individual). It’s just that it didn’t work for me. They threw the whole shebang at me (to avoid Surgery as I have serious medication allergies) and nothing improved - in fact, induction stalled the progress I had been making. And for me - the underlying reasons for the (probable) failure to dilate that are still there (cervical scaring). So it doesn’t seem a logical choice to try again.

I actually hated the recovery from CSection, not being able to lift my baby (and this time I’ll have a 16 month old too), healing slowly etc.

BUT I also get that it’s so different for different women. My dream was a pool birth last time 😂 was deemed too “high risk”.

I’m sure others have far more of a scientific explanation than I do, but I know something that worries me about C Sections is that you are not advised to have too many of them, or have them too close together- because it is major surgery and tough to recover from.

Hence my particular confusion this time being told something completely different than what I had expected!

A baby born by a vaginal birth at 38 weeks is less likely to have respiratory issues and need support in scbu than a baby born by lscs at 39 weeks. It’s to do with vaginal birth, being squeezed through the birth canal helping to activate surfactant production as well as the mechanical part of squeezing fluid. Section babies are generally more mucosy.

So if medical reasons dictate they will schedule an induction for 38 weeks but might feel the risks outweigh the benefit for a lscs at that gestation. Of course if they felt it was indicated they would do a lscs at 38 weeks or even earlier.

If you go into labour first then they will do the lscs then. If you start with contractions you ring up and tell them you’re an el lscs and they will do it. Just because technically it’s now an emergency lscs doesn’t mean it’s danger and drama, etc. There will be time to do it safely and calmly.

@SinkGirl thanks. That’s what I thought I was going to this appointment! My trust notes say they do Birth Choice Appointments at 22 weeks. I asked to be referred today and was told the first appointment is April. But will chase again and hopefully get a date sooner! Good to know you found to helpful. Sorry your experiences were so tough x

@Covidcovid thanks. That actually makes a lot of sense.

@Covidcovid thanks yes that makes a while lot of sense - is that the main reason for baby?

[quote SlB09]@Covidcovid thanks yes that makes a while lot of sense - is that the main reason for baby?[/quote]
Yes absolutely. It’s the reason why nice guidelines changed to saying electives from 39 weeks onwards unless a medical need. The risk is small but it’s there and it’s unlikely any obstetrician would schedule a lscs for 38 weeks unless necessary. If that baby happened to be one of the unfortunate ones the hospital would have their arse sued. And obviously the devastation to the family.

I managed it in 2014, but it was not straightforward. First child was an emergency induction at 38weeks, followed by general surgery and 9 days in hospital (because of me, not the baby). For the second my consultant offered me an elective csection, but I still had to talk to a midwife counsellor (the most useless experience of my life as she had never heard of the thing that I had been diagnosed with, and as I had requested and read a full copy of my notes I knew more than she did (she didnt even gave my notes)). C section was originally scheduled for 39 weeks, but due to public holidays and days that my hospital did scheduled csections it was only going to be closer to 41weeks, I fought it, and was c sectioned at 38weeks (2 doses of steroid injections). All ended well, was only in hospital overnight!

My twins were born at 36+5 via CS- mine was scheduled for 37+1 (recommendation for twins is 37-38 weeks)but I went into early labour. We had no SCBU stay but they did need heated cots and we had feeding issues as they were so sleepy and wouldn’t latch. Lots of weight loss after birth and they’re only really catching up now on their charts. I was told we were very very lucky to escape special care. If I could, I would keep them in as long as possible.