Fibroid + C-Section versus Natural Birth

[FLYMO]

I'm not sure whether to post this on childbirth or pregnancy - so I'm going to post on both! I wondered if anybody could share their experiences on vaginal birth versus c-section, with a fibroid? I have one (over 10cm) on the anterior wall. At the 20 week scan they said it wasn't blocking the cervix, so shouldn't cause a problem, but I have a scan booked for 36 weeks (I'm now 32), to determine where the baby is in relation to the fibroid, and whether I will need to have a c-section as a result. My main concern is that I don't want to try for a natural birth, and then end up with an emergency c-section (for whatever reason), largely because I think(?) c-sections with fibroid can be more dangerous? I don't really understand how it works (this is my first) but say an emergency c-section was needed in the middle of the night who would be available to do this!!? And how would they know where the fibroid is etc etc? I think I am being quite paranoid about this and it's probably nothing to worry about at all - but I'm just wondering what I need to ask the consultant at the 36 week scan! Thanks in advance for any info!

I can't help on the fibroid question - though a friend of mine had to have CSs due to fibroids - but for emergency CS they do have a fully staffed surgery ready and waiting all the time. I was rushed in at 3.30 am, and remember asking the 11 people all gowned up and waiting for me there if they had all been kept in a cupboard just in case they were needed (got to love the painkilling drugs!). Fortunately they didn't take this personally, and all went well for me and DD.

I had two fibroids and this was my concern aswell. I had a scan at 38 weeks to allocate exactly where the fibroid was situated. I decided to have a natural birth but my waters broke and it was normal procedure to wait 96 hours, still nothing happened and a top consultant talked me through my options which were induction/epidural or a elective CS. I didn't want to risk an emergency CS because if the fibroids get accidently cut there is a risk of high blood loss and poss hysterectomy. And as this consultant said he would do it (He is Camilla Parker Bowles doctor) I agreed especially as I was particularly anxious.

You are right to be concerned as some of the consultants I had seen previously had very little knowledge of fibroids.

Thanks for your answers!

Yogimum - just to be clear (think I'm being a bit slow today) you opted for an elective CS? I am wondering whether just to push for that, almost regardless of where the fibroid is, as I too have heard horror stories about surgeons not being sufficiently aware of the fibroid, and doing exactly that, cutting through. I guess I've got a few weeks to decide though ....

I really wanted a natural birth but then was booked in for an elective cs though I felt it was a bit out of my hands really. I then went to see another consultant(not at my hospital) who said if I really wanted a natural birth that would be fine. I was all geared up for it but my waters broke and nothing happened so I was advised not to wait any longer and they wanted to induce me but as the consultant (who I really trusted) gave me the option of cs I decided to go with that instead which happened the same day. Hope that makes sense.

Flymo, I have had 2 c-sections due to fibroids. The first one was a very traumatic emergency one after a long labour, when the baby got stuck behind a fibroid which hadn't been spotted on the scans. My second was an elective c-section by choice - I was given the option of trying for a natural birth but wasn't going to risk going through my first experience again. The doctors "couldn't really say" whether my fibroids would obstruct a vaginal birth but thought it was "worth a shot", but I disagreed.

I can't really advise you on which option is best for you, because fibroids can be irrelevant to natural childbirth, if they are small enough and well-situated enough. On the other hand, if they are in the wrong position they can make it physically impossible.

You - and the doctors - may not know which category you fall into. The problem is that scans don't give the whole story, because they are only a two dimensional view, seen only from the front, and once the baby is a certain size it will block a lot of the view anyway. This is why the scans in my first pregnancy didn't pick up my fibroids - they were on the back wall, hidden behind the baby. Also, fibroids usually grow during pregnancy because they feed off pregnancy hormones, so even if they are small at the beginning of your pregnancy they can be large by the end.

How much information do you have on the size and position of your fibroid? When did you get this information (before your pregnancy or during it)? Have you had any other types of scan done on it (normally only possible before you are pregnant)?

Hi Yogimum - yes that makes perfect sense now! Thanks!

Tuttifrutti - it's on the anterior (front?) wall and at the last scan was about 10cmx8cm, I think. It was first identified at the 20 week scan although you could feel it on the outside by then. I guess it's good news in the sense that they have identified it already - but I think it's grown more as the midwife can now feel it in a completely different place to where it was originally, if you see what I mean. I don't think it's actually blocking the exit route (or at least it wasn't at the 20 week scan). I suppose I'm most worried about whether in an emergency situation all medical people concerned would be sufficiently aware of what it was, where, and what to do! The registrar who the midwife had asked to arrange the scan thought the fibroid was the baby and asked me what I was doing there! I just don't want to have to explain it when I'm totally out of it or in bad pain! Although my DH will be there - so I guess I can make sure he is fully briefed!

Are ultrasounds not done as a routine before an emergency c-section to check what is going on before they dive in? Maybe not, but I would have thought it was a sensible precaution and they don't take that long to do.

Also bear in mind where the fibroid is on front wall - if low down you may need a vertical incision rather than the more usual transverse bikini cut to avoid the fibroid. I assume all emergency c-section surgeons can perform this type of cut but as it is unusual maybe it would be better to elect if you knew this would be the type of cut you would need. I am having this one cos of fibroids in the wrong place & have been told I'll be having one of the "top" surgeons, whatever that means!

We also discussed the type of cut as one of my fibroids was quite low down though in the end I had the horizontal cut. Funny how much you forget. However I do remember that they were causing me lots of problems as was in and out of hospital with the pain from them and they grew to the sizes of oranges. I never knew I had them until I had my first scan as I was measuring big for dates (midwife told me it could be twins but I am in my forties so maybe more common.

I've just been searching for posts about fibroids, I'm currently only 10 weeks pregnant but have had at least one fibroid identified. It's currently the same size as the baby. I knew it was there before I got pregnant and has grown a lot during the pregnancy so far.

I was wondering (if this gets seen). I'd love to know how your birth went x