Help, 37+ weeks sudden change of birth plan

[Londonrungirl]

Hi everyone,

Recognise this is a decision no one can make for me but wanted to get some input from those who have been in a similar position and maybe some ideas for next steps.

All through my pregnancy I was told I might need a c-section due to a 10cm fibroid near cervix. At 30 weeks consultant said definitively that in her view as fibroid in cervix and so large vaginal birth would be impossible and therefore we should book elcs at 37 weeks (for 39-40 weeks). I questioned this as at the time my preference was vaginal unless there was a good reason not to. Fast forward to today (37+2) at my consultant booking meeting and the fibroid has completely shifted and moved high up and out the way - consultant was shocked but not apologetic and I feel like I’ve been messed around.

She said I still have a choice for an elcs but it would now be maternal request and I could try vaginal birth if I want. On top of this they seem very booked up for sections in the next two weeks so I’m waiting for a call back to book me in at 38/39 weeks.

I felt very blindsided in the appointment and didn’t have time to think it through, have done no birth prep and although I’m a well researched person haven’t chatted through birth plan or anything similar with midwives. I’ve also had three nights of severe Braxton / hicks labour pains which have made me worried I’m going into labour ahead of due date.

Labour route:

• Would have to be obstetrican led due to risk of bleeding, cannula in hand for emergency access.
• Originally I would have wanted to try water birth / gas and air / hypnobirthing so this feels a little way away from that although I’m open to pain relief and epidurals etc but it feels far removed from optimum especially as I’ve done no prep
• still the chance the fibroid could negatively impact contractions / result in complications and an EMCS

EMSC

• high chance of bleeding too but more at the end not during as the fibroid is posterior so they won’t cut into it as such
• affects future pregnancies / longer tough recovery

In a rush we sort of agreed if I went into labour before my section I would give it a chance to see how it progresses but this scares me because as I understand it if it’s not going well and you need forceps etc it’s normally too late for a section. This would essentially mean I wouldn’t run the risk of induction and essentially give it a chance to go either way - but depending on the date they give me it will sway the likelihood of this happening.

I also can’t get it out of my head that I now have the chance for a “normal” birth which is something I wanted all along - although I understand how unpredictable this is.

For those that have made it this far - thank you

First off, you can do this (if you decide to, or if things progress out of your control).

Secondly, for birth preparation, I really strongly recommend the Sarah Lavonne Youtube channel. She is a qualified maternity nurse from the US and she is really good at explaining exactly what happens at each stage of birth (not just what the baby is doing, what everyone is doing). She also has a really good understanding of the emotional journey of labour and has videos on preparing for a C-section.

I found her videos more helpful than antenatal classes as she's got the medical understanding of what is happening, doesn't peddle wishy washy woo nonsense, and focuses all her videos on supporting the woman with what she wants to do (unlike a lot of other birth/doula Youtubers who tend to be very anti-interventions which is useless for those of us who need them).

I had a last-minute VBAC after being told that I had to have a repeat CS, and it was a really good experience (my first CS was traumatic and I really wanted a vaginal birth with DC2) but I wished they'd told me earlier that the CS wasn't a definite because I spent a lot of the third trimester stressing about having another unwanted invasive operation.

Be prepared to advocate for yourself and be clear in your decisions and communicate them very clearly to the midwives whichever birth you have. It's good practice for when the baby is here and you need to set firm-but-kind boundaries with people (and with the baby once they're a toddler).

OP I had a similar potential last minute change to birth plan. DD was breech, flipped at 37wk and they took the ELCS off the table. Explained to them that CS was still the plan as I had settled my mind on this. Fortunately DD decided to flip breech again 2 days prior to CS so it became a moot point.

Don't let them push you into anything you aren't comfortable with. FWIW I had / have a fibroid lurking around my cervix which did move however consultant was concerned about haemorrhaging as they can be quite 'bleedy'. Now on the list to get it excised they couldn't do it during CS due to the potential for even more blood loss, I lost 1.5l during my CS.

Wow that is a lot for you to process.

Have you got a birth planning appointment with your midwife too?

If you are considering a vaginal delivery, realistically there’s not that much you can actually do to prepare for labour, so don’t feel disadvantaged that you’ve missed out on prep time. I found it useful to understand the “up” stage and “down” stages of labour (many YouTube vidoes on stages of labour). The main premise of hypnobirthing is trying to stay calm and think positively.

I think you just have to go with what you feel most comfortable with. If that’s an elective section by maternal choice then that’s a valid choice and you shouldn’t feel bad about it.

It's definitely not too late for section if you need forceps! I was obstetric led care because of recurrent reduced movements although went into labour spontaneously whilst waiting a slot for induction. Laboured well generally, and epidural was excellent but baby was facing sideways and not turning when I was pushing. Had a forceps delivery in theatre that would have converted to c section if they weren't able to turn baby.

Was able to labour quite far at home with my twinkly Christmas lights,calm music and a bath. I did some of the hypnobirthing things once in hospital, but was requesting an epidural as soon as we arrived so never would have made it into the midwife led side anyway!

I felt similarly regarding induction - I talked it through with the obstetrician when I was listed and decided I wanted to see how ready my body was, and would have considered pessary and breaking my waters - but didn't want the drip! In the end, I went into labour before they had room for me anyway.

Birth choices are really hard anyway, and you've got an extra variable to consider especially when the fibroid moved unexpectedly and you didn't think a vaginal delivery was an option. You could always seen how late they'll let you book the elective section?

Thank you all for your kind responses - this is really helpful.

@DuploTrain we sort of missed that appointment / didn’t go through it as it was last week and she said I’d be better to go through the c-section preferences with the consultant. So I’m wondering if I should call to try and get a discussion in with a midwife - I don’t find my regular midwife very helpful so maybe just someone else.

Yeah I think perhaps I try and say no to the 38 week section as it seems quite early and maybe push for one at the end of the 39 weeks.

Good suggestions too about advocating - I guess this is where I feel unprepared in terms of knowing what I want or what would be optimum depending on how things progress. I also have a history of vulvodynia so unexplained nerve pain the vulval area so tears really scare me. But equally I know c-section recovery can be really challenging with long term implications