Date of 3-section- terrified

[TheNoisyJadeDreamer]

Hello there

I’m just looking for some advice.

I went to meet my consultant yesterday. I’m due to have my third child, the first two births were C-sections. The first was an emergency and the second was an elective because the first was an emergency.

I was quite shocked that they were actually offering to me to have a natural birth and wouldn’t give me advice on which pathway was the best, other than going through the risks and benefits of both. To me each risk and benefit has different weights attached to them. I am terrified of dying in labour. I think being a mum of two makes this fear very acute.

I chose to have C-section because of risks to my health and they scheduled it right up close to my due date.

I’m worried. I’m worried that I will going to natural labour that the scar will rupture and this is a very high risk risk. The doctor said if I go into natural labour they cannot guarantee a c-section.

I’m wondering what’s normal in terms of schedule sections for your third (or later) C-Section on the NHS and if anyone would be willing to share the experience.

I had planned to work close up to the scheduled date, with this date being a week later than I had expected, I am considering taking slightly earlier leave, at the very least not to stress my body and provoke early labour.

I’ve been scheduled for 39+4.

Thanks! Your insights and experience mean a lot.

That'd be spot on for here; they aim for 39+3 - 40+3; ideally. If you go into labour and there's any signs of an increased risk, they'll do an emergency section. If you go into labour and you don't want to give birth that way, they'll still do a section, but you'll be triaged against any other emergency sections going on at that time.

I met my consultant yesterday and he said they've changed how they assess risk now, and they're keen for me to explore a vaginal birth after previous cat 1 emergency sections. They've invited me to a VBAC clinic to talk about it, but it looks like for most people, the risk of scar rupture is not high at all - about 0.5% if you've had two previous sections.

Obviously there are risks to sections too, which is probably why they wanted to run through them with you - especially repeat sections, and if you already have children at home, so resting for the required period is a lot tougher. They have to take an evidence-based approach.

If you're really unhappy, you could look at transferring to another hospital; if you have one nearby with a different policy. I don't think anyone will plan the section before 39 weeks though, unless there's a medical need for the baby. Statistically, it shows worse outcomes for lung health, allergies and overall health to be born in advance of that.

You could also talk to the consultant again and ask for reassurance that if natural labour starts, you will be able to choose a section; or request to change consultant.

I'd highly recommend following csuk and 360mama on Instagram, they have loads of advice on all types of c-section for various reasons

Unless there is a medical indication to deliver sooner, our ELCS's in my trust are booked from 39 weeks onwards so this is standard. If you do go into labour before then they will do everything they can do give you your c section, they just can't 100% guarantee it in case you arrive in too advanced labour, or if there are other emergency cases in theatre where either the woman or baby's safety is at risk. I am an anaesthetic/recovery nurse working on a delivery suite and I can count on one hand the amount of ladies coming in in labour that weren't able to have a section. All the best.

Not before 39 weeks as babies have higher chance of breathing issues if CS before this date.
The chance of your scar breaking down is not huge, it's about 0.5% and even then the chance of significant harm to you or baby is much much smaller.
Try not to over think it. If you go in to labour they will take you for a CS there and then. They just have to advise you if the chances of each thing to give you the best chance of making a decision that feels right for you.

I wanted a VB with no 3 after having had 2 sections. I went into labour a few days after my due date. Labour didn’t progress and they wouldn’t use anything to speed things up in case I ruptured so I ended up with another section. I went on to have a 4th which was at 38 weeks.

Thanks, I remain shocked, last delivery was in 2016. I had baby 2 at 38+5, and was never given the advice about additional risks to baby.

I googled the mortality rate of a rupture and it says its 11%. So whilst a 1 in 200 risk sounds low, it seems a very high risk possibility.

I just feel I am being trapped into a natural labour. I was so desperate for a natural labour previously, but I just want something predictable and where the risks are much more manageable.

I have another appt with consultant and I am going to ask if there is a chance to go earlier to closer to 39 weeks. Is that reasonable?

That's not the mortality rate of a 1:200 rupture.

www.rcog.org.uk/for-the-public/browse-our-patient-information/birth-after-previous-caesarean/

I can't see why you think you're being pushed to deliver vaginally. You've been booked a CS, at 39 weeks as per national recommendation as safest. If you labour before they will do you a CS there and then. This is what they do for pretty much everyone planning a repeat planned CS. It's standard safe care.

Doctors are purely there to give you recommendations and statistics based on the information and evidence out there. They can't advise you on "what choice is best" because what might be best for one mother, wouldn't be for another. It's your job to balance the risk in your own mind and make the decision, but vbacs are certainly safe options for some women.

It seems you are fixated on the risk of a scar rupture when there are also plenty of risks associated with caesarian too which actually are more likely to occur and also carry the risk of mortality. Don't want to fearmonger but my point is you need to assess all risks and benefits and look at them objectively.

You didn't have to have a C section for your second birth. The NHS is exploring natural births after C sections. Why not do your research on this, or ask your doctor?

I had a natural birth after a CS, and it was great.

Are you at a very small hospital with only one theatre? Maybe they are saying that if you have a very quick
Labour it might be all done before the theatre is unoccupied if there's a queue of emergencies?

I had my 3rd c section at 38+1. I’m now unexpectedly pregnant again and the c section risk is a large part of my worry about whether to continue.