‘Forced election at 39 weeks’

[XjustagirlX]

I am having my second baby soon. For my first baby I had very early preeclampsia so had to have a cesearean.

for this baby, I’m being monitored for preeclampsia but no signs yet. I would like to try a vaginal birth but book a csection for around 41 weeks. Obviously if I get preeclampsia my plan will have to change.

I was told at my appt today that they ‘won’t let me’ go past 39 weeks. But they encourage induction from 37 weeks.

this seems ridiculous to me. I explained that provided I have no preeclampsia signs then I should be able to go to 41 weeks to see if I labour naturally before my due date.

has anyone experienced this before and got any advice on what to say to the consultants.

edited to say the title should read - forced csection at 39 weeks

They can't force you. But I honestly think it's sensible for obstetricians to be risk averse. Having babies is a risky business.

I'd request a second opinion. I had pre-eclampsia with my first (31/40, emergency section at 31+3/40), discovered I had high blood pressure that had probably been there before I got pregnant but pregnancy had unmasked it.
Stayed on BP meds afterwards.
Held off having a second until this year - first child now 7 (turned 7 a week after new baby arrived).
I was well controlled on BP meds throughout pregnancy and closely monitored.
Originally I was told that they could book an elective section at 39/40, or if all was well I could just see what happened and go for VBAC. I didn't fancy the uncertainty (I was quite anxious through the pregnancy understandably!) and just wanted a section.
In the end it was brought forward to 37/40 as BP started to go up, baby moving less and getting headaches (but no pre-eclampsia).
I was told very very clearly that they do not do electives at earlier than 39/40 due to increased risk of baby requiring respiratory support unless there is a good medical reason (they counted rising BP headaches and change in movement as a reasonable reason).
I would request a second opinion, or to see consultant midwife to discuss risks and benefits properly. There may be more to it than initially meets the eye (scans? BP? New partner? Long gap between pregnancies?) but it would be better to have a clear discussion about this.

I had similar discussions with my doc/midwife when I was pregnant late last year albeit for slightly different reasons.

I'd really recommend 'in your own time' by dr Sara wickham (she has stuff on her website and insta too) - she talks about the research and what the studies actually demonstrate in terms of probabilities and risk (including how some of the statistics are used in a way that conveys more risk than there actually is)

I used the info in the book to ask questions which put my midwife/consultant on the spot in terms of what they were recommending and why. My doctor and midwife
were really keen to tell me the risks of not doing x and y but did not like it when I asked what the potential risks were of their proposed approach! (BTW the websites for
NICE and RCOG also have great resources). Eventually I got the birth plan that I wanted as a result

Ultimately they are very risk adverse and there is (particularly where I live) a big culture of over interference with giving birth - often for no good reason other than 'well your old' (I was actually told this - I was 37)

You are entitled to make your own decisions and if they truly do think what they are proposing is the best option they will be able to properly discuss it (as opposed to trying to coerce, shout over, or frighten you into it)

All of this might sound like I'm saying you should ignore the advice you've been given. If that is how this is coming across that's not my intention. What I would say is that trying to get answers out of overstretched nhs doctors who (because of their very jobs) see the most complex patients can be quite tough and in my experience the 'because I'm telling you to do this' seemed to be an acceptable way to communicate. For me I did wonder when my obstetrician last saw an uncomplicated pregnancy/birth as it felt like everyone I spoke to who knew her said she was v interventionist.

Do the research - arm yourself with info and then go back into it with them. Don't accept 'because I say so' as an answer to a reasonable question and don't be pushed into anything you don't want to do.

Ye I absolutely will not be accepting ‘because that’s our policy’ as an answer.

when I have asked for evidence, they can’t give it me. I won’t be agreeing to anything I don’t want to do.

i just think it’s ridiculous that assuming I have no signs of preeclampsia and baby seems fine, then they would actually try to force me to either have a section at 39 weeks or start inducing at 37 weeks. Apparently these are my only two options.

again I have had preeclampsia before so I know the signs and I’m monitoring my BP at home and taking medication. I also live 15 minutes from the maternity hospital.

im happy to take the slightly increased risk and will be reassessing every few days.

The doctor also looked confused when I said I absolutely would not be having a suggested membrane sweep at 37 weeks.

Yeh definitely be careful with a sweep.
That was another thing that was being pushed with me. From a similar time as well (37 weeks) what they don't tell you is if they accidentally break your membranes while doing a sweep and your labour doesn't spontaneously start within 24 hours then they have to induce due to the risk of infection.

Have a look at the serenity doula on instagram she talks about a lot of this stuff.

@XjustagirlX would you mind me asking how bad your preeclampsia? I take it was they weren’t able to get it under control with medication like Labetalol?
I had preeclampsia and was hospitalised a few times for a few nights each time and was at a risk of an emergency C-section however they managed to find the right dosage for me to control my BP and get me into the day ward every second day to monitor movement and bloods. My liver function starters declining but they still waited out until I was 40 weeks to do a C-section. I wonder if it depends on the hospital and the consultants in charge.
I know things can turn really quickly with preeclampsia and it can have such detrimental effect on both baby and mum that it’s not worth the risk but if you don’t have it (and hopefully won’t get it) then surely they can just continue monitoring you quite frequently and if anything changes they can reassess it. Not sure why they would push for a much earlier birth date than needed if there’s no immediate need for it.

The risk of preeclampsia is higher after 40 weeks. I didn’t want intervention and baby came just before 40 weeks. My blood pressure went up during the birth but it was okay! I hope you are okay too.

Sorry had bad pre eclampsia first baby and am talking about second baby. I don’t know if preeclampsia is always better second time but for me it was!

The success rates on a VBAC are really low and there are a number of factors that make it more dangerous to carry a pregnancy later if you’ve had a recent c section. I’d follow their advice rather than seeking a vagunal birth for the sake of it. Also, I’ve just had my second c section in a row and both were great but my second one I recovered even faster than the first despite having a 16 month year old toddler I was picking up so in my experience the advice worked well.

A couple of things to add in case they are helpful:

• Planned c sections are generally much better health outcomes for both the baby and the mother and much easier to recover from than emergency c sections. You should not see them as the “same” thing.
• The reason I was given for not going past 39 weeks was that I’d had a C-section only 16 months beforehand and there is a small risk of uterine rupture (but if it happens it’s really bad). Also, as you get older (I was 40) the risks of stillbirths increase so again best practice to do it a little earlier.

Could you look into changing to another hospital (or at least speaking to another consultant at a different hospital to get their viewpoint)? I have just transferred hospitals but for different reasons - my consultant at the first hospital I was going to said they wanted to induce me early as I am over 40 and because the risk of stillbirth goes up after 40 weeks. The consultant at the 2nd hospital said there is no evidence that this is the case unless there are other issues. This info obviously isn't relevant to you but shows how different consultants can be at different hospitals and worth checking out your other options at least.

What do the NICE guidelines say. It might be useful to use these as your guide when talking to the hospital.

That is soo interesting about planned c sections being better for baby and mother. I’ve had two emc and now having an elective but possibly emc if I go before my dates (highly likely). What the negatives of an emc vs elective??

Came to ask this too, I have heard of.peoplw having to.sogn disclaimers if they go against NICE guidelines

My understanding is that EMC’s have to be performed faster, with much less warning and time to prepare, and if you are already in labour of course they are trying to cut everything open whilst your body is literally moving around which makes everything much much harder (plus there may be other complications involved). My elective c sections were very very relaxed.

they are not trying to cut while your body is moving around!

What do you think contractions are?
If you’re already in labour and they have to do an emergency section then yes, they do have to cut into a uterus that’s periodically contracting!

usually the spinal/epidural top up/GA will have stopped/slowed them right down.

I’ve never had an emergency one when already contracting as mine were at 38+5 but even having to put the spinal in when you are contracting seems high risk and certainly my doctor friend said one of the reasons EMCs are higher risk is because you may still have some of the impact of contractions going on. I don’t know anymore than that. The rest of the points also stand though - being able rushed through is bound to add risk and by definition if it’s emergency there is usually a reason it needs to be completed quickly unlike with an elective.