Cesarean at 38 weeks? Unnecessary?

[Mamofboys5972]

Hi everyone, to try and keep a long story short.
I'm due DS2 the 1st of April. My first son was 9lb 6oz at 39 weeks, natural delivery, no gestational diabetes.
Growth scans indicate this baby is already bigger than DS1, at the scan today, 37+2, he is apparently measuring 9lb 14oz. This time around I have gestational diabetes and I'm taking steroids for other health issues.
Doctor seems adamant I need to have a cesarean, I can get on board with that, but she wants to book it the day I turn 38 weeks, next Tuesday. All the guidelines and evidence suggest waiting until 39 weeks minimum? If I've already agreed to a section why the rush to get him out? I just dont understand how the risk of waiting a week is higher than the risk of bringing him early? When I tried speaking to her she just kept bringing up vaginal delivery risks.
Would you accept a 38 week section for large baby? Not sure what I'm asking for other than maybe advice/experience in the matter. Feel like im in shock over the whole thing.
Also, myself, all maternal family and DS1 have asthma, so don't want to increase risk of potential lung issues.

Hi - I had one cs at 39weeks and one at 36+4 both babies absolutely fine no problem. At 38 weeks your baby should be fine - if the docs are suggesting it I would go with their advice. Unfortunately diabetes and large babies go together as well as many other complications so at 38 weeks they've decided safer out than in. I'd look at the positive of meeting baby sooner x

You can request a 2nd opinion

I'm soo excited to meet him I think I'm in total shock at the news, only got told today! I think I'm more baffled due to my first son being over the 99centile and all being okay, but this one seems hugely different, a lot more alarm and medical intervention. My blood sugars are all well controlled. I'm just wondering why they can't wait till 39, it seems safer to me to wait. But I'm not a doctor. Hopefully I'll feel reassured when I see his little face x

I'm going to ring tomorrow I think and just query the date and timing of it all!

38 weeks is term, I think in your circumstances I'd listen to the rationale. There must be one if they're prepared to book you in now. Ultimately, does it matter if you're both safe?

See, I've had multiple doctors say different. Some state 37 is term, others 39. One doctor categorically told me they wouldn't bring baby earlier than 39 weeks electively unless there was a serious medical issue (which I don't have). Others, like today, said 38 is fine and safe. I feel conflicted and not reassured at all. I know it's only 1 week, but my niece was born early and needed to bring an oxygen tank home and have the hole in her heart surgically repaired. It's worrying

Presumably the Dr is aiming to avoid spontaneous labour which could happen any time?

You can ask for a second opinion, it's your right, but I'd get on with it and decide in advance what you'll do if they agree with Dr 1.

my niece was born early and needed to bring an oxygen tank home and have the hole in her heart surgically repaired. You need to ask the Dr if this has any bearing on your baby.

I was induced twice at 37 weeks. I guess it's to stop the possibility of an early labour.

I will caveat that I'm not a dr, but as I understand it then 37 weeks plus is term. How early was your niece? Was the oxygen for her heart or prem? It might also be that they are prioritising your safety too - at 9lbs14 there wouldn't be a worry over low birth weight so booking you in means you avoid the roulette of going slightly early and ending as an emergency

Doctor said today if I went into labour they would still perform the section, just not on the planned date obviously.

Very good point I will ask, they know she was prem, most of my family have prem babies unfortunately.

Quoted from NHS and NICE etc

"While a pregnancy at 37 weeks is considered "term" and the baby is likely capable of surviving outside the womb, it's considered early term and not full term, which is defined as 39 weeks or more.

In the past, any pregnancy between 37 and 42 weeks was considered "term," but research has shown that babies born between 39 and 40 weeks have better health outcomes.

Babies benefit from the extra time in the womb, especially for lung and brain development, and waiting until 39 weeks can reduce the risk of complications. "

Maybe I'm over thinking it just being 1 week but to me it seems like a lifetime!
They thought the oxygen was due to prem, but when they found the hole and repaired it she didn't need it anymore.

Guidelines change all the time and I'm certainly no medical expert but just to say I had my DD1 by section at 38 weeks due to pre-eclampsia and (opposite to you), small birth weight.
She was pretty teeny but otherwise absolutely fine and we were discharged after 24 hours. She didn't require any oxygen or other intervention or anything and is a very healthy, lively 4.5 year old now.

I think sometimes it's to do with avoiding spontaneous labour - yes they can try and get you a section anyway but it's dependent on theatre space and could be too late. Also a section where baby is partially down the birth canal is not the same as a normal ELCS which could be a factor due to your baby's predicted size.

I'm 38 weeks and would be happy to go into labour right now!

Hoping all is ok with your niece now. You are feeling worried about what appears to be an unsimilar situation, so I think you should discuss this with your Dr.

They may intend to do a CS if you went into spontaneous labour, but it isn't wholly controllable. That'll presumably be why the Dr is discussing the risks of VB. If they are advising a planned CS, it is because they want to avoid either a VB or an unplanned CS. The experience and risks of an unplanned CS are different to a planned CS, due to the prep and planning time.

No one here can tell you what to do, so have a thorough chat with the Dr.

It is usual for ELCS to be booked at 39 weeks so the Dr must be concerned about you waiting that long and the risk of going into spontaneous labour with such a big baby. If you did then they will still do a caesarean but it is much riskier in terms of how quick labour would be, if there were other emergencies in theatre and it's a more difficult and traumatic procedure if baby has already gone down into the birth canal. Unfortunately with childbirth it's all about weighing up the risks vs benefit and your Dr likely feels that extra week of baby being inside isn't worth the risk to you both in case baby decides he's coming out!

Don't know the ins and outs of your history so not giving medical advice or anything, but just wanted to say you're right about guidelines. Higher chance of TTN and NICU admission if born by elective less than 39+0 so usually date is given for 39+.
You can always ask for another appointment to go over any outstanding questions you might have.

If they would still do the section it then becomes an emergency c section which changes things and might not be such a nice experience. DD came out a week early.

Ask for an explanation and good luck x

Perhaps researching the Big Baby Trial might be of benefit to you.
The full evidence isn’t fully published yet, but there’s lots of discussion surrounding it.
ultimately, it is your decision.

I've had a big baby previously and he was part of the trial. Which is why I'm confused to the apparent medical urgency regarding this one. There is only a few lbs different in the two. But thank you. I will have another read

The guidance for diabetes is 38-39 weeks because of the risk of stillbirth increasing after this.

if it was just large baby alone then 39weeks and beyond is fine.

it’s the diabetes that changes it. Are you diet or insulin managed?

Get a second opinion. Elective caesareans are deemed slightly safer at 39 weeks than 38 so the typical gestation was changed 20 years or so ago. Prior to that it was 38 weeks .A 38 week baby is considered full term but there are tiny statistical differences that brought that change in. In your case there are complicating medical factors that your surgeon feels tip the balance towards an earlier delivery being safer. They haven’t imparted their reasoning clearly to you so it is very reasonable on your part to question and ask for a clear explanation from them or a second opinion and explanation from elsewhere.

I was meant to have a c-section with one of mine, also large and also due to GD. I went into labour naturally and there wasn’t enough time for a section. I barely made it to the hospital. It was not a pleasant experience.

I wouldn’t recommend this risk. If they are suggesting a C-section at 38 weeks it isn’t for their benefit, it is for the baby’s.

Have you considered that second births can be quick compared to firsts. So there may be not much time to get onto surgery. However, I agree with a second opinion as possibly big babies the labour doesn't progress? Honestly, me, my sister and my daughter are all in the late term(not c section though) and are absolutely fine.

The diabetes is controlled with diet and low dose metformin. They are really happy with my numbers. To be honest I passed the glucose test at 28 weeks but due to his size they had me monitoring my blood sugars at home and due to a couple of minor spikes they said as precaution they were prescribing metformin. My sugars have never been consistently high, or really high at all. I make big babies naturally without the GD. I suppose it does make a difference regarding medical decisions and interventions though

Yes I actually discussed this. They checked my cervix and the midwife joked "it's welded shut" and baby isn't engaged yet. I know everything can change quite quickly. But I would expect a slow labour due to his size anyway, my son took days to get down. Still a possibility though. I'm just unsure what risks outweigh other risks at this point x

OP, do ask your doctor about the pros and cons of steroids. I didn’t, and completely trusted my consultant when she was completing the preparatory forms for my ELCS at 38+5 and breezed through that part, saying ‘not necessary as you’re so close to 39 weeks’.

My daughter spent 5 days in NICU with respiratory issues. One of the wonderful midwives asked quite pointedly if steroids had been discussed with me and made it clear that her midwife and consultant colleagues had different opinions on their use at 38 weeks.

I don’t say this to frighten you but just to say that if you’re not already clued up on this, do read up and take advice. Who knows if I’d have done anything differently, but I just wish I’d been able to make an informed choice.