Elective C Section Before 39 weeks?

[PulmonaryEmbolismHelp]

Hi all, just looking for a bit of advice from anyone who can help!

I have a medical condition which means that if I were to go into labour naturally, then I would need to have a general anaesthetic for my c section. However, a spinal would be fine if the c section was scheduled and non-urgent.

My consultant refuses to schedule the section for before 39-40 weeks due to risk to baby.

I’ve requested it to be 38-39 weeks but have been told that unless baby is in danger, they would never do this. They would prefer the risk of a general anaesthetic to baby being born slightly earlier.

Do I have grounds to keep requesting this/to speak to somebody else about it? I am absolutely terrified of a general anaesthetic c section! I’ve had a tough pregnancy and it ended under a general just fills me with so much anxiety and dread.

My last baby came naturally at 38w5d!

The risk to a baby being born too early is far greater than the risk to a mother of having a GA. That’s why your consultant will not acquiesce to your request.

I had 2 at 37 weeks. (APS). First pregnancy 37 week delivery recommended by my specialist. Moved house and new hospital trust delivered at 39 weeks for APS. I formed them they would be delivering at 37 weeks in line with previous pregnancy advice. They did. They actually said it was up to me when I delivered as well as how.

So they will unless they feel risks outweigh the benefit.

FWIW I also wanted a general anaesthetic in my first pregnancy - I had a spinal fluid leak a few years ago and was very averse to risking another. The GA was the bit they pushed back on, but examination showed I wasn’t a good epidural candidate, along with my spinal leak history, so had spinal only both times (sounds like if shouldn’t make sense but it’s a smaller needle) - nothing like a bit of time pressure added on! They did finish with plenty of time to spare though.

Are you on blood thinners? Have they said you would definitely need a general anaesthetic if you laboured before your elective date? It’s generally recommended to wait 24 hours after your last dose before having a spinal anaesthetic, so unless the recommendation is longer in your case, and depending on how quickly the caesarean would need to be carried out, it is sometimes possible to wait until you can have a spinal, especially if you’re only in the very early stages of labour.

You can keep discussing it and request to talk to another consultant if you want to, but if they consider that the risk of bringing the section date forwards is greater than the risk of needing a general anaesthetic you won’t be able to force them to do it.

Is 38+1/2/3 really that much more dangerous than delivering at 39 though?! I’d personally take the risk of a few days earlier vs. having a GA c section and the effects of this!

We know that quite a lot of development is still happening before 39 weeks, and if your baby is born before then, specifically by planned caesarean, there’s a higher chance of breathing problems and potentially needing to go to the neonatal unit for support. It’s different in a vaginal delivery or a caesarean when you’re already in labour, because you being in labour tells the baby to prepare for birth. If you have a planned caesarean they get no warning they are about to be born, and can struggle more to make that transition. So because of that, unless there’s a really good reason, planned caesareans are done after 39 weeks.

OP - what’s your dose of blood thinners? And what’s the reason for the CS? Hope you don’t mind me asking but those things might change what I would say. However, it does seem a bit unfair they are being so black and white about it - it would seem reasonable for you and your doctor to be able to have an informed discussion around the pros and cons of earlier birth for both you and baby. Even though there might be a small increase in risk for baby being born before 39 weeks, it is only small, and should be balanced with the overall situation not least maternal wishes. As others say, elective CS is generally done at 39 weeks because at a population level that’s a better time, and avoids some NICU admissions for short term breathing issues, as well as seemingly being marginally better for baby’s overall development. But at individual level and particularly for someone who has laboured before 39 weeks before, it seems a bit rigid!!

I’m sorry also I just realise you didn’t say anything about blood thinners and I’m making assumptions based on your comments plus your username. Sorry if I’m off base there.

My second section (third child) was scheduled for 38 weeks exactly. This was due to a suspected placental abruption during my first - vaginal - birth. The reason was to minimise the chances of going into labour naturally. The consultant’s reasoning was that the risk from a placental abruption to both mother and baby outweighs the risks of temporary respiratory issues to the baby due to being born at 38 weeks. For my first section they let me get to 39 weeks, but this time the consultant was more cautious. Our son did have breathing problems (Temporary Transient Tachypnea) and spent just under 48 hours in NICU, but recovered very well and we both went home at that point with no further follow up required.

As an aside, my placenta was sent to pathology, as is the protocol with unexpected NICU admissions, and I did actually have an infection developing in the uterus. It didn’t get to the baby and was not the cause of his breathing issues as his blood tests showed no infection, but might have done had he been born later. So it was a lucky coincidence for us.

OP I have no knowledge of your issue but can you ask for a second opinion from a different consultant? I believe it’s considered good practise in the nhs to allow this when a patient is unsure of the diagnosis or recommended treatment.

I had 2 CS at 37 weeks but in both cases it was due to the baby being at risk if they stayed in longer. Sorry this doesn't help.

I had a planned c section at 38+6 but was abroad in a small place where they only did planned c sections on certain days of the week so I could choose 38+6 or 39+4 and I went for the former.

Given your history I’d echo a second opinion.

I had 2 elective c-sections planned for 38 weeks. The reasoning was that they wanted to get in before spontaneous labour. This was 2000 and 2006. Maybe they have changed the guidance?

I was scheduled for 38w2d with my first due to combination of GD and my age (41). She actually wanted to come at exactly 38w anyway and no breathing difficulties (but she was a quite sleepy for the first few days). This time I have been told it could be 38 weeks again due to my age (just over 45 at delivery).

I guess they weigh up the combination of risk factors for you and the baby but they are happy to go earlier than 39 weeks depending on the risk factors.

Yes I am. I’m on 80mg twice a day (which is considered a high dose for my weight).

So if I go into labour naturally, it’s likely that I would have to wait close to 24 hours for a spinal (and a bare minimum of 12 hours), so they would go straight to a GA.

I’m on 80mg twice a day (which is considered a high dose for my weight) due to multiple pulmonary emboli.

It’s the black and white attitude that I’m quite annoyed with. My consultant has shut me down every time I have mentioned preferring a slightly earlier c-section date, just stating that my health issues are all concerning me as opposed to the baby so they will leave baby in until 39 weeks.

I have expressed preference due to anxiety around a GA, a lack of childcare should I go into labour naturally, the side effects of a GA, 2x episodes of reduced movements at 34 weeks but nothing has made a difference on the “not until 39 weeks” answer.

I will have to stay in for 3 nights anyway due to my PE, which I’m sure would be enough time to monitor a baby born at 38-39 weeks!

I believe guidance used to be that anytime after 37 weeks was OK, but it’s now 39 weeks.

My dd was born at 38+3 in 2022. She was small for gestational age (although actually right on the cusp of being growth restricted) and an IVF baby. No breathing issues and we were sent gone after exactly 24 hours. She was very sleepy though - we had to work very hard at feeding for thr first week or so. She did develop mild jaundice.

There is a reason electives are not done before 39 weeks.

Look up the rates of respiratory distress and transient apnea of the newborn. If your baby struggled to breathe at birth and ended up being admitted to NICU, even worse ended up ventilated and transferred out to a specialist NICU, the doctor who agreed this would be HEAVILY questioned as to why.

Term admissions to NICU are monitored nationally and hospitals that were getting higher than average results would then be under external investigation.

No doctor would risk this and if you truly understood the risks than neither would you!

And in response to your comment about staying in hospital longer being ok. It’s not just that. Babies that suffer RDS or TTN at birth are at an increased risk of asthma and lung problems in later life. Have higher rates of respiratory infections in later life. Babies that are required to be ventilated due to this are also at increased risk of lung scaring, chronic lung disease and developmental delays. It’s not always a short term problem.

It's not worth the risk to baby, ike other's have said tern admissions to SCBU/NICU are monitored and maternity is the largest area of complaints/compensation in the NHS so practice is defensive. I work in maternity and see the babies who have to go to Special Care due to breathing problems and it's very distressing for parents seeing your baby on breathing support or not being able to hold them after birth. I understand a GA is also distressing but in most cases, if you go into hospital as soon as you have any tightening or pain they can delay labour long enough to get you to 12 hours. Our normal advice for women on blood thinners is stop them if you get any sign of possible labour, but you could speak to your consultant.

I had an ELCS approved for 38 weeks. I had my first at 37 weeks and was at risk of premature labour with my second so they approved 38 weeks for me, subject to baby being big enough etc. so had to have additional growth scans before the date. As it happens, went into labour too early for an ELCS but they definitely approved it before that point.

I was allowed 38+6 in the UK but a private wing of an NHS hospital. 39+0 fell on a Saturday so I got to chose between the Friday at 38+6 or the Monday at 39+2 and went with the earlier date because it seemed preferable to not have to wait longer! Weirdly they wrote 39 weeks on all the paperwork though. And child is now 8 so things may have got stricter since… Subsequent babies had midweek due dates so never faced that issue again.

37 weeks is technically term. I had an elective c-section at 37+3 a few months ago for medical reasons - my consultant is a well known OB at a major teaching hospital in central London and it was him who recommended it. My son is absolutely fine,

I would,m however add that but for my circumstances, he would've waited longer.

Each day in utero confers benefits to the baby up to their due date. I can’t understand why anyone would choose for an earlier delivery by caesarean without a pressing medical indication, unless they’re not reading the evidence.

There’s proven increased rates of feeding issues, jaundice, breathing difficulties, behavioural and learning difficulties. Not to mention the fact there’s increased rates of autoimmune diseases, allergies, asthma, diabetes and obesity just from being born by elective section. At least minimise the other risks! It’s a roll of a dice, but not one I’d roll without good reason.

Evidence changes all the time, but there’s growing solid evidence on all the above and the admission rates to NICU from CS prior to 39 weeks is indisputable. Don’t go by anecdote.