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!

What does the anaesthetist think? It should have been a multidisciplinary decision (including anaesthetists +/- paediatricians) to weigh up the pros & cons of different dates and different anaesthetic types. It may be worth asking for their input, particularly if you have any other anaesthetic risk factors that might make a difference to the balance of risk and benefit with GA vs Spinal. (Doi: anaesthetist)

This is so frustrating for you OP. I have some small experience of this in my births…

DC1 went into spontaneous labour at 38 weeks. Had an emc

DC2 went into spontaneous at 38 weeks. Had an emc (wanted a vbac)

DC3 was elective or supposed to be. I told them I wanted a week 38 elective. They said yes. Later on in pregnancy they said they had fully booked all their slots and booked me a 39+4 and I was horrified. I was at risk due to having 2 scars at risk of abruption. They agreed I shouldn’t go into labour as it was risky but also they couldn’t help on the 38 weeks… I spoke to various consultants and they did agree a 38 isn’t considered risky to baby (none of mine had lung problems…)

anyway, I went into labour again at 38 weeks and had an unplanned c section…

but yeah all mine are 38s and it’s considered the cusp of a full term baby. No steroids needed. I’d be annoyed in your shoes

I get where you’re coming from OP. I see there are a lot of people commenting that “no doctor would deliver before 39 weeks unless there is an indication,” but that’s completely ignoring the fact that you do have an indication. You have even stronger indication if you’ve had recent PE during the pregnancy because your dosing should be timed to ensure minimum time off blood thinners as well, and that all gets thrown off if you have an emergency situation especially if that leads to excess bleeding.
I would ask for a second opinion. In my unit (not in the UK) we’d be very happy to book you slightly earlier than 39 weeks, and I can assure you we are very up to date with evidence base and with balancing maternal with fetal risks, and also individualised care rather than once size fits all.

Why would you need to wait for 12 hours?

I had an elective c section booked but I went into labour a week before my date. I had a spinal and epidural just hours later.

The blood thinners cause increased risk of bleeding into the spine where the needle goes in for the anaesthetic…. And this is bad

on anticoagulants there’s a higher risk of epidural haematoma if you do a spinal within a certain timeframe - usual advice is 12 hours wait for a preventative dose, 24 hours wait for a treatment dose (which is what the OP’s on).

Ah ok. Thanks for the explanation @Greybeardy and @TenThousandSpoons00. I assumed it was the hospital delaying things!

I had an elective c section at 37 weeks with DS2. I'm diabetic and he was measuring large but Drs also took into account my personal circumstances which meant I wanted to have the baby as early as safely possible. I was given steroid injections a week before to help his lungs develop and he was born with no complications or issues, healthy 9lb 5oz. This was in 2018 so could be things have changed.

An emergency c/s following spontaneous labour isn't the same as an elective c/s at the same gestation though.

I appreciate that but what I meant was my third c section I was signed off for an elective section at week 38 without any labour.

I had an ELCS with DC1 at 38+1 privately because I was told 38 weeks is standard for private consultants to avoid risk of going into labour. DC1 had no problems as a result of an early CS.

for DC2 I wondered if I should leave it longer to allow more development time but she decided to make an appearance at 38+ 0.

I think some NHS consultants would allow you the early CS and others will stick stubbornly to protocol. Is it possible to speak to a different consultant?

unless there’s a clinical indication for an earlier delivery the reason for doing a 38/40 elective section in the private will be more likely to minimise the risk of the consultant having to come in overnight to do the cat3/2 section if a patient goes into labour…it’s not necessarily good medicine.

There surely can’t be that many negative effects of a c section between 38-39 weeks though if some consultants are willing to do them?!

Your scenario is going to be different to a lot of people’s. It’s important to think about the best thing for the baby in terms of development etc, but 9 times out of 10 the best thing for the baby is to do the best thing for the mum and sometimes an earlier delivery is absolutely right, but not always.

No one on here can say what the right thing is for you because no one here has all the info (things like the clot size/when it presented/your other general health and risk factors/whether this is a first pregnancy +/- what mode of delivery you’ve had before /what the exact reason for the section is/other anaesthetic risk factors all need factoring in).

The difference between 38-39/40 isn’t my area of expertise when all other things are equal, but in complex cases the advice is usually based on guidelines and multidisciplinary input. A quick skim of the RCoA guideline doesn’t suggest an ‘ideal’ gestation for delivery for women with VTE and it’ll be more of a case by case decision (eg perhaps if this is a first baby with no sign of labour then an extra week on anticoagulants may be better for the clot and cardiovascular stability at delivery, but if it’s a 2nd or 3rd baby after quick vaginal deliveries at bang on 39weeks and pushing is absolutely contraindicated then that’s a different scenario). They should be able to explain the rationale for the advice to you and if they haven’t in a way that makes sense yet then just ask again.

it is worth remembering that the decision making in the private isn’t always as clinically driven as one might expect.

I had one scheduled for 37 weeks

Hi OP,

I am not sure if this is still relevant and you have already given birth. I had this exact same thinking regarding 38-39weeks gestation, but there is research which shows it does affect the babies lungs.

For me, I suffered a third degree tear from a 9lb + baby born at 39+2 with my first. I opted for an ELCS with my second. Whilst I was informed of the risks from my consultant (who I requested was the same lady who stitched me back together/did my birth debrief from DS) we discussed at length the possible long term health risks of me going into natural labour, delivering quickly (which also happened with my first) and most importantly the affects on my mental health. The additional worry of what if etc and we opted to deliver 38+2. It could have been anytime week 38, but that was when her particular schedule was.

Unfortunately, my little lady did require 48 hours of neonatal care due to breathing difficulties which was pretty horrific to endure as well. So it is possible this could be the same for you.

good luck with your decision and advocating for yourself!