Advice needed re elective c-sections

[fledtoscotland]

long story but with DS #1 i had a very difficult birth. was induced at 40+7 (had had major abdo surgery during pregnancy so scar wasnt holding up very well), had an allergic reaction to the prostin gel, labour had to be stopped and had ARM with epidural and DS was born 15hrs later with ventose that caused his skull to fracture. I also have a posterior cervix so going into labour naturally is unlikely.

am now 26 weeks pregnant with DS #2 and am starting to panic. as i cant be induced my MW said that they will let me go to 43 weeks and then it will be a c-section but i dont want. to wait 43 weeks by which point the head will be engaged etc etc. i have an appointment with the consultant at 34weeks to "discuss my options"

basically - do i ask for a c-section at 38 weeks? i know the complications of major surgery (i'm a nurse) but am also terrified of another VB after DS#1's skull fracture. I dont want to be in hospital more than 48hrs as DS#1 is only a year old

HELP!

Discuss your options but sounds like you had a horrendous birth. I had an 'emergency' section for DD ( failed induction) and have asked for one this time which they are doing at 39 weeks. They did try hard to persuade me not to but I don't want to end up with a real emergency one which was what was terrifying me. So in 19 days I am off to hospital and looking forward to it.

I was fully intending to ask for an elective section with the dts, but as it was I didn't have to fight for one, it was considered safer and they came at 35 weeks, planned. I would say you have good grounds for wanting an elective section, are aware of risks and I don't think they'd let you go past 40 weeks.

All you can do is ask. Good luck

Also if you are panicking about a natural birth are you swaying towards a section and if so would this mean that you can actually enjoy the rest of your pregnancy?

I had an emergency c - section with my dd. I want an elective with my second, will the doctor/midwife try and talk me out of it. I really don't want a vbac, I'm petrified of my scar bursting - silly I know!

I had an elcs with DD (I had a distressed baby and emcs with DS) and it was very calm. You'll need help with looking after DS when you come out- you shouldn't be lifting him, etc. , but if you really don't want to try another VB, make your wishes very clear to the MW so it's in your notes when the consultant sees you. I was booked in at 34 weeks and had ELCS at 39 weeks. Good luck.

Learningallthetime - make it clear from the start that you want a section, my MW was supportive, registrar just doing his job.

Your midwife is absolutely right - if you are likely to go to the later end of normal with your pregnancies(do you have a long cycle?) then waiting longer is probably the best option, given that you would be in hospital longer than 48 hours with a section. Induction is a whole different ball game to natural labour, if you weren't ready last time then that could have caused a lot of the problems - the posterior cervix is the big clue that you weren't ready, they all are until your cervix starts to soften and thin, then it comes forward, if your cervix was posterior and firm, then you had virtually no chance of labouring without lots of augmentation and intervention(as you found out)
the baby's head being engaged makes no difference to a C/S - it can be fully engaged from 36 weeks with some people, so given that most electives are done at 39 weeks then an engaged head is fairly common - the danger is that by asking for an elective, there's a chance(and a fairly good one)that your baby could be up to 5 weeks preterm with the chance of needing special care

I don't understand. I thought that if you had an elective section then it had to be done at least a week early so as to avoid going in to labour.

My elective was at 39 weeks.

thanks for all your support - i am scared of another VB but also worried about the recovery from a c-section although DH will be off work for 3 weeks and my mum will stay with us for another 2 after that.

the MW seemed very anti c-sections (suppose that is her job) but she didnt have 3 tears, a cut and a baby in the children's hospital.

how to i approach my consultant? she seemed quite understanding at 15weeks. also how long will i have to be in hospital?

sorry jamila169 - i don't understand about the posterior cervix thing. i had 3 sweeps with DS#1 and once the MW had got the cervix round she was able to insert her finger (sorry for TMI) and said it was soft and thin but even during labour and when i was dilating, it remained posterior. why should this change with this birth?

Our hopsital policy is 3-5 days, I was in 3 days after that and sounds like you have the support that you need as well.

Just state how you'd like your baby to be born FTS. If you want a section at 39 weeks, state why. Be clear and concise.

she's not anti sections Fled -the fact is that she has to promote the safest way for you to give birth, which is always going to be vaginally after spontaneous labour, she's being very relaxed about your 'term' so she must suspect from your cycle length and the fact you weren't ready last time that you are a 42 week plus pregnancy type of gal.she'll also be mindful of your circumstances and not wanting you to go through a major surgery if it's not indicated

I had an Elective Caesarian at 39 weeks with my 3rd child.I had 2 Traumatic births with DS and DD1,using Forceps and Ventouse.I stipulated thats what I wanted at the beginning,and at the end she was Transverse lie,so I had no choice.I would have been discharged after 48hrs,but I was Group B Strep positive,so my DD2 had to monitored for 48 hours anyway,so I stayed an extra day.
My CS was wonderful,very calm and relaxed.i had no real pain after,and I got moving asap which helps.

sorry for asking you so many questions jamilla but why would the consultant this C-section was indicated if my MW doesnt? The consultant seemed concerned about DS's fracture which the MW doesnt think important.

my other concern is that if labour doesnt happen naturally it will be a section anyway so what is the point of waiting (i know i'm the impatient type )

fled:
re the cervix:
its because,if you can imagine as your cervix softens, flattens and dilates, it moves forward(or in my case forward and left!)and as the baby's head descends it becomes more and more central - You obviously dilated with the prostin and dilated after the arm, and the baby did come through, so you'll have got to 10cm - the bodged delivery didn't alter that. It seems as though you were given prostin on a very unfavourable cervix,had a reaction (hyperstimulation?) and things were being rushed at a pace you weren't ready for at all , you sound like a victim of the 'well you're here so your're going home with a baby' mindset.In some hospitals, an ufavourable cervix would mean that you were sent home rather than try to force labour from a cold start as it were

The MWs opinion on CS will have no bearing on what the consultant's opinion is.

Every professional will have their own view, and you need to speak to the obstetrician yourself about this.
Personally I think a skull fracture in a new baby is important, and can fully understand why you are so concerned. I would have been frantic. Was your MW actually at DS's birth?

This is a decision for you to make with the obs consultant. Honestly.

jamila - they had to induce labour at 40+7 last time. I had my ovary removed at 9+3 with DS#1 and my scar was overstretched. i had the gel and had an allergic reaction (no stimulation at all let alone hyperstimulation!) and they were going to take me for an emergency c-section but because i was 2cm they gave me the epidural and then i had ARM. there was never an option of going home without my baby!

the consultant seems to think that the reaction to the gel caused the fracture rather than the delivery but i'm not convinced as his heart rate dropped and it was a case of "get him out now" so that was probably when the fracture occured.

i suppose it all boils down to the fact i'm terrified of a repeat performance

BTW Fled, I'm coming at this from the standpoint of someone who had the cascade of interventions and ended up with an emergency C/S for deep transverse arrest with my first, and 3 natural births of larger babies, and I always put in my birth plan that i would go to 43 weeks (99% have delivered by then) before another section, I never had another epidural or ARM(apart from the last one where i was stuck at 8cm, it was a calculated risk) as I'm positive that the immobility, plus the removal of the cushion of waters caused my first C/S. I'm also a qualified nurse preparing to study midwifery so I've read an awful lot of studies and picked an awful lot of brains in the last few years. I'd suggest that you get proactive, get your past notes and join UKmidwifery- you can run stuff by them and they'll explain it for you and then you can do some research and look at policies and make your decision with all the information at your disposal -I found it really helpful to debrief my first birth that way and accept what happened, and move on with a clear head if you like. If you still want a C/S after that, then you'll be doing it from a calm, prepared place, rather than the traumatised one you're in at the mo - the first pregnancy after a bad labour brings it all flooding back

Starlight -I take it you're talking about my wandering cervix? i know it's posterior and tilted to the right , cos when i go for a smer, the nurse moans her head off about having to go looking with the speculum , and obviously It's ended up central when i've had the kids, or someone examining me would comment lol1

i understand what your saying jamila. I'm also an RN but when it comes to this, i think most people would be scared too. I will just have to discuss my concerns with my consultant at 34 weeks and see what she says. Much as i like my MW, she has never had any children and i feel she practices "by the book" rather than by gut instinct.

Hello! Had a very slow labour that ended in emergency C - Section with my first born. If I remember my cirvix is posterior too!! Took a while to come forward. Uterus tilted to posterior also. With my 2nd baby I decided to have an elective. It was absolutely lovely. Very calm, post operative pain was managed well. I recovered steadily (much quicker than with emergancy section). I felt very happy with the procedure and recovery.

My husband had a month off after the planned C - Section, so I took the chance to rest a lot. Just concentrated on my DD1. Talked a lot to DS1 so he would'nt be jealous. Gave him lots of hugs instead of carrying him, coz of wound.

All in all i was pleased i made this choice.