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Mumsnet hand grenade: are elective ceasars riskier for babies?

74 replies

Gizmo · 07/09/2006 18:26

I'm just a bit surprised no-one is discussing this news today.

There are some quite interesting discussions today on US Ob/gynae blogs about why this situation is arising: one theory is that elective caesars expose women to a greater risk of having their dates miscalculated and consequently delivering babies that are slightly prem.

Does anyone in the US get advised that an elective CS is riskier for the baby, I wonder? And does this research impose a duty of care on US (or even UK) doctors to mention this as a factor?

OP posts:
ruty · 07/09/2006 23:02

thanks for that jimjams - i'll talk it over with the obstetrician next time and see what they come up with. My last c section was for non progression but also they were worried he was distressed after 24 hours of bloody labour so i don't want to go thru that again. An American friend who trained as a doc says there if you have had a c section already, they automatically make sure you have a c section for subsequent births - something to do with the weakness of the womb/scar i think. So surely this factor should be put into play in the safety stakes when deciding to have a c section that is not your first?

morocco · 07/09/2006 23:07

I think the US insist on it for reasons of insurance rather than safety but I'm slightly cynical on that aspect. I wonder if that was factored in to the study?

Heathcliffscathy · 07/09/2006 23:07

this makes such common sense to me.

but doesn't make me condemn mothers that choose to have ceasars without medical need IF they are aware of these facts.

the risks are still tiny (although significant) and some mothers are so traumatised by their first births that this is the only option they can contemplate.

i do feel very strongly that this information should be widely disseminated though.

Ellbell · 07/09/2006 23:12

But ruty, a second c-section is not necessarily necessary (sorry for poor English - really tired). It all depends on the reason for the first one. I had an elective section with dd1 for placenta praevia. It probably saved both our lives and I don't regret it for a minute. My placenta was (I was told) 'hanging by a thread', and in fact some had already come away. My section was performed at 36 weeks, which is probably earlier than recommended, but they didn't feel they should wait any longer, not least because I'd been in hospital and bleeding on and off since 27 weeks, so getting to 36 was an achievement.

But placenta praevia is not a recurring condition, and when I was told that my placenta was away from the cervix with dd2 I had no hesitation in going for a VBAC. Would not have opted for another section just because I'd had a previous section. My consultant was very much in agreement (and also agreed that continuous monitoring in labour just because I'd had a previous section and in the absence of any other worrying signs was unnecessary...). I'd also agree with the idea that elective sections may be exposing women to greater risks through miscalculation of dates. My dd was more like a 35-week baby than a 36-weeker (and was small even by those standards) so it was very likely that my dates were slightly wrong.

Jimjams2 · 07/09/2006 23:12

ruty- If properly monitored and no syntocinon etc used then the risk from a rupture is very small. In fact when they did my 3rd c-section they said my scar was "paper thin" and there was apparently fluid leaking through it, but that was after a labour and a 3rd section. The rupture risk would be higher with a vertical incision or a breech baby etc but all things optomised should be minimal.

I found recovery from my first section a doddle, far harder 2nd and 3rd time round.

Are you pregant then? Congrats I missed that!

ruty · 07/09/2006 23:15

oh no Jimjams I'm not preggers! We're not trying yet but talking about it - want to move somewhere bigger first. I'm getting quite keen to get on with it, can you tell!

Jimjams2 · 07/09/2006 23:16

awwww good luck!

ruty · 07/09/2006 23:20

thanks!

eidsvold · 08/09/2006 07:37

i did have one registrar who wanted to automatically book me for a second c-section after dd1's emergency c- section. I got my named consultant to agree to let me try for a vbac and if nothing happened before 10 days over - then we would review it and see what would happen.

That way dd2 was well and truly cooked and ready to come out when she did. She was born 10 days late by c-section - worked out best for us and dd1.

3rd time they told me I had to automatically have a c-section - am going to see if I can get same consultant and let him agree to us deciding at term what to do - that way no need for babe to be born early.

eidsvold · 08/09/2006 07:39

i wonder how much of that is down to the fact that a no of consultants like to do c-sections at 38 weeks - if your dates are out - then the babe can be born even earlier than 38 weeks and not be ready for 'birth' iyswim.

Dd2 - elective c-section - had no hassles post birth.

MrsFio · 08/09/2006 07:39

IWorshipAtTheShrineOfCod, I most probably read it wrong but I thought it reffered to no medical conditions of the Mother, rather than maybe the baby who may have stopped growing weeks before or similar?

I agree though, I think c-sections are chosen without people giving them too much thought. It's highly laughable that people think they are somehow 'easier' and pain free. They also carry the same risks as any other kinds of surgery so I think it would make sense

rustybear · 08/09/2006 08:01

I would assume that problems with the baby would come under 'complications of labour' which were excluded

IWorshipAtTheShrineOfCod · 08/09/2006 08:05

MrsFio - no it excludes women with medical reasons for the procedure which would include problems with the baby like growth etc.
(It's harpsichordcarrier btw)

MrsFio · 08/09/2006 08:20

ahh ok and hello harpsichrodcarrier!

harpsichordcarrier · 08/09/2006 08:24

sorry I didn't mean to sound snotty
am multitasking....

batters · 08/09/2006 08:47

This reply has been deleted

Message withdrawn at poster's request.

LaDiDaDi · 08/09/2006 10:47

I think that the dates issue is likely to have a significant bearing on this study, esp as it was done in the US where my feeling is that c-sections are performed earlier than they are over here. I wonder what happens to the results if they look at babies who were delivered by elective section at 40weeks or once mum was in spontaneous labour? I suspect that it wouldn't be so bad. That's the info that is personally of interest as I had an em section with dd and would be keen to have an elective with a future pregnancy but only if I could have it under those conditions, ie not at 38 weeks.

harpsichordcarrier · 08/09/2006 14:24

I doubt it would make too much difference, ladida, because at 38 weeks the baby is effectively term i.e. fully developed.

but it would be interesting to see.

morocco · 08/09/2006 14:37

(curious not argumentative tone!) I'm not sure that is true, harpsichordcarrier, if they were really 'ready' at 38 wks, I guess they would mostly be born then.

cutekids · 08/09/2006 14:42

haven't read full thread,but on hearing this news yesterday i had to wonder where these scientific facts are coming from. i'm no expert,but - after having an emergency caesarian - i had an elective one exactly 12 months later and again exactly 12 months later than that! i was wheeling a double buggy around and had no one to help with 3 babies straight after as my hubbie worked away. probably going off on a tangent here, but i do think some of this "hype" is really just to put women off choosing elective c/sections. sorry...bit of a rant i know!

harpsichordcarrier · 08/09/2006 14:52

well lots of them are born then, morocco. if a baby is born at 38 weeks, then it is not classed as premature at all. the human gestation period is a bit of a mystery all round but being born at 38 weeks is certainly not life threatening. in fact more consultants are worried about babies born later, because of the risk of the placenta deteriorating after that time.
cutekids - it was really a very big study - 5.7 million babies. so I don't think it's hype, really.

ruty · 08/09/2006 16:09

But surely if the dates are wrong then if you have a cs at 38 weeks you run the risk of getting the baby out a bit too early, you could be two to four weeks out. i do find it a bit upsetting as i said no to an elective cs first time round and then ended up having an emergency under horrible conditions and with ds distressed and heart beat erratic [thank god he was ok]So i do not want to go thru that again. I know no one is trying to make mothers feel guilty for choosing c sections but it is worth bearing in mind not everyone who has them is 'too posh to push.'

wheelsonthebus · 08/09/2006 17:34

my doctor said they were riskier for mums but safer for babies. my dd was born by csrn at 38 weeks

harpsichordcarrier · 08/09/2006 19:10

ruty, noone is saying that. I had a C section fwiw.

HappyMumof2 · 08/09/2006 19:20

Message withdrawn