C Section

[hankyspanky]

I'll try and keep this as concise as possible, please bear with me!

Daughter is 27 weeks pregnant with second child. First pregnancy was textbook up until delivery (6 years ago). Ended up with an emergency cesarian section that went horribly wrong. I was with her in the operating theatre and still suffer from PTSD due to events. The bottom line is baby basically 'got stuck'. From the information we were told after, it transpired babies neck was stuck under the pelvic bone. To say all hell broke loose would be an understatement. I could see the fear on the Registrars face and everyone seemed to be panicking, unsure of what to do. Thankfully the main consultant just happened to be on call and was in the theatre within minutes. I know, had she not of been, I would have left that day without either my daughter or grandchild. To try and give some scale of the problems we were in the operating theatre for 5hrs and 40 mins, which by any stretch is a long time for a c section.

There were concerns of possible brain damage due to the length of time it took to deliver but thank God, it all turned out ok. My daughter had to have 5 blood transfusions and stay on the epidural for 4 days post delivery. The Consultant explained she had had to do a 'classic' incision which meant any future pregnancies would have to be delivered earlier by cesarian, there would be no possibility of allowing a natural birth due to the risk of rupture.

Fast forward to now. We have the consultants letter which she kindly wrote for my daughter explaining the previous problems and how future pregnancies will have to be carefully managed and delivered early so there is no chance of going into labour, but she has unfortunately retired. New consultant has said he will do a cesarian at 39 weeks. My daughter (and myself) are horrified at this. I am trying to reassure her that the consultant knows best but I genuinely think in this instance he has made a mistake.

How would you try and convey that you think he is wrong? I thought he would suggest delivery at 37 weeks, so when he said 39 my brain sort of shut down! We have another appointment with him next week and I'm wondering if I should stress the mental anxiety this is causing my daughter? I genuinely would welcome any thoughts or suggestions.

What an awful experience for you both, it must have been so frightening! And what a long time for your daughter to have been in surgery. Not surprised you’re both feeling anxious this time round! It sounds like it was horrendous for her.

I suffered a shoulder dystocia in my first labour - nowhere near as severe as your daughters. I’ve just had my second baby and opted for a section this time.

Did your daughter go in to labour naturally last time and if so how many weeks was she? It may be worth looking at some research to support your thinking that a section at 37 weeks would be safer, then when you discuss it further with the consultant you are armed with some evidence. This is what I did so that I could have a section.

39 weeks is much safer for baby. A baby being born earlier will need steroid injections, given to Mum to develop lungs to help them develop. If your daughter went into labour at 39 weeks then they will do the c section then.

You need to ask the consultant about the risks and benefits of going a c section at 37 weeks v 39 weeks.

Ask him why he thinks it is appropriate to deliver so late when 37 weeks is full term and offers the least risk of her going into natural labour, if he still doesn't agree to bring it forward to at least 38 weeks then tell him you want a second opinion from another consultant !

@hormonesorDHbeingadick 37 weeks is full term, they wouldn't give steroid injections.

I was induced at 38 weeks the consultant said it was up to me if I wanted it or to wait till it happened naturally.. my baby was 8 Lb 9!

Baby is considered term at 38 weeks and my father (who was a doctor) said any time after 33 weeks is ok. I’ve had two planned sections and both were scheduled for 38 weeks (son decided to come 9 days earlier than that already weighing over 10lbs)!
Your daughter should speak to the consultant expressing her concerns. We were even able to change the (original) date so as not to clash with my stepsons birthday!

Full term is 37 weeks for a baby born from spontaneous labour. Before 38 weeks guidelines are to give steroids.

@hormonesorDHbeingadick my sister had her daughter at 37+1 they didn't offer steroids.

39 weeks is reasonable, gives baby enough time to ensure lungs are fully developed. If she goes into labour earlier they will just do a section then.

I’m just going off the conversation I had with my consultant on Monday.

I'm a NICU nurse and I'm rather busy at the moment so just quickly I'll add- it's far far safer for the baby to be born by a cold c section at 39 weeks than at 37 weeks

If she goes in to labour, she'll be fast tracked to a c section. The only way she'd have to give birth naturally is if she went into sudden and v quick labour and gave birth before she got to the hospital, which is pretty rare, especially as she'd be contacting the hospital as soon as anything started.

Given its a no to her giving birth, rather than going into labour, 39 weeks will be fine.

Your experience sounds petrifying. No wonder you are worried this time around. I was told my my mw they currently do electives from 37 weeks so I am sure your request could be granted if you express your concerns. Confused by some of the 37 week vs 39 weeks when they class 37 weeks as full term. I had my last elective section exactly 39 weeks. I have no idea when they will do it this year as right over Xmas and new year x

I've had 4 c sections, one at 42 weeks, next at 41 weeks, 3rd at 39+3 and 4th at 38+4. The 4th was born 'early' because of a transverse lie, otherwise I'd have been left til 39+2. I too was surprised at being left so late but it was explained that it's best for baby and if by chance I went into labour I was to come in to hospital and still have my c section. If your dd shows any signs of labour prior to her c section date she can just ring ahead and tell the hospital and go in. They can still deliver by c section.

Thank you everyone for your input and advice.

I totally understand the reasoning for allowing baby to stay for as long as possible in the womb but after reading literally hundreds of medical papers I personally think the risk of respiratory problems versus risk of uterine rupture, in this instance are outweighed.

The consultant who delivered my previous Grandchild stressed the importance of not going into labour under any circumstances, hence the reason for early delivery. I didn't realise that the incision she had made was only done under extreme circumstances and accounts for 0.1% of C sections.

My daughter went into natural labour at 39 weeks exactly last time. I think this is why its causing so much distress. (That I'm having to hide to reassure her that everything will be ok).

I read somewhere (but can't find it again to copy) that the risk of death for mother and baby rises to more than 50% in the case of uterine rupture after a classic c section.

I really, really don't want to be with her in the operating theatre and her partner works over an hour away. Obviously if push came to shove then I would be with her, but not by choice.

I'm going to pass on @HJWT advice and if the consultant isn't open to negotiations then ask for a second opinion.

I think we would both feel better even if it was 38 weeks but I know she thinks 37 weeks is best for her. Fingers crossed and I will update all you kind ladies as to the outcome of the appointment.

HJWT My dc4 was delivered by elcs at 38+2 weighing in at 11.6lbs and i did have steroid injections because they were delivering before 39 weeks!

I'm not in the UK but I had a traumatic emcs with my dd at 39.5 weeks. I had a PPH and was on high dependency care for about 24 hrs afterwards.

I got pg again with Ds fairly quickly afterwards and it was a shock so I had another c section 16 months later. My consultant insisted on doing that at 37 weeks. We were both fine and it was a much easier recovery.

No steroid injections for me. Ds was 3.3 kg same weight as Dd.

Good luck!

Will be very matter of fact here.

He's not wrong. They know what they're doing, and he's told you what's best for mother and child. I totally understand the panic and concern after that awful experience before, but don't look too disagree with him.

Secondly, with regards to before, I'm so sorry to hear what happened. Something very unlikely happened and it went very wrong. Don't lose sight of that. It was not the norm by any standard. It by no means it's any reflection of what will happen this time.

I'm a mum of one planned CS and having another (two) at Christmas with twins. I'm bricking it about going into labour early and them flying out the natural route and all the stuff that could go wrong in accordance with that. But what if I don't. What if I'm panicking for nothing, and it turns out I go in on my selected date, and have a hassle free planned CS. What good is it too stress about a future event that no one can predict? So whilst I can't eradicate the worrying thoughts from my head, I do consciously try to talk some reason to myself when I get stressed about it. I might have a perfect birth. And so might your daughter

I completely understand your concern. The new consultant seems to be minimising the risk of rupture. In your DD's shoes I would be writing with the evidence you've found from your research, and asking for a written explanation of how the relative risks in her case have been assessed. Copy to Chief Exec of the trust and to PALS.

I'm sorry to hear about your trauma.
Even with twins my c-section was planned at 38+5. I remember thinking it was so late for twins and worried about going into labour because the positioning of the babies dictated a section.

It was a worry and towards the end I didn't do anything for fear of going into labour (and because I couldn't move!) but I'm glad we left it so late as the children were very healthy and didn't need any steroids etc.

I’m worried that a lot of these posts seem to be about you want but your not the mother, your daughter is.

OP I completely understand your concerns and why you are worried for your daughter and grandchild. This is a very specific situation, due to the previous classical incision (a point which some of the more recent posters seem to have missed....)

If I were in your shoes I would ask for a second opinion sooner rather than later. Write down all the questions to which you want answers, take any relevant research you've found with you.

I'd be pleased if my mother were as supportive and involved as you are

Ask the consultant how easy it would be to do a section once the first signs of labour start. If a section is fine then you have your answer (or rather your daughter does).

Is the dad around? Are you the birth partner? Someone needs to make sure she is prepared to move as soon as the labour starts just in case.

A ruptured uterus is horrible and dangerous (I had one with my dc2) but not as statistically dangerous as you thought, OP. I just read a study that out of 159 ruptures in a year in the UK there were 2 maternal deaths and 18 infant deaths. So definitely not a 50% chance. And if your DD gets to hospital as soon as she feels anything then the risk is much less. My uterus ruptured partly because I stayed at home when my "contractions" were really close together and I should have gone in sooner.

@hormonesorDHbeingadick I just want to ensure my daughter and baby have the safest option, I'm absolutely not putting my 'wants' before their safety.

@pennypineapple thank you, I've tried to stress how different a classical section is to a normal section but I never realised myself, until after it had happened to my daughter and researched it. She is going to request a second opinion at the consultants appointment next week.

@MyOtherProfile the consultant has said, should she go into labour before the planned date, it would be treated as a Grade 1 emergency which is something she clearly wants to avoid. The plan is for her partner to be with her but I am on 'standby' should the need arise, which I am seriously praying it won't!!

I managed to find the link giving the statistics and have posted it below.

www.glowm.com/section_view/heading/Cesarean%20Birth:%20Surgical%20Techniques/item/133#r88

The incidence of uterine rupture may be increased in patients with a previous single-layer closure. However, in patients with a previous classic uterine incision, the risk of uterine rupture may be as high as 9%, with one-third of these occurring before the onset of clinical labor. In one study on preterm cesarean sections the risk of uterine rupture was similar for both types of uterine incision. In the event of uterine rupture, fetal mortality and morbidity are highly significant. When a classic uterine incision ruptures, the fetal mortality is in excess of 50%, compared with 12% in the event of rupture of a prior low transverse incision.

Thank you all for taking the time to reply.

Morning @hankyspanky
I cannot comment specifically on csections, however I can sympathise as when I was an agency nurse I cared for a lady in a similar situation who ended up with a vertical Caesarian and mechanical breaking of her pelvis for the baby’s safety! It was a long hard recovery for both mum and baby!

Back to original point though - I myself have chronic high blood pressure and my consultant told me I HAVE to deliver at the hospital and be constantly monitored (put my plan of home birth right out the window 😢) due to this I was to be induced in my 37th week because 1) I live a minimum of an hour away from the hospital - more atm because of the tourist traffic, and 2) I have very quick labours!
Now at 35+ weeks (& fear of several other complications picked up at several scans) I have been cleared for natural delivery so I don’t have the same worries as your daughter about csections! However I do understand where you are coming from with regards to date for delivery! My 37+week induction has been moved several times and now they are saying 40+2! This is my fourth dc and the others all came at 39 weeks! I physically cannot get to the hospital any faster and the risks to myself and baby could potentially be quite high! Whilst I equally don’t want an induction and would rather go into natural labour, I also want to eliminate all risks that could be potentially dangerous to myself and my baby! So because of this I can understand yours and your daughters fears (despite being an entirely different situation)
If I were you I would fight your daughters case and get the consultant to explain exactly why he feels 39weeks is the best option. Go with a list of pre-prepared questions and items you want to raise. Also my hospitals protocols are all on the internet, maybe yours are too? Might be worth doing a bit of research into it perhaps. Although having said that I have read my hospitals protocols(relating to my complications) but I have a nursing background so I have prior knowledge and understanding, there is a chance if you can find the right protocols you might not make head nor tail of them OR they could make you more anxious! Your call, my personal choice would be to be armed with all relevant knowledge though! It might be worth portraying that you see the risk of uterine rupture as far greater than the risk of the baby having respiratory problems, and also I would recommend pushing for delivery at 38weeks because again the risks are far less than at 37 weeks though.
Good luck!

Sorry for not coming back sooner with an update!

We saw the Consultant who refused to deliver any earlier than 39 weeks so we changed hospitals.

Daughter much happier with new hospital and without even asking, the new Consultant stated she would deliver at 37+4. I finally was able to 'relax' in the knowledge my daughter was happier and reassured.

BUT.....the best laid plans......of Mice & Men!!

Out shopping with her friend a couple of weeks ago and her waters suddenly burst. She was rushed into the hospital she was booked at but unfortunately, as they don't have a level 3 NICU they had to transfer her back to the original hospital. It is now literally an hour by hour wait and see scenario. The Consultant said this morning their ultimate aim is to try and let her get to 34 weeks and then deliver.

Fingers crossed.