Mears or lulu help! I know NICE guidelines state...

[Hopeitwontbebig]

that a caesarean shouldn't be performed before 39 weeks but I am suffering from terrible sacroiliac pain and am not sleeping much these days. My consultant has booked me in for a cs at 39+3 as baby is breech. They only perform elective cs's on Wednesdays and Fridays. I am 39 weeks on Sunday 16th Sept, so he's booked me for the Weds 19th. He point blank refused to book me for the Friday 14th, even though it's only two days before 39 week threshold.

Also, the baby is already looking big. My scan at 36+3 showed the baby was already 7/8lbs. My previous 2 babies, although they went overdue, were both over 10lbs.

The question I have is, risk assessment, is it worse for baby being delivered 2 days before 39 weeks, or continuing to 39+3 with Mum being in dreadful pain, and not sleeping?

If it is more risky for bub to be delivered before 39 weeks, then I will just have to get my head round it. I just wish I was able to sleep. I really really am not looking forward to the early sleep deprived weeks with a newborn.

I am currently 37+1

bump

oh sweetie am not sure where lulu is at the mo but she may pop up somewhere soon x

hi im suffering just the same as you are but not breech. personally i wouldnt think those few days would make a difference. plus our due dates are only a indication and its 2 weeks either side. dont worry too much consultant would nt do anything to put bubs in danger.

feelings are with you on the pain and sleep side it really getting me down now. hard work when its not 1st bub as you can barely rest my dd is 21months how old are yours?

I think it's highly unlikely to make much difference if you are 38+5 or 39+3 in terms of the baby's health. Did the consultant give any reason why he wouldn't book you for the earlier date?

agree with daisy......

hospital policy might be very strict re date of elective c,s

they might have targets to hit and numbers to attain

none of which helps you

agree you should ask why the refusal for that date, when only 2 days before threshold

missyhols, fortunately my 2 boys are that bit older, they're 10 and 8. Have to confess I am still in bed , I just feel utterly exhausted, bless them, they have made their own lunch and are being really quiet so as not to disturb me.

Lulu, I did ask him if he'd consider doing my CS on the Friday and he said no. I said, 'even though it's just 2 days before 39 weeks' and he said they have a very strict rule about not doing it before 39 weeks because of lung development.

I even mentioned the fact that the baby was showing up big on the scan, plus the fact that I have a history of big babies.

I also said, that I was 'falling apart at the seams', he dismissed this and just said 'well we'd just have you in for a long hospital stay then'

What should I do?

Is you community midwife nice? Have you spoken to her? You could ask to be referred to a different obstetrician or even a different hospital. It might also be worth contacting PALS and making your case via them. Your cons sounds very unsympathetic.

Sorry, meant to say that your cons is within his rights to refuse a CS as if something went wrong as a result of you being less than 39 weeks it is his professional registration on the line. Not much comfort to you though!

I've only met my community midwife once! And that was over 20 weeks ago! Most of my antenatal care has been at the hospital, due to extra scans and tests for gestational diabetes.

I have just sent an email to a private obstetrician in Oxford. We have Bupa insurance, and the only thing Bupa cover you for in pregnancy is an elective caesarean for medical reasons.

I am waiting to see if he will reply. His name is Lawrence Impey. Has anyone heard of him? He's written a book!

Really? Bupa didn't cover me for anything pregnancy related.

Sounds like this might be the way to go then but that you should need to.

Yes I know, Bupa useless. I had to have an emergency scan in the first trimester and Bupa said they wouldn't cover it because it.....wait for it...... is for another person, albeit inside me!!!!!!!!!!!!!!!!!!!!! Hilarious!! But they do cover for elective caesarean if baby is breech etc. Don't quite understand the logic but there you go.

FFS!

Hope it gets sorted for you hun. I've decided to go for all the other tricks to induce. Been having lots of pains last week and half but they have not done internal as they don't like to risk infection. I've been on bloody monitors but contractions are just not enough.

You poor thing missyhols. Keeping fingers and toes crossed that things get started for you NOW!!

I've heard back from the private obstetrician and he thinks he can do it on the 17th! I know it's only 2 days earlier, but boy what a difference those 2 days make! I'll keep you posted.

there is a risk of what they call "wet lung" for babies delivered by CS before 39weeks, which is why your cons is being ultra cautious. You can understand it as at the end of the day it's his job/reputation on the line if he went against policy & delivered early & then there was a problem.

FWIW my hospital have the same policy, no CS before 39wks unless mum or baby are in imminent danger.

this is an extract from the BMJ which explains it

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British Medical Journal : Elective caesarean can increase the risk to the fetus

In cases where normal vaginal delivery incurs considerable risk to the mother and fetus, elective caesarean section may be justified, but decisions must take into account the risk to the infant associated with delivery before 39 weeks' gestation.

It is now clear that respiratory distress syndrome is indeed seen in "term" infants and is a considerable source of morbidity and mortality in this group. A recent article by Madar et al shows that mechanical ventilation to treat presumed surfactant deficiency is 120 times more likely to be needed after elective delivery at 37-38 weeks than after delivery at 39-41 weeks.

We recently revisited this issue as part of a departmental audit...These findings are consistent with the findings of previous studies and confirm that babies delivered before 39 weeks' gestation are at increased risk of respiratory distress and that for term infants caesarean section before the onset of labour results in a considerably greater risk of neonatal respiratory morbidity than delivery by any other means. Moreover, the risk of respiratory morbidity is halved with each completed week of gestation between 37 and 41 weeks.

Evidence based guidelines should be established so that when there is no clear benefit to mother or fetus elective caesarean section before 39 weeks' gestation is avoided.

Thanks for that info BetsyBoop.

I definitely don't want to have my cs before 39 weeks then! Looks like I might be having it done at 39+1, so that's fine.

Hi Hopey, what a nightmare for you. I know you know a little of my past, but thought I'd just put it here for you to read. Ds1 was an em cs at 38+4. Ds2 was elective cs at 38+5. Neither had any respiratory problems. Neither had prophylactive steroids or any other preparation for birth. Both fit and well. As you know (!) ds3 was had em cs at 35+6. They tried to keep us going longer (was told ideally to 37 wks), but other problems meant he had to come out. Had I not been on steroids for most of this pregnancy, they would have given me 2 steroid injections to boost his lung function. He was born fit and well with absolutely no lung problems. Btw, ds3 was booked in for an elective cs at 38+3 had he made it that long.

I just wanted to give you 'real' stories. I know they have to be work within guidelines, but at the end of the day, that's what they should be - 'guide' lines. It makes not sense at all that one hospital won't book elective cs's before 39 wks, yet others, including my hospital has had me booked in twice before the 39 wk mark.

Anyway, good luck with the private option. That sounds like nothing less than you deserve. Take care. K x

Aw thanks for that kinki. It's SO nice to have you back! It is interesting isn't it, that so many hospitals have completely different policies regarding the 39 week thing. I think there's a couple of people on our thread that are being 'done' before 39 weeks.

Also, it will be interesting to see how much this LO will weigh! Considering it'll be born earlier than my other two and she's a she!

I've spoken to Bupa and DH's company are just FANTASTIC (not often I say that) because they've taken out an all singing all dancing policy with Bupa. Basically this means that Bupa's payment guidelines are £200 short of what my private obstetrician charges. So along with the £150 excess that we'd have to pay under our policy, we'd have to make up the £200 shortfall. BUT, because of the policy DH's company have taken out, we're covered in full, which has just made my day!! I went to bed last night feeling really guilty, because this c-section was going to cost us £350!! Now it'll only be £150. So happy. Just on tenterhooks now, because I'm desperate for the surgeon to get back to me and confirm that he can do the 17th.

Oh come on and confirm that date pleeeeeeeeeeeeeeeeeeeeeeeeeeeeease!

Right, it's all confirmed and booked for the 17th now! Eek, that's less than two weeks to go!

Wow good luck. I'll be thinking of you on 17th!

thanks missyhols. Keep in touch and let us know how you get on. I'll be checking in for your news.