To demand a caesarean

[angel772]

I’m 33 weeks pregnant and have gestational diabetes. I’ve been discussing birth options with my midwife and she’s adamant they should induce me early if the baby’s getting too big, or let me go to 40 weeks if not. I suggested a caesarean but she said induction was the preferred route with an EMCS if required.

Having looked into this, I came across this link and am now absolutely panicking that my baby could have oxygen starvation during birth, leading to severe disabilities:

www.gestationaldiabetes.co.uk/ceiras-story/

I can’t for the life of me understand why the hospital are even considering making me try for a vaginal birth given the huge risks to my baby, who is already on the large side (5.5lb!!) and so could very easily get stuck. I feel women are offered caesareans for much less and can’t see why it’s not been put forward as an option for me. Why are they risking my baby’s health and WWYD?!

We really need to stop believing that measurements in utero = baby size.

@turnthebiglightoff I agree! My first scan after diagnosis I was scared to death by a sonographer who said my baby would be “big” and had an abnormally large stomach. My diabetic midwife explained in a nicer way it was a side effect of the diabetes and would reduce which it did but the growth scans were plotting my daughter as much bigger than she was!

Thank you for the replies. It's all really helpful info but I'm now even more confused as to which option I should be pursuing - there seem to be so many positives and negatives to both.

My gut instinct though is still that a caesarean is safer for the baby overall in my circumstances. I never wanted a caesarean (was hoping for a natural birth) but I now feel it's the best of two bad options.

I am worried though by the poster who said surgeons may be diverted to the covid wards and that I could get junior medics carrying out my caesarean - that is a frightening thought.

I'm not bothered about a difficult recovery from c-section as the baby is my number one priority and I just want them to be safe.

Besides, I doubt recovery with a 4th degree tear after giving birth to a baby with a big head vaginally is a walk in the park either.

I was scared to death by a sonographer who said my baby would be “big” and had an abnormally large stomach. My diabetic midwife explained in a nicer way it was a side effect of the diabetes

My baby's head circumference is measuring big as well though - I doubt that can reduce in size?!

surgeons may be diverted to the covid wards and that I could get junior medics carrying out my caesarean

Surgeons don’t perform caesareans - obstetricians do, and if you’re low risk it is very common for a junior doctor to do it (junior meaning not a consultant, not a total newbie). For all the “OMG MAJOR SURGERY” posts here, it isn’t an especially complex operation. It’s just that given the size of the incision etc it’s an invasive operation and will take some recovery.

in my local area there are no obstetricians who have been diverted anyway, but I can’t say for sure if that’s nationally or not.

The truth is if they can’t staff a maternal request section they’ll cancel it and you’ll have to reschedule or have a VB, you won’t be given a section by someone unqualified to perform it

And yes plenty of vaginal births are harder to recover from. Induction carries a significant risk of instruments or EMCS, both of which can be way harder to get over than an ELCS, but it just depends how you get on, and sadly no one can know till it happens - hence pick the option you’re most comfortable with!

Thanks.

The Fetal Medicine Centre recommend a caesarean for head circumferences of 40cm and above for babies with ventricumgaly:

fetalmedicine.org/education/fetal-abnormalities/brain/ventriculomegaly

My baby already has a very big head so I need to monitor that as I get closer to the birth.

My babies head was 95th centile and he was back to back and nearly 9 lbs, I had an episiotomy and a couple of other tears. It hurt a lot for about 2 weeks and then I was much better. In those 2 weeks I took Tramadol and was able to be up and about most of the day, everyday. My recovery would've been a lot slower with a C Section. It's really up to the specialists to I for you on what's safer for you and the baby.

You can request a C section I did that. Some people might not agree with my decision but it was the right one for me at the time. I had such severe pelvic girdle pain that I couldn't walk I was in constant pain it was an absolute nightmare they wanted to induce me as my baby was expected to be 11lb And I didn't feel like I would be able to have an active labour at all and I had horrible images of an emergency C section and lots of damage. I met the consultant who was very serious about all of the risks of C-section but we stuck by saying that it was what I wanted and they gave it to us.

In the end my son was born 9.4 So not gigantic but a large baby.

Can I weigh in slightly, my daughter was predicted to be a big baby (she ended up tiny but that’s not the point) she was born at 6lb 13oz, she got stuck. Shoulder dystocia, a full blown emergency. Big red button hit and a flood of midwives.

Sometimes, big or small, babies get stuck. I was the 1/150 who had a shoulder dystocia birth, except I had NONE of the risk factors, not one. This time I’ve got the major one, previous shoulder dystocia. It takes my risk up to 1/10. That’s a scary number. I’d like to think it won’t happen this time. But I understand the odds are stacked against me. I can only hope for a better birth.

You can do this, it’s a rarity. It happens but it’s a rarity xxx

Sorry you're going through this stress OP. I had two vaginal births then an elective c section with my third. Big baby (correctly diagnosed as such!) borderline GD - I don't live in UK but in European country with consultant led care, slightly higher c section rates and a quite cautious approach in the private healthcare system. I made the decision with my doctor after weighing up risks either way. There's a really good chance that your fears for a vaginal birth would never be realised but don't be shy of pushing for the birth you want. It is major surgery but my recovery wasn't much tougher than getting over use of forceps first time around tbh - I was very active by 6 weeks (doctor approved swimming for example). Ultimately it should be your choice. God knows how we factor in Covid19 tbh though!

The way i see it there is no pain free way of getting a baby out...

We know elected C sections are quick and straight forward procedures, and it will probably hurt afterwards and take a few more days to recover.

And on the flip side a vaginal birth could be quick, easy and an absolutey joy (well maybe not that far but some people do say :) or it could be horrendeous - or somewhere in the middle.

So you are either going with an option that you know has it's challenges or you roll the dice!

If you want advice on which to do, maybe it's a case of really trying to go with your gut. There are pros and cons on each side so difficult to rationalise, especially if you have a doctor saying there is no risk.

Some women feel like they are missing out on childbirth by having a C section, other women really have no interest in childbirth and want to go with the controlled option. Maybe spend some time visualising each scenario and see which you feel more drawn to. Good luck!

I am worried though by the poster who said surgeons may be diverted to the covid wards and that I could get junior medics carrying out my caesarean - that is a frightening thought.

Unlikely. Most services are moving the juniors (who normally rotate between different departments, so have lots of transferrable skills), and keeping the seniors in place to run the service.

@angel772 I'd do a lot of your own reaseach. A lot of childbirth research hasn't been updated for a long time. Also hospitals in different areas have different ideas, so that shows how non standard the views are. There are risks to both and it depends on what the team at your hospital has been told to push for. If you know all the risks yourself, you can push for either.

@nocoolnamesleft I had a junior and he was so fresh out of med school he was amazing! Home in 2 days and all healed in 2 weeks. Induction is no picnic medically along with the forceps and ventouse that almost always go with it. Also induction wards tend to be quite grim.

Hi OP. Long post. I understand your concerns and believe you should be listened to and your wishes and concerns taken seriously. I think you are generally very scared of childbirth and a possible GD and baby weight is only going to make things worse in your mind.

I'm 8wks with my second DC and I am planning to request ELCS after first failed induction and EMCS to avoid the same story happening twice. I don't think that following 'professional' advice 100% of time and following the herd like sheple is something we should always do when we have concerns which are not taken into account. My own experience with DD1 pregnancy care and birth was rather poor but I was young scared and lacked experience and support so I followed advice and sat quiet which put my daughter's wellbeing at risk.

My pregnancy was ok but I was totally ignored and not even given any advice on my paralysing SPD, my birth options were not properly advised (high BMI and we were discussing water birth up until 36 weeks to then be informed that I was way to fat right at the start of PG for it), having it suggested by MW that I had too much amniotic fluid and being left without a follow up or support for another 4 weeks, scans showing opposing measuring results (baby way too big or too small), no discussion about potential risks during labour due to frontal placenta (I only knew abt it when the baby was born by EMCS and the surgeon explained his decision saying I should have been referred to CS straight away) and the list goes on and on. My induction at 41+2 was 6 days long with no progress at all. I was pushed back in the queue due to weekend and delivery ward being busy. I was left without care even after my water started pouring. My DD1 was 11lb at birth and was in the anterior position so she would get stuck in a birth canal.

I would trust my gut feeling and press the MW and consultant in writing if ELCS is what you want. EMCS after long induction is not a walk in the park. Sadly, NHS is treating birthing women more like a statistical number and they advise on what's the fastest and cheapest option for them. With CS you are likely to spend a total of 4 days in hospital comparing to less than 24hrs with VB (although induction may take up to 6 days). CS is simply much more expensive and with the first baby you need to press hard to get ELCS. However, take into consideration that we have a major pandemic and weigh pros and cons of a longer hospital stay.

Also just to say that while hospital stay can be as long as 4 days, it can be as little as 24 hours

Most hospitals have enhanced recovery and want you up and about if possible ASAP.

ELCS are generally less traumatic and recovery is better so this is much easier than with an EMCS.

I had an ELCS and was up taking short walks around the ward as soon as the spinal wore off and then was discharged 24 hours after surgery.

Agree @Willow4987 I would have been out the next day but stayed an extra night for help with breastfeeding.

Just to add to what @willow4987 says, even if you do have a natural birth you will be in for 24 hours anyway as they have to monitor the babies blood sugar. The baby has to pass 3 readings. I was in until 5pm the day after she was born and would have been discharged sooner but they only had one person doing the baby checks needed before discharge.

A lot of the people on here posting about how awful c sections are either haven't had one, or have had an emergency section.

Obviously people's experiences vary, but they do tend to be much more positive for electives. I've had two, and they really were easy.

The sections themselves were utterly pain free and delightful births. Minimal blood loss, no tiredness, it was great.

I mean, I feel sorry for those that needed help to stand and get out of bed for weeks, but I was shopping pain free within 3 days. I took painkillers for a couple of weeks just in case, but bar mild discomfort for the first 48 hours, and some pain in first mobilising, it really was easy.

Also bear in mind a lot of the stats about babies going to NICU etc are for all types of section, not just electives. And also babies that are poorly are more likely to be born by section, so that further skews the figures.

You'd likely be given the all clear to go home after 24 hours (though I was given and took the option to stay another night). For a straightforward planned sections, you're unlikely to be in for 4 nights or anything like that.

Great feedback, yes there is a big difference between elected and emergancy (the latter of which being harder to recover from as you also dealing with the impact of birth complications up til that point).

Mine ECS is booked on 2nd July and i can't wait! If i was having a VB it would be a very different story! but that's just me :)

I've been doing some further reading into this and one of my concerns about a caesarean is that it can affect the baby's breathing as they're not squeezed out through the vagina.

Does anyone have any experience or knowledge of this?

I know that an induction may well end in an emergency caesarean anyway so could have the same issue.

Feeling exhausted by having to make this decision - it's so difficult as both methods have risks.

@angel772 I was told it was a potential risk. The hospital I had DS at do skin to skin in theatre which they say improves outcomes for babies. They've actually won awards for their program. Ask if that's something your hospital would do. DS had some funny sounding breathing until he managed to dislodge a big bit of mucous which may not have happened without a c-section.

DD needed some help after my c-section. The theatre staff downplayed it all calmly so we weren't panicking us but looking back her scores were fairly poor. She was whisked off straight away and was given help for about 10 minutes, during which time DH could see her but I couldn't. Wasn't the golden time for skin to skin I had hoped for but thankfully they managed to give her some oxygen and get her breathing well on her own without needing to go to SCBU. The lovely midwife who looked after DD said it's fairly common for c-section babies to need a little extra help shifting the mucus and getting going.

I’ve heard this can be a risk but for me it was a minimal one

My DS didn’t have any breathing issues but did cough for a couple of days until the mucus came up. Wasn’t a big deal