Which mode of birth would you choose in my situation? Struggling here

[Missmonkeypenny]

Background : pregnant with DC3. DC1s birth was forceps delivery at 42 weeks,very traumatic, DC not breathing, PPH of 1.5L
2nd degree tear, needed a birth debrief. DC2s birth was wonderful, induced at 38 weeks due to a LGA baby +polyhydramnious but wonderful experience, just gas and air, active labour was 5 hours and 0 stitches for minimal grazing.

DC3 is a whole other kettle of fish. Current 32 weeks. Since 18 weeks I've had bleeding. At first it was suspected to be a hematoma but it transpired at a 26 week growth scan due to DC2s size that I had an extra placental lobe covering the cervix, a form of placenta previa ( main placenta is anterior high ). Between 18 and 32 weeks, I've had 17 bleeds. All of those after 23 weeks (11 of them) have been overnight hospital stays, all have meant having a cannula in, steroids at 27 weeks and meeting NICU team as tightenings after a bleed, nil by mouth at 30 weeks due to tightnings after a bleed. Told explicitly I'd need a section due to placental lobe location, would need a scan at 32 weeks to check to see if it had developed into Vasa Previa with the vessels running across the cervix would have meant a section between 34-36 weeks. Had a scan at 28 weeks which showed the same thing, panic stations from medical staff, told go to in for any bleeding/pain/tightenings etc, keep a very close eye on movements. 'High risk of placenta abruption and fetal demise' were the words used multiple times. I've not slept properly for 3 months, terrified I'm going to wake up in yet another puddle of blood. DC1 is an anxious wreck worried Mummy won't be there when she wakes up again ( lots of the bleeds have been in the early hours of the morning ). I had to stop working as a bleed = needing to go straight in without waiting for someone to cover me which wasn't feasible in my job.

So I went for that scan yesterday with fetal medicine, DC has turned head down and it's bloody moved. After being told it wouldn't move, it's bloody moved and now I don't know what to do. The lobe is 17mm away from the cervix, they like it to be 20mm away for a vaginal delivery but apparently 17mm is fine because it's a lobe not my main placenta. The consultant has booked me in for an elective section between 37-38 weeks and has said I can choose what I want to do but my brain is absolutely fried. Its been such an anxious, uncertain pregnancy and the only thing which was certain was the non negotiable fact I needed a section and I was counting down the weeks until then so I wouldn't have to be pregnant any more and now it's another choice I have to make. Seeing the fetal med consultant again at 35 weeks for another scan.

I'm just exhausted and don't know what to do.

Oh you poor thing. I don’t know what the answer is but could not read and run. Are they doing another scan with the 35 week appointment? Maybe the answer is that there is no answer till then. Maybe that app will make it clear which way you should, or want, to go.

That sounds awful, you’ve really been through it! What does the consultant advise now that it’s moved? When do you have to make a decision, could you see where it is at 35 weeks then change to a vaginal if that’s preferable to you?

If you reacted well to being induced early last then, perhaps they could try and induce you at 38 weeks and see what happens then you’ve got a section booked in if it is taking a long time? I think in your shoes I’d be guided by the professionals because of the complications you’ve had so far.

Yes, another scan at 35 weeks by the arrival consultant, I've not seen the same one twice before now.

Stick to plan A, have the section. Give yourself some certainty. You will go in to labour full of worry otherwise and that’s not going to make it easy.

Sorry no advice really, just wanted to say I think they're being really unfair putting such a big decision in your hands, they should be advising you on the safest option for something like this. Would they induce you around the same gestation if you wanted to a natural birth? If not then I would go for the section. Or could you decide after your next scan when they might know more?

I agree with @Megan2018, I would opt for planned section.

ah what a stressful time. honestly if it were me i'd have a C-section just to have a bit more certainty and less anxiety. You could be induced at 37 weeks but that could take days to work if it works at all and you may end up needing the C-section anyway.

But at the end of the day you have to go with your gut and do what's right for you

I would chose a section.

*choose

I would stick to the plan and have a planned section which apparently are pretty good! Good luck, sounds very tough but you're almost there now x

I would always always take the elective section. I had a similar situation, dc1 was forceps, third degree tear required surgery, he was heavily bruised, post birth trauma etc. Then pg with twins. DD was breach so elective booked in until I went for my bloods etc to be taken pre surgery and told she had moved so I could deliver naturally if I wanted to. I was so shocked, I didn't know what to do. Wonderful midwife came to me when doc left room and said, "Off the record, if you were my daughter I would go for the section." I was incredibly grateful to have someone helping me in the decision. Section was amazing and much much easier to heal from than the forceps. But more importantly, DS2 was very ill when born with chest infection and he didn't even rupture his sack, they delivered him in it and showed me (not common, probably because he was so ill). I'm convinced if I'd waited for natural birth he would have died so somehow that midwife saved his life.

It's harder for you as you've had one good, natural birth. But in your shoes, particularly with the medical history, I would definitely go for the section.
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I would choose c section too. To avoid any more trauma.

My first pregnancy involved multiple bleeds due to low lying placenta and an emergency c section at 32 weeks; lots of uncertainty and stress. With my second pregnancy they said that I’d have an elective c section due to how my c section was done but I was massively relieved to know that it was happening that way. After the uncertainty and stress of my first pregnancy it helped to know there was a bit more control around my next birth; my elective section was a very positive experience

I would absolutely choose a c section in your position (I've had one hideous natural birth, similar to your first and an ELCS) It sounds like you're really been through it, so if you have the opportunity to make things a little bit easier, take it!

You already have enough stress to deal with, I would personally go for the section.

I'm a huge advocate for vaginal birth and no interventions but you don't sounds like you want that. You don't need anyone's permission to have a section. It's perfectly fine to continue with your original plan.
The heath professionals have to give you all the choices available to you, but if that makes you anxious rather than happy then just stick to your plan.
Caesarean is a perfectly valid method of birth.
All the best.

Statistics show that the safest mode of delivery for a baby is by c-section, and that's without complications. The risks during a section are mostly for the mother.

I would have the section.

Thank you all, lots to read over and consider although I'm surprised by the apparent landslide answer.

I'm aware a C section is a valid birth choice but I am also aware of the implications of one (not driving, having two other children at home, husband having to take more time off etc ) and feel selfish for considering it when it isn't ' necessary' any more

@Megan2018

Stick to plan A, have the section. Give yourself some certainty. You will go in to labour full of worry otherwise and that’s not going to make it easy.

I'd go with this option too. I had a family friend with some similar issues years back and they were faced with a dilemma to go c-section or (as was being re-mooted), vaginal delivery. Friend opted for C-section and found it less traumatic as it was the one thing that was planned for, IYSWIM.

@zurala

The heath professionals have to give you all the choices available to you,

Exactly. But that doesn't mean they have no private preference/ secret opinion.

My tried and tested never fail formula is this. I ask the DR " If I were your wife/mother/sister; if this was your dad/father /child; what would you want them to do? "

The results can be surprising, controversial, indiscreet. I choose what they'd do and have never regretted it.

As the uterus expands, the placenta can indeed move in relation to the cervix. It is currently 17mm away. At 35 weeks, it could very well be 20mm away.

I’d wait for 35 week scan to make a decision. If the placenta is 20mm or more away, I’d go for spontaneous vaginal birth. If it is still less than 20mm away, I’d opt for a C-section although with it being booked at 37-38 weeks there is risk to the baby coming out early and having breathing difficulties and such. I think I’d want the C-section at 39/40 weeks to lower that risk to the baby.

I would not opt for an induction as that increases risk of placental abruption which you are already carrying a risk for with a low lying placenta.

No matter what you choose, I would ask about having my blood taken and stored at the hospital to be used in the event I would haemorrhage and need a transfusion. You will definitely be giving birth in a hospital and so even if you do haemorrhage, it is still very unlikely you’d die as they have the medical staff and equipment to handle such complications.

If you are planning on another baby after this one, C-sections do increase risk of placental issues in later pregnancies. If this is your last baby, nothing to worry about.

If you'd already made a decision that you were happy with, then stick to that decision. No point stressing yourself with more and more scans to see if it's moved 3mm either direction.

Have an elective section. Mine was amazing, my recovery was so quick compared to my 'natural' first birth. Traumatic 72 hr labour, 4th deg tear and an op a year later for correction - never again.

I chose to have a drug free natural birth, but in your situation with your history I would 100% have the section.

(And actually, looking back on my birth, I realise that the baby was a lot more at risk than I realised at the time, it wasn’t until the homebirth midwife started lying on the paperwork to cover our tracks that I realised I should have been transferred to hospital for emergency section as the baby was basically stuck for hours. We were well and DD is fine but I would not make the same choices again.)

I’d have the section. I’ve not have one myself but you’ve been through the mill and I think the certainty would be a good thing. A planned section is definitely more relaxed than an emergency one.