Consultant not booking C Section any earlier than 39 weeks despite GA risk if spontaneous labour…

[PEhelpp]

Hi all,

I have been diagnosed with multiple pulmonary embolus this pregnancy and I’m on two doses of blood thinners per day (9am and 9pm).

A spinal can’t be performed for 24 hours after a thinning injection, meaning that if I were to go into labour naturally, I’d have to have a c-section under general anaesthetic. I am absolutely petrified of this and the risks that this brings.

My consultant says that this isn’t a good enough reason to perform the c section any earlier (I requested 38 weeks), and that if I need a general anaesthetic, then that’s what I’ll have to have. Apparently the risk to baby is higher at 38 weeks than 39 (my last birth resulted in a c section at 38 weeks due to spontaneous labour prior to my c section date and DD was completely fine!).

Does anybody know whether I have grounds to take this any further for an earlier date? I have super bad anxiety about the thought of a GA after what has already been a terrible pregnancy.

What terrifies you about GA OP?

This
Mine were fantastic, go to sleep and wake up with babies.. perfect!

It is optimal to perform a CS as close to term as possible to
minimise the very real risk of respiratory distress in the newborn.

I am a little confused by your post. Why would you not be able to go into labour and have the baby naturally? No criticism, I just don't understand?

I have 3 blood clots in my lungs and have to have blood thinning injections twice daily. I have had previous c sections. I have been advised that c section is best for me.

The grogginess after waking, not seeing my baby straight away, the general risks of GA, not having that instant bonding experience with my baby…

Unfortunately no there’s nothing you can do to take it further, it’s safest for the baby to be in up to 39 weeks so that’s what is done. Anything earlier than that is a preference and kindly that isn’t relevant to the consultants and doctors in charge.

It’s irrelevant really that your last baby was born at 38 weeks okay, another baby born at 38 weeks wasn’t. The safest thing for baby is to be inside for as long as possible.

The general risks of GA are no worse than any other birth options so please don't worry about that part.
Yes, it isn't ideal to be asleep, but if it's needed it's needed. The grogginess doesn't take long to come round from at all, not from a short GA like this surgery requires.
In this instance I'd trust the consultant - there's been lots of evidence that c section babies before 39 weeks are far more likely to have breathing issues and have a much higher chance of developing asthma. I would take the short term potential negatives over the long term.

I didn't see 3 of my babies straight away as I had pre eclamsia and they had to go to SCBU it didn't affect any bonding experience at all.

what does the anaesthetist think? The decision re how to do the anaesthetic and the relative risks vs benefits for you is more down to them and they may have advice/liaise with the haematologist and obstetrician to come up with the safest plan for you (it'd be a bit surprising if that sort of MDT decision hasn't happened already). For most women avoiding a GA is the safer option (contrary to PP's suggestions), but that isn't always the case and depends very much on your exact medical history. If you haven't seen the anaesthetist in clinic yet then that may be a way to clarify things re the relative risks and benefits for you/timing/how high risk a GA would be if it came to it, etc. (DOI: in case it wasn't obvious...am an anaesthetist!).

Didn't see either of mine straight away. Both born emergency csect, 1 at 35 weeks, other at 37.
Main concern for everyone was babies out safely and immediate NICU care where needed. No issues at all with bonding.

I haven’t met the anaesthetist yet! It’s never been mentioned so I’m not sure whether I will?

If everything goes to plan and I don’t go into labour spontaneously, then a spinal will be used.

The issue is just if I go into labour early whilst on blood thinning injections - my last dose needs to be over 24 hours ago else I’ll need a GA (which would be likely as I currently take them every 12 hours).

Hi

i had a thrombotic storm and spent over a year in hospital after the birth of my first child

i was on blood thinners a lot and had a c section with both

they only need you to stop it for 12 hours and yeah once was a GA which was no issue at all

Thanks for sharing. I have been told 24 hours by my consultant (currently on 80mg enoxaparin 2x per day).

I had a couple of hours talk though with the anaesthesiologist. Who absolutely calmed my nerves. I would ask for that?

I had my second thought at 35 weeks because of pre eclampsia but I didn’t want it. I wanted to wait but my high risk dr said no

i take it you have a high risk dr and a special thrombosis dr?

Just for clarity, in general for most women, having a spinal or epidural top-up is the safer option rather than GA. There are some exceptions to that rule and the OP may be in one of those categories though. There is a bit more than just the grogginess to think about and it does take some joined up medicine to decide.

That’s their choice then.

I would ask for a chat with the anaesthesiologist

I'm sure 24 hours would be optimal. That's what I was told before my booked section at 39 weeks. Unfortunately my DD had other ideas and came the day before I was due for my section. I had my reasons for requesting a section so still persevered with it. I did bleed more but wasn't told the spinal was any issue and recovered well.

Obviously all cases are different so you can only be guided by your medical team.

Oh yeah I know all that - just saying it's not something to be terrified of in itself. If that is what's needed when it comes to it.

If you've had a recent PE then you should be being seen by an anaesthetist in clinic whatever mode of anaesthetic/delivery you're having as there's more to think about than just when the last dose of anticoag's were given - probably a good idea to ask when that referral is happening/when the appointment will be.

The fact is that the closer to 38 weeks your baby is the less likely they are to suffer with issues caused by under-development seen in premature babies such as under-developed major organs and breathing/circulation problems leading to brain damage. The only reason why the medical professionals would go with a premature birth is if leaving the baby longer would present a significant risk of medical complications for mother or baby or both. Unless your condition makes a C-section significantly more risky for you or baby than it would be for another mum and baby, leaving the baby as close to term as possible and then delivering by c-section is the safest thing for you both.

There’s a BIG difference between a caesarean section at 38 weeks when you’ve laboured vs an elective caesarean section at 38 weeks with no labour. Look up the rates of RDS in newborns born by electives. Ultimately if they agree to this and your baby ends up being admitted to SCBU as a result the consultant will have to justify why this decision was made and can have restrictions on their practice made as a result. Term admissions to neonatal are very closely monitored and assessed externally so they need to be really careful.