Preterm c-section

[ByHazelMaker]

could you please help
i am 36 weeks + 2days i still have low laying placenta shown by today’s scan and they told me i should have c-section in the following 5 days!!!
And give me the choice of having steroid injection before the surgery. What do you think ..? Is it safe or not ???

The steroid injection is absolutely safe, that's why they've offered it. It's imperative for the babies lungs. If they've advised you to have a section in 5 days then you'll be 37 weeks which is considered full term. My DD was born via section at 37 weeks, I had 2 steroid injections. She's absolutely fine. She was a bit jaundice but that's about it.

What's made you question the safety of the steroid injection? It's also imperative for C section (and all births) for baby to have the vitamin K injection. If you are vaccine adverse please make sure baby has that vaccine.

At this stage I would opt out of the steroid injection if I were you. I was advised by a consultant to have it at 36 weeks but the midwife told me to research it first and there is a growing body of evidence that steroid use in pregnancy can cause autism/ behavioural problems. Obviously if you were at an earlier gestation the babies life is the most important thing but this late on it’s worth weighing up the options and doing some reading

At 37 weeks my consultant advised against steroid injections. My child did have to spend a few days in NICU with breathing problems. I don’t know if they would’ve been fine if they’d had the steroid injections. My other child was born pre 37 weeks and had the steroid injections. Both still young so not sure of any long term effects. I think advice is a bit more ambiguous once they’re technically term. I had the same consultant for both so the advice differed based on gestation.

There's a huge difference between 'steroid use in pregnancy' and one or perhaps two individual injections. There is absolutely no proof whatsoever that steroid injections cause autism in babies. Autism is heavily influenced by genetics. This is such bad and dangerous misinformation.

Had one at 37 weeks, with steroids… absolutely healthy as a horse 6ft boy with his head wedged on the fridge constantly nowadays. 5lbs 4 at birth, no special care, no breathing problems. Home in 3 days after that section but only because I had a general anaesthetic.

Next one with no steroids, 37 weeks. Healthy as a horse kicking a football around 5 days a week. 5lbs 6oz at birth, no special care at all, me & him home in 24 hours.

Pre eclampsia is a bitch, made both my babies teeny tiny.

Bloody marvellous and safe as houses here!

@LiveLaughLidl respectfully, it’s not, the research is specifically about the steroid injections given for babies lungs, I can link if you like? Obviously the most important thing is the babies overall health but being informed matters so you can make informed choices

Have the steroids, and the c sec. You're pre term but honestly by the time you're in you'll be pretty much term.
36 week twins came in at 6lb 13 and 6lb 14.

I only had time to have 1 jab. At 35 weeks ds was 5-7oz.
He and I were absolutely fine..

no need to link. I've found some.

this one only shows a potential link to infants with POSTNATAL steroid therapy in infants with very low birth weight. https://pubmed.ncbi.nlm.nih.gov/31791046/

https://conexiant.com/pediatrics/articles/prenatal-steroids-linked-to-autism-adhd/ this study states there is potentially a 2.3% increased risk of autism. I say potentially as other sources state there is no written or documented risk or direct correlation to autism.

As per the NHS website and information on WHO, 1-2% of children are autistic. A number that is arguably increasing due to more awareness and research. So worst case off those above stats, it could potentially increase the risk of autism to 4.3%. It's also important to take away that 70-90% of autistic children have autism in the family, and is genetically passed down. So that 4.3% is not taking that into account.

Corticosteroids reduce neonatal death by about 31% (see WHO for these stats)
according to the PMC website, about 41% of babies died neonatally without the steroids, and 23% died with the steroids. Meaning the survival almost doubled in some premature babies.

The benefit absolutely outweighs any risk to help a babies lungs mature and to avoid respiratory distress. It's also worth nothing that premature babies, who have had the steroid injections, or not, are at much higher risk of developing ADHD or autism. This is due to being born before the brain had fully developed in the late stages of pregnancy. Most premature babies do have the steroid injections and studies show they cannot directly correlate the impact of the steroids themselves with autism on these babies, because the prematurity of them enhances the risk itself rather than the steroid.

I was also advised to research the links with autism before accepting the steroid injections. I had my c section at 37 weeks and refused the injections went home next morning LO all fine just a little bit of jaundice

Why would 'you' be advised to research the autism links? Surely the medical professional should be advising?

@LiveLaughLidlthey said links had been made and to do my own research to make an informed decision. Tbh my care was shocking throughout so I went with my gut and refused it.

The latest RCOG Green Top Guideline number 74 around antenatal corticosteroids no longer give a blanket recommendation to give steroids for all planned c sections between 37+0 to 38+6. The maternity unit I work in (and I believe many others) have updated guidelines to reflect this. It's recommended to discuss risks vs benefits in your particular scenario. If your doctor hasn't done that, and you're unsure, then definitely request further discussion! If you're asking whether to go ahead with the section or not, I'd imagine they wouldn't recommend a section at this gestation without good cause.

A piece from the above guideline in case you're interested:
"For women undergoing planned caesarean birth between 37+0 and 38+6 weeks an informed discussion should take place with the woman about the potential risks and benefits of a course of antenatal corticosteroids. Although antenatal corticosteroids may reduce admission to the neonatal unit for respiratory morbidity, it is uncertain if there is any reduction in respiratory distress syndrome, transient tachypnoea of the newborn or neonatal unit admission overall, and antenatal corticosteroids may result in harm to the neonate which includes hypoglycaemia and potential developmental delay."

I had my DD by ELCS at 36+1, had the steroid injection to help her lungs, but absolutely wouldn’t have had it any other way, ensured she was here safely which was all that mattered

Have had c sections at 36 and 35 weeks and had the steroids. The guidance changed between both babies as the 36 week was meant to be born at 37 and steroids were still routinely recommended then where it had changed by the time the next one was born. 36 week had a short time in NICU due to severe jaundice, 35 week didn’t need NICU but did have jaundice treatment and a hot cot on the postnatal ward. Neither had issues with breathing.

I had the steroid injections at 34+5 when my baby needed to be born within the next few days due to preeclampsia. He’s now almost 3 and healthy. He has moments of behaviour issues but he’s also a toddler learning his emotions. I would say 80-90% of the time he’s the sweetest, polite little boy.

If I had been almost 37 weeks I might have said no, but then again if a doctor was telling me it was needed or helpful I possibly would have said ok.

I am in the same position as you with a c-section scheduled at 37 weeks due to placenta praevia and I have decided to decline the steroids.

The latest RCOG guidelines make clear that there is little evidence that steroids are beneficial after 35 weeks so in most cases the risks are higher than any potential benefit:
https://www.rcog.org.uk/media/karfqj1i/corticosteroids-in-pregnancy-patient-information-leaflet.pdf. NHS trusts seem to be implementing this differently, some (like mine) still routinely recommend steroids prior to a c-section before 39 weeks while others no longer do this from 35 weeks (with consultants advising on a case by case basis).

During this pregnancy I have been under the care of 4 different medical teams for different health issues. I would never blindly follow medical advice as they always give one size fits all advice which may not actually apply to you.

I hope your c-section goes well