C section at 39 weeks due to 'reduced movements'?

[firsttimepregnanthelp]

I am on a reduced movements pathway because I have an anterior placenta and can't always feel baby moving although this has got much better in the last couple of weeks or so - I dont think it is 'reduced movements as such (i have twice weekly ctgs which are always fine), just that I can't feel them. I saw a consultant this morning and she was pushing me to sign for paperwork to have a c section at 39 weeks as babies with reduced movements can be stillborn - she was very pushy but I asked for some time to think about it and talk to my partner. Is it accurate that the baby could be stillborn if I waited til closer to 40 weeks? She has scared me a bit tbh.

Also if I do have a c section I'd like to be out the next day if all is well but one of the dates offered was a Friday - would I be able to be discharged on a Saturday or would I need to wait til more staff are in to review on the Monday?

Don't know on the first question. Second question yes you can be discharged any day of the week, anytime of day.

It’s pretty common for c section date to be 39 weeks regardless of any pathway you’re on. I think it’s to reduce the chance of you going into labour naturally. Seems a bit intense to be pushy about stillborn being a risk at this point and then still saying 39 weeks.

They would discharge you on any day, they need the beds!

I would have the section (I’ve had 3). I would take the medical advice. My second child almost died and the medics over rode my wishes to save her life and I’m so glad they didn’t listen to me (I wanted a vbac and was rushed into theatre).

yes you can get discharged any day of the week also morning afternoon or evening.

If you don't want an induction, have the C-section. The vast majority of elective C-sections are done in the 39th week as routine anyway. Entirely up to you how to proceed, but in your shoes I would be wanting baby out sooner than later.

And yes you can be absolutely be discharged at the weekend. It might take longer as there are fewer doctors around, but beds are forever needed. I was discharged on a Saturday with my first and a Monday with my second. Took until 5pm to get out of there on both days

The consultant is right that reduced movements can be an indicator of a pregnancy not going to plan but as you say, it's not clear that your baby's movements are reduced.

How far along are you now? Hosp staff often come across as pushy about section or induction dates because they want to get them booked in. A planned C-section is very different to an emergency one though. Definitely worth talking it through with your partner and weighing up pros and cons.

Maternity wards are not M-F, you wouldn’t be delayed for discharge because it was a weekend.

If you can’t really feel movements I can understand why they’re suggesting getting the baby out as soon as possible. Are you almost 39w now?
If you can’t feel most movement anything could happen and you wouldn’t know. Is there a reason 40w appeals to you more?

Thanks everyone

@Freedomsjustanotherword @gozi am 32+4 and my midwife said we wouldn't discuss birth planning til 36w so today came as a bit of a surprise.

@gozi know that baby is fully formed etc by 39w, I guess I just thought that 40w was better as that is what due date is based on

I think I’d be pushing for access to CTGS more frequently, rather than a 39 week C section.

Yes with anterior placenta there is a risk you wouldn’t feel reduced movements but that risk also exists at 37 or 38 weeks so I’m not sure why an early C section is a magical solution. Better monitoring is the appropriate solution.

@firsttimepregnanthelpall elective sections are booked in for the 39th week. It’s a complete safe time to get the baby out. It’s just when they do electives.
If the issue is you not feeling movement I’m honestly surprised they’re only looking at 39 weeks for the possibility of reduced movements. Most people I know went around 37/38w for reported episodes of reduced movement, not always confirmed reduced movement.

Honestly there’s really nothing to worry about 39vs 40 weeks, it’s completely normal. Afaik there’s no advantage to waiting until the 40th week.
I’ve had an elective and the date options were only 39w.

The doctor was surely unclear with you. If they really thought that movement was worryingly reduced now, they would be acting now, not suggesting a c-section in 7 weeks.

The planned section must be for another reason.

@minipieA 39w section isn’t early though, it’s the normal time frame they are booked for.

Full term is anything from 37 weeks

Failed induction that resulted in EMCS.
Doctors pushed the C-Section as soon as I went in (39 weeks). Midwives said to wait.

Knowing the risks now (reduced movements, stillbirth risk, my age) I would have gone straight for the C-Section.

Can you ask why it would need to be a CS and not induction? Presumably there is a reason, but they should be able to explain the difference in risks.
And most of the time, they make you stay in after a CS, though one friend did get to go home the same day or day after (sorry can't remember which) when it was her second baby.

Is the c-section because it will be more difficult to monitor movements during induction OP?
Its not easy to know what to do I suppose if the doctor wasn’t very clear but if you need more information could you contact their secretary and email a question?
My first DD was stillborn at 39 plus 5 (don’t be scared by this, I had a placental abruption which is very very unusual) and there were reduced foetal movements but they didn’t monitor the way they do now. (This was 2013). I really really don’t want to scare you by mentioning that btw, just to add to the voices who say if they’ve advised a c-section for reduced movements there’s absolutely no way I wouldn’t take it - but everyone sees things through their own lens OP and the best thing you can do is get some more advice from the doctor. Best of luck

The longer the pregnancy continues, the more likely stillbirth becomes - that is the case for all pregnancies regardless of your perception of fetal movements. But you must also weigh up the risk of caesarean delivery to both yourself and the baby, and the risk of an early term delivery in terms of baby’s brain development etc.

Have a look at the results of the AFFIRM trial, it’s one of the biggest and most influential studies on the management of reduced fetal movements:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31543-5/fulltext

Yes I know

But that’s when there is a reason for a planned C. Like placenta praevia for example.

Here there is no reason OP needs a C section, or an early delivery. The concern is that IF she has reduced movements (no reason to think she will) she won’t feel the difference due to anterior placenta.

I don’t see why a C section at 39 weeks solves that risk? What if she gets reduced movements at 38 weeks?

Maternal request C-sections with no medical reasoning are also done at 39 weeks. There's no difference.

Though talking about it now is a bit odd I agree. It wasn't mentioned in the initial post that OP was only 32 weeks.

I wonder if the eagerness by the consultant to get a C-section booked in is so OP has a definite end date to her pregnancy. That way between the twice weekly CTGs to monitor for RFM and the C-section date the hope might be to reduce OP's stress. Or perhaps it's to get OP used to the idea of having a C-section. So that should the monitoring pick up anything concerning, having a C-section won't come quite as a shock. Or, most likely, it's hospital policy to offer a C-section after multiple episodes of RFM when the baby isn't term yet.

Yep… I agree with you! I read this and noticed OP was 32 weeks and thought very odd that they are pushing a c section at 39 weeks when that’s 7 weeks away… if they are concerned why not act now.

I would be pushing for weekly monitoring and going into triage with any concerns. That would be more beneficial then waiting until 39 weeks for a elective

Nope, it’s literally just the week electives are aimed to be booked for. No justification or underlying issues necessary. It’s the standard time they are done.

In terms of OP’s case specifically I imagine they’re just booking a 39w elective to get it in the diary. Theres already a higher risk of stillborn the further along you are, she’s currently under additional care and monitors with regards to the movement so it’s a case of 39w at the latest if all goes well and if there’s a concern with the monitoring it would be brought forward via an emergency section. Typically when there are issues it’s more like 37 weeks but it’s a delicate balance of risk as it is slight better for the baby to go to 39.

Yes sorry what I mean is here there appears to be no reason the OP needs a C section at all?

Term is 37 weeks. I had a c/s (planned) at 38 weeks and all was good. I recovered much quicker than my previous emergency c/s. I was in hospital for a week prior to this as well.

Having had an elective section I would 100% book it in for 39 weeks. It’s likely given your reduced movements and the increased risk etc you may find that you need a section sooner

OP doesn’t have reduced movements

She has reduced ability to feel movements due to anterior placenta, but when checked, baby is fine

I experienced reduced movements during the latter stages of pregnancy with DS and was monitored, but no issues found. I was advised to go for induction at 39
weeks but this was more due to prior history (miscarriage including a late one at 17 weeks) and age (I was 41). When the induction started to take effect and contractions began, DS very quickly showed signs of distress and I was whisked away for a cat1 emergency c-section. Good job too as DS turned out to have a true knot in his cord, and if the knot tightens (as it did during contractions) it could be fatal.

This is not meaning to scare you @firsttimepregnanthelp but just to share. It sounds like your reduced movements have a diagnosis that doesn’t carry risk, though, so your options should be more open. It also seems quite drastic to jump straight to section - induction could also be an option.