Thinking of refusing steroid injections at 38 weeks - unsure, what would you do?

[Unsure1045]

I’m currently 36 weeks pregnant and due to have a C-section in two weeks time due to severe pains caused by a hernia in my pregnancy. Baby is 99th centile and as well as HG I also have gestational diabetes. I am a high risk pregnancy but baby is doing really well.

My consultant agreed to a 38 week C-section but told me I must come in a week before to have two lots of steroid injections. After a lot of thought and research I’m considering declining these.

has anyone else been in this situation and what did you do?

Thank you.

I should have probably explained this in my OP. My first son was born poorly with low blood sugar levels and was in nicu for a couple of weeks. I’m already at a higher risk of that happening again, and the side effect of the injections is low blood sugars so it could be a double whammy affect.

Unfortunately my consultant told me absolutely nothing and just said “you’ll have to come in for these” but I didn’t know what they were really or what the pros and cons were.

There isn’t much data yet but they are looking into if steroids cause any developmental/milestone delays, having mental health and anxiety myself will I be questioning myself for having the steroids with my full term baby if my baby is behind? I’m worried even if she is and it’s completely coincidental that I would blame myself.

If my baby was being born 36+6 or before I’d take the steroids but I’m going to be 38+2 so I’m just trying to see what others would do before I speak to my consultant again tomorrow.

There must be more to this, OP. I’ve been induced 3 times at 38 weeks because of gestational diabetes. I’ve never been offered steroids.

Thank you, of course I am and will but I just wanted to see if anyone else was in this situation at 38 weeks or had been before. Obviously some mums have commented not understanding why I’m asking who have probably not been in my shoes but I’ll speak to my consultant tomorrow x

What reason have you been given? Because it’s not because your baby is early.

Not sure why you’ve quoted me in that

I asked for a 38 week c section due to severe pains and mental health, was told by consultant that’s fine, I’ll book you in for this date but you’ll have to come in at 37 weeks to have 2 lots of steroids and stay for 24-48 hours. Anyway I’ll see you Monday and you’ll get a letter with your c section date on in the post.

I wasn’t told of anything so I’ve left a bit confused. I have been gathering some information myself so I can go and ask her about it more tomorrow x

No one I know has been offered these steroids at 38 weeks so that’s why I have decided to question it , ultimately just want best for my baby

Exactly this.

I should of asked at the time and kicking myself that I didn’t, I was just in a lot of pain and crying during my appointment that I was so happy she agreed, left feeling happy then confused about the injections as I started to tell my husband and parents

Even the NHS says steroid injections aren’t given after 36 weeks (assuming a baby with no complications) https://www.nhs.uk/pregnancy/labour-and-birth/premature-labour-and-birth/

Edited to add. The NHS regards a baby from 36 weeks as full term

I know. I can’t understand why there are woman on this post that are slating me for making an informed choice. Even the consultant didn’t tell me why I’d need these.

Being induced is different to a c-section. The birthing process squeezes the gunk out the baby’s lungs and helps them breathe. That doesn’t happen in a c-section.

My consultant told me not to have steroids because of the possible effects later on. A different consultant said otherwise.
Difficult to know who to believe

So unbelievably hard to make an informed choice and decision when you don’t know the full information or haven’t been told why

You’re putting soothing your anxiety over your child‘s potential ability to breathe. That’s no way to make decisions for a baby who is dependent on you to make the best ones with the best expert advice.

We had a consultant who was very balanced and highighted the link between steroids and increased risk of behavioural issues. We read the studies he shared and felt there wasn't strong evidence of benefit post 37 weeks, so we decided that we would have steroids before 37 weeks, but not after. In the end DS came at 37 weeks so we ended up not having the steroids. He had no breathing issues so it turned out to be the right decision for us.

That doesn’t change the fact that the baby is full term and so lungs are fully developed.

Some has gotten lost during the conversation with the DR. Either he hasn’t explained is well or OP has misunderstood.

If I listened to professionals with my son then he would have became a lot poorlier than he was. No one believed me when I had concerns from 37 weeks and when he was born and didn’t look “right” I was brushed off by these professionals. Luckily my HV noticed he was poorly on day 2 and he got the help he needed in neonatal.

Some woman like to make informed choices about their birth and baby, and questioning these things when you haven’t been given pros or cons but consultant is absolutely fair.

I may not of been through years of training and education, but I knew my son needed help.

I wasn’t told anything was just told I’d need these at 37 weeks a week before my c section. I think she needs to explain to me tomorrow why she believes I need these injections and go from there x

Not necessarily. Here’s a random NHS Trust’s page that says steroids may be recommended for a planned c-section up to 38+6: https://www.dbth.nhs.uk/antenatal-steroids-in-pregnancy/

I’m not sure why you think this, I’m just a mum trying to make an informed choice. There are risks to steroid injections and risks to not having them. After 37 weeks sometimes risks of having them outweigh the benefit.

Hence me speaking to a consultant and asking and doing research. It’s not based on emotional factors,

I had one premie at 34 weeks who had steroids but he didn’t get the two doses and ended up on CPAP in SCBU for 1 week. My other was a full term c section with no steroids and no breathing issues at all.

I have not heard of been offered steroids before an elective term c section but I understand the rationale but only if given 24 before the birth. Surely 1 week before is too far away for any clinical benefit?

https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.17027

Here are the Royal College guidelines. They say that the evidence for benefit of steroids between 37 and 38 +6 weeks is less compelling. Definitely have another chat with your consultant.

I’m going to come off this thread now but want to thank everyone for your replies. I need to speak to my consultant and find out why I need to have these at 37 weeks, why I wasn’t told of any pros or cons and find out what these are for my case and go from there.

If you are a mum about to have a baby and you’re not sure why you’re being told you need something, you are allowed to make an informed decision and choice for your baby. I do not feel an ounce guilty for questioning. Perhaps if my consultant advised me of the why’s at my appointment I would understand more.

OP, I’m an obstetrician (not in the UK) and we don’t give steroids after 34 weeks any more, even for sections/gestational diabetes. I’m usually very compliant with all medical advice but even I would decline steroids for a 38 week section! The guidance has changed in the last few years.

If you decide to have them I’d also ask about why they’ve suggested a week before, as they will have worn off by the time you have your c section, so I’d want them closer to delivery. Good luck with whatever you choose OP