Risks of c-section at 36 + 6 ?

[ItchyTits]

Dear all

My consultant is going on holiday (!) but apparently he is the best man for the job - despite a somewhat patronising manner.

Any thoughts on whether I should I hold out for a later date? I have been told I'm high-risk if my body goes through labour (previous surgery means I have a big scar on my uterus which could rupture)

Your advice will be greatly appreciated.

36+6 seems quite early for a section if the risk is you going into labour. However, both my children were delivered at this gestation and they didn't need to go into SCBU, although they were not as healthy and robust as term newborns.

I'm not sure if your question relates to which surgeon should do the job? Surely the hospital has more than one experienced surgeon? The guy has to sleep some hours in 24 even if he is not on holiday?

Thanks, yellowcircle.

I agree that it's meant to be unusual to go into labour more than 3 weeks early for a first baby. They haven't said categorically that's why the date has been set so early (part of the reason for feeling patronised) but the doc who did my previous uterine surgery felt that 37-38 weeks was the optimum time for the Caesar

Did your children have any specific health issues that may not have been present had you gone to term?

Without being a pain in the a**e I'd like to have an informed discussion with the doc and feel he is taking me seriously

far too early. really it is. recommendations now are for an elective to be carried out at 39 +. really helps to avoid breathing difficulties

there will be other obstetricians there. you dont want your baby in NICU because your surgeon is on holiday, and that is a real possibility if delivered at 36 weeks

even if you held out until 39 + and started in labour, you could go straight in and be given a c.s

have you had a previous c.s?

are you in the UK?

There is quite a difference between 36+6 and 40 ish.

My 1st (DS) has a little bit of trouble breathing and vomited lots of mucus. He also struggled to latch so breastfeeding was difficult at first. He was "flimsy" - long and thin and when he put on weight, he grew longer, not fatter. He remained flimsy and was lateish to hold his own head up and sit unaided In fact, he's now 4 and although probably genetics is the reason why he is thin, he has never put on weight as fat, just as height. He doesn't have health issues now, he's just thin and that probably is genetics.

My 2nd (DD) was far more robust and a little heavier (at the same gestation). I believe that this was largely because she was female and her birth was a little easier as she was a 2nd born (no instruments). Anyway, when I tried to breastfeed her, I held her in the position and she just latched in 1 second. I then realised how "weak" my DS had been at birth.

Every day you can hold out will help your baby's lungs. Personally in your position, I'd aim to get to 37 + few days up to 38 weeks and go no further. It is very difficult as when I was pg, every day I went on, I was terrified for the safety of my baby

I don't know anything about your condition re scar or what sort of risk levels you are looking at, but there are statistics on how likely baby is to need SCBU etc at various gestations.

Another point is that you need a c section but both mine were delivered vaginally - the risk of breathing difficulty is greater with a c section I believe.

Thank you for your responses.

Oh dear, that sounds pretty scary stuff, Yellow. What is SCBU? But I'm glad to hear your babies are thriving now.

Yes, lulu, I am in the UK. This is my first child, but the scars are from previous uterine surgery. Apparently there is a "large scar in the back wall of the uterus" as I had a harmless, but painful, massive (11-12cm) lump of endometrial tissue embedded there.

I ran the c-section date past my GP, who is pretty helpful, and she seemed unconcerned about the differences between 36 + 6 and 37 + a few days. She rates this particular surgeon very highly.

Does anyone have reliable sources I could look at before my next meeting with the surgeon on Tuesday?

I did suggest to the specialist waiting to go into labour, but my hospital is nearly an hour away, and the worry, and guilt if something went wrong, could be unbearable!

(I could stay in a nearby hotel....)

Sorry I don't have any proper evidence just another anecdote. My dd2 was born by c-section at 36+2 and seriously struggled with breathing, she was almost put on a ventilator, thankfully we just avoided it but she lost 1lb 6oz in 24 hrs. She was in intensive care for 4 nights & special care for 2. She is absolutely fine now, but still tiny. She's like a minature dynamo though, hitting all her developmental stages. I'm surprised that they would schedule a section so early, I needed to be delivered because of danger to my health & the absolute earliest they would schedule a section was 37 weeks. Obviously I didn't make it to then. Onthe positive side (for your decision) a paediatrician told me that 9/10 babies born at 36 weeks will be fine.

By fine I mean no health problems at all.

I had my son at 34 weeks and he had no breathing difficulties whatsoever, only spent 2 days in neonatal ward - but that was a vaginal delivery.

I also think that 37 weeks is deemed "term" so you would only be one day before that.

Having said that - I don't see why your baby should be delivered so early when there is no real medical reason and just to fit in with holidays. That just seems weird and a bit complacent.

My firstborn son was delivered vaginally at 34 weeks.I went into spontanous labour unexpectedly, no reason found. He had no breathing difficulties whatsoever but was obviously very small and kept in baby unit for five days just for observation . He is now nearly 15 years old, bright academic and tallest in his year. Since leaving hospital at 34 weeks five days has had ZERO health problems.

Middle son born at 37 weeks gestation via caesarian section. Perfect newborn in every way, straight to regular postnatal ward and now at 13 years old has never had anything more serious than the expected chicken pox and an odd cold.

My last boy was again caesarian section, this time at 36 weeks 2 days. High apgar score, no stay at special baby unit and again no health issues at all, he is now four years old.

Every pregnancy is different, noone can predict the exact outcome at birth whether full term or a few weeks early but statistics are overwhelmingly on your side ie absolutely most babies born past 35 weeks should be fine. Most babies born past 30 weeks are fine in fact but obviously need extra help in special care unit.

Please try not to worry , it really shouldn't go wrong . Wishing you all the best and am actually a bit jelous of all this newborn baby joy you're about to experience.

My DD was born at 35 +6 by section and they said they expected her to need to go to special care for a few hours, but she came out screaming and breast fed straight away and was very healthy and still is... think it depends on the baby!

Thank you all so much for your comments, ideas and experiences.

As well as the worries, I'm VERY excited too - and yes, it's my first.....

The reason given, other than the surgeon's holiday was that my previous scar could rupture in labour - a highly risky proposition. But the doctor who did the former operation recommended the Caesar at 37-38 weeks

even if you went into labour, you could go straight to hospital and have an 'emergency' c.s , i would look at the risk of rupture compared the risk of breathing difficulties etc for delivery at that earlier stage

39 weeks is really optimum for c.s in terms of neonatal health.

i absolutely would not agree to a c.s due to the surgeon being on holiday

there will be other obstetricians available and for me, it seems too big a risk , but that is my feeling

lots of women do labour with a scarred uterus, i did, as i had a previous c.s .. scarred uterus is an increased risk of rupture, but it is not a guaranteed outcome ifyswim

Thanks Lulumaam - why did you ask if I'm in UK?

Do you have any links to your sources? I'm meeting the doc on Tues and want to be prepared.

It might be worth asking for more information on the type of scar you have if you're not dead set on a caesarean.

For example, a 'bikini line' caesarean scar has very low chances of rupturing (less than 1 in 200 chance) while a classical vertical scar has something like a 1 in 10 to a 1 in 20 chance of rupturing.

If your scar is small and low in the uterus, you might be safer, but if it is higher up or large, you'd be taking more of a risk in labour. A small, low scar is more likely to have dehiscence (that is it comes away a little bit but can be fixed) while a large, higher scar is more likely to rupture catastrophically.

I wouldn't be too worried about the surgeon to be honest. All obstetricians are well experienced in C-Sections. I'd be more worried about the date and giving your baby the best chance of a healthy start possible - prematurity might affect your breastfeeding relationship too if you're planning to do that.

Perhaps a good question to ask your consultant would be, 'is my scar more likely to rupture than a c-section scar' and if the answer is yes ask why, & how much more likely. Because as lulu says lots of women labour with c-section scars (mine is about 10cms long I would say if size is an issue) and deliver naturally too. There is quite a bit of info on scar rupture out there in relation to previous c-sections (google vbac) so you will have info to compare with.

Also, obstetrics isn't the rigorous science that obstetricians would have us think. Some consultants have different attitudes to risk than others. It might be worth asking for a second opinion anyway just for comparison purposes.

I hope everything goes really well & like mintcandy I'm a bit jealous of you having a newborn soon, it the way they smell & their gorgeous hands & feet (Fowl goes all misty eyed...)

Oops cross-posted with Carmen! The info she gives is exactly the kind of thing you need to start the conversation with your surgeon.

Hi - I've had 3 c-sections - first was an emergency at 39 weeks. Second was at 37 weeks as I went into labour and was booked for an elective.

DS2 did have breathing difficulties and spent a week in special care - fine now though.

DD was an elective at 38w5d and fine although nearly ended up in special care because of breathing issues but luckily didn't.

I did lots of research into dates and know most Obs like to get you as close to 39w as possible because of the breathing difficulty issues in the baby. Trying to remember where I read stuff and think it was on the Royal College of Obs website.

I'd just ask about the breathing issues with regards to the baby and see what your consultant says.

Good luck.

I ask , because on he whole, you don't get an obstetrician arranging his list like this in the UK on teh NHS !

if you are in the UK, the NICE clinical gidelines are a big help

and carmen has given you some brilliatn pointers there for what to ask to help you make an informed decision

making a decision partly based on the surgeons holiday plans is not a fully informed one

I was told by my consultant that the baby is twice as likely to have breathing problems if delivered by c-section prior to 39 weeks.

So of course some babies will be fine but there is a higher risk of problems.

I do have a c-section type scar (two, in fact!) but it's the internal one I am more concerned about rupturing...

Blimey, it's hard to decide whether being pushy with my surgeon could be counter-productive

I had one elective section at 37+1 wks (my eldest son) and one at 37+6 (my youngest son). My eldest had a mild breathing problem (he needed CPAP) and spent 48hrs in NICU, my youngest had no difficulty whatsoever. Both were strong babies and a good weight (eldest - 6lbs 14oz and the youngest 7lbs 14oz) and hit all their developmental milestones. They're now 3 and 20mths and thriving.

My consultant said in both cases that she was happy to perform the sections from 37wks onwards (and earlier if indicated, of course). I'm now pregnant again and will be having another elective at around 37-38 wks under the same consultant.

So, yes there is a small risk but I wouldn't worry to much about long term effects. I'm no expert but the consultant told me that while it was best to wait as near to term as possible (not an option for me) the risk to the babies was not huge.

I think the risk is that as the uterus gets bigger closer to term there is the risk of the scar rupturing, with or without you being in labour. That is not just seriously dangerous for baby it is also very dangerous for you.

I thinks it's really off putting that the surgeon's holiday was even mentioned to you as this is clearly blurring your thinking. I would talk through your concerns for baby with him, and let him explain why he thinks it should be done at 36+6. You could ask to talk to the neonatologist as well for more advise about risk to baby. Is the bump measuring a good size? Or you could ask if there would be any benefit to having a growth scan before the early c section to reassure you baby is well grown.

Just as an aside regarding baby's size. DS2 who arrived at 37 weeks by c-section was 7.5lbs but still spent 8 days in NICU with breathing problems.

Good luck with your meeting tomorrow. Hopefully he can go through your concerns and offer you some options.