Question regarding scheduled c-section....

SmilingBluEyes · Jul 24, 2005

You are right to ask your OB all of this. His/her knowledge of your history, past labor and delivery (details we can't access here on a board) makes it imperative you ask that person. I cannot possibly give you info that will truly alleviate all your concerns. But I will offer a few thoughts.....

You do need to know your HCP and the hospital policy. A lot has to do with his/her attitude, tolerance for risk (LGA babies do present a distinct risk for dystocia), and also, how you feel in all of this. There is no way to be absolutely certain of this baby's size, even if serial u/s sizing is done; they can be horribly wrong--off by as much as a pound or more either way!

I have to ask: Do they even ALLOW VBAC at your hospital? If not, then your having a lady partsl birth is literally out of the question, unless you present in the very last stages of labor, ready to deliver. That is my question; many hospitals will NOT allow VBAC anymore due to risk management issues (litigation etc), so all this speculation won't make much difference anyhow, if your hospital disallows TOLAC/VBAC. If that is the case, go ahead and schedule the csection; you will want this done PRIOR to going into labor if you can.

If they do allow VBAC, would you be interested in having a lady partsl delivery, if you are progressing well? Or are you set on a csection? If so, you will get the csection, if your dr is like ours are. Even if you present in active labor----If you are scheduled and set up for a csection, and you want it, you will have it---no hassles or questions.

The BIGGEST question on my mind---and should be on yours: what do YOU want to have happen?

SmilingBluEyes · Jul 25, 2005

One more thing: Congratulations to you! I wish you a safe and joyous birth.

LaNorteBellaRN · Jul 25, 2005

Thank you for your input and the well wishes :)

I delivered lady partslly the first time. It was very traumatic (mostly for baby, given her injury) and NOT the delivery experience I had imagined, however, as you said EFW is something that cannot be "accurately" measured, even with ultrasounds, therefore SD is somewhat unpredictable as well. Besides I know MANY women who have given birth lady partslly to babies much larger than 9lbs4oz :)

My main concern is for this baby. 5-8% of all Brachial Plexus injuries, especially palsies do not resolve and there is permanent deficit. Of course, my preference is not to have a section, it's major surgery, the recovery time is longer and the risk of infection etc. However, this internal debate I have with myself where the other side is telling me KNOWING what my last delivery was like, knowing I have predisposing factors to SD going in (lge baby, past hx etc) am I willing to risk the baby's well being in order for my own desire to have a lady partsl birth????!!??? The answer is no.

I certainly respect this physician. His reputation is great, and the simple fact that he presented the option of a c-section to me but would not let me decide then and there tells me he wants me to make an informed decision that is not rushed and involved both my husband and me. I was just curious, based on the experience of others (especially nurses :) ) if I were to go into labour at 36 or 37 weeks if most OBs would still proceed with the planned section or present the option of lady partsl delivery given the gestational age, and HOPEFULLY smaller baby size.

Thanks again for your input. I have an appt this a.m. and will be asking some questions.

SmilingBluEyes · Jul 25, 2005

I wish you well, whatever you do decide. I would NOT blame you one tiny bit for having a repeat csection, in your case. It's not a poor move to make. Let us know how things go, ok?

AlaskaKat · Jul 25, 2005

First of all - congratulations!

One thing that pops into my head is that if you went to 41 weks last time the odds of going into spontaneous labor at 36 weeks this time is fairly low. So I wouldn't think your OB doc would be faced with that decision, though knowing what might happen if you did would be a good thing. I'm assuming your OB must feel like this is a fairly large baby as well or he wouldn't be suggesting a C-Section. I guess if I were you I would ask him if he felt like an induction at about 38 weeks would be a good idea. Odds of baby problems due to prematurity are largely gone by then, and your baby would (hopefully) be somewhat smaller than 9 lbs by then as well.

I'm sure you'll make the right decision for you and your baby! Considering your history, I don't think an elective section in your case would be a bad thing!

enfermeraSG · Jul 25, 2005

Even if you were to go into spontaneous labor before the scheduled section (happens often enough) the decision is still yours. When Moms come in and are in labor and were supposed to be a scheduled c-section, they still have the right to decide, or change their mind. Also, don't forget that a rough delivery and potential injury to this baby are not the only risk factors to be considered with a lady partsl birth after c-section(vbac). There are huge risk factors involved, and although statistically low - if something does go wrong (for example uterine rupture) it is not pretty. Best of luck! SG

tntrn, ASN, RN · Jul 25, 2005

The OP is not in the position of having a VBAC: she has stated her first baby was delivered lady partslly. There's a lot of consider and I'm glad to see that your physician is giving you the option of a scheduled c/s, but with good information along with it, so you can make an informed decision. Best of luck to you.

enfermeraSG · Jul 26, 2005

The OP is not in the position of having a VBAC: she has stated her first baby was delivered lady partslly. There's a lot of consider and I'm glad to see that your physician is giving you the option of a scheduled c/s, but with good information along with it, so you can make an informed decision. Best of luck to you.

OOoops, duhhhh on my part. Sorry about that, I got carried away through all the posts and went off on another track. SG

RNnL&D · Jul 26, 2005

Has your doc suggested induction at 38 weeks as opposed to csection? Csection will limit your options for future deliveries if you are planning any more.

I can only offer you two for instances:

A personal friend of mine had a longing pushing stage with first baby, and delivered a 7 1/2 pound girl with bp palsy after a shoulder dystocia and a 4th degree tear. Second baby, they offered her the option of induction at 38 weeks. US estimated weight between 6-7 pounds. She was induced at 38 weeks and delivered a 6 1/2 pound girl over an intact perineum, with no dystocia.

A patient of mine had a shoulder dystocia with first baby (8 lbs), and a 3rd degree tear that did not heal properly and required reconstructive surgery at 3 months PP. They offered her induction at 38 weeks. A few days ago she came in with spontaneous labor at 37 weeks, and had a lady partsl delivery of 7 lb baby with not even a skidmark. :)

Both of these Moms had serious concerns about shoulder dystocia. Delivering smaller babies a littler earlier, made all the difference.

DoulaKelly · Jul 28, 2005

Ultimately the choice is yours, that said, an induction 38 weeks might be a good option for you if you want to avoid a c-section. Chances are the baby will be smaller and at much lower risk for SD.

My second son was born at 37 weeks after an ultrasound revealed that he was around 8 pounds and my OB and I weren't sure that I would be able to wait until 40 weeks so I was induced. My son was 9 pounds, delivered lady partslly. We didn't have any trouble with SD, but I am so glad that I delivered him early and avoided a section. In fact, I don't think my OB even mentioned a section.

Congratulations on the new addition to your family! Good luck with the delivery!