If you're having an ERCS why does size matter? What's the hurry?

[pampered_mom]

My SIL is pregnant. Hubby's been fielding all the phone calls from his mom b/c I also happen to be pg (most especially now that I'm 40+6), but I happened to hear the conversation he had with his mom last night.

SIL isn't due until January - has had numerous u/s because she's "high risk" (for no other reason than her previous c/s with a low-transverse incision). Now she's apparently measuring ahead - 38cm and she's 34 weeks. They sent her to a specialist to have a 3D and 4D u/s to check lung development because the baby's "already 7lbs" (yeah, yeah) and if they waited until her due date it will be 9lbs.

My puzzle here being...if she's already scheduled for a ERCS what's the rush? What difference does it make how "big" the baby is? I thought the issue with the whole "big baby" thing related to vaginal birth...hence the rise in c/s for suspected fetal macrosomia.

This is really more of a my curiosity thing. Her first c/s was for being "overdue" (but not) and a "big baby" (far smaller than u/s estimate) after being told she'd need one for weeks before it that she'd need one because baby was breech at 32 weeks (which baby wasn't by c/s day). I've mostly just kept any thoughts to myself since the last time I tried giving her alternative information it was clear she wasn't interested.

MIL is all excited because she thinks it's so cool that the babies could have the same birthday...I'm a bit worried because if they estimate this baby's gestation incorrectly this really could be a serious situation.

[AFWife]

I dont' trust late term u/s. My mom asked about having one done when I was in my 3rd tri and the doctor said that measurements can't be trusted... They had actually done a c/s on a mom because the baby was breech and the u/s said he was 10lbs...Turns out the u/s was wrong and the baby was 8lbs. They were still glad to have done it for the breech position...but the size was all off...

[Drummer's Wife]

huh. A bigger baby may be a little harder to get out during a section depending on position and if the head is engaged at all. Just means more tugging, I think.

I wonder if the doc is using it as an excuse to make sure she doesn't go into labor beforehand thus having to be called in instead of scheduled (which, is obviously more convenient for everyone but baby!)

[nikirj]

This is one of the theorized reasons our morbidity/mortality stats are so bad in the US. Performing elective c/s too early.

[pampered_mom]

The timing is all a bit fishy, though it was fishy for her first as well given that the u/s and scheduled c/s (literally the u/s first and then straight off to c/s) was on the Friday of Labor Day weekend. Hubby and I must be having some impact on his mom because she speculates they won't "let" SIL go too much closer to the holidays.

nikirj - I was actually thinking that precise thing...most especially after the MOD's Prematurity Awareness Month...well, that and the state she lives in got an "F".

[miriam]

Ultrasound is accurate for fetal age to the 20th week of pregnancy; doctors should know this as it is common knowledge - even I know it. Then heredity takes over, and the baby is whatever size its genetics dictate by the 38th to 42nd week. When the baby is ready, it is ready.

[pampered_mom]

Thankfully in SIL's case level heads prevailed and in spite of the fact that they're telling her both her and babe are "38 weeks" they won't be doing the ERCS until the 39th week based upon her original due date. It's a bit odd, but I'm thankful they won't be pushing it too much. She's been told that the baby is "huge" and if she wanted amnio to check lung development they'd do it.

She's passed on that for now. She's hyper aware though since now that the baby is officially "huge" it's "really dangerous" for her to go into labor (apparently unlike the rest of us she'll go from in labor to giving birth through her "too small" pelvis in a very short amount of time).

I still can't quite figure out the need for the u/s to check dates this late (since it'd be about as accurate as the baby's estimated weight) given her previous u/s that would have included estimating dates and been a great deal more accurate. I'm glad to know I wasn't missing something with the connection for the need to do the c/s early, though.

[Storm Bride]

Originally Posted by pampered_mom

She's passed on that for now. She's hyper aware though since now that the baby is officially "huge" it's "really dangerous" for her to go into labor (apparently unlike the rest of us she'll go from in labor to giving birth through her "too small" pelvis in a very short amount of time).

Once a woman has had a c-section, she will be treated by most doctors as though a single labour pain is a death sentence. BTDT (too many times). It's freaky and really unpleasant. They don't want us going into labour at all. And...of my three scheduled sections, the one that caused the most long-term pain was the only one they managed to do without a single labour pain...

[pampered_mom]

Originally Posted by Storm Bride

Once a woman has had a c-section, she will be treated by most doctors as though a single labour pain is a death sentence. BTDT (too many times). It's freaky and really unpleasant. They don't want us going into labour at all. And...of my three scheduled sections, the one that caused the most long-term pain was the only one they managed to do without a single labour pain...

I guess I probably should already "know" that, although I guess that's also why I'm glad I didn't go with an OB after my first cesarean. I still wish it could have been different for you, though, Storm Bride.

[Sudonk]

I don't know the circumstances of her previous birth, but I do know that a friend of mine was given a RCS several weeks early because her baby's size made her OB consider her "exceptionally high-risk for a rupture". He convinced her that if she didn't have the baby by 36-37 weeks, her uterus would explode and kill them all. I think it may have had something to do with the long weekend coming up, but who am I to say?

She is a pretty smart woman and should have known better, but he had terrified her even before the pregnancy, telling her during her previous c-section that her uterus was "so badly scarred and damaged that it's not going to survive another pregnancy". She spent the first 11 weeks of her accidental pregnancy crying her eyes out and expecting to die any second. When she finally got in to see the OB she told him how scared she was based on his comment and he had no idea what she was talking about. He looked at her chart and told her she was "over-reacting", and her uterus was fine. But then promised to "take the baby early" to make her feel better. There aren't enough eye-roll smileys in the world to express what I think of that OB.

[kltroy]

No idea why size is a concern, but the most recent medical evidence is that you really need to wait until at least 39 weeks to schedule a c-section unless there's a medical need to get the kid out ASAP. Tons of evidence about this now. Here are some links to articles about the research:
http://news.bbc.co.uk/2/hi/health/7137945.stm
http://www.medscape.com/viewarticle/569669
http://contemporaryobgyn.modernmedic.../detail/637970

Most importantly, suggest to your SIL a list of questions that she should ask her OB, such as:
What are the risks to the baby of doing a cesarean now versus waiting until my due date (or at least 39 weeks?)
What are the benefits of doing it now versus later?
Same questions, but risks for MOM - are there any additional risks to MOM?

Consider risks in terms of: baby's lung development, birth trauma, growth, breastfeeding, mom's healing and ability to be a mother to two children, etc

Oh just saw update post. Well never mind then, but either way I hope she has a good experience and heals quickly. Too bad she and her docs probably never even discussed a VBAC.

[pampered_mom]

Originally Posted by kltroy

No idea why size is a concern, but the most recent medical evidence is that you really need to wait until at least 39 weeks to schedule a c-section unless there's a medical need to get the kid out ASAP. Tons of evidence about this now. Here are some links to articles about the research:

Thanks for the links. I don't send her information on anything anymore as it's clear she's not interested. She will do whatever the doctor suggests even if there might be evidence to the contrary. At this point I've had to decide that I have other things to do with my time, but that doesn't mean I'm still not personally curious when it comes to odd bits like this one.

If they had scheduled the c/s for last week or this one I could have sent her all sorts of peer-reviewed articles, information put out by the ACOG or the MOD and she still would have done exactly what her doctor said. It's a bit frustrating, but everyone has to make their own choices.

[miriam]

It's a bit frustrating, but everyone has to make their own choices.

That has been my experience all of my life. Yes, it is frustrating, but I have hope.

[suzywan]

Quote:
It's a bit frustrating, but everyone has to make their own choices.

That has been my experience all of my life. Yes, it is frustrating, but I have hope.

Oh, sing it sisters!

[Storm Bride]

Originally Posted by pampered_mom

I guess I probably should already "know" that, although I guess that's also why I'm glad I didn't go with an OB after my first cesarean. I still wish it could have been different for you, though, Storm Bride.

The funny thing is that I've only actually gone with an OB once - my last pregnancy. My first three were under the care of my family doctor, with an OB consult on numbers two and three, because I had the uterine scarring. It would have never occurred to me to see an OB for prenatal care.