Thoughts on scheduling Cesarean at 37w...

[Shoxie]

Hi mamas,

I have a quandry. I'm 36w today - so thankful I've made it this far w/a placenta previa. I've had two relatively minor bleeds, one at 25w3d and one at 34w2d (really spotting). I've been on strict bedrest since the last one as when the most recent U/S was done at the hospital bedside, the previa looked like a partial, though my OB still calls it a complete for some reason. I have 2 DC, the first born at 38w6d and the second born at 38w, both vaginally and healthy, no induction.

My OB scheduled a c-section at 37w1d due to the possibility of me bleeding at any time. How does this sound to you, mamas? I was hoping to go a bit later, but I'm also nervous that the longer I go, the higher my risk of hemorrhaging - it's a tough line to toe. My OB is amazing, more midwife than many midwives out here. But he is nervous, as am I. I have one more u/s scheduled for this Thurs. AM at 36w3d, and I still have hope, but not much this late in the game. I've thought on starting with cinnamomum but am afraid as I've read it can cause uterine contractions and is contraindicated in pregnancy - probably too late for it to help now anyway.

I've had a complete posterior PP since the 20w u/s that hasn't moved much until really late - a small, thin lip is now covering most of the cervix. The chance of it moving far enough away to birth vaginally are infinitesimal. My other option would be to schedule a few days later 37w4d (Sept 10th). Any thoughts/experiences would be appreciated! I'm so scared of having a cesarean but so frightened of bleeding profusely...yikes.

[Baby~Braatens~Mama]

I do not have any experience to share, but I would like to send you a few vitrual s. Wishing you the very best of luck.

[Stayseeliz]

I had my youngest at 37w2d via c-section due to preeclampsia and she was fine. Completely healthy with no breathing problems. I know it's hard when you have an issue like the one you're dealing with and you're walking the line between trying to get the baby as far along as possible and trying to minimize risk. It's rough. I was going in twice a week for the last 6 weeks I was pg for non-stress tests and ultrasounds. I remember how stressful it is. Do what your gut says. Hang in there!

[taffywelsh]

Do you know the sex of the baby yet?
That might help you decide.

[texmati]

I'm no expert, but how far I was from the hospital ect would help me make my decision. PP is a scary one! If the hospital was very close I might feel more comfortable waiting. Best wishes for whichever way you decide!

[GoBecGo]

no experience, but my brother was a previa born during an abruption at 31 weeks and i was the next baby, born by cs (due to previous T-incision) at 37+4 because that was a convenient date for my mother (believe it or not they let her schedule then because it was half term so my 16yo sister would be around to care for my nearly-4yo brother (the previa baby). I was her 6th baby, and at 37+4 was 8lbs8oz, apgars 10 and 10 and basically the healthiest babe on the ward that week.

What are your instincts telling you about how the baby is? Will they do an amnio to check lung maturity?

[Shoxie]

Thx, mamas. Yes, it's a boy - so that would make me lean toward later, right? My second is a boy and he came at 38w all on his own...eesh, these decisions are terrible. Thanks so much for the compassion and hugs - I could use them!

[Shoxie]

OB said they'd do the amnio if there were any doubt after the last u/s. I'm not sure how accurate u/s is to determine lung maturity...

I'm about 15-20 mins away from my OB's hospital. There's another hospital that's only 7-10 mins. away from my house which I originally didn't even consider b/c they are so C/S-prone, but it's there for an emergency.

This baby is measuring on target (my last two measured small according to the fundal height - both born around 6lbs8oz). As far as weight by u/s, which I know is notoriously inaccurate, he measured just shy of 6lbs at 34w4d.

I'm trying to feel out my gut - I would LOVE to keep the little guy in longer, but I also feel like a ticking time bomb. Still praying for a miracle, too!

[Mrs-Mama]

I think I would try to get them to agree to the amnio, esp if you are unsure at all about your conception date. I also live in the world of scheduled c-sections, but I have never had previa so I don't know the exact worry about that. My friend had a scheduled c-section at 38 weeks due to complete previa. She had a "labor scare" a week or so before that and went in, but they found no evidence of labor or any reason to do the c-section earlier so she waited.

Good luck with your decision!

[bri276]

I'd do it, personally, but that would be my own anxiety/comfort level. I wonder if they'd do steroids for lung development this late?

[kalamos23]

They won't do steroids this late - at least when I had preterm labor at 32 weeks, they wouldn't even do the steroids then. They said between 32-34 weeks is iffy if they do them so I doubt after 34 weeks they would.

That being said, I wouldo schedule it for 37+4, since that is closer to when your other 2 came. If you have any sort of contractions, I would go in. At this point, it wouldn't matter if you went to the c/s happy hospital since you are getting one anyway, right?

[Stayseeliz]

I would NOT do an amnio with the risks of complications from that. I'd just shoot for 37w4d. Even with a boy that should be fine. You'd probably be looking at a few hours in NICU tops if he'd need it at all. A friend had her little boy in the spring at 35ish weeks by c-section and he was only in the NICU maybe 24 hours.

[MegBoz]

Also, if you do start to bleed, does the hospital have 24/7 in-house anesthesia so they can do a CS immediately?

One friend of mine had sons born at about 36W and 35W & perfectly fine (5# 6 oz for #1, 5# 10 oz for #2.) No breathing difficulty.

However, #2 didn't have the strength to BF well. Others I've known with babies born even at 37W didn't have the strength. My one friend finally had to give the baby special high-cal premie formula when he lost birth weight & just wasn't gaining. She worked like CRAZY to build up her supply, but it never happened. She never got more than 3 oz or so at each pumping, despite herbs, drugs, etc. & he never BFed again. I wonder if it's just a case of - the supply isn't well built up by a strong baby immediately after birth, then it's hard to 'catch up' & build a strong supply after that window closes.

So, I'd factor that into my decision making too.

[nova22]

My earliest naturally born baby was born at 37 weeks. We may have had our dates wrong, because she was over 8#, but either way she was fine. I had an emergency c-section at 33 weeks and my baby's APGARs were actually better than most of my other kids' scores were, and she weighted a pretty healthy 5lbs 3oz. She was in the NICU for a month because she was having a hard time breathing and eating from a nipple (bottle or breast), and she had to come home with a heart monitor, but she was also a complete surprise - the pregnancy had been perfectly healthy up until my water broke at 33 weeks, and they gave me a steroid shot but had to do the emergency c/s before it had time to do anything. A friend of mine happened to be due the same day as me and also had a preemie, but she was showing some risk signs and had gotten steroid shots. Her baby was in the NICU for just over a week and went home weighing about 3#. Are you getting steroids? That would put my mind at ease if I were in your position. Personally I'd be more comfortable with the September 10 date, but I can understand your fear about being a "ticking time bomb" and I am praying for your discernment on the whole thing.

[JTA Mom]

With the previa, I'd go earlier rather than later.

Ds was born at 37 wks. I had pre-eclampsia though, and was on mag. sulfate for the 22hr labor/eventual c/s. He did have some breathing problems, but they were related to the magnesium sulfate (it's a muscle relaxer). Once it was out of his system (about 3days according to the PED), he was good to go. They did keep him a few more days because the NICU has several requirements (keeping temp for a certain amount of time, eating so much for a certain amount of days, etc). All in all, he spent a week in NICU.

He breastfed really well too, no problems there.

I think the fact that you cooked your previous babies fast, I'd go for earlier rather than later.

Just in case though, I'd be prepared to pump right after you come out of surgery if your baby needs NICU time. Once I was aware enough, they brought out the breastpump and I started pumping every 2hrs and it brought my milk in and kept my supply up.

Ami

[Shoxie]

Thanks so much, mamas. I'd much rather go a bit later, as many of you surmised, but what gives me pause is that my other two were on the early side, as JTA stated. If they were both around 40w or so, I'd feel a bit differently. DH doesn't think the extra few days will make a difference, but I don't agree. Right now, I'm scheduled for 9.7 at 2pm, and I'll go in this Thurs. to get the u/s. If I see some significant movement (highly doubtful but I'm always hoping!), maybe I can reschedule - though my OB only does scheduled Cs on Tues. and Fri. which puts another damper on things.

And, nope, I was never given steroids even though I was in the hospital twice for bleeds. OB is really non-interventionist which is good. And yes, I can definitely head to the C/S-happy hospital in case of an emergency - as I'm pretty much a done deal that way. That's my biggest concern - that I'll just start bleeding heavily...it's such a tough line to toe...

Thanks so much for all the kind words of compassion and encouragement and stories of babies making it through on the early side. I take comfort in knowing that most 37w (thankfully, I'm very sure of my conception dates) will be ok. The possible BF challenges do worry me though as does the surgery itself...

You ladies rock!

[MeepyCat]

ITA that with a previa, I'd go for the earlier date. It sounds like that's what you're doing.

My daughter was born at 32w4d after a major hemorrhage from placenta previa. We got to go to the hospital by ambulance and everything, and it seriously sucked. As a result of this experience, I'm pretty opposed to anything that increases the risk of contractions in cases where previa is an issue. By all means, get all the follow-up ultrasounds and hope that the placenta shifts, but if it doesn't, scheduled surgery is the way to go.

Keep in mind, also, that if they really start to worry, they'll get you into the OR with the best surgical team they can muster absolutely as fast as they can.

[nova22]

Originally Posted by Shoxie

The possible BF challenges do worry me though as does the surgery itself...

That's a common concern no matter what, but just so you know, my daughter was fed through a tube or an artificial nipple for about 90% of her feedings for the first month of her life. She went on to be a very successful little nurser and I did not have to supplement at all when I brought her home. She nursed until I weaned her when I was pregnant and sore. more !!!

[MeepyCat]

I basically agree with Nova, although it took about 2.5 months to get my preemie onto the breast, and she did receive bottles quite a bit.

[myk]

i had my unscheduled C/S at 37w0d. baby was fine! very strong and healthy. good sucking reflex, though i had severe edema due to pre-e combined with flat/inverted nipples, so bfing was rocky at first. as soon as i lost the excess fluid (70+ lbs) we got the hang of latching her no problem, and continued for 4 years we had absolutely no problems due to her early delivery. i think if i didn't have the excess fluid, bfing would have been great right from the start.

good luck!