Should I cancel my scheduled C-Section?

[Emeraldcitty]

This is my second child, the first I delivered in October of 2008 by emergency C-Section at 30 weeks due to severe Preeclampsia and HELPP syndrome. I was originally induced and could not tolerate labor.

Anyways, I'm currently 37 weeks along with baby boy #2! This pregnancy has been nothing short of a miracle. I was originally advised that I would be lucky to make it past 30 weeks due to a super high cardiac output detected early in my pregnancy, which my doctors felt was probably a predictor for my second round with preeclampsia. I've managed it successfully with medication and a few lifestyle changes. In fact, my pressures are still relatively low compared to most. The baby is growing well, there haven't been any problems with my placenta and I haven't had any symptoms or alarming test results in my last trimester

My whole pregnancy I've hoped for a VBAC. I despise the thought of having another C-Section even though I've known it would be a likely occurrence for my situation. I've been told by almost all the OB's at my practice that they would only be comfortable with me going to 38-39 weeks. I had faith that I would start labor before then but it's getting close and I'm getting nervous. Last week DH and I were persuaded at my prenatal appointment by one of the pushy surgeons in the practice to actually SCHEDULE a section for June 20th, I will be 4 days shy of 39 weeks at that point. Almost immediately I didn't feel right about it, as there really aren't any medical reasons to end my pregnancy without allowing myself a trial of labor at this point. I feel like I'm really limiting myself, especially because I'm showing signs of early labor, a L & D nurse actually told me last night she would be surprised if I made it another two weeks. So I'm considering putting my foot down and trying to reschedule or cancel the surgery, just to give myself a little more time. Is that crazy? Does anyone have any experience with a situation like this?

[ryan'smom]

Originally Posted by Emeraldcitty .... of the pushy surgeons in the practice to actually SCHEDULE a section for June 20th, I will be 4 days shy of 39 weeks at that point. Almost immediately I didn't feel right about it, as there really aren't any medical reasons to end my pregnancy without allowing myself a trial of labor at this point. I feel like I'm really limiting myself, especially because I'm showing signs of early labor, a L & D nurse actually told me last night she would be surprised if I made it another two weeks.

Sounds to me like you've already answered your question!  Cancel the surgery!!

[ablepearl]

I agree, without a real medical indication why are they even scheduling before 39 weeks?  That goes against the ACOG guideline for elective delivery.

[AlexisT]

Docs are very gun-shy with former preterm pre-e patients and women on anti-hypertensives. The thing about that ACOG guideline is that it's for elective delivery with no medical indication. Depending on the situation, this could be considered medical indication. A lot of OBs would classify it that way, and they'd deliver a patient like this at early term.

I'm in similar shoes though my pre-e was later onset. Do they have you on regular NSTs? If I had good pressures, no protein, and reactive NSTs, I wouldn't schedule. My OB is comfortable with letting me go as long as I meet those criteria.

[phathui5]

Why not ride it out and see how it goes? You said that you and the baby are both doing well, so there's no need for surgery at this point.

[katelove]

I don't know that I would cancel the appointment now. You said you're only 37 weeks? If you cancel now that gives your doctors two weeks to hassle you about making another appointment. You could leave the appointment in place and then, if you haven't given birth but don't want to go ahead with the c/s, just ring up the day before or the morning of the appointment to cancel then.

[cinderella08]

I'd cancel.  From what you have posted, there is simply no reason.

I was induced and has a cesarean at 37+6 with my first baby.  I had severe preeclampsia which rapidly declined into HELLP syndrome in a day's time.  I had a cesarean for FTP/CPD though...

11 months later, I found out I was expecting again.  On BP meds and full bedrest starting at 17 weeks.  Preeclampisa diagnosis yet again at 38 weeks.  Induction necessary at 39+4 and I had a WONDERFUL VBAC.

[Emeraldcitty]

May I asked how they induced you? I'm not a fan of medical induction, but honestly if there's a deadline I'll take what I can get. I was told that induction wasn't an option at my hospital due to risk of uterine rupture. I'm not really sure how comfortable I am with going post-date though, and I know for sure my doctors wouldn't like it.

[Emeraldcitty]

Originally Posted by AlexisT 

I'm in similar shoes though my pre-e was later onset. Do they have you on regular NSTs? If I had good pressures, no protein, and reactive NSTs, I wouldn't schedule. My OB is comfortable with letting me go as long as I meet those criteria.

I'm having a Biophysical profile and NST done weekly, at two appointments. I'm being very well monitored so I think that might be an option.

[cinderella08]

Originally Posted by Emeraldcitty 

May I asked how they induced you? I'm not a fan of medical induction, but honestly if there's a deadline I'll take what I can get. I was told that induction wasn't an option at my hospital due to risk of uterine rupture. I'm not really sure how comfortable I am with going post-date though, and I know for sure my doctors wouldn't like it.

-
 

Yes, there is an increased risk of UR (uterine rupture) with an induction - but for me - the risk of a repeat cesarean is far worse than the risk of uterine rupture.

Approximate rupture rates taken from the article listed below:

Spontaneous labor - around .5%

Induced with Pitocin - around 2%

Induced with Cervadil or other prostaglandin - around 4%

I was induced with a very low, slow, gentle dose of pitocin.  I was 39+4 and the pitocin only had to be bumped up 4-5 times before my body just sort of took over.  I labored in a rocking chair the entire labor - my baby was posterior and asynclitic.  My water broke at 8cm spontaneously and I was complete 3 minutes later - literally.  I pushed for about an hour and a half.   I had an epidural-free labor and my entire labor + pushing lasted just shy of 9 hours.   If I were ever in the position where it was an induction or a repeat schedule cesarean - I'd be induced again without thought. 

This has great information and statistics on the rupture and complication rates for various induction methods.  http://emedicine.medscape.com/article/275854-overview#aw2aab6b5

Also - is your OB not comfortable letting you go to term, or do you not want to go past your guess date?  Is that the only reason for the scheduled c-section.  No BP probs now or anything like that?

[ablepearl]

http://cat.inist.fr/?aModele=afficheN&cpsidt=23202465  This is an interesting cohort study on VBAC and UR in spontaneous, augmented or induced labors.  

From the abstract:

Results The risk of complete uterine rupture among women without labour was 0.01%. The risk in spontaneous labour without augmentation was 0.15%, considerably higher when there was augmentation with oxytocin (1.91%). The risk with induction of labour was 0.54% for oxytocin alone, 0.68% for prostaglandin alone, 0.63% without either and 0.88% when they were combined. Compared with spontaneous labour, risks were increased three- to five-fold for any induction, six-fold for prostaglandin combined with oxytocin and 14-fold for augmentation with oxytocin.

[Emeraldcitty]

UPDATE: I did end up rescheduling for my due date. I'm really hoping that will be enough time for baby to decide to move out on his own!