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Discussion Starter · #1 ·
FWIW, I did a search here to see if I could find a post that addressed this and I was unsuccessful. Here's my situation:
I am scheduled for a c-section next month in the birth of dd #2. I had a scheduled c-section for dd #1 as well, due to scarring I have from a very bad fibroid experience a few years back. The c-section was indeed necessary, as there is a portion of my uterine lining that is very weak (he used the phrase "paper thin"). So the c-section decision is not in question (it took me a long time to reconcile myself with it the first time around, and I'm done analyzing it). Other than that and the other risks I have (chronic hypertension, obesity, and bipolar disorder requiring medications which are questionable during pregnancy), I had a totally uneventful pregnancy with dd #1, and a very easy birth and recovery.

This time, all of the same risk factors exist, basically. In the time since dd #1 was born, I managed to get rid of one of my meds, and change another to a different drug. But again, the risks are basically the same, and I am having a relatively uneventful pregnancy again. So I was completely shocked when, almost without any warning or discussion, I was told that I was scheduled for an amnio the day before my c-section.
: My OB never brought it up - I found out from the receptionist who was giving me the appt schedule for that week. The following day, I called the doctor's office and spoke to the nurse, who babbled something about it being "required." Yeah, right. Then why didn't they do it last time? There is literally no question as to my dates, I know pretty much the day this little one was conceived.

I saw both the OB and the perinatologist Tuesday, so I asked each of them about it. The peri (I saw him earlier in the day) said it was a "guideline" to take a fetal lung assessment for any birth before 39 weeks. I mentioned that this wasn't done with dd #1 (also 38 weeks), and he acted as though that were unlikely. Umm, hello? Do you think I would forget having a needle like that put into my belly/baby?
: When pressed, he punted and suggested that my OB would be the one to discuss it with. Which I'd already planned. I go to the OB and bring it up, and he also insists we did it last time.
: He explains that it's an ACOG guideline, which is now "hospital policy", and it's not that big a deal, blah, blah, blah.

I really don't want to do it. First off, I see no reason. I've gone out of my way to avoid having an amnio - it's one of the main reasons I skipped the triple/quad screens. And knowing what I know now about my uterine lining, it just doesn't seem like a bright idea to go puncturing it. It obviously wasn't "necessary" last time around. So my entire body and spirit is against this. If someone else posed this situation to me, I would emphatically encourage them to refuse to consent. Yet somehow, and I really didn't expect to have this happen, I am just feeling bullied into it and helpless to change it. Which is sooooo not me - and I really feel crappy about the whole thing.

It probably really isn't that big a deal, but it's my body, and it's an invasive procedure. I don't know why I feel so un-empowered in this situation. I am generally the first to speak up for myself, and have no trouble doing so. Anyway, DH agrees with me on this. I am tempted to bring him along to one of my appts (if we can work it out schedule-wise) for back-up. I can't believe how lame I am.

So I guess I'm looking for input - whether you think the amnio is no biggie and I should just do it, or if you agree that it's pointless, some words of wisdom on how to refuse it.

TIA
 

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Perhaps the answer you need is "What will you do if I refuse the amniocentisis?"
 

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I don't get why you wouldn't want to document lung maturity, since one of the major risks of a scheduled section is iatrogenic prematurity.It's possible for a 38 weeker to not have mature lungs.
 

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i would refuse the amnio and schedule it for after 39 weeks.

of course, if you go into labor before the date, they will have to do the c-section regardless of if you have the amnio or not.
 

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Ask your docs "What happens if the lungs are not mature enough? Will you reschedule the c/s for a week later?" If that's the case, I'd tell them you are not going to have the amnio and will just wait another week for the c/s.

Also, I'd ask your OB for the test results from the amnio with your dd#1. If you had the test done, it'll be in your records. Have him prove to you that it was done.

Frankly, I wouldn't do it either. I'd just wait another week. They don't need to test if you're at 39 weeks. It's your body and your choice . . . regardless of hospital policy. You do not have to consent. They cannot make you have the test. You know that.

Find your inner tiger, mama! Stand strong! You can do it! And I hope you have another easy birth and recovery.

Good luck!
 

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Yep. It's one of the few good rules out there (though not always followed)

Personally, if I HAD to have a section, I'd wait until I went into labor to try to assure that they baby was ready.

-Angela
 

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W/dd, my water broke at 31w6d. We managed to keep off labor until 35.5 weeks. We were going to induce, as I was told the risks of her being born were now less than the risks of her staying put, but we did an amnio to confirm lung maturity. I had taken 2 courses of steroids to help maturity. We did the amnio - not comfy, but reassuring. The results came back 4 hrs later that she was fine. Doc asked if we wanted to induce that night or get a good nights rest and induce in the morning. I decided to wait, which was great b/c she decided to come on her own later that evening.

So, I'd find out what the other options are- what will happen if lung maturity isn't there, what will happen if you refuse, etc., and decide from there.
 

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I agree with holding off on the amnio and either going into labor yourself and then having the c-section or scheduling the date for as close to term as possible. I guess I don't understand the rush to section at 38 weeks??? If an amnio shows the lungs are not ready then will they do steriod shots and wait a few days or wait a week or so until the baby has a higher chance of breathing on it's own??

Personally, I'd refuse and amnio and go in for the section after labor has begun.
 

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Quote:

Originally Posted by Drummer's Wife
I agree with holding off on the amnio and either going into labor yourself and then having the c-section or scheduling the date for as close to term as possible. I guess I don't understand the rush to section at 38 weeks??? If an amnio shows the lungs are not ready then will they do steriod shots and wait a few days or wait a week or so until the baby has a higher chance of breathing on it's own??

Personally, I'd refuse and amnio and go in for the section after labor has begun.
No, steroids are useless after about 34 weeks. they'd just wait another week.

It's possible that the rush to section is that it is possible to have UR without labor, and the longer the pregnancy the more likely it is. The move is often to a 38 week section for repeats for that reason.
 

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I too would probably just reschedule the C-section for 39 weeks. If you don't have the amnio and you have the C-section at 38 weeks and baby's lungs aren't mature, you're looking at a NICU stay, which is no fun for either of you. Better to wait and give those lungs a chance. And if baby decides to come before the scheduled date, just call your OB and tell him to get to the hospital to do a C-section. If baby is trying to come on his own at 38 weeks, he's probably got mature lungs.

There's really no reason why your body couldn't decide to deliver just before 38 weeks (like 37+5, for example), so there's always the chance that you'll go into labor before the scheduled date anyway. Why not add a week to the scheduled date?
 

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When I was almost induced for PIH / borderline PreE at almost 35 weeks, they wanted to do an amnio. But my placenta was in front of the baby so the OB decided that the risk of the damage to the placenta outweighed the benefits of the amnio (to determine lung maturity). Instead I was put on strict hospital bedrest and meds to help control my blood pressure. I was borderline too high the whole time until my induction at almost 38 weeks (BP was avergaing around 140 / 100, and spiked to 150 / 100 when not on bedrest and meds).

My OB also told me it was a recommendation to determine lung maturity, but it wasn't "required".
 

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Discussion Starter · #14 ·
Quote:

Originally Posted by Apricot
Perhaps the answer you need is "What will you do if I refuse the amniocentisis?"
This is exactly it. And I knew that, and I should've just said it to the OB when I was there.


It probably wouldn't be that big a deal to move it back to 39 weeks. The reason we're doing it at 38 weeks is that there is a risk of rupture; the object is to avoid having me go into labor. Although that often seems like a bogus excuse to do a section, in my case it is genuine. I see my OB again on Monday, and I think I will put all that out there to see what happens.

Thanks for confirming that I'm not being ridiculous about this.
 

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Just FYI there is some new research that freaking out about "windows" in the uterus is not really warranted. I wish I'd kept that link... the idea is that it's actually probably quite normal and not at all an indicator of a high probability of rupture.

-Angela
 

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I think the new research is on lower segment c-section uterine scars, not scars from other uterine surgeries. Fibroid surgery done on a non-pregnant uterus is by definition not in the lower uterine segment, as the lower segment doesn't exist until the second trimester.

Wishing you a good birth and an easy recovery, Dana.
 

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With my DS, we talked induction at 37 weeks (I had a bad case of GD, and we just couldn't get my blood sugars under control at the end of my pregnancy.) We did do an amnio, and his lungs were not developed enough - so we waited five more days.

At 38 weeks though, I don't know, I'd probably refuse. I will say that the end o pregnancy amnio was really awful, and I don't think it was due to my doc's technique or anything - I just found it extremely stressful (baby was moving a lot) and painful. (For context, I had an amnio at 15 weeks in this pregnancy, to r/o downs because of an increased risk on my nuchal translucency test, and there was no comparison - it was virtually painless.)

What I'm saying is - a lot can happen in a week at the end of a pregnancy. 38 weeks is considered full term, isn't it? At 37 weeks, it seemed to make some semblance of sense - at 38, less so.
 

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I just think this whole situation in bizzare.
My ds was induced at 37 weeks due to preeclampsia. No one ever mentioned lung maturity or amnio.
If you are sure of the date of conception and you are measuring appropriately, why would an amnio be warranted?
I could see them wanting to not have you go into labor with your uterus being what it is. To me, the amnio is useless.
Maybe they are trying to avoid malpractice, by being absolutely sure that the lungs are mature.
Stay calm, stay strong. This will all work itself out.
The last thing you need at this stage in the game is all this stress. Wishing you peaceful thoughts and a peaceful delivery!
 

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Quote:

Originally Posted by noteworthy
I just think this whole situation in bizzare.
My ds was induced at 37 weeks due to preeclampsia. No one ever mentioned lung maturity or amnio.
If you are sure of the date of conception and you are measuring appropriately, why would an amnio be warranted?
I could see them wanting to not have you go into labor with your uterus being what it is. To me, the amnio is useless.
My understanding is that it is suggested that amnio be done when the c-section is not needed right then medically (as in preeclampsia)

-Angela
 

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Quote:

Originally Posted by noteworthy
My ds was induced at 37 weeks due to preeclampsia. No one ever mentioned lung maturity or amnio.
In the case of pre-e, doctors have to make a decision... risk mother going into full blown eclampsia, or risk baby having immature lungs and requiring a short NICU stay. In your case, it was probably determined that it was safer for everyone if your baby came, mature lungs or not. They do that with pre-e preterm fairly often. If mother/baby are going to die if baby doesn't come out, it's worth risking immature lungs. The baby's lungs *will* mature outside the womb. The baby just needs help for a little while to breathe, and in some cases might need surfectant added (my preemie was given that).

So a pre-e C-section is a good bit different from a scheduled C-section as the OP is talking about. Her life is not in immediate danger, and neither is the baby's. That's why it can wait a little bit, although there is still risk of uterine rupture.
 
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