[omshantihi]

Hi,<br><br>
I'm facing a medically necessary c-section for a very low lying placenta. No issues with bleeding or spotting until now (38 some weeks), but my ob is concerned about abruption during labor and wants to schedule a c-section at 39 weeks. I've researched and exhausted most of my options at this point. So my question going into next week is this: is there a benefit for baby/mom to waiting until labor or closer to it if a c-section is inevitable? The reason I ask is because I have been given 2 date options. One is at the start of 39 weeks (a more practical/convenient date and time); the other is at 39 weeks, 3 days, so there is a chance labor could have started or is about to (based on the onset of labor with my last pregnancy). This second date is right at the edge of Memorial Day weekend, so I'm wondering if I should choose the earlier date just to get a better chance at good/more alert medical staff. However, if there are definite benefits to getting closer to labor, I'd choose the later date. Any advice or suggestions would be greatly appreciated. Thanks!

 

[bicyclingbethany]

If your OB is worried about an abruption, then it seems prudent to go with the date at 39 weeks. Your baby will be full term and a scheduled c/s with an epi would be much better than a crash c/s with general anesthesia, IMO.

 

[4Blessings]

I've had 4 c/s and labored with all of them. However, I did not have any complications going into it. I've been happy to know that my babes were ready to be born. I certainly won't worry much about delivering at 39 weeks.<br><br>
I will say that my first was born just before Memorial Day in a small town hospital. My staples were left in far too long due to the office being closed for the holiday (the Dr. didn't remove them before I was discharged from the hospital). I'm sure this isn't typical but boy did that hurt when they did come out <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/irked.gif" style="border:0px solid;" title="irked"><br><br>
Good Luck to you <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/joy.gif" style="border:0px solid;" title="joy">

 

[pacificbliss]

If it's a low lying placenta as in a placenta previa I would go with the early date. I would not want to start dilating with the placenta there. Also, if that earlier date means you would likely get to go home before the holiday weekend i would consider that a plus. I would not worry at 39 weeks.<br><br>
Good luck and happy baby moon!

 

[PlayaMama]

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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>pacificbliss</strong> <a href="/community/forum/post/15425062"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">If it's a low lying placenta as in a placenta previa I would go with the early date. I would not want to start dilating with the placenta there. Also, if that earlier date means you would likely get to go home before the holiday weekend i would consider that a plus. I would not worry at 39 weeks.<br><br>
Good luck and happy baby moon!</div>
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<br><img alt="" class="inlineimg" src="/img/vbsmilies/smilies/yeahthat.gif" style="border:0px solid;" title="yeah that"> i agree.<br><br>
and some <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/goodvibes.gif" style="border:0px solid;" title="Goodvibes"> for your babies birth!

 

[Storm Bride]

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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>Proud2BeAnAmerican</strong> <a href="/community/forum/post/15425037"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I will say that my first was born just before Memorial Day in a small town hospital. My staples were left in far too long due to the office being closed for the holiday (the Dr. didn't remove them before I was discharged from the hospital). I'm sure this isn't typical but boy did that hurt when they did come out <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/irked.gif" style="border:0px solid;" title="irked"></div>
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I've had them out at 2 days post-op, 3 days post-op, 4 days post-op and 7 days post-op. They all hurt a lot.<br><br>
Stitches were awesome.

 

[AlexisT]

I would want to find out just how dangerous it is for you to go into labor. I know that for previa, it's really important. If there's a risk of bleeding, then that's more important than the benefits of labor.<br><br>
That said, I don't think a few days is going to make a crucial difference either way. 39 weeks is good for a scheduled section. If 39 weeks even is more convenient, then it's fine--we're not talking 37 weeks here.

 

[caned & able]

If you wait for labor, at least you know your baby is probably ready at this point and you avoid the wrong dating that happens with the sonogram and guessing.<br><br>
The mechanism that the baby, placenta and uterus use to initiate labor will help the baby be ready to breathe.

 

[omshantihi]

Thank you everyone for your input! Just to clarify to those of you who asked, my placenta is low lying but not a previa. However, my ob wants a 2 cm clearance from the cervix which I did not have at 38 weeks. I haven't had any bleeding or spotting episodes. I've decided to take the later c/s date just to have a u/s measurement taken one last time at the start of 39 weeks. I'll ask my ob again about what the dangers are if labor starts. If they are worried, I suppose they could admit me for a couple of days to the hospital while I wait for their available c/s date.

 

[LovelyBella]

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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>omshantihi</strong> <a href="/community/forum/post/15424081"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Hi,<br><br>
I'm facing a medically necessary c-section for a very low lying placenta. No issues with bleeding or spotting until now (38 some weeks), but my ob is concerned about abruption during labor and wants to schedule a c-section at 39 weeks. I've researched and exhausted most of my options at this point. So my question going into next week is this: is there a benefit for baby/mom to waiting until labor or closer to it if a c-section is inevitable? The reason I ask is because I have been given 2 date options. One is at the start of 39 weeks (a more practical/convenient date and time); the other is at 39 weeks, 3 days, so there is a chance labor could have started or is about to (based on the onset of labor with my last pregnancy). This second date is right at the edge of Memorial Day weekend, so I'm wondering if I should choose the earlier date just to get a better chance at good/more alert medical staff. However, if there are definite benefits to getting closer to labor, I'd choose the later date. Any advice or suggestions would be greatly appreciated. Thanks!</div>
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This is what happened to my other cousin who gave birth early this year. My cousin visited her OB and then her BP was checked and it was so high so they brought her to the hospital. She was there for 2-3 hours already and her BP is still not going down. She is not yet due and she's not yet in labor but her OB advised her to force the baby out and have a C-section procedure because her placenta is very low already. Her due date actually is the week after that, so she's one week early of her due date. So they had to do it since that's what her OB said. Now, her baby is very healthy and really cute!! <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/thumb.gif" style="border:0px solid;" title="thumbs up">

 

[*MamaJen*]

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<div>Originally Posted by <strong>LovelyBella</strong> <a href="/community/forum/post/15427217"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">So they had to do it since that's what her OB said.</div>
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Just wanted to gently correct you on this statement. You never have to consent to a medical procedure just because your OB says.<br>
You'll find that on this board, a lot of women prefer to use a midwife or an OB who respects the idea of informed consent. It's a completely different philosophy of care.<br>
There are a lot of policies and procedures in American hospitals today that are not evidence based, which help contribute to an outrageously high C-section rate or other bad outcomes. There are a lot of things that go on in hospital delivery rooms that are actually bad for mothers and babies, like early induction of labor for non-medical reasons, not letting the mother be mobile during labor, overuse of pitocin, and so on. Just because a doctor or OB says it does not automatically mean that it's the medically right thing to do.<br>
Low lying placenta, which the OP is talking about, is something that can be a true medical concern and often makes a C-section an actual necessity, but she's being proactive about her health and gathering information so she can give truly informed consent. Which is rad.<br>
OP -- Good luck with everything. It wouldn't hurt to get that last ultrasound to make sure things haven't shifted. But whichever way it winds up, I hope everything goes great.

 

[stik]

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<div>Originally Posted by <strong>caned & able</strong> <a href="/community/forum/post/15426091"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">If you wait for labor, at least you know your baby is probably ready at this point and you avoid the wrong dating that happens with the sonogram and guessing.<br><br>
The mechanism that the baby, placenta and uterus use to initiate labor will help the baby be ready to breathe.</div>
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This is generally good advice, but it can be really dangerous in cases of previa because cervical dilation causes bleeding and can compromise the functioning of the placenta, dramatically increasing risks for mom and baby.<br><br>
OP, it sounds like your doc is being conservative, but since you haven't had any episodes of bleeding, the later date is probably OK. Would you feel comfortable getting a sonogram before surgery to see if the placenta has cleared the 2cm margin by then? I've heard of cases in which placentas continued to move.

 

[Cheshire]

Hi,<br>
I'm cutting and pasting from a reply I posted a while back. Another momma had previa and was looking for info - my advice still applies for marginal previa as well (that's what I had).<br><br>
Best wishes!<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Placenta previa is a risk factor for vasa previa. Vasa previa is when the cord vessels transverse the os and tear during delivery (usually when the water breaks) causing the baby to bleed out.<br><br>
I had a marginal previa that finally moved enough to be cleared for a vaginal delivery at my 37 week scan.<br><br>
The doctors/ultrasound techs missed that I had a velamentous cord insertion (where the cord vessels insert into the amnion, travel through the amnion and then go into the placenta - once the vessels insert into the amnion they are not covered by wharton's jelly and are completely vulnerable to tearing) and vasa previa. Sometime during my labor my son's cord tore and he lost the majority of his blood before we got him delivered. He fought for 12 more hours after his birth but his body started to shut down so we removed him from life support and held him while he died.<br><br>
It was horrible and it could have EASILY been prevented if they had done their jobs right. I should have never been allowed a vaginal delivery. My son would be alive today if I had been given a c-section.<br><br>
If you are cleared for a vaginal delivery just ask them to visualize the placental cord insertion and verify that the vessels insert correctly into the placenta and that there are no vessels that transverse your OS. This is all really easy to see on an ultrasound.<br><br>
Do a little Googling and be prepared. Ask them to humor a pregnant momma and look for it.<br><br>
I don't post this to scare you. I post this because when I came to these boards looking for research on marginal previa I wish someone had told me what to ask for. I had never heard of velamentous cord insertions or vasa previa and how I would give just about anything to have heard of it just once to know what to ask about.<br><br>
You've been given the gift of knowledge - there is still plenty of time for your placenta to grow away from your OS and give you the vaginal birth you want. In the time you have left in your pregnancy you have the ability to ask more questions - armed with knowledge they may think you're nutty but I'd rather be branded a difficult patient than live without my son.<br><br>
Best wishes to you and congratulations!</td>
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[omshantihi]

OP again. Vasa previa is scary and tragic if not detected earlier in a pregnancy. My ob was very good about investigating this possibility. I was cleared at 35 weeks both for vasa previa and velamentous cord insertion.

 

[lunarlady]

I don't know if this helps much, but I've heard that time of day is more important than day of the week. Meaning you don't want to be the last c-section of the day, better to be in the morning. I don't know if they've given you the time choices, but it might be something to consider. And for what it is worth, most medical professionals don't get the same long weekends as we do, so it falling on Memorial Day weekend really might not be that big a difference for them, since some or all of the staff might be working anyway.<br><br>
Check with your OB and see if starting labor is a major risk for you. After all, it is good information to have either way because there is a possiblity you could go before the either date and you would want to know how serious that situation would be.

 

[caned & able]

.

 

[JessicaS]

Of course there is a chance of the placenta moving but I think once one is in the last weeks that "most" decreases significantly.<br><br><br><br><img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/hug.gif" style="border:0px solid;" title="hug"> to you OP.

 

[MeepyCat]

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<div>Originally Posted by <strong>caned & able</strong> <a href="/community/forum/post/15428764"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I do know of women with placenta previa, marginal and partial, who waited for labor to begin with no consequences to them or the baby. Of course, the hospital was close by.<br><br>
You should know that c/secs themselves increase the chances of future pregnancies being complicated by placenta previa and placenta accreta. Doctors know this because the rate of placenta previa and placenta accreta have increased over the past 20+ years along with the c/sec rate.<br><br>
That happened to my own sister with her own second pregnancy, but she did wait for labor nevertheless.<br><br>
And remember, that in most cases the placenta will move out of the way...!</div>
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The c-section rate may be increasing the rate of previa, but if you HAVE previa, WHY you have it is of far less interest than how you're going to deal with it.<br><br>
If the OP is at 38 weeks and the placenta isn't sufficiently clear, then it's time to make some plans. Schedule a follow-up scan to make sure the surgery's *really* necessary, sure, but the surgery should be on the schedule.<br><br>
To the OP - I'd want a follow-up scan to check current placental position, and to take a look at the cervix, if possible, to see how it's going. You want them to use the highest tech scanner they've got (NOT the beat-up old portable they push around the L&D unit). If the placenta is low and there's any sign of dilation, you want to move this up. But here's the thing about previa: if it comes down to the wire, they do not care whether or not you're on the schedule. They'll bump someone with a less urgent case and take care of you.

 

[omshantihi]

Hi, OP again. My last birth was vaginal, this is my second, so in my case, a c-section did not cause my marginal previa/now low lying placenta. They first saw it in a u/s at 21 weeks. I didn't give it a second thought because most move, right? I said the same thing at 28, then 31, even at 36 weeks. Now I'm definitely running out of time and see the writing on the wall :-( Still, I've asked for that final 39 week check. I want to go into the c/s feeling like I've done all I could. Thank you everyone for your input and support. To the PP, yes, that's a great idea to have the measurement done with a quality u/s machine.

 

[blessedwithboys]

if it were me, and i know its not...how many weeks did you carry #1? was labor spontaneous? i ask bc my induced labor was at 42wks and my spontaneous labor was 42w3d. both csecs, not for previa. if i was in your shoes and i knew i had no cervical changes until 42 wks, i would be asking why we couldnt wait until 41 wks as opposed to 39.<br><br>
if you r 1st labor started at 38 wks on its own, then ignore this post. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"> GL!