by Karla ° Friday, October 13, 2006
Being pregnant, and knowing that the birth of this child is looming closer and closer have caused the memories of Ava’s delivery to return with a vengeance. Like oil on stormy water, thoughts of her birth experience and the birth of this baby are not mingling well together. Especially frightening, is trying to envision going through labour (or an elective c-section), without the baby dying, particularly when all the technology in the universe can’t predict if this baby has the same heart issue, or garantee he won't die if it could.

So now I feel stuck. If my placenta continues it migratory travels posteriorly north, the choice between going through with labour and attempting a VBAC (vaginal birth after c-section) or having a c-section is mine. Knowing Ava’s history, her heart, her distress from labour and that she aspirated meconium and was never able to breath on her own after all was said and done, I have been leaning more towards the c-section route, with the goal of avoiding labour completely. The thought behind that, although not a medically necessary surgery, is to avoid tempting fate and the circumstances that already led to the death of one baby.

That being said, I went into labour with Ava at 38 weeks. The plan, if I choose the c-section route, would be to deliver the baby before I go into labour, which in this case, assuming there is a chance I could go into labour at the same point in this pregnancy, would be before the 38 week mark. Most elective c-sections are done at 39 weeks. Mine would be done at 37 weeks and 5 days. Here is where my hesitation begins. Although most babies are considered full term by 37 weeks, there have been instances where lungs have not yet fully matured by this point, hence the reason a full term pregnancy can be anywhere from 37 to 42 weeks. I’ve harped on my doctor at every visit about my concern for lung maturity and the timing of the c-section.

I know with my first pregnancy I took on a holier than though attitude about unnecessary testing and procedures, but this time around, I’m all for tests that can help prepare us and keep us informed about the state and health of this baby.

For example, there is a test called, fetal fibronectin, that can predict premature labour in those at who are at risk. I thought this test was great. A quick swab of the naughty bits and I would be given a heads up notice if labour was about to start within two weeks. The problem here is that I have a typical pregnancy with no atypical symptoms of premature labour. This test would do nothing for me because there is no benchmark to measure it against. Also, the ultrasound technology at Mount Sinai measures the length of the cervix, which, according to my doctor, is just as good indication of impending labour.

Still not satisfied though, I asked about an amnio. Typically done at around 16 weeks to test for fetal abnormalities, this test can also be used to predict lung maturity. At such a late stage in the pregnancy, although there is no risk of triggering a miscarriage like in early pregnancy, it can trigger labour, which of course, is what I am trying to avoid.

A catch 22, no?

The choice is mine. My OB is flexible and will work with whatever decision I make.

What does the mighty internet think about this? Am I crazy for electing to have a c-section (sometimes I feel like I am), and, do I go through with an amnio “just to be sure?” I know it’s unlikely, but what if this little nestling newborn’s lungs aren’t strong enough to breathe on their own?

And, because the internet is an evil web of information overload, what if I have a c-section and they can’t stop me from bleeding and I end up needing a hysterectomy?

I sort of wish humans were more like robots and had secret traps doors all over their body to replace, update or remove stuff. If that were the case, I think I’d opt for a boob upgrade during the baby removal process for good measure.

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Wow... that really IS a catch 22. Be assured, though, that being ALMOST 38 weeks will definitely help with lung maturity... though nothing is guaranteed, of course. I hope everything goes well for you.

My heart aches for you and your husband - you've been through so much already. I don't blame you in the least for opting for a c section however I would for go the amnio (my opinion) to me its just now worth the risk of premature labour. If its any comfort at all, my 2 nieces were born by C section at 35 and 36 weeks and perfect in everyway. My younger sister had my nephew just this past July at 35.5 weeks by emergency c section and he was perfectly healthy. At almost 38 weeks I think the scales definitely lean in your favour.
Posted by Anonymous Colleen in Toronto :  October 13, 2006

Sorry.... i really do know how to spell. That should read "fogo" the amnio and "not worth the risk"
Posted by Anonymous Colleen in Toronto :  October 13, 2006

I'm at a loss on the advice front. I know that when they were trying to prolong my pregnancy with Matthew, they were injecting me with steroids to speed up his lung development. Is that something the doctor has talked about at all? They may not do that so late in pregnancy though.
Posted by Blogger Heather :  October 13, 2006

Decision, decisions. So much to consider. I don't think you are crazy for considering an elective c-section. There were times at the end of my pregnancy where I wished I could have a c-section just to insure the well-being of my baby. Kind of the thought, "I know she's healthy and thriving now in my womb, so let's not take any chances and let's just get her out NOW to be safe." I know the recovery from a c-section is brutal but there are some advantages despite that. The choice is ultimately yours and whatever you choose will be what you think is best.
Posted by Anonymous Amanda :  October 13, 2006

I also don't have any advice for you never going through either the natural birth process or a c-section myself. I do say go with what feels right to you. Womens Intuition.I think a little bit goes a long way. I can't imagine how hard and scary this must be for you. And I am honestly amazed at how strong you have been up to this point. You'll contuie to be in my thoughts daily.
Posted by Blogger Beth :  October 13, 2006

The medical info available on the Web has given me panic attacks many times. Don't read it. Doctors usually know which info is important and which isn't.
Posted by Blogger Kurt :  October 13, 2006

I had a C-section at 37 weeks due to the possibility of the cord falling out(!) if my water broke, since he was a stubborn breech baby. I was supposedly already beginning to dilate, so they went ahead a bit early. Mr. P was absolutely fine.

I know that you must be absolutely paranoid about the whole thing, and I don't blame you for a nanosecond. If possible stress to the baby is a factor in executing a natural birth, then I am thinking the C is the way to go.

As for the amnio, I don't think I would do it. That is just my personal opinion, though.

Posted by Blogger Gina :  October 13, 2006

Hi Karla,

I would say take the C-section ! If there is something going on and the need to get the baby out quickly you are already in the OR and don't have to wait !

I had a c-section myself with my daughter , but my pregnancy was induced on the 10th day past my due date ,I then had 42 hours of hard labour , my doctor asked me how I felt about a C-section and I told her to make the choice that was needed , as I had no Idea what to expect as this was all new to me . It was off to the OR for my c-section. Which I felt was the best decision ever made :)

My best friend delivered her second Baby via C-section 2 .5 years ago little Breanna was born 8 weeks premature ! Once she felt labour coming on she went to the doctor and they sent her off to the hospital and they gave her a shot in her hip to help with the lung development of the baby , and also was given another lung shot I believe it was 12 hours after the first one was given ! Labour progressed quicker than what they thought and they ended up taking Breanna Via C-section within hours of receiving the second shot:)
At 8 weeks premature Breanna weighed in at just under 4 pounds ! and was doing amazing ! she spent the first 6 weeks of her life in the special care nursery and was monitored very closely and to this day has had no affects of being born so early !

Take a deep breath and follow your doctors lead and if they say c-section then listen to them , they are the pro's and know what they are talking about !
Posted by Anonymous Lora Watt - Vancouver B.C. :  October 13, 2006

Hi Karla,

I have to say that you are absolutely an amazing woman. It is very understandable that you want an elective c-section. As much as I am a strong advocate for natural childbirth at home, I probably would do the same thing if I were in your shoes. Then the next pregnancy, I would be brave enough to try a VBAC. Laboring is already very stressful for the mother and babe-in-womb. To add more stress on whether the baby will be okay or not on top of that would not be good for you or your little boy.

However, I agree with your commenters that the amnio is probably not necessary. That's usually reserved for people who have a medical reason to get the baby out but want to check and see if the lungs are developed, i.e. a woman who has placenta previa and labor is beginning at 35 weeks. If you have a C-section at past 37 weeks, the baby will be fine. Maybe I'm wrong but I've never heard of a baby's lungs not being fully developed after 37 weeks unless there was already a medical problem.

Good luck in deciding what you want to do. Of course, we all will be cheering you on and looking forward to seeing your little boy in your arms. =)

P.S. Thank you for your response to my last comment. I'm happy to hear that your "bad belly shots" are not "bad" as in a negative way but in a "cool" way, like bad-ass. ;) So, my bad! Teehee!
Posted by Blogger Keri :  October 13, 2006

I just don't know. Talk it over with your doctor some more.

This post did make me think how much it would suck to be an elephant in the same situation. Their pregnancy is 2 years or something. And they don't have access to many elephant doctors. So they just have to guess. And their babies weigh 100lbs or more. Ouch..
Anyways, if you have any more questions I here to help..

If I were you I'd go for the c-section for the same reason suggest above. If there are any complications, you are already in the best place.

Can your doctor alert all those involved with your care about your two previous pregnancies? I would want to be sure to be surrounded by compassionate professionals. Those who would understand that you have reasons to be more stressed than most laboring moms.

I had a terrible nurse after my youngest son's birth. But, everything went well, so I just let it slide. If there had been complications I don't know what I would have done.

Judy (who really doesn't know much about these things)
Posted by Anonymous Anonymous :  October 13, 2006

Holy choices. I can see why you can't decide. I would think the amnio, is one of the riskier choices.

My friend delivered at 41 weeks and her babys lungs were't fully developed, so you just NEVER know. I think a c section would help put you a little more at ease..if that is even possible :/

37 weeks and 5 days, couldn't they comprimise and do 38 weekks and 2 days or something. The chances of you going into labour at the same time with this pregnancy are

My friend had her first 3 weekd early and her second almost 3 weeks many,many variables.

I am praying for you and MArk to make the best decisions..tough as they may be!
Posted by Anonymous Donna :  October 13, 2006

Thank you - everyone - for all your thoughts and advice. It is much appreciated. After reading Happy's comment, I'm so lucky I'm not an elephant.

Judy - my OB will be the one performing the c-section, which is another reason why a scheduled section sort of makes sense to me because she knows my history and can plan to be there with me this time around, but I do carry around my medical records just in case.

Donna - You are right about there being little chance the timing of labour with this pregnancy will the same. The reason for the 37+5 week scheduled date is because of Christmas holidays. If I want my doctor there (and I do because she is wonderful and so compassionate and understanding), the 22nd of December is my last chance before the new year to have her deliver the baby.
Posted by Blogger Karla :  October 13, 2006

never had a child, never went through this, can't add much but to keep my fingers crossed for you (which explains my miserable typing)
Posted by Blogger methatiam :  October 13, 2006

I'd say go with the c-section. Even if baby's lungs are not fully developed, he'll be able to recover completely. So many babies have recovered with absolutely no side effects. I cannot imagine the thoughts that must be swirling through your head these days. My thoughts and prayers are with you.
Posted by Blogger Linda :  October 13, 2006

Wow I couldn't even imagine what you are going through. I think I would be incredibly scared as well not knowing what the future holds. But with that said, I would definantly go with the c-section at 37 wks. And my son was born on Dec. 21st so that's a good day I would say!
Posted by Blogger Amber :  October 13, 2006

I can see your dilemna. I had both mine naturally with no drugs or anything, but it's not always the best option. I don't really know what I'd do if I were you, but if I could try to imagine myself in your shoes I think I'd go with the scheduled c-section. My main reason against the vbac is that you will probably be very stressed out and emotional, and I think your emotions release chemicals that affect the babies' stress levels. Andrew aspirated meconium, and while I can never prove it, I believe it was because my nurse was fighting me every step of the way. She spent an hour yelling at me not to push when I was fully dilated. It was because they couldn't find the midwife. I feel my stress from her affected Andrew. He had a bowel movement and he had his arm above his head like he had been fighting in there. So that's why I'd go with the c-section, for the hopefully healthiest baby possible.
Posted by Blogger Julia :  October 13, 2006

I had my first baby by c-section after induced labor (41 wks 6 days) with no progression (stayed at 2-3cm). I thought for sure I'd be doing the VBAC with baby #2. It was entirely up to me. But then my sister (pregnant at the same time for both babies) told me what her doctor told her. If you go for a VBAC the baby is at risk, while if you go for the c-section, the mother is at risk. That decided it for me! Plus, the eternal pessimist that I can be, I figured if I went for the VBAC either the same thing would happen as the first time (labor AND c-section) or worse yet, something would happen to the baby and I would not be able to live with myself.

As for the amnio, I don't really know. It doesn't sound like your doctor is urging you to have it done, so maybe it is not necessary?

I have recently found your blog and cannot believe all that you have been through. I am praying for a safe delivery of a healthy baby for you!!
Posted by Anonymous Colleen :  October 13, 2006

Well, I have no medical advice for you, and I think most people who have commented here have given wonderful input. I just wanted to say that I am thinking and praying for you...I can't imagine having to make that decision. Go with your heart. As a mother, sometimes I think that is all we have to go on, with the over flooding of info and suggestions, and opinions, and options out there.
Posted by Anonymous angela :  October 14, 2006

My own personal opinions, which I guess is half of what a blog is for, right? :-)
It doesn't sound like the amnio is needed, but if you FEEL like it is, that's all that matters. If you go into labor, you have the C-Section right then. Doesn't sound like you need it though.
As for the C-Section itself, it sounds like a really good idea! As you've said, no sense in tempting fate, and if you can skip labor, why not? :-) I had 38 hours of it with Ty, and I'd never opt to do that again!! And I don't think you need to worry about bleeding too much. I'm sure in that aspect, you're going to be just fine. Don't worry about things like that that don't affect your baby, because worrying does affect him. Honestly, worse case scenario if that did happen, you already have your son, and you're all 3 happy and healthy.
You'll be ok hun, just try to take it all one day at a time, and before you know it, he'll be out here smiling at you :-)
Posted by Anonymous arlene :  October 14, 2006

Karla, I think you should do what you feel is right. It is a catch 22, but I would opt for the c-section, there are no guarentees but there are no guarentees in life. I also think the Amnio is definitly a no go, why now when you are so close to the delivery. I would not do it!I would go for the c-section though because you are more worried about the stress of labor. Ok just my opinions but you asked and I think you are incredible Karla so you do what you feel the most comfortable with! K
Posted by Blogger TBG :  October 14, 2006

I don't have any personal experience to fall back on here with C-sections or amnio tests, so I don't have wise words about what you should decide. I just wanted to send you a hug a let you know I am thinking about you.

Trust your inner voice. It won't lead you wrong.
Posted by Blogger Cuppa :  October 14, 2006

My little boy arrived on his own schedule at 38w1d and he was healthy and ready to be born. My feeling is that 37 weeks and 5 days would be totally fine, I was at risk for premature labour due to some bleeding early on in pregnancy and I know that once we hit 37 weeks I totally relaxed.
Posted by Blogger trish :  October 15, 2006


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