paul williams wrote:

Wifes now 36 weeks but baby is measuring up to 40 weeks already so it
looks very large.

Consultant has given us the choice :-

1. Elective C-section at 39 weeks.
2. Induce at 40 weeks.

Option 1 seems OK but consultant highlighted the risks involved with
any C-section.

Option 2 seems better if natural birth is possible. However, theres a
higher risk of emergency C-section which is obviously worse.

Are there any stats on how many Elective C-sections have problems ?

What about stats on how many large babies get forced down the
emergency C anyway? What about the extra risks of an emergency C
compared to an elective?

Also, my wifes decided on an epidural anyway in the event of normal
birth. Does'nt this provide problems with larger babies anyway? I'e'
forceps or ventouse delivery? Not what we want either....

Confused Father....


Sorry, but I might be here to confuse you even further.
Late pregnancy ultrasounds are notoriously bad at estimating
weight accurately. The margin of error is at least 1.5 *POUNDS*
either way, which is huge when you're talking about newborn
babies! Furthermore, there is no medical evidence that it
makes any sense to induce for suspected large baby, much less
incur the risks of a c-section for suspected large baby.
Frankly, if there's nothing going on besides a suspected large
baby here, I would summarily *FIRE* any caregiver who
actually suggested a c-section just because the baby seemed
big.
Yes, there are stats on the risks associated with
elective c-sections. While elective c-sections are slightly
less risky than emergency c-sections, both are significantly
more risky for the mother than vaginal birth. According to
one relatively recent study, the maternal mortality rate
for c-sections is 5 times that of vaginal births (after
eliminating the really high risk situations). They found
the risk for intrapartum c-sections to be 1.5 times that
of elective c-sections. A study came out earlier this
year in the Journal of Perinatology showing that vaginal
delivery is achievable in almost 90 percent of pregnancies
with macrosomic infants. Personally, given that you don't
even really know this baby is big to begin with, I would
be extremely uninterested in signing up for a c-section
when there's a really good chance that a vaginal delivery
is possible! Furthermore, studies don't suggest that
inductions improve outcomes in this case either, so I
wouldn't be all that excited about signing up for an
induction, which can put her on the fast track to a
c-section if her body isn't really ready.
Henci Goer's books (_Obstetric Myths verus
Research Realities_ and _The Thinking Woman's Guide
to a Better Birth_) give a bunch of stats on c-sections.
Here are the risks mentioned:

- Pain (25 percent report pain at 2 weeks, 15 percent at
8 weeks; 15 percent report difficulty with normal
activities at 2 weeks; 10 percent at 8 weeks)
- Transfusion (1-6 percent of women need a transfusion
after a c-section)
- Injury (2 percent rate of surgical injury to bowel,
bladder, uterus, or uterine blood vessels; some studies
show a uterine injury rate as high as 10 percent)
- Infection (8-27 percent)
- Pulmonary embolism (1-2 per 1000)
- Blood clots in legs (6-18 per 1000)
- Baby cut (1 percent of head down babies; 6 percent breech)
- Baby more likely to be in poor condition at birth (babies
with low APGARs after healthy pregnancies were half again
as likely to have been c-sections; c-section babies three
times as likely to need intermediate or intensive care
and five times more likely to need help with breathing)

One of the big things to weigh when considering a
c-section that might not be necessary is the risk of
placenta previa and/or placenta accreta/increta/percreta
in future pregnancies. If you're planning on future
pregnancies, a prior c-section significantly increases
the risks of these conditions, which can sometimes be
quite dangerous. In addition, with a prior c-section,
you'll have to weigh VBAC versus an elective repeat
c-section for future births.

As far as the epidural goes, that could potentially
be an issue. *IF* the baby is large (which is by no means
established), her ability to move around and adopt different
positions during labor can make a huge difference in her
ability to deliver vaginally. An epidural can make it
difficult for her to do that. Staying off her tailbone
can open the birth canal an additional 30 percent. While
some women with epidurals can manage a side-lying position,
other positions will be impossible.

Best wishes,
Ericka