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Tough decision - Elective C or not ?



 
 
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  #11  
Old September 26th 03, 05:12 PM
Circe
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Default Tough decision - Elective C or not ?

"paul williams" wrote in message
om...
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.

As others have said, you left out option 3 (which really *ought* to be
option 1), which is to do nothing at all and let the baby come under its own
steam.

Before you make any decisions, I suggest you read this article on induction
of labor for suspected large babies by Henci Goer, an acknowledged expert in
childbirth and childbirth research:

http://www.parentsplace.com/expert/b...234322,00.html

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?


It might, but you can't even be sure you've *got* a larger baby. Really.

The "issue" with larger babies and epidurals is that a large baby might get
hung up on the pelvis during descent (called "shoulder dystocia"). The most
effective solution to this problem is to get the mother to flip over into an
all-fours position. This move usually frees the baby's shoulder from the
pelvis and allows a normal descent. The problem is that if the mother has
had an epidural, she's probably not going to have enough sensation in her
legs to support herself on all fours. So the practitioner has to resort to
other methods for freeing the baby, some of which can result in birth
injuries.

But honestly, *most* vaginally birthed large babies don't encounter shoulder
dystocia at all and a fair number of babies who *do* experience it are not
large.

I'e'
forceps or ventouse delivery? Not what we want either....

Assisted delivery (whether by ventouse or forceps) goes way up with
epidurals *regardless* of baby's size. I had one birth with an epidural and
ventouse assistance was needed at the end of the pushing phase because I
could not feel well enough to push properly. Baby was an even 8 lbs., though
he did have a rather large head (15").

So if you don't want a forceps or ventouse delivery, you'd have the best
chance of doing so by avoiding the epidural regardless of the baby's size.
Obviously, epidurals have their place in childbirth and your wife should
have one in labor if she feels the benefits (pain relief) outweigh the risks
(potential assisted delivery, limited options for treating dystocia, etc.),
but maybe she shouldn't make that decision until she's actually *in* labor
and knows how well or poorly she's coping. Because, honestly, I've had two
unmedicated births since that first one with an epidural and I was never
remotely tempted to have another.
--
Be well, Barbara
(Julian [6], Aurora [4], and Vernon's [18mo] mom)

This week's special at the English Language Butcher Shop:
"She rose her eyebrows at Toby" -- from "O' Artful Death", by Sarah Stewart
Taylor

Daddy: You're up with the chickens this morning.
Aurora: No, I'm up with my dolls!

All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman


  #12  
Old September 26th 03, 05:21 PM
Puester
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Default Tough decision - Elective C or not ?

KR wrote:


There are lots of big babies (10+ pounds) who are born naturally
without incident. Some people even claim that bigger babies are
easier to push out.




And some people lie....

gloria p
  #14  
Old September 26th 03, 06:00 PM
Sue
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Default Tough decision - Elective C or not ?

I would do neither one and let nature take its course. You have to remember
that ultrasound weights are typically off and just an estimate. I have heard
of women being told that their babies are measuring 10 lbs and they are born
at 7 lbs. Measurements based on ultrasounds are just an estimate too. Are
you sure about the dates? Dates can go two weeks either way so I wouldn't
put too much emphasis on what the ultrasound is saying. Based on that
knowledge alone, I would not induce nor have a C-section. Women's bodies are
made to have children, trust your wife's body to deliver the baby (unless
there is medical problems or baby is in huge distress). Your wife should
probably educate herself more on delivery and perhaps find different
techniques that will get her through labor.

--
Sue
mom to three girls

paul williams wrote in message
om...
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....



  #15  
Old September 26th 03, 06:54 PM
Larry McMahan
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Default Tough decision - Elective C or not ?

paul williams writes:

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

This is notoriously unreliable. Even ultrasound, probably the most
accurate way to measure late size can be off by a pound or two. I
would suggest remaining skeptical.

: Consultant has given us the choice :-

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

Why? I would suggest telling the consultant to buzz off, and waiting
for labor to begin natrually. Is this your wife's first baby? If so,
I think you could be severely limiting your future options by doing an
elective c-section.

: 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?

Some studies have been done showing the following.

1. Women do better in later pregnancies if the c-sections is preceeded
by a trial of labor.

2. Attempting to induce creates a larger risk of having to go with
the c-section.

I have not seen any data saying that elective c-section is better.

: 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....

Why is she certain about an epidural? This also raises the risks of
requiring a c-section. Of course, it may be necessary if your agree
to induction.

: Confused Father....

I would suggest doing your best to avoid all of c-section, induction,
and epidural. Your chances of an uneventful birth are better in that
case.

Good luck,
Larry
  #16  
Old September 26th 03, 07:33 PM
Ilse Witch
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Default Tough decision - Elective C or not ?

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


IME estimates at this stage are highly unreliable. I have seen a
friend deliver a 5lb baby, where it was estimated at at least 7lb.
Simply because she was small, they overestimated the babies size.

Also, women give birth to 9 and 10lb babies naturally. Although
it is rare, it is not impossible. Average 40w babies are around
7lb, if yours is really that heavy now, you'd probably end up
with a delivery weight around 9lb. In the past, when gestational
diabetes was less well known, babies could even weigh up to 14lb
and still be born the natural way. The biggest problem is the
size of the head compared to the width of the pelvis. If the
head fits (and it usually does) the rest will be able to come
out as well. DS had a big head, measured 3 weeks ahead of normal
around 32 weeks, but still came out the normal way.

Finally, there is nothing that guarantees the baby will grow at
the current rate during the last weeks. DS grew in spurts, and
would sometimes measure one week ahead, then one week behind. He
didn't grow much at all during the last month.

So before you decide any which way to go, just wait and see.
I would opt for the baby to come out the natural way *and* at its
own time. Really, my impression is that the doc is making a big
fuzz over nothing, making you worry unnecessarily.

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....


Epidurals always have a higher risk of interventions, since the
mother is less aware of her contractions and when to push.

--
-- I
mommy to DS (14m)
guardian of DH
EDD 05-17-2004
War doesn't decide who's right - only who's left

  #17  
Old September 26th 03, 07:53 PM
Clisby
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Default Tough decision - Elective C or not ?



Ilse Witch wrote:
paul williams wrote:

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



IME estimates at this stage are highly unreliable. I have seen a
friend deliver a 5lb baby, where it was estimated at at least 7lb.
Simply because she was small, they overestimated the babies size.

Also, women give birth to 9 and 10lb babies naturally. Although
it is rare, it is not impossible.


Is it really *rare*? My mother had 6 children, and 4 were over 9
pounds. One was over 10 pounds. I was in college before I realized a
7 lb., 11 oz. baby (me) was not unusually tiny.

Clisby

  #18  
Old September 26th 03, 08:01 PM
Circe
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Default Tough decision - Elective C or not ?

"Clisby" wrote in message
...
Ilse Witch wrote:
IME estimates at this stage are highly unreliable. I have seen a
friend deliver a 5lb baby, where it was estimated at at least 7lb.
Simply because she was small, they overestimated the babies size.

Also, women give birth to 9 and 10lb babies naturally. Although
it is rare, it is not impossible.


Is it really *rare*? My mother had 6 children, and 4 were over 9
pounds. One was over 10 pounds. I was in college before I realized a
7 lb., 11 oz. baby (me) was not unusually tiny.

Well, my understanding is that a baby is considered large for gestational
age (LGA) or macrosomic if his/her weight is at or above the 90th percentile
for full-term newborns. So, in theory at least, only about 10% of babies
should wind up being macrosomic (which is typically defined as a birthweight
over 8 lbs., 13 oz.). That may not be really rare, but it does mean that the
vast majority of babies should NOT be macrosomic.

That said, a woman who has already had a macrosomic baby has a much greater
chance of having another. Which could explain why more than half of your
mother's babies were macrosomic.

The question is whether having a baby who is at or above the 90th percentile
at birth should be considered a problem at all. Both my boys went to weights
and heights at or above the 90th percentile by the time they were a month
old in spite of having been around the 50th percentile at birth. No one
thought it was a problem that they'd gotten big after getting *out*, so I'm
not sure why it should be thought to be a problem if they do it before
getting out!
--
Be well, Barbara
(Julian [6], Aurora [4], and Vernon's [18mo] mom)

This week's special at the English Language Butcher Shop:
"She rose her eyebrows at Toby" -- from "O' Artful Death", by Sarah Stewart
Taylor

Daddy: You're up with the chickens this morning.
Aurora: No, I'm up with my dolls!

All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman


  #19  
Old September 26th 03, 08:09 PM
Nina
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Default Tough decision - Elective C or not ?


"Circe" wrote

Well, my understanding is that a baby is considered large for gestational
age (LGA) or macrosomic if his/her weight is at or above the 90th

percentile
for full-term newborns. So, in theory at least, only about 10% of babies
should wind up being macrosomic (which is typically defined as a

birthweight
over 8 lbs., 13 oz.). That may not be really rare, but it does mean that

the
vast majority of babies should NOT be macrosomic.

That said, a woman who has already had a macrosomic baby has a much

greater
chance of having another. Which could explain why more than half of your
mother's babies were macrosomic.


Interesting, my kids were 8lbs 12 oz and 8 lbs 15 oz, I never knew there was
anything unusual about it. In fact, Im over here now making sure I eat
enough because I want the new one to be "decent sized" too,lol.



The question is whether having a baby who is at or above the 90th

percentile
at birth should be considered a problem at all.


Probably not if the mother isnt tiny. My kids were born big and will stay
big. My 8 year old daughter has been as large as her 10 year old brother for
about 2 years now, since I have aunts and cousins who are over 6 feet, Im
not worried.


  #20  
Old September 26th 03, 08:44 PM
Kereru
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Posts: n/a
Default Tough decision - Elective C or not ?


"paul williams" wrote in message
om...
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....


I am 38 weeks pregnant with my second child. My first was 10lb 8oz at birth,
he was delivered vaginally. This time around I had a scan (to rule out
breech presentation) at 36 weeks and the baby measured at about 9lbs this is
+/- 1lb, the estimate was 11lb by term and his head circumference is
measuring really big.

Fundal height is only a guide and give you a very rough estimate of size.

Given that my first was so large the chances are that the scan is right and
this one will be big too. Probably even bigger.

I will not be having an elective cesarean. I have discussed it with my
primary carer. Induction at or near term is an option but one we both want
to avoid. So the plan is a series of internal exams to hopefully stir things
up, and some acupuncture.

Plenty of people give birth to really large babies without intervention and
have a much better recovery because of it. Some people even say that big
babies are often easier because gravity helps.

I would be really reluctant to have an elective c-section in your position
and I would view induction as a last option. Don't be scared of having a big
baby!

Judy


 




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