Tough decision - Elective C or not ?

well, gave up reading all the other answers as head spinning.
the only answer is to do what you feel is best for you.
the prime reason for delivering early or by caesarean a large baby is to
avoid shoulder dystocia. this is where the baby's head delivers, and the
shoulders get stuck. it can be a very difficult problem, and all the
obstetricians and midwives on your unit will have regular emergency
drills where they practice the different manouvers to release the baby.
these are not straight forward, and there are risks to the baby as well
as mother.
however, although a baby over 4kg is at a higher risk of this, it is by
no means assured that it will happen, and babies less than 4kg also get
shoulder dystocia. the fact the baby is large doesn't mean that the baby
will have difficulties, just that since it is impossible to predict
easily on a person basis, may obstetricians will leave you free to
decide whether you prefer to have an unnecesary induction/caesarean or a
problem birth with complications as your better of 2 evils scenario.
since neither of you are tall, adn the baby seems big on scan [scans can
be 1lb out, so no magic there either] i think your consultant is
offering you best care by offering you a choice, and not pretending that
there is a right answer.
--
Helen Johnson

That depends. Exactly what outcome are you hoping for?

Obviously, a birth with as little problem as possible resulting in a
healthy baby and healthy mother.


Ah, then here's what to do. You and your wife take Bradley classes (or just
read the book, it's a bit late for classes at this point). Get a midwife if
possible. Find a nice birthing center if possible. Go as naturally as
possible, avoid epidurals, episiotomies, lying down to push, etc. Just let
your wife's body do what it is designed to do, which is give birth without any
medical interventions. If a problem does come up, it can be dealt with then.
No sense in having major medical procedures done to avoid potential problems.
That's like having your appendix removed just because you might get
appendicitis someday.

Yes. Ideally for everyone involved a natural birth is MUCH, MUCH
better than
anything.

Yes.

Since the baby is big (based on head and abdomen size NOT 'guessed'
weight)

Unless your wife has a narrow pelvis, probably not a problem.

the consultant has said that an induction at term would be
done rather than waiting too long.

Also, more convenient for the doctors because everything is scheduled out . . .



But, neither of us are keen on ventouse or forceps. Risks of this are
increased with epidural, large baby, and inducing....

BUT - you can totally avoid two of those three, and the third risk isn't
definite, because u/s measurements are not always accurate.





However, an emergency C-section after 25 hours labour is the worst
option by far. You're operating on a mother whos already exhausted,
possbily having to rush the op, cutting through contracting muscle
etc...

Nope - a baby born by csection after several hours of labor is going to be
healthier than one born by elective section with no labor. Labor squeezes
fluid out of the baby's lungs.

However, we both understand the issues with a C, in terms of recovery.
Yes, it is major abdominal surgery. (BTW. My wifes a qualified nurse -
recovery specialist at that !)

Hmm.

So, sounds to me like you just want the c-section. So why even ask?


Amanda

"paul williams" wrote in message
om...
Ericka Kammerer wrote in message
...
If the baby is a girl, the 97th percentile at birth
would only be about 9.5 pounds, which many, many women
deliver quite successfully vaginally (even with lousy
support--with the support of a birth team skilled at
supporting vaginal births of large babies, the odds are
even better).

Why the difference between boy and girl? Are boys born larger then?

Yes. The average newborn boy weighs right around 8 lbs.; the average newborn
girl weighs about a 1/2 lb. less.
--
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

"Helen Johnson" wrote in message
...
In message , Elfanie
writes
And you're operating after many hours of labor...
which is BENEFICIAL to the baby! That's why many moms who PLAN to
have a cesarean...still want to wait and go into labor and labor for a
while before the planned cesarean. There are many health benefits to
mom and to baby if they labor prior to surgery.

A cesarean after 25 hours of labor isn't usually considered the worst
option....since you've given your body the option of having a vaginal
delivery as well as prepared the baby for birth.

i have to strongly disagree here. an emergency caesarean section after
labourin for 35 hours is a terrible option - both pychologically and
physically for the mohter. the risks of haemorrahge, infection and deep
vein thrombosis are significantly raised.
i disagree entirely that there are health benefits to be gained from
labouring before the caesarean. show me your data, and i'll show you
mine.
--
Helen Johnson

Helen. Agreed. Can't see any way how this is beneficial.

"paul williams" wrote in message
om...
Not sure I agree with you there. Doctor has offered his opinion that
induding at 30 weeks is the best option.

I think you mean 40 weeks, but never mind.

My wife is keen on the C section.

BTW. My wifes a registered nurse (and a theatre recovery nurse at
that!) so knows a bit about things.

She knows what recovery from surgery is like; what she doesn't realize, I
suspect, is how much *harder* recovery from surgery generally is than
recovery from a normal vaginal birth.

Still, it's pretty obvious to me that:

1) You put complete faith in the ultrasound estimates of your baby's size
despite a lot of evidence that it could be inaccurate.
2) You are convinced that a large baby is a problem and intervention is
necessary.
3) You don't WANT to consider alternatives to intervention.

That being the case and given your wife's apparent fear of a vaginal birth,
I'd actually go with a C-section over induction because I think the chances
are VERY high that induction at 40 weeks with a suspected large baby will
fail (statistically, the odds are not good for successful induction prior to
41 weeks in women who have not had a prior vaginal birth and they are also
not good for *any* woman being induced because the baby is suspected to be
large) and your wife will end up with a section anyway. In your situation,
I'd give induced labor no better than 50/50 odds of succeeding, and probably
less. If you're not willing to let nature take its course to give you the
best chance for a vaginal birth (and if you look at the research that has
been done by medical professionals, waiting for spontaneous labor does give
you the best chance regardless of the baby's size or gestational age), I
can't see any logical reason to put your wife through an induced labor (the
worst sort, IME) she doesn't want when there's such a high likelihood of a
c-section being the end result anyway.

I wouldn't normally recommend an elective c-section, but I'm a realist:
you're one the road to one anyway, so why not cut out the middle man?
--
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

paul williams wrote:
Ericka Kammerer wrote:
If it's successful without causing any problems, definitely
ideal. The only downside to trying to birth the baby vaginally
is that you might end up with an intrapartum c-section rather
than a scheduled c-section. While intrapartum c-sections are
slightly more risky than scheduled c-sections, they are not
as risky as true emergency c-sections. It is *not* an emergency
to do a c-section for failure to progress because the baby is
too large. It may not be the most fun choice to labor a while
and then end up with a c-section, but with good planning and
a supportive birth team you've got a really good chance of
making it and not having to deal with the consequences of
a c-section.

Best wishes,
Ericka

Agree that not every unplanned C should be classed as emergency.

Yes, if there is true failure to progress, the OB usually talks to you
about options, and if there wasn't any anesthesia before, the woman
gets an epidural and then they prep an operating room, etc.

However, every unplanned C where labour has taken place for any length
of time (be it natural or induced), results in an op being performed
on a possibly fatigued and stresses mother, and also having to cut
through contracting muscle (i.e. the uterus).

This doesn't make any sense at all -- and I saw you repeated this
several times about 'contracting muscle'. A c-section on a
contracting uterus is NOT a problem at all!! It is not medically
worse to have a c-section once labor had started (an exhausted Mom who
has to also recover from major abdominal surgery has it a little worse
than the women who slept right before, sure

But, in fact, the opposite is true -- labor prepares the baby to be
born, and babies born from scheduled c-sections are more likely to
have breathing problems specifically because none of the hormones
generated in labor have helped the baby's system get ready. It is
significantly better to labor and see how it goes. When women have
problems like pre-eclampsia with super high blood pressure, the
response is to *induce* *labor*. Not to schedule a c-section!

Also, no matter how the OB tries to tell you they have 'measured' the
baby, it is just a *guess*, not an exact measurement like if you set a
ruler down next to something and read off 20 in. It will be inaccurate
with wide margins of error in the ultrasound measurement and as such
as a rought approximation of the baby's size.

Carolyn

--
Carolyn Fairman
http://www.stanford.edu/~cfairman/

"Circe" wrote:
I wouldn't normally recommend an elective c-section, but I'm a realist:
you're on the road to one anyway, so why not cut out the middle man?

I agree with Circe. You really sound like you've made up your mind
already and like nothing you read that disagrees with your preference
makes any impact. Happy c-section, and I hope you don't want a lot of
children.

--
-- Vicki
Married DH May 21, 1995
Ima shel DS, born 11/16/99; and DD, born 5/19/02.
"Stay-at-home" Ima since October 2002.
An ounce of mother is worth a pound of clergy. -Spanish proverb
I may not currently be pregnant, but I look pregnant, does that count?

I agree with Circe. You really sound like you've made up your mind
already and like nothing you read that disagrees with your preference
makes any impact. Happy c-section, and I hope you don't want a lot of
children.

--
-- Vicki

Yep - I agree with this. What I don't understand is why the OP would post on
here as if looking for info, but when presented with anything that goes against
what he's already decided, refused to even listen. Why even ask?


Amanda

paul williams wrote:

Last two ultrasounds where head and abdomen were measured have put the
babies size slightly above the 97th percentile...

Have you ever considered talking to a doula or midwife? Or even
having a second opinion by another doctor? Don't forget: we are
talking major surgery here, having a second opinion is perfectly
warranted. Wouldn't you want to make sure that surgery is really
the only possible alternative? I'm sure you would if this weren't
a pregnancy but some rare illness.

Besides, midwifes and doulas approach birth from an entirely
different aspect, but are equally well trained (especially the
midwife) as an OB/GYN when it comes to normal births. In spite
of your wife being a nurse, she doesn't know what it is like to
give birth as long as she hasn't done it. It is perfectly normal
to be afraid of giving birth, especially when they tell you the
baby is big.

It does sound like you put way too much faith in what this one
doctor says, and I can only add my warning against that. I've
BTDT and regretted it ever since. Please go for that second
opinion. If you don't believe us, perhaps you will listen to
what another physician or experienced midwife has to say.

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

Helen Johnson wrote:

In message , Elfanie
writes

And you're operating after many hours of labor...
which is BENEFICIAL to the baby! That's why many moms who PLAN to
have a cesarean...still want to wait and go into labor and labor for a
while before the planned cesarean. There are many health benefits to
mom and to baby if they labor prior to surgery.

A cesarean after 25 hours of labor isn't usually considered the worst
option....since you've given your body the option of having a vaginal
delivery as well as prepared the baby for birth.


i have to strongly disagree here. an emergency caesarean section after
labourin for 35 hours is a terrible option - both pychologically and
physically for the mohter. the risks of haemorrahge, infection and deep
vein thrombosis are significantly raised.
i disagree entirely that there are health benefits to be gained from
labouring before the caesarean. show me your data, and i'll show you mine.


http://tinyurl.com/p369
CONCLUSION: Severe RDS [respiratory distress sysndrome] on the basis of
HMD [hyaline membrane disease] can also occur in near-term babies after
CS; even a fatal outcome can not be excluded. The severity of illness in
elective CS without labour may be quite high and is comparable to
newborns delivered by CS (after onset of labour and/or rupture of the
membranes) who were 1 week younger.

http://tinyurl.com/p377
Respiratory morbidity is an important complication of elective caesarean
section. The presence of labour preceding caesarean section reduces the
risk of neonatal respiratory morbidity.

http://tinyurl.com/p37h
Respiratory morbidity in term neonates is an important complication of
elective cesarean delivery. The effect of preceding labor on the
incidence and severity of respiratory morbidity in two comparable groups
of neonates, 107 with and 80 without labor and with no predisposing
factors to respiratory morbidity, was evaluated. Transient tachypnea of
the newborn accounted for the majority of cases in term neonates.
Respiratory morbidity occurred less frequently in neonates delivered
after the onset of labor compared with those delivered before labor
(11.2 versus 30%, P less than .002). The risk of respiratory morbidity
decreased 1.5 times for each week of advancing gestational age. The
presence of labor significantly reduced the risk of respiratory
morbidity, independently of gestational age (P less than .03), and
disease was less severe in neonates born during labor. Awaiting the
onset of labor appears to be beneficial in preventing respiratory
morbidity in term neonates delivered by elective cesarean section.

http://tinyurl.com/p37p
The mechanisms of fetal and newborn adaptation to extrauterine life
after normal and abdominal delivery were under study. Laboratory and
instrumental methods were employed to examine the status of the
intrauterine fetus and the clinical picture of the newborn adaptation in
the early neonatal period: radioimmunoassays of dopamine, noradrenaline,
adrenaline were carried out in fetuses and newborns after normal
delivery and after cesarean section performed before and in labor. The
results evidence that the adaptation shifts develop later in the
newborns after cesarean section performed before labor than in those
born spontaneously or by cesarean section that was performed in labor.
The same tendency can be traced in the changes developing in the
sympathoadrenal system. This result brings the authors to a conclusion
that planned cesarean section should be performed after the onset of
labor, if possible.

Gotta run--there are more, though.

Best wishes,
Ericka