QuestionI am 36 weeks 6 days in my 4th pregnancy. My first and second pregnacies were in 1995/96 - both babies (boys) were delivered by C-section at 32 weeks due to slowing/lack of moment in the womb - by the same obstetrician. My first little boy was breathing on his own for the first 9 hours but was not put on to a ventilator and he just got tired. He stopped breathing - was resucitated but died when he was just 38 hours old. My second little boy appeared to have an infection at birth - I had been given steriods to mature the lungs but apparently these did not reach the baby due to calcification in the placenta? He lived for only 13 hours. I was told that his lungs had burst. Early last year I fell pregnant again - but miscarried at about 12 weeks. I fell pregnant again almost immediately thereafter.
My pregnancy has been obstetrician led. I was told at my last visit that the c-section would be performed at 37 weeks because my previous notes are not available (i had the babies in Zimbabwe) and it is not known what surgical procedures - particularly which uterine incision - had been performed. I went to see the obstetrician yesterday to discover that the required forms had not been completed - my bookings not made - and I am now required to wait until 39 weeks. I don't want to push for an early c-section - but I NEED to know what is safest for my baby. I cannot lose another one. Please can you help.
AnswerThis is something that should be discussed with a perinatologist, a doctor who specializes in high-risk pregnancies. It seems odd that your babies would both have needed to be delivered so early; it is very, very rare that it is safer for the baby to be out of the womb that prematurely, and it is likely that this extreme prematurity was a significant contributing factor in their deaths. A skilled perinatologist may be able to determine the necessity of your previous early deliveries, and the likelihood of a recurrence and its effect on your delivery date.
Here are some general facts I can give you: When you schedule a c-section rather than waiting for labor to begin naturally, you are gambling on whether or not your baby's lungs are fully developed. Doctors want to schedule a c-section in the absence of surgical records because they are concerned about the possibility of uterine rupture during labor. The risk of uterine rupture during labor with a vertical scar is about 4%. If you have a horizontal scar, your risk of rupture during a natural labor is only 0.5%. On the other hand, every week prior to your due date that you schedule a c-section increases your baby's risk of respiratory distress (from prematurity), from 2% at 39 weeks to 10% or more at 37 weeks.
You have the right to weigh these risks for yourself and decide what you would prefer to do. You have the right to a refuse a scheduled c-section entirely and go for a vaginal birth if you want to, even after 2 c-sections. You could request an ultrasound examination to attempt to determine the location of your uterine scar; if your scar is horizontal, your odds are much better if you at least wait for labor to begin naturally, even if you then choose a c-section instead of vaginal birth. This way, you would know for certain that your baby was fully developed and ready to be born.
