Dr Beer recommends planned c/section at 38 weeks

[Anonymous]

Did anyone follow this advice? Have had two miscarriages after my first born son and am now almost full term on our third try with a girl. Have the option to go with a vbac or a repeat c/s. Reading Dr Beer's recommendation to cut out early and prevent a still birth has been haunting me.

[Anonymous]

My MFM recommends inducing in the 38th week. Not related to anything Dr. Beer said but most of her patients are on lovenox. At one point she used the analogy with me that babies are like scuba divers and their supply of oxygen is limited. At some point they are better off out than in.

I think Dr. Beer was probably noticing that for many of his patients this is the safest course of action. He had a very difficult subset of patients to treat, which certainly doesn't describe 99% of women. You don't say you are an immune patient, but do you have reason to believe you would fit into this category?

[Anonymous]

There are two issues, one is the risk of stillbirth (rises after 39 weeks) and the other is the risk of the VBAC. How old are you? Older moms tend to have a higher risk for stillbirth as pregnancy gets to term and beyond. Also, if you have any other underlying conditions or pregnancy complications that would make vaginal birth more risky for you/your baby, those are important factors to weigh in your decision.

The labor/VBAC itself does not pose an added risk, it's when labor is induced, particularly if your body hasn't started preparing for labor yet (no dilation or effacement) that can increase your risk of uterine rupture during a VBAC. Studies have also shown that women whose pregnancies go postdates are at an increased risk of emergency c/s, but women who deliver by 40 weeks with an induction are NOT, even if they had a prior c/s. In other words, there's no reason to believe you will have an emergency c/s just because you had a prior c/s. Check out the Evidence Based Birth site for info on this.

Knowing how presumably hard it has been for you to carry a baby to term, your OB probably wants to take every possible measure to prevent a stillbirth (and while stillbirth risk is very low before 39 weeks, for a large percentage of stillbirths we don't know the cause). But c/s carry some risks too, and even at full-term/38 weeks some babies aren't as healthy as they would have been at 39 or 40 weeks (from an OB's perspective that's ok because they will get more immediate treatment if necessary, rather than having to wait to come out naturally).

Would your OB be open to a gentle induction, with cervical-ripening drugs first, in week 38? I think I'd at least ask if that was a safe option, and have a discussion about risks. This is if you want to try for a v/b and it's safe for you and your baby. These are not easy decisions but they're so important. Good luck.

[Anonymous]

Depends in part on how old you are and other risk factors. ACOG guidelines on risk factors for stillbirth are at http://www.acog.org/About-ACOG/News-Room/News-Releases/2009/ACOG-Issues-New-Guidelines-on-Managing-Stillbirths

There are lots of ACOG guidelines on c-sections; reading and discussing them with your doctor might help you reach a decision you feel comfortable with.

I will say from watching a lot of friends, recovery seems to be much better from elective c-sections than ones where the woman labors a long time then has a c-section. So if if there's a good chance you're going to need a c-section no matter what, that's important to factor in.

[Anonymous]

I say go for the section. I had a planned one at 37 weeks in my high risk pregnancy after stillbirh. It was an easy recovery and my kid is now 17 months and thriving. MFM would have preferred I wait until 38 but for me, that was Xmas day so it couldn't be scheduled then and when faced with the choice of 38+ vs. earlier, they said earlier.

[Anonymous]

Thanks! OP here... csection booked for 39w2d. After sleeping on it I feel like I just want a healthy living baby out of this, not to win any birthing story awards. Only complication this pregnancy which I had with my first too is gestational thrombocytopenia (platelet count at 95k at last check). So my vbac would be without an epidural. RE didn't find immune issues but I am heterozygous for prothrombin so I've been on baby aspirin whole pregnancy and also took progesterone suppositories in first trimester.
Praying all continues well and baby will be here in 3 weeks. After you've experienced loss and know that your baby can die in your body at any time for unknown reasons I don't think you can ever rally relax until that baby is breathing on your chest.

[Anonymous]

Really the wrong board to be posting this question on.

[Anonymous]

Anonymous wrote:Thanks! OP here... csection booked for 39w2d. After sleeping on it I feel like I just want a healthy living baby out of this, not to win any birthing story awards. Only complication this pregnancy which I had with my first too is gestational thrombocytopenia (platelet count at 95k at last check). So my vbac would be without an epidural. RE didn't find immune issues but I am heterozygous for prothrombin so I've been on baby aspirin whole pregnancy and also took progesterone suppositories in first trimester.
Praying all continues well and baby will be here in 3 weeks. After you've experienced loss and know that your baby can die in your body at any time for unknown reasons I don't think you can ever rally relax until that baby is breathing on your chest.

Good luck, OP. Sending you positive vibes that all goes well and you will be snuggling with your new baby soon!