OB recommending elective C-Section

liz4paws

I had my 24 week appointment and follow up a/s yesterday. Everything looked good. However, I also did my 1 hr glucose test, and it looks like I majorly failed. I'm not surprised at all though, I was insulin resistant to begin with. I'll be doing a 3hr GTT next wee and I'm completely prepared to learn I have GD. 

Anyhow, in my consult with the doctor yesterday, he asked me about my preferences for birth. I have always said that I am going to leave it to his choice because I trust him and I think that I'll be setting myself up for disappointment if I have my heart set on a certain birth plan and it doesn't come true. He said he was glad to hear me say that because he was recommending an elective C-Section at around 39w4d, so definitely fully cooked, and not early. I would never consider early "just because." I also get she could decide to come earlier than that on her own.

His rationale is that he knows how much we have invested in this baby and he has seen us lose two others to m/c. He thinks a planned C-Section will give us the most complication-free delivery and the outcome of a healthy baby and mom. He'd prefer it to be controlled. We go in, have surgery, and have a beautiful baby at the end. I asked him about recovery and he agreed it will be more difficult, but still thinks it's worth it to avoid any kind of scares or complication a vaginal delivery might pose.

So I'm a little unsettled about this, even though I'm open to it. Until he brought it up, I figured I'd give the vaginal delivery a shot, but would have still been okay with a c-section if I needed one. But I absolutely see his point and I see some benefits in just going right for the c-section. I'm not being naive about the fact this is major surgery and will have a difficult recovery. And I've decided that if I do end up with a GD diagnosis, I will just agree to the elective c-section. But in case I don't, I'm still on the fence as to what to do. I'm unsettled about it at the moment and trying to sort it all out in my head.

Has anyone else's doctor recommended a planned C-Section just based off of the idea that you've been through hell to have this baby so lets make the birth as straightforward as possible? I'm also worried about the judgement a planned c-section might bring. Not a lot, but I'm sure I'll get a lot of negativity if this is the route I take. Hopefully not from you ladies, but others.

Thanks for responding!

ball.and.chain

Interesting. My hospital has banned elective c-sections, so I know I won't be having a scheduled one unless a medical reason arises in the next 3 months. But it is your baby and your birth, and I think you should do whatever you are most comfortable with. Let them judge if they want to.

sunflowermama42212

If it's medically necessary that's one thing but my OBGYN also has been through my whole journey with me and he has us on growth scans and any time I call he gets me what ever I need wether it's an ultrasound or a test I want done. He told me he is completely on my side and admitted to the special treatment since we have been through so much and he wants to see us take our baby home. With that said, he doesn't believe in me having an elective c section because a vaginal delivery is better for the baby and mother overall. For medical reasons and bonding reasons. His goal is to see me give birth vaginally and do the skin to skin and breastfeed as soon as possible and of course in a perfect world that's great but if things happen they happen. I personally feel an obgyns goal should always be anything before c section because they shouldn't have a preference in skill when it comes to what's best for everyone involved.

I'm also not judging because I wanted an elective c section because I just wanted my baby out and healthy and I think after having so much medical intervention in the beginning I lost trust in my body to do what it was made to do. I did a lot of research and became comfortable with the unknowns of birth but it's different for every person. If you feel like an elective c section is best for you then that's great. C sections are not horrible and you can still get all the bonding and accomplishments with your baby that you want. What made my decision was that I was tired and done with doctors doing things for my body and I wanted some control back.

Also my SIL had two elective c sections and everyone around her tells her how lucky she was... I've never seen people judge her so I honestly think c sections are becoming so normal that people don't think twice about them. Don't let anyone start a mom war with you because at the end of the day you will still be a great mom.

kz's_girlygirl

liz4paws said:

His rationale is that he knows how much we have invested in this baby and he has seen us lose two others to m/c. He thinks a planned C-Section will give us the most complication-free delivery and the outcome of a healthy baby and mom. He'd prefer it to be controlled. We go in, have surgery, and have a beautiful baby at the end. I asked him about recovery and he agreed it will be more difficult, but still thinks it's worth it to avoid any kind of scares or complication a vaginal delivery might pose.

What kinds if complications does your Dr think that you are at high risk for? I think that would help influence my decision.

Vaginal deliveries and c section deliveries each have their own risks and recovery issues- and it really varies from person to person. C section will be tougher in general, but you can do it if you choose that route!

Not everyone can or wants to deliver vaginally, but I don't think I would choose a c section because it would be simpler overall if there weren't actual concerns about risks during a vaginal delivery.

(Fwiw, I will have to have a c-section because I'm having a TAC placed. Some people view that as an elective procedure so I get where you are coming from RE:feeling judged.)

KristyLynn26

Everyone has brought up some very good points but I would just add that just because you elect for a scheduled c section and set a date doesn't necessarily mean you make it to that date. What if you go into labor early and everything is progressing perfectly. Would your doctor be ok with you trying for a vaginal delivery?

I had the complete opposite happen to me with DD. We had all intensions of a vaginal birth even when I went into labor early at 35 weeks but after 3 days, trying pitocin (among other things) and still failing to progress I ended up with a c section. This time my OB and I discussed "trying" for a VBAC in the beginning and then I found out I have partial placenta previa. Oh well I guess it's just not in the cards for us.

One more thing is you might want to double check to make sure your insurance will cover elective c sections? I had a friend that wanted a c section because she was terrified of labor but after discussing with her OB and insurance found out it would not be covered if not medically necessary.

Just take time and think about it and look into hospital/insurance policies. You have plenty of time but ultimately you need to do what's best for you and baby and screw what everyone else "thinks" you should do. Good Luck!

FutureMrsW9

I think I would ask for more information, and maybe wait out the pregnancy a little longer to see how things are going since we know things can change a ton from day-to-day when it comes to pregnancy.  I'm also a big question asker and I ask why to literally everything, even dumb little things that don't matter.  Like when I went for my ER, I refused to sign the consent form before I got to talk face-to-face with the anesthesiologist...they thought I was nuts, but I wanted all of my questions answered before they started doing anything to my body.

Also, this...

ThoseThreeWords said:

My thought is that OBs are trained surgeons - they are trained to cut and for some that is their comfort zone.  That is where they get to show their skills.  So, maybe consider if the OB is recommending it because it is his personal preference.

liz4paws

kz's_girlygirl said:

His rationale is that he knows how much we have invested in this baby and he has seen us lose two others to m/c. He thinks a planned C-Section will give us the most complication-free delivery and the outcome of a healthy baby and mom. He'd prefer it to be controlled. We go in, have surgery, and have a beautiful baby at the end. I asked him about recovery and he agreed it will be more difficult, but still thinks it's worth it to avoid any kind of scares or complication a vaginal delivery might pose.

What kinds if complications does your Dr think that you are at high risk for? I think that would help influence my decision. Vaginal deliveries and c section deliveries each have their own risks and recovery issues- and it really varies from person to person. C section will be tougher in general, but you can do it if you choose that route! Not everyone can or wants to deliver vaginally, but I don't think I would choose a c section because it would be simpler overall if there weren't actual concerns about risks during a vaginal delivery. (Fwiw, I will have to have a c-section because I'm having a TAC placed. Some people view that as an elective procedure so I get where you are coming from RE:feeling judged.)

At the moment, none. He's just suggesting it as the most straightforward way to give birth given that we have "so much at stake" and he says he has special interest in us because of all we've been through. I honestly do believe him, and I don't think he has personal motives here. He is allegedly the best C-section surgeon in my practice, and even in the area, from what I understand. He didn't paint it as a simpler birth, but a more straightforward one and one he feels comfortable controlling.

It may end up being a moot point if I end up with GD because then I'll be completely on board. But since I'm not there yet, I'm still on the fence since it's not for a medical reason. I am glad I have more time to decide.

liz4paws

Thank you all for your input! Lots to consider, but thankfully have lots of time.

kz's_girlygirl

I think if the choice isn't made for you, it will just be a matter of what you are most comfortable with. It sounds like you have a dr you really trust so that is fantastic. GL as you continue to research and make your choice! .

mfarmer0811

The dr. You gave does have a great reputation, the whole practice does. I think it's great that he is being very compassionate about your situation regarding your history. As you know, I had a c-section (not planned) and it was not bad at all!! I was up walking that night, took a shower the next day, and discharged a day early. I never had to take anything stronger than montrin, was able to drive by day 7, as was given the all clear for sex and exercise at week 4!
I do have a very high pain tolerance, but I knew I had to be strong and recover quickly for LO.
I think whatever you and your husband decide, you are in great hands!

liz4paws

@mfarmer0811 - SO glad to hear you say this as someone who knows the ins and outs of the practice! We're really leaning toward going with his recommendation, especially because I see a GD diagnosis coming this week. Thanks SO much for replying as someone who has been through it first hand with the practice!

brooklynesque

Just make sure you do your own research. I think the latest and most comprehensive studies actually show worse outcomes for babies with C sections, especially higher rates of respiratory distress. There's also evidence of significantly higher food allergy and asthma rates among children born by C section. The trend is really away from elective C sections so please be skeptical. Good luck in making your decision.

liz4paws

brooklynesque said:

Just make sure you do your own research. I think the latest and most comprehensive studies actually show worse outcomes for babies with C sections, especially higher rates of respiratory distress. There's also evidence of significantly higher food allergy and asthma rates among children born by C section. The trend is really away from elective C sections so please be skeptical. Good luck in making your decision.

Thanks for responding! I'm leaning toward going with the c-section, but am still keeping an open mind if something major comes up to sway me. Everything I read about elective c-sections and higher rates of problems were when the elective c-sections were before 39 weeks. He is recommending it after 39 weeks which makes me feel a lot better. I am banking that I have GD based on my super poor 1hr screening test so I have a feeling I'll be diagnosed this week anyway.

Peanutz21

For one I don't think you should worry about the potential for any negativity  - to heck with those people! 

In terms of elective C section or not, if there are otherwise no complications requiring a C section, I personally would prefer a vaginal try first....   I absolutely get your doctor's perspective in terms of fewer complications but there are also certain downsides to C sections (i.e. breastfeeding may be a little more difficult at first).  It's a more controlled setting, your baby will have a more perfect looking head , etc

It's a personal decision though, whatever you decide you know we won't judge you on here!! 

brooklynesque

liz4paws said:

brooklynesque said:

Just make sure you do your own research. I think the latest and most comprehensive studies actually show worse outcomes for babies with C sections, especially higher rates of respiratory distress. There's also evidence of significantly higher food allergy and asthma rates among children born by C section. The trend is really away from elective C sections so please be skeptical. Good luck in making your decision.

Thanks for responding! I'm leaning toward going with the c-section, but am still keeping an open mind if something major comes up to sway me. Everything I read about elective c-sections and higher rates of problems were when the elective c-sections were before 39 weeks. He is recommending it after 39 weeks which makes me feel a lot better. I am banking that I have GD based on my super poor 1hr screening test so I have a feeling I'll be diagnosed this week anyway.

Hi, Liz.  Also read up on the latest ACOG recommendations about elective C sections; they explicitly recommend against if you plan on subsequent pregnancies, because a C section significantly increases your risk of bad things like placental issues and uterine rupture.  

Do they recommend C sections for everyone with GD?  I know the babies can be extra big in the case of GD but I don't know a lot about the usual recommendations otherwise.  

pcrumley

im too early to give an input --as if i have been recommended this, but i just wanted to say your doctor sounds very reassuring and knowledgeable, i hope you're comfortable with whatever you guys decide to do  

Deardra77

Hiya!

Couple of things I can share as similar experience. For my first pregnancy I had no blood sugar issues before getting pregnant, not insulin resistant/pre diabetes or anything. My clinic made that check mandatory before proceeding with IVF. At my 12 week pregnancy appointment they looked at all my risk factors & decided to do an early test for GD (advanced maternal age, 35 at delivery, family history in parents of pre diabetes, grandparents being diabetic & my mum having GD with me, also I'm a little on the cuddlier side but not high enough that in of itself they considered it a risk factor). Sure enough at that early stage I had already developed GD! & remember I didn't even have insulin resistance to begin with!

Then my second pregnancy, this one, I had developed insulin resistance after having GD with the first. Before I was even allowed to get started on my IVF process I needed sign off from a perinatologist that my fasting sugars were consistently below 90 (to put that into context, a "normal person" will always be below 100, a pre-diabetic below 120 & diabetic above that), my 1 hour after eating needed to be consistently below 130 (to put that into context a diabetic needs to be below 180 at 2 hours). So I needed to get that level of control even before I was allowed to move forward with IVF due to the risks involved. To be perfectly honest it's kind of shocking to be that they didn't have you controlling you numbers before you got pregnant as you were insulin resistant before pregnancy. And as for not checking you before your 24 week check up, that's just really bad. Total side eye to that whole thing! Not trying to be mean or anything but it's pretty negligent standard of care I would think.

Cause of that I would think long and hard about any advice from your OB. Again, not trying to be mean or anything just sharing how different the care I have received was/is. I was insulin dependent with baby #1 from about 16/17 weeks I think it was (granted I was given the option of pills first but they can cross the placenta & I wasn't scared of needles anymore, thank you ivf :-) so opted for that ). You get monitored twice a week with ultrasounds etc. from 34 weeks forward. It's high risk so nothing is left to chance. But at no time did anyone mention an elective C-section. They said they would try to avoid as long as it was health for both baby & me. During his stress tests at weeks 35 & 36 his heart rate was slowing during contractions & this was of concern on how he would tolerate labor, at 37 weeks I was induced due to my placenta crapping out & my fluid levels dropping to a 3 (ideal is a 12) and I still had a vaginal birth. Granted I couldn't eat the whole way through labor as it was a possibility at any moment that I could have needed a C-section. There are health risks associated for both mum & baby, baby doesn't get exposed to the microflora in the birth control & also doesn't get all the fluid squished out of the lungs in the birth canal that can mean respiratory issues like asthma. In a heart beat I would have agreed to have a c section if it is what was needed for my baby to be safe. Zero hesitation. But doing it electively is something to give more thought to. Either way that works for you but just don't feel pressured into anything based on a GD diagnosis. incidentally, my little boy was just 6lbs 4oz so GD doesn't equate to a large baby once it is managed.

The high risk board is pretty cool for advice on GD, there are bunches of ladies over there that have it. Good luck in your decisions!

edited to add: due to the GD & insulin they won't let me go past 39 weeks & will schedule an induction if baby hasn't come by then. It's cause of how the placenta holds up versus in a non GD pregnancy.

Also, do not concern yourself with what other people will say or judge. It is totally none of their business. You don't owe anyone an explanation of your medical choices! People don't even need to know it is elective, you can shut down questions by saying you are not comfortable discussing you personal medical issue or what ever. Do what will be right for you

Allison7

After reading all of this, I would say to just talk about it more with your OB. Most people I know IRL with GD ended up with c/s - mostly due to size. I have no idea if they were planned or not. And you don't have to tell anyone that it is "elective" either.

If I was staring down GD, I would do a lot of research and also talk a bit more with the doc. Ultimately, if my OB thought it was best, I would probably agree, but not until after I properly educated myself. Good luck - I know you are facing a tough decision.

liz4paws

I just got the official diagnosis. I do have GD which we will be attempting to treat with diet and will talk to a nutritionist tomorrow and get going with all of that.

@Deardra77 - Thanks for the information and sharing your experience. FWIW, I have been seen by three REs and two OBs during the course of our infertility and all of them knew of my insulin resistance during my treatment. None of them took the strong stance of prohibiting treatment without rigorous testing and treatment of any kind. I was not at diabetic levels though. It sounds like your OB is extra cautious, which is a good thing. But I definitely don't believe my current OB is being neglectful in how it's been handled. I understand it's pretty standard to test for it around 24w-28w. Our LO is at the 48th percentile and my amniotic fluid looks normal. Everything looks great and normal aside from this GD complication so it sounds like we caught it in time and I plan to take it very seriously. Glad to hear your pregnancies went well!

I appreciate everyone's input and because of this GD diagnosis and for oodles of other factors I have considered and will continue to consider, I think we will lean toward the planned C-section. Thanks ladies! 

auntjessy

Just to help put your mind at ease a bit, I had a C-section 3 weeks ago to deliver my twins (not really elective - they were both transverse) and it really wasn't bad.  I had soreness for a few days and my belly is still a bit sore, but the recovery was nothing compared to being pregnant with twins, LOL.  If you do have a C-section, it'll probably be a lot easier than you think.