Scheduling c-sections vs Spontaneous labor then a Section.

WannaBeCrunchyMama

So if a woman has to have a c-section for some reason. Vaginal delivery is not an option. What are the pro's and cons of scheduling a c-section vs going into labor and then having the csection?

 

iris427

C-sections after labor tend to be harder on the mother than scheduled c-sections.  They put her at higher risk for infection and other complications, and recovery can be harder.  If they know she will be having a section, she probably wouldn't be in labor for too long so that would minimize some of those risks.

A scheduled c-section before labor begins puts the baby at higher risk for respiratory troubles at birth. 

Also I suppose it would depend on why vaginal delivery is not an option. 

NanaDi

In my case, I knew I would have a c-section, scheduled it, and went into labor at 5am the morning before the "right" day. We had to navigate rush hour traffic in silicon valley, the hospital was at least 1.5 hours away at that time of day. DH got so upset I was afraid he couldn't drive properly, so we pulled over and called for an ambulance. Everything turned out fine, but it would've been better to not be so rushed.

Obviously, the advantages to scheduling are you know what day you need to go, the doctors can be scheduled (so if you're in a practice with multiple docs you can be sure to get your favorite), you're on the anesthesiologists' schedule so you have a better chance of not having to wait. If you have out-of-town family, they can be there.  

Advantages to waiting are you know the baby is ready if you're in labor. You should do what feels right for you. 

papagena

Pros for scheduling:  Risk of infection is slightly less if you haven't been in labor before the c/s.

Pros for waiting:  Baby is 'ready' - you don't have the risks of baby being delivered early and having medical issues because baby was delivered before he/she would have been.  Baby does get some benefits from contractions and hormones that get going with a natural onset of labor.

There may be certain pros or cons that are more directly related to whatever reason she cannot have a vaginal birth, as well. 

WannaBeCrunchyMama

My baby recently decided he's sick of being head down.

I'm only 34 weeks so he has plenty of time to change his mind, and time for us to try to get him to flip. I just thought maybe I should start looking into the possibility of things not going how I expected. 

My doctor worked with midwifes for years so he's very supportive of med-free vaginal deliveries. I'm hoping that he has experience with breech babies just in case this kid decides to stay bum down.

Csection would be the last option but I still need to know what I would do if that ends up being the reality.

The hospital is nearby, ten minutes tops in bad weather and traffic. So I think I'd rather go into labor spontaneously than schedule his delivery.

WWYD? 

flowerchild77

WannaBeCrunchyMama:

My baby recently decided he's sick of being head down.

I'm only 34 weeks so he has plenty of time to change his mind, and time for us to try to get him to flip. I just thought maybe I should start looking into the possibility of things not going how I expected. 

My doctor worked with midwifes for years so he's very supportive of med-free vaginal deliveries. I'm hoping that he has experience with breech babies just in case this kid decides to stay bum down.

Csection would be the last option but I still need to know what I would do if that ends up being the reality.

The hospital is nearby, ten minutes tops in bad weather and traffic. So I think I'd rather go into labor spontaneously than schedule his delivery.

WWYD? 

Id first ask the OB how he felt on vaginally delivering a breech baby. If he wasnt comfy, Id search around for one who was. I hate the whole scheduling a section just because baby's breech. Babies can be born safely even when breech. Its just finding a provider whos comfy adn experienced.

And Id start looking on spinningbabies. Theres a bunch of techniques on there to encourage baby to turn headdown.

To answer the original question- I vote spontaneous labor. You live close to the hospital, and the benfits of letting your body go into labor on its own outweigh the small chance of infection. Think of ALLLLLLL the women who have emergency cesareans after a failed induction or for whatever reason. Im not hearing massive amounts of stories surrounding negative outcomes bc the mother was in labor prior to the cesarean.

schoolsoutbride

With a breech baby (assuming Frank breech not footling?  B/c footling has a good cord prolapse risk), I'd go into labor first if possible.  With a first baby, labor is probably going to move slowly anyway, and I think you'd have plenty of time.  I'm not sure how many hospitals will agree to that, though.  I think the ocytocin release from labor would be worth the weight, as would knowing baby was "cooked."

For something like placenta previa, I'd schedule it b/c the risks outweigh the benefits.

That said, if my breech baby doesn't turn, having to deal with child care for the 1st might be enough to make me schedule it.

I'm torn on this one...

iris427

flowerchild77:

WannaBeCrunchyMama:

My baby recently decided he's sick of being head down.

I'm only 34 weeks so he has plenty of time to change his mind, and time for us to try to get him to flip. I just thought maybe I should start looking into the possibility of things not going how I expected. 

My doctor worked with midwifes for years so he's very supportive of med-free vaginal deliveries. I'm hoping that he has experience with breech babies just in case this kid decides to stay bum down.

Csection would be the last option but I still need to know what I would do if that ends up being the reality.

The hospital is nearby, ten minutes tops in bad weather and traffic. So I think I'd rather go into labor spontaneously than schedule his delivery.

WWYD? 

Id first ask the OB how he felt on vaginally delivering a breech baby. If he wasnt comfy, Id search around for one who was. I hate the whole scheduling a section just because baby's breech. Babies can be born safely even when breech. Its just finding a provider whos comfy adn experienced.

And Id start looking on spinningbabies. Theres a bunch of techniques on there to encourage baby to turn headdown.

To answer the original question- I vote spontaneous labor. You live close to the hospital, and the benfits of letting your body go into labor on its own outweigh the small chance of infection. Think of ALLLLLLL the women who have emergency cesareans after a failed induction or for whatever reason. Im not hearing massive amounts of stories surrounding negative outcomes bc the mother was in labor prior to the cesarean.

Of course you're not hearing massive amounts of stories like that.  You need to look at studies with fairly large sample sizes to discern these types of patterns.  You can't rely on just what you've heard from people you know to make an accurate assessment of risk.

From a purely anecdotal perspective, I had a cesarean after a long labor and it was a miserable experience.  I didn't end up with any postpartum complications but the surgery itself was awful because my body was exhausted and worn out from laboring and my baby was wedged deep in my pelvis, so it was hard for them to get her out without hurting me.  Having such a rough birth definitely interfered with our bonding.  Granted this would not apply to the OP's situation but a c/s after active labor can be emotionally and physically very hard on the mother and I don't think that should be dismissed.

OP in your situation I'd want to wait for labor to begin if you can't find anyone to do a vaginal breech birth.  That will give you the most time to try and get your baby turned, or for the baby to turn on their own.  But I wouldn't labor for too long, just so things aren't harder on you than they need to be. And I wouldn't allow many cervical exams, because those can increase your risk of infection.

GL hopefully your baby will turn and this will all be a moot discussion anyway  

WannaBeCrunchyMama

I'm definitely going to wait and see if my ob would deliver a breech baby. I don't know how he is positioned exactly because he WAS head down at my last appointment. I woke up a few days ago and he felt weird, I whipped out the doppler I borrowed from a friend and sure enough, his heartbeat was about my belly button on the opposite side from where he was last time. 

Hopefully, sense he obviously still has room to move around, he'll flip back. 

UGH. It would have been nice if he just wouldn't have gotten me worried about it in the first place though. 

If my OB won't deliver a breech baby we'll either have to go two hours away or csection because he's certainly the only one in town who would consider it. 

papagena

Ditto pp's mention of spinningbabies.com - I got DS to turn around 36 weeks or so - so you definitely still have time.  Good luck!

LittleEgypt

I had a c-section for a "suprise" breech baby, after laboring. Here are my opinions on it

1) Babies can flip very late. Mine did! Also, it was nearly impossible to tell where he was positioned, and I wouldn't trust a home doppler to determine position. We didn't know until I showed up 8cm dilated and had an internal exam.

2) Since I had a short labor at home, I felt good about having gone through about as much labor as I could before having the c-section. I would do it the same way again, even if I knew he was breech. My experience was so vastly different than what Iris had - I was laboring at home, no induction, taking a bath, eating a sandwich (LOL). The only parts that sucked were the car ride to the birth center and the one to the hospital.

3) If I had a MW or OB who did breech births, or if there were any in my area, I would have had a vaginal breech birth. However, after reading stories about "breech extraction", which is not really the same as a natural birth, I would seriously consider whether that was better than a c-section.

GiGi1221

I monitored both of my babies with the doppler and I was positive the one was breech... when I went in to deliver he was transverse and went head down once baby a made his exist.  So yours could be transverse- which usually turn head down, no problem.

WannaBeCrunchyMama

GiGi1221:

I monitored both of my babies with the doppler and I was positive the one was breech... when I went in to deliver he was transverse and went head down once baby a made his exist.  So yours could be transverse- which usually turn head down, no problem.

I was wondering this actually because he feels SO high. It seems like his back is up against my ribs.

GiGi1221

I would for sure say he's transverse then... but I'm not a dr!

Just because of plain old gravity though his head should get into position first-so I wouldn't worry yet!  Good luck!

Also- I think most ob's are pretty cool with breech deliveries now a days- so ask around...

WannaBeCrunchyMama

My ob has been pretty amazing so far. Well hopefully he just flips on back down and this is all just for theoretical education purposes.

missfire

My OB just told me today that she'd like to schedule a C-section at my 30-week appointment, if neither of my babies are head down yet. I don't want to schedule anything THAT early, but a month later, I may go ahead and schedule something. We'll see -- it may depend on how close to 40 weeks she would let me schedule it.

My reasons would be that I had a very fast labor and birth with my DS. I would rather be able to plan for my parents to be here for my son, instead of having to call them during labor and wait for them to arrive. I would know the right people were on staff to handle me and two babies. I think it might help me prepare for it emotionally, too.

WannaBeCrunchyMama

missfire:

My OB just told me today that she'd like to schedule a C-section at my 30-week appointment, if neither of my babies are head down yet. I don't want to schedule anything THAT early, but a month later, I may go ahead and schedule something. We'll see -- it may depend on how close to 40 weeks she would let me schedule it.

My reasons would be that I had a very fast labor and birth with my DS. I would rather be able to plan for my parents to be here for my son, instead of having to call them during labor and wait for them to arrive. I would know the right people were on staff to handle me and two babies. I think it might help me prepare for it emotionally, too.

Ya if I had a fast previous labor and needed a csection, I'd feel different about scheduling.

From looking at my families labors and knowing this is my first, I think it's fairly unlikely I'll have a fast labor. 

AutumnBride929

What about laboring before a c-section increases the risk of infection to the mother?

WannaBeCrunchyMama

Maybe just because you're more tired your immune system is compromised?

I don't know. I just pulled that out of nowhere.