Childbirth Choices Debate

Hi all!  I haven't been here in a while but a friend of mine is making a choice that I thought might make for interesting discussion. 

Background:  After an induced, excruciatingly long and painful labor, her first son was stillborn.  He was alive until an hour before the delivery and could have been saved by a c/s but for various reasons it didn't happen.  Second son was born by planned c/s at around 39 wks, as she could not face another vaginal delivery.  Even though an amnio showed his lungs were developed, he spent some time in the NICU and still gets occasional respiratory infections, including a serious bout of pneumonia at a year.  She is aware of the possible connection. 

Now she's pg and due with a girl in February.  She will have another c/s and wants to have it 11 days before her due date.  The only reason is that the day of the week is convenient and if she waits another week, she's afraid she'll go into labor before the surgery.  Do you think her doc should do it or make her wait until at least 39 wks?  Should he even tentatively agree pending amnio results or say no right now?

  

 

 

Interesting indeed.

Our experiences definitely colour our perceptions of relative risks and I can see a case for a planned c/s in this circumstance for the Mum's psychological well-being even though, approaching things logically, it's probably the riskier option.

I cannot, however, make any kind of case for ending a healthy pregnancy before term. Even marginally prem babies can have difficulty with eating and breathing and are generally more vulnerable than their properly cooked cousins.

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I do not think any OB should schedule inductions or C-sections for reasons of convenience.

I vote for counseling for the mom. I think the issue of timing of delivery is obviously directly related to her feelings about the first birth.

I agree.  She definitely needs counselling.  As someone who considers it a good day if my 7 year old DS only covers 50% of the They Sayisms about babies born early, I don't endorse the "36 Weeks is the New 40 weeks" attitude about scheduled births.

I can understand her desires from an emotional standpoint. I know that when I was pregnant with my second child, I kept a mental calendar of the number of days and weeks along I was when bad things started happening in my first pregnancy, and looked toward them all with dread. When I would pass one of these "milestones" (for lack of a better word), without incident, I would feel really great. I needed to be induced for my first baby at 36w5d, so that was my ultimate goal: passing that day and continuing to carry the baby to full term, if at all possible. In the end, I was induced at 37wd2, when I was actually sicker than I had been with the first baby, and she was born the next day. But my doctors for my second pregnancy were much more liberal about my treatment, and were okay with keeping me on bedrest and having frequent checks, as opposed to getting the baby out sooner. I was thankful for that, and for the extra 3 days she got in utero (she was born at 37w3d, her brother was born at 37w exactly. 3 days is nothing to sneeze at! ;O)

But from a logical standpoint, like Isabel said, I can't see ending a pregnancy early when there isn't a medical reason to. I think that having the c/s in and of itself is risky enough, even though I can understand why she's doing it, and that compounding the risks of the c/s by delivering before the EDD is only adding problems where they don't need to exist. I know of a woman (online) who had a stillbirth at a pretty early stage (around 34 weeks, I think?) and was so scarred by it that when she became pregnant again, she wanted to deliver the baby ASAP, via induction. She wanted to go at 36 weeks, which her doctor said he would do if the baby's lungs were mature enough. So she had an amnio, and of course the baby's lungs were not mature so he didn't induce. I think they tried the amnio again a week later and still no dice. In the end, they went ahead with the induction between 37 and 38 weeks anyway, knowing the lungs weren't mature, and the baby had a lot of problems after birth. I couldn't believe the lengths this woman went to in the attempt to have her baby early. I never said anything to her about it, but I disapproved heartily. TWO amnios, and still had an early induction, with a baby who wasn't fully cooked?! That's just asking for trouble, IMO.

I don't think Mom's desires should mean *nothing*, but I also don't think Mom's desires really have that much to do with anything when it comes to something that is entirely left up to nature, like when a baby is truly fully-cooked and ready to greet the world. I know that for me, every additional day with the baby still in the womb was something to celebrate and be thankful for, so while I get the emotional side, I don't think that's more important than the physical/logical side, if that makes sense.