C-section at 37 Weeks

Updated on October 18, 2008
L.P. asks from Old Greenwich, CT
32 answers

UPDATE: I think a few of you mentioned being on blood thinners. I am also on a blood thinner- lovenox shots- because I have MTHFR which is a clotting disorder. I actually did not know with my first and had a healthy pregnancy for the most part but now that I know with my second, did not want to take chance that I 'just got lucky' with my first. ALSO, due to scheduling conflicts, the amnio for lung development will now be TWO days before the scheduled section.

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I had a c-section with my first child 3 years ago. I was induced due to size at 40 weeks. I had contractions since 33 weeks but made it to 40 with no labor!. During the induction- which is what they eventually had to do, I had hard back labor. I never progressed and ultimately needed a c-section. I am now pregant with my second. My Dr. said while I was in the hospital with the first that the next would be a 37 week c section because he feared uterine rupture. I apparantly almost ruptured with my first and had a lot of bleeding. Well, it is now time for my next and I am being told the baby will be fine and at term at 37 weeks (it is a boy). They are even doing an amnio the day before to confirm lung maturity is complete (I hear the lungs are the last organ to develop). If lungs are not mature, then we are going to wait another week and four days (after christmas). Any thoughts on this? My husband wants me to hold off until 39 weeks but I am really scared because if I go into labor, I put myself at risk according to the Dr. I would love a third child as well. Any thoughts or advice?

And by the way, I asked about VBAC and my Dr. did not recommend that- I am too scared to even attempt that.

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J.G.

answers from New York on

I had my second child(also a boy) c-section at 37 weeks. They did an amino, like you said, and it worked out well. I had a c-section for my first too, so they asked me what i prefered for the second. I said a c-section. He was fine. He we weighed 7lbs, 9oz. I think it will work out. My husband wanted to wait a week too, but the doctor said no, is the amino shows his lungs are fully developed, we will do it and they did. Good Luck!

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C.B.

answers from New York on

At 37 weeks you will be fine. My waters broke at 37 weeks and my contractions didn't progress. I was given pitocin and with some help she was born vaginally. She was tiny but perfect!

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B.C.

answers from New York on

I gave birth to my son at 37 weeks vaginally, no inducing. Everything was fine, and like others said considered full term. We are about to celebrate his 3rd b-day!

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J.E.

answers from Rochester on

Hi L.! As long as the amnio shows that the baby's lungs are ready I would go ahead with the c-section at 37 weeks. 38 weeks is considered full term so you would only be 1 week early. Many babies are born alot earlier than this and are fine. Our medical technology is amazing now. Uterine rupture which could be very dangerous for you and your baby. Good luck!!

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L.W.

answers from New York on

I'm sure it's been said, but get a 2nd opinion. Some docs are more conservative than others due to liability, not due to the safety of you and your baby. You'll feel more confident if two un-related doctors make the same recommendation, or more confident going to 39 weeks if another doctor doesn't think you're at as much risk. Good luck.

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L.G.

answers from New York on

Hi L.,

I had my daughter six years ago and she was born at 36 - 37 weeks (depending on whose due date you believe) and she was perfectly fine! She weighed 6lbs 3oz and was perfect! I also had an unplanned c-section, though not an emergency - she was simply in a breach position when my water broke. We left the hospital after 3 days and she is healthy as a horse!

I'm sure you will make the right choice for you, but if I were to have another child, I would go for another c-section, just to be safe and wouldn't worry about going a little before 40 weeks, if advised by my doctor.

Good luck to you and I hope you have a wonderfully healthy baby and a good birth experience!

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L.D.

answers from Albany on

If you trust your doctor, don't stop now. I loved my doctor back home and while my first was an emergency c-section at 38 weeks, he swore up one side and down the other my next could be a VBAC. My oldest was 9.3 at 38 weeks. Not a little over 2 years later when I got pregnant with my next, my doctor and all of his associates said absolutely no VBAC. With having such a large first baby, there is a great chance the next one will be the same size or bigger. I know someone who ruptured and she said it was very painful and she is into extreme sports!!

37 weeks is NOT considered premature. If your doctor is suggesting this and he has done nothing in the past to make you question his judgment, then I would do as he suggests, especially when he is taking the extra step of the amnio.

Now keep in mind, my next son ended up being my smallest at 7.12 but my third was 9.2. I had c-sections for all three and would much rather have a planned c-section than an emergency or take the chance of something going wrong during a VBAC.

Best of luck to you,
L.

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L.L.

answers from New York on

I had a scheduled induction at 37 weeks (due to being on blood thinners) that ultimately turned into a c-section. My son was small (5 lbs. 11 oz.) but was fine - his lungs were fine - he was fine. He didn't require any special medical care - he was with all the other babies in the nursery. He went home when I did.

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R.E.

answers from New York on

i had one a t 36 weeks, its fine. i'd listen to your dr. and not risk your health. if it erupts, you could die and so i think that your baby could as well.

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K.G.

answers from New York on

I would listen to your Dr. People take being pregnant and giving birth very lightly these days. With the help of medical technology, yes giving birth anyway is not as risking a long time ago but there are som amny things that can go wrong. I don't think your husband actually realizes what "can" happen. SOund very weird but when I was pregnant with me first child we happened to watch the move "Jersey Girl" the mom dies in that movie (if you never saw it) while in labor. After that my husband looked at giving birth in a whole new way. Maybe you can watch that together ????? but please listen to your Dr.

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R.D.

answers from New York on

Hi L. - I've had 4 c-sections, all with different doctors. One said no more than 4 and the next two said I could keep going. I think it really depends on your body and why you're having the c-sections. Typically, American doctors don't want to do VBACs because the insurance cost for them is very high. In California, most simply won't do it at all so they don't have to have the insurance.

As for my own experience, my 2nd delivery was at 39 weeks and my 3rd and 4th at 38 weeks. Personally, I'd be leary of delivering earlier without a really good reason but that's where your body and your doctor come in. Does he see a danger of rupture or is he just very conservative? It's definitely better for baby to stay longer but it's also better for him to have a healthy mommy. Maybe the amnio is the doctor's way of balancing the two. You have to decide if it's the right balance for you given the risks associated with the amnio, early delivery and possibility of rupture. Talk to your doctor and your husband together and come to a decision that's right for your family. No worries though on subsequent c-sections.

Good luck to you and congratulations on yor wonderful son!

B.F.

answers from New York on

Hi L.,
Congratulations on your second pregnancy! I was induced at 37 weeks for different reasons (I am type 1 diabetic and had choleostasis - which is a liver thing that sometimes arises late in pregnancy). Because I was complaining of the choleostasis symptoms the day before they were going to do the amnio, they decided to skip the amnio and just go for the induction. I also did not progress, and after nearly three days, had a c-section. 37 weeks is technically full term, and the lungs should be fine- if the baby is already on the big side, this may mean that he is developing quickly too (my son was three weeks ahead of sched nearly the entire pregnancy- he was 9lbs 7oz at 37 wks!! and didn't need any oxygen or lung support). I wasn't excited about the amnio, so was releived when they said we were just going for it without that procedure. For my next child, I would like to push my dr's to let me go a little further to see if I go into natural labor maybe a VBAC, but this is up to you. If you want to try for a third, you may just take the safe route and schedule the section. I suggest you get another OB's opinion on this especially with the rupture complication. However, I also know that dr.s just don't like to do VBAC because its got more risk involved- but it can be done, and women I know who have done it have been really happy with that decision. In the end its the final product that matters most!
Good luck,
ask another ob for a different opinion

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W.M.

answers from New York on

My son was born via c-section at 36 weeks & 6 days due to a cord issue & breach presentation. They also did the amnio to check for lung development. My son was born VERY healthy at that gestational age. He is now a happy, healthy 18 month old. I was high risk & my Perinatal doctor told me that after 37 weeks anything over that is just weight being put on & no real reason for the child not to be born - they ALWAYS recommend the baby be born at 37-38 weeks - they NEVER let anyone get to 40 at my perinatal office - due to increased risk to the baby. Email me if you need more information. Your baby will be fine.

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J.T.

answers from New York on

37 weeks is fine for delivery, even if it's a boy. Usually by 36 weeks, things are ok. I'm sure that the amnio is just for precaution...and I would listen to your doctor, not your husband or anyone else on the matter.

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C.H.

answers from Rochester on

Hi L.,

Isn't it amazing that we can feel so excited and blessed on one hand and fearful on the other. Have you tried praying about your fears? I find that when I turn my fears over to God and ask Him to give me clarity, there is a peace that comes and a knowing. Turn your fears, turn your pregnancy over to God L. and trust that He will provide.

God Bless,
C.

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R.J.

answers from Albany on

I had a c-section for my first at 35 weeks (due to uterine rupture risk) and she was in the NICU for about 2 weeks (she was born on 12/20 and went home on 12/31). I had to have a c-section for my second for the same reasoning but my doc wanted to wait till 37 weeks. I had an amino about an hour before the scheduled c-section and the reading was in the "grey area" where as he could be fine or may need some help with probably only a max of 1 day in NICU. (I actually delivered at 36 weeks and 6 days). It was my choice whether or not to deliver...I chose to go ahead with it (was having contractions anyway). He was born completely healthy no issues with his lungs at all...in fact he screamed the whole entire time...the second he was born till I asked them to take him to the nursery (about an hour and a half later). I think you should go with what your doc says because if you rupture, you and the baby could suffer. Good luck.

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A.M.

answers from Rochester on

All I can say is that I think you should wait if you can. I am not sure why your doctor is pushing it. Waiting as long as you can is really best for your child. I would continually monitor him and you but wait if I could...and an amnio the day before scares me. Just my opinion. I have never gone through any of this, but have done a lot of reading and have an 8 year old son.

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A.S.

answers from New York on

COngrats L.. I agree with many other responses listed--37 weeks is considered full term, and even what we call "near term" babies 35-36 weeks in women who go into labor "early" are usually just fine, go to the well baby floor, etc. Being induced at 37 weeks is really not a big deal, but it is especially indicated for someone like you who may have significant complications yourself if you let the pregnancy progress longer. I would listen to your doctor, and do what you need to do for the health and safety of both you and the baby.

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D.Z.

answers from Binghamton on

Hi L.,

Obviously every situation is different. I've not heard of an induction that early when everything is otherwise normal...my planned c-section was at 39 weeks. I've also had a c-section at 41 and then another at 42 weeks. I didn't read your responses, but if you trust that your doc won't put your baby at harms way, 37 weeks probably is ok...but seems like an amnio puts you at risk as well. Interesting choice by the doc there. But I'm certainly no expert...I've had a lot of kids, and every situation has been completely different. I wish you well. I'll be planning another c-section early next year and I'll probably go at 39 weeks...the doc offers 38 but I don't want to go too early...39 weeks is my father's birthday so that will be good. Take care.

D.
stay at home, homeschooling mother of 5 (soon to be 6)

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K.M.

answers from Syracuse on

My last 2 pregnancies were c-sections done at 37 weeks. You are considered full term at 37 and there is really no reason to even go through the amnio. My doctor had said I could go at 36 weeks with amnio, and 37 without. You should ask if it's really necessary. Both of my little guys have been perfectly fine being born 3 weeks "early". No breathing problems, no allergies, nothing. We went home 2 days later, and it would have been sooner if I could have convinced the doctor! The boys are almost 2 and almost 3, and the smartest little things ever! I should add that my oldest son was born at 32 weeks via emergency c-section. He spent only 6 days in the hospital, and is now 8, smart, and healthy! You have nothing to worry about, except whether or not you'll feel like sitting on the floor to open gifts with your 3 yr old on Christmas morning. Good luck!

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L.C.

answers from New York on

PLEASE ... take a DEEP breath ... or MANY and when you have time to sit still for awhile ... read and ask questions ... even get a second opinion at:

www.BAC.com Even if you choose (or your body) to do otherwise I believe this site may put you at ease and provide you with ALL of the issues and views and INFORMATION ...
that not any one type of health care provider may have.

In particular this excerpt on uterine scar rupture, I decided to copy and paste here from the site:

What is a uterine scar rupture?

A complete uterine scar rupture is a potentially life threatening condition for both the mother and/or the baby that requires immediate surgical intervention. Fortunately, uterine ruptures from a prior cesarean with a low-transverse scar is a rare event and occurs in less than 1% of women laboring for a VBAC. It is a tear through the thickness of the uterine wall at the site of a prior cesarean incision. The majority of cesarean uterine incisions are low-transverse. The scar form this type of incision is the least likely to rupture in a subsequent pregnancy, labor, and birth.

Uterine ruptures have also been known to occur in some women who have never had a cesarean. This type of rupture can be caused by weak uterine muscles after several pregnancies, excessive use of labor inducing agents, prior surgical procedure on the uterus, or mid-pelvic use of forceps.

Some women have a low vertical incision on the uterus, made when there is a placenta previa (low-lying placenta), a large baby, a baby in a transverse position (lying horizontally in the pelvis) or a premature breech delivery.

When planning a VBAC it is important to determine if the previous low vertical scar has not stretched to the body of the uterus in the current pregnancy. The risk of rupture for a low vertical scar has been reported to be the same as for a low horizontal scar and as high as 1-7%.

Sometimes a woman may have a "T" or "J" shaped scar on the uterus or one that resembles an inverted "T". These scars are very rare. It is estimated that between 4 and 9% of "T" shaped uterine scars are at risk for rupture.

Rarely, a woman may have a classical (vertical) scar in the upper part (the body) of the uterus. This type of incision is used for babies who are in a breech or transverse position, for women who may have a uterine malformation, for premature babies or in extreme circumstances when time is of the essence.

The risk of rupture for this type of scar has been reported to be between 4% and 9%. A classical scar on the thinner and more vulnerable part of the uterus tends to rupture with more intensity and result in more serious complications for mothers and babies. Mothers who have had several children and have a classical uterine scar are at higher risk for uterine rupture.

The American College of Obstetricians and Gynecologists (ACOG), the Society of Obstetricians and Gynecologists of Canada (SOGC) and the Royal College of Obstetricians and Gynaecologists (RCOG) of Britain recommend that women with a classical scar have a repeat cesarean birth.

What are the symptoms of a uterine rupture?

A uterine rupture cannot be accurately predicted or diagnosed before it actually occurs. It can occur suddenly during labor or delivery. A few studies have suggested that measuring the thickness of the scar by ultrasound or following closely the pattern of contractions in labor may be useful in anticipating and therefore preventing a scar rupture. However, there is not enough information to prove that these methods should be widely adopted.

Several symptoms have been identified, but do not necessarily occur with every uterine rupture. Signs of uterine rupture that may or may not be present.

Vaginal bleeding

Sharp pain between contractions

Contractions that slow down or become less intense

Abdominal pain or tenderness

Recession of the fetal head (baby's head moving back up into the birth canal)

Bulging under the pubic bone (baby's head has protruded outside of the uterine scar)

Sharp onset of pain at the site of the previous scar Uterine atony (soft muscles)
To date, studies have shown that a uterine rupture can be detected by electronic fetal monitoring (EFM) because the women in these studies laboring for a VBAC were monitored electronically. Although some caregivers closely monitor VBAC labors with a fetoscope or a hand-held ultrasound measuring device (the Doppler), no VBAC studies have yet been published on this method. Guidelines from the ACOG, SOGC, and RCOG recommend that women laboring for a VBAC be offered electronic fetal monitoring.

Abnormal fetal heart tones, variable decelerations, or bradycardia (slow heart rate) have been associated with a uterine rupture. It is important to note that with a uterine rupture, labor sometimes continues, there is no loss of uterine tone or amplitude of contractions.

How often does a cesarean scar rupture occur?

For women who had a prior cesarean birth the rupture can occur at the site of the previous uterine scar. Dozens of studies report that for women who have had one prior cesarean birth with a low-horizontal incision, the risk of uterine rupture is 0.5% to 1.0%. A woman who has had more than one cesarean with a low horizontal incision may have a slightly higher risk of rupture. One study that looked at the risks of uterine rupture for planned VBACs over a ten-year period at a teaching hospital that was often able to perform an emergency cesarean very quickly found the following results:

Risk of Uterine Rupture with Low Transverse Uterine Scars* Revised 10/14/2002
Number of Previous Cesareans Successful VBACs Rupture Rate Perinatal Mortality
10,880 Planned VBACs with one prior scar 83% 0.6% 0.018%
1,586 Planned VBACs with two prior scars 76% 1.8% 0.063%
241 Planned VBACs with three prior scars 79% 1.2% 0
Source: Miller, D. A., F. G. Diaz, and R. H. Paul.1994. Obstet Gynecol 84 (2): 255-258

*This study included women with breech babies and twins and use of oxytocin.

How does the risk of a rupture compare with any other complications of labor whether the mother had a prior cesarean birth or not?

For women whose labors begin spontaneously, uterine rupture is reported to be less than 1% and the risks similar to or less than the risk of any other unpredictable complication of labor and delivery.

Medical experts state that the risk of a uterine rupture with one prior low-horizontal incision is not higher than any other unforeseen complication that can occur in labor such as fetal distress, maternal hemorrhage from a premature separation of the placenta or a prolapsed umbilical cord.

Respected studies have concluded that the probability of any woman needing to have an emergency cesarean those other complications is approximately 2.7% or up to 30 times as high as the risk of uterine rupture.

For the year 2000, for approximately 4 million live births, the US National Center for Health Statistics reported the following complications that occurred during labor and birth: The table below compares the risks of a uterine rupture (with one low-transverse scar) with the risks of other unpredictable complications of labor and birth.

Reported Complications of Labor and Delivery in US for year 2000 Rate per 1000 live births
Umbilical Cord Prolapse 1.9
Fetal Distress 39.2
Abruptio Placenta 5.5
Source: CDC: NCHS: Births: Final Data for 2000
www.cdc.gov/nchs/data/nvsr/nvsr50/nvsr50_05.pdf

Uterine rupture rate per 100 women laboring for a VBAC, based on worldwide systematic reviews (0.09 to 0.8 %) 0.9-8.0
Source: Enkin et all 2000. A Guide to Effective Care in Pregnancy and Childbirth.

Data from the Vermont/New Hampshire VBAC Project shows a risk for uterine rupture to be 5 per 1,000 for women who labor for a VBAC compared to 2 per 1,000 for women who have a planned cesarean birth. The RCOG in Britain states that uterine rupture is a very rare complication, but is increased in women who labor for a VBAC (35 per 10,000) compared to women who have a planned repeat cesarean (12 per 10,000).

What happens if the scar ruptures?

Although uterine scar ruptures for women laboring for a VBAC are rare, the medical response is a rapid cesarean.

The longer it takes to diagnose and respond to a uterine rupture the more likely it is that the baby and/or the placenta can be pushed through the uterine wall and into the mother's abdominal cavity putting women at increased risk for hemorrhage and babies at increased risk for neurological complications and very rarely, death.

The authors of A Guide to Pregnancy and Childbirth, an internationally respected evidence-based text, state that any birthing facility equipped to respond to a medical emergency can care for women laboring for a VBAC.

Whereas ACOG guidelines for an emergency cesarean previously allowed for a maximum response time of 30 minutes for an obstetric emergency controversial VBAC guidelines revised by ACOG (1999 and 2004) have recommended that birth facilities who care for women laboring for a VBAC should have a physician capable of performing an emergency cesarean, anesthesia services, and staff "immediately available." The SOGC recommends "urgent attention and expedited laparotomy [surgical incision into the abdominal cavity]" when a uterine rupture is suspected. The RCOG recommendations are “immediate access to a cesarean section and on-site blood transfusion services."

Birthing facilities vary in their guidelines and protocols for VBAC and response time to a uterine rupture and other unforeseen complications of labor. Many US facilities have recently determined that they don't have the capability to respond "immediately" in case of uterine scar rupture and are currently denying women the option to labor for a VBAC.

Caregivers who support VBACs say that the focus should be on improving access to quality of care for women who want a VBAC, not on discouraging them because of negative outcomes publicized in high profile medical malpractice law suits.

Dr. Bruce L. Flamm, an eminent researcher on VBACs cautioned that if US physicians were to discourage women from planning VBACs and to adopt a policy of elective repeat cesareans, it "would mean performing an additional 100,000 cesareans every year. It is unlikely this huge number of operations could be performed without many serious complications and perhaps even some maternal deaths."

In the event of a uterine rupture, what are the outcomes for mothers and babies?

The majority of studies report that in the rare event of a uterine rupture, if the labor was carefully monitored, the birth attendant was trained to attend VBAC births, and if the medical response was rapid, mothers and babies usually do well. One study in a large California hospital which had 24 hour emergency coverage reported that outcomes for babies were better when the response time was 18 minutes or less.

With access to a rapid cesarean, fetal death from a uterine rupture is an extremely rare event. Three large studies that determined the number of babies who died as a direct result from a uterine rupture when women labored for a VBAC found the following:

Number of women who labored for a VBAC Number of babies who died from uterine rupture Reference
17,613 5 Rageth, et al 2000
10,000 3 Rosen, et al 1991
5,022 0 Flamm, et al 1994

The Vermont/New Hampshire VBAC Project findings show the overall risk of infant death from a VBAC attempt is 6 per 10,000 compared to 3 per 10,000 planned cesarean births.

Women who receive good prenatal care, whose care providers are trained and experienced with VBAC, and who labor in a facility that is equipped to provide immediate medical care usually have good outcomes.

Women who are thinking about laboring for a VBAC at home may want to consider and make plans for the possibility of a uterine rupture. Home VBACs are not recommended by the US, Canadian, or UK professional guidelines.

Women thinking about laboring for a VBAC in a free-standing birth center may also want want to consider making plans to access emergency services in the event of a uterine rupture.

To find out more about VBACs in accredited birth centers in the USA contact the National Association of Childbearing Centers at www.birthcenters.org.

Can the risk for a uterine rupture be reduced?

Although it is not possible to predict which women are likely to experience a uterine rupture while laboring for a VBAC, recent studies have suggested that the risk for uterine rupture is higher when:

Labor is induced with oxytocin, prostaglandin preparations, or misoprostol (Cytotec).
The prior cesarean incision was closed with a single-layer of sutures (single-layer closure- often done in recent years to shorten the time in the operating room) as opposed to two layers of sutures (double-layer closure).
Women become pregnant and labor for a VBAC within less than 24 months after a prior cesarean.
Women are older than 30 years of age.
Maternal fever was a consequence of a prior cesarean birth.
A classical uterine incision was used in a prior cesarean birth.
A woman has had two or more prior cesarean births.
According to ACOG, prostaglandins for induction of labor in most women with a previous cesarean should be discouraged. Similarly, the SOGC states that misoprostol "is associated with a high risk of uterine rupture and should not be used" when women labor for a VBAC.

Informed Choice-Informed Refusal

Current US health law and medical-ethical guidelines give childbearing women who once gave birth by cesarean the option of laboring for a VBAC or scheduling an elective repeat cesarean. ACOG states that

"it has become clear that patients are entitled to participate with their physicians in a process of shared decision making with regard to medical procedures, tests, or treatments"; Once the patient has been informed of the material risks, and benefits involved ; that patient has the right to exercise full autonomy in deciding whether to undergo the treatment, test, or procedure or whether to make a choice among a variety of treatments, tests, or procedures. In the exercise of that autonomy, the informed patient also has the right to refuse to undergo any of these treatments, tests, or procedures. This election by the patient to forgo a treatment, test, or procedure that has been offered or recommended by the physician constitutes informed refusal."

Women are encouraged to ask questions, gather information, and discuss their concerns with their care providers to enable them to make an informed choice for a VBAC or a repeat cesarean birth.

For additional information see Making Informed Decisions and Patient Rights.

References:

American College of Obstetricians and Gynecologists (ACOG) July 1999. Vaginal Birth After Previous Cesarean Delivery Practice Guidelines. Practice Bulletin Number 5.

American College of Obstetricians and Gynecologists (ACOG) July 2004. Vaginal Birth After Previous Cesarean Delivery Practice Guidelines. Practice Bulletin Number 54.

Bujold, E. et al. 2002. American Journal of Obstetrics and Gynecology 86 (6) :1326-30.

Enkin et al 2000. Effective Care in Pregnancy and Childbirth.

Flamm, Bruce. 1990. Birth After Cesarean, a consumer guide book.

Flamm, B. and E.J. Quilligan, Editors 1995. Cesarean Section Guidelines: Appropriate Utilization.

Flamm, B.L. 1997. Obstetrics and Gynecology 90 (2):312-315.

Institute for Clinical Systems Improvement 1998. Health Care Guidelines G32. Vaginal Birth After Cesarean. On-line www.icsi.org/guide.

Leung, A.S., E.k. Leung, and R. H. Paul 1993. American Journal of Obstetrics and Gynecology 169(4): 945-50.

Lydon-Rochelle, M. et al 2001. New England Journal of Medicine 345(1):3-8. Norther New England OB Group 2003. Birth Choices After Cesarean, from the Vermont/New Hampshire VBAC Project. Available free from .....

Rageth, J.C., C. Juzi, and H. Grossenbacher 1999. Obstetrics and Gynecology 93(3):332-337.

Shipp, TD et al 2001. Obstetrics and Gynecology 97(2):175-77.

Society of Obstetricians and Gynaecologists of Canada, December1997. Clinical Practice Guidelines Policy Statement: Vaginal Birth After Previous Cesarean Birth. (Number 68). [acrobat pdf]

Society of Obstetricians and Gynaecologists of Canada, December1997. Clinical Practice Guidelines Policy Statement: Vaginal Birth After Previous Cesarean Birth. (Number 147). [acrobat pdf]

Zelop, C.M. et al 1999. American Journal of Obstetrics and Gynecology 181(4):882-6.

I pray you have a peaceful and powerful birth!

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S.T.

answers from New York on

Hi L.,

I had my daughter without being induced at 37 weeks. My water broke and I went into labor on my own. She was born completly healthy. I had my son 3 months ago at 37 weeks, but I was induced. I had an amnio done to check his lung development before the induction. He was born with a very healthy set of lungs and there were no problems. My doctor would have not advised the induction at 37 weeks if he didn't feel that the baby would not be healthy. That is why he did the amnio! I wouldn't take the risk and I would just have the amnio done to check lung developmemt. If the test comes back that the lungs are developed than I would have the C-section done at 37 weeks. Of course it is better to wait and have it at 38,39 and 40 weeks, but at 37 weeks your baby is considered full term.

Good Luck to you and Congratulations.

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B.M.

answers from New York on

Both my girls were born by c-section -- one at 33 and one just shy of 36 weeks -- both in emergency situations. It isn't something to chose lightly but we were blessed to have no health issues with either. Many of the c-section dangers are associated with emergency c-sections so a planned surgery, with a check on the baby's lungs, at 37 weeks is not a great risk if your Dr feels it is best. Congratualations and enjoy your new little one!

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O.S.

answers from New York on

L. First of all congrats on your baby boy. At 37 weeks the baby would be considered full term and if this was your first and normal delivery the question around lung development may not have come up, you would just be allowed to deliver. I had my first child at 37 weeks and everything was fine, I went into labor naturally however like you never progressed and ended up with a c-section. Your dr may just be over cautious which is a good thing. My friend also had a c-section exactly at 37 weeks b/c of preeclampsia concerns and again the questions around lung development did not come up, her girls was fine and healthy and continues to be. You are right lungs are the last organs to develop and continue developing after the child is born. Continue to ask your dr to explain his concerns and the risks around it. I am also expecting my second child, a girl, in Feb and will be a c-section as well and my dr told me to pick a date after 37 weeks, with no concerns around the lung development. The idea of picking a date vs going on labor on my own doesn't appeal to me but she has also adviced me about the risks around rupturing the uterus.

I think there is a drug that can be given to the mother to promote faster development of the fetus and it is sometimes used for mothers who are at a high risk of pre-term labor, which doesn't seem to your case, sorry I don't remember the name but I read it somewhere. Again this doesn't seem to be something you should be concerned about but it is better to be informed. Continue to talk to your dr about his concerns around the baby's development even at 37 weeks as well as the benefits/risks of having an amnio be as informed as you can so that you can ask more questions. Hope this was helpful.

O.

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J.L.

answers from Rochester on

At 37 weeks you are fine!!! I just had my son via c section at 37 weeks and we just celebrated his 12 week b day. He is fine he weighed fine at 6.13lbs. These are risks that the Dr. needs to discuss with you they area very small risk though. If you have maintained a pretty healthy lifestyle during pregnancy you should be fine. Congrats on the baby boy!

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B.B.

answers from Albany on

I had both my babies early by C-section - first one at 38 weeks and second one at 35 weeks. For our first, I had a scheduled C-section b/c our DD was breach. Schedules don't always work with babies and I did go into labor early. For our second, I had some complications, i.e. lost my amniotic fluid for no good reason. Our DD came out healthy and is a thriving 2 year old.

I would take your doctor's advice seriously - you would not want to rupture and have any complications, especially if you are considering a third. If your husband is still questioning your doctor's decisions (which I'm sure are based on YEARS of experience), I would think about bringing your hubby to the next appointment so that your Dr. can explain why he thinks an "earlier" delivery is best. And remember, typically, the due date is a best "guesstamation" based on your ultrasounds.

Good luck and congrats on your newest member of your family!

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S.S.

answers from Glens Falls on

Babies born after 36 weeks are very healthy, unless there is some underlying health problem and then waiting 2 weeks wouldn't change that. (Sorry to be negative - I hated negative thinking when I was pregnant)
I think you are safer going at 37 weeks, for your safety and for the baby's.
My cousin had a baby at 35.5 weeks and he came home in 2 days because he was perfectly healthy. He's now 14 months old and still perfectly healthy.

Good Luck, I'm sure this is a difficult choice.

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H.P.

answers from New York on

With all three of my children (a singleton girl and twin boys), I was induced at 36 weeks 2 days after an amnio to confirm lung maturity. All three had mature lungs. Other than my daughter's two-night stay in the NICU for low blood sugar (unrelated to early birth), the kids were great. All weighed about 6 pounds. Once you are at 36 weeks, they consider it full term.

Most importantly, listen to your doctor. My first child was unfortunately born still. When my doctor told me she was inducing me early in my subsequent pregnancies, I listened to her... Your doctor isn't pushing the induction for her convenience... she's trying to save you and your baby....

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N.V.

answers from New York on

why wouldnt the lungs be devleoped by then? at 36 weeks you are classified as full term according to my doctor...he took my daughter at 38 weeks because she was breeched and she was perfectly healthy...lungs and all...but if there is a risk with a rupture and bleeding alot and you really trust your doctor then maybe following his advice wouldnt be a bad idea

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D.

answers from New York on

well, your first pregnancy was term. 40 weeks is a full term baby so you weren't early. Your due date is an estimation, nothing more. And any time from your due date, plus or minus 2 weeks, is considered a full term baby. So 37 weeks isn't as early as you think. If you almost ruptured last time I definitely wouldn't try the VBAC. I will say this about the repeat section. I had one with my son after 21 hrs of labor. I made 10cm and pushed 4 hrs and didn't progress. So we did the section. I was exhausted afterwards. With my daughter I did go into labor on my own (the day before my scheduled c-section). But I was only in labor for 6 hrs at the most. I wasn't as tired afterwards because my body didn't go through all that labor. My recovery was faster too since my body wasn't tired. Believe it or not, you will enjoy your 2nd c-section much more then your first. I wanted to try the VBAC as well, I had planned that with my midwife group since I found out I was pregnant, but 4 weeks before delivery she turned breach and wouldn't go back. I was HUGE with my daughter (47cm) and my body had been through enough so we decided on the repeat section. I don't regret it. I was much more rested after my 2nd section then my first.

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A.S.

answers from Rochester on

Hi L.,

Early congrats on your baby! I also had a c-section with my first son. It was an emergency c-section & they had to cut the uterus vertically & the belly skin horizontally. I was told I would never be able to do a VBAC or else I would risk uterine rupture. My twins were born at 35 weeks & are just fine. My son left the NICU after a week. My daughter got a staph infection due to too many needle pokes for blood tests & had to stay in longer. But, they're developmentally on par. First, listen to your gut & if something doesn't feel right, question it & question it again. Second, listen to the doctors because they have the education & insight to keep you safe. Third, I'm not saying your husband doesn't know anything, but he needs to cooperate with the doctors. A baby is considered full term at 37 - 40 weeks, so if you deliver at 37 weeks, you're fine. Baby boy may have to stay a little bit in the NICU, but chances are, you'll go home together.

Best of luck,
A.

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C.B.

answers from New York on

your fears are understandable. it is my belief that big medicine, big insurance, big pharmaceuticals puts these fears into us and we don't even realize it. most doctors, especially in nj, are against vbac, even though our bodies are perfectly equipped to have v-births, even after a c. that said, modern medicine is miraculous and they can see and hear a lot of things through ultrasound and other technologies. i'm not a doctor, nor an extreme natural earth momma. just have faith that your body is doing what it should, your baby is developing as he should and your doctors will keep you and your baby safe.
i think it's normal to have fears this late in the pregnancy- we're so nervous and excited and our jobs are almost done and we can't wait for that baby to be here, safely, and hold him. be anxious, be excited, but have faith. it hope this helps.

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