The Tricky Business of Scheduling a C-section
This week we engaged in an intense study of the calendar, trying to find the ideal day to schedule my C-section (if one actually exists).
And although my lower back and hips are aching to deliver this baby today, I don't want to schedule my C-section too early. Every minute counts, according to two recent studies on gestational periods.
Some essential brain development occurs in the last several weeks of pregnancy, and I was surprised to learn that even slightly premature babies (born at 34–36 weeks) may have a 36% higher chance of developmental delay or disability, according to a recent study. "A late pre-term baby is not the same as a term baby," says Dr. Steven Morse, the study author and director of Community Newborn Services at the University of Florida.
Although the fetus might be physically capable of life outside the womb, the "bun" needs a little more time in the "oven" before its brain is ready. So I'll tell my back and hips to tough it out for at least another month. But after 36 weeks, I could schedule it anytime, right?
Up until recently that was the case, but OB's have been pushing that date back to 39 weeks, following a 2009 study published in The New England Journal of Medicine.
That study found that babies born by repeat elective C-section in the 37th and 38th week of gestation may double their risk of problems, including "adverse respiratory outcomes, mechanical ventilation, newborn sepsis, hypoglycemia, admission to the neonatal ICU, and hospitalization for 5 days or more."
The American College of Obstetricians and Gynecologists' guidelines specified that a repeat elective C-section should not be performed until 39 weeks—but many women and their doctors were ignoring that guideline for the sake of convenient timing.
Next Page: Can I wait too long? [ pagebreak ]I understand the fear of waiting too long and possibly going into labor. In my case, testing positive for Group B Strep again means that I'm risking a second infection if labor begins on its own. And you also risk having the doctor on call perform the C-section, rather than the doctor with whom you have formed a trusting relationship.
This may not sound like a disaster, but it sounds awful to me. I have spent the last eight months grilling my doctor about this upcoming birth, and I feel safe in his hands. Deciding to forgo a VBAC in favor of an elective C-section is nerve-racking enough. If I didn't recognize the eyes of the person holding the scalpel, it would make me exceedingly nervous.
Since the fetus is measuring a full two weeks ahead of schedule, my doctor recommended that he perform the C-section on the day I am officially 39 weeks pregnant, which is the Sunday of Memorial Day weekend.
Although my doctor is not opposed to performing the C-section that day, I've been cautioned against heading to the hospital over a holiday weekend. I may not receive the standard of nursing care I would on a regular weekday and a study found that Canadian patients were more likely to die when admitted over a weekend (a fact the researchers correlated to lower nursing staff levels).
Balancing my wish to wait as long as possible with my desire to avoid labor, I scheduled my daughter's birthday for Tuesday, May 26. At 39 weeks, two days gestation, our little baby should be raring to go. I know I am.