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is C-section a must if bb is not engaged by week 38?

  1. #1
    dudu is offline Registered User
    Join Date
    May 2006

    is C-section a must if bb is not engaged by week 38?

    I am now 38 week pregnancy and this is my first child. My doctor has recommended a C-section to me and the reason she gives to me is that my baby has not been engaged by now. She also told me that for first pregnancy if bb is not engaged by week 38, the chances of bb being engaged around the due date is very low. She also said that the non-engagement also signals a CPD (meaning the size of the head of the bb is bigger than the size of my pelvis) although she is not sure whether I actually have a CPD until I have tried V delievery and failed.

    However I have heard of cases where some babies are not engaged till moms are in labor (I am talking about first pregnancy here).

    I personally prefer a vaginal dilievery over C-section and my bb is of a normal size (3.1kg based on ultrasound by the end of week 37). I am now at a loss and also very confused after my doctor told me the above things.

    I would like to ask the following questions:

    1. has anyone's doctor recommended C-section for same reason?

    2.also, my doctor says that if I decide to go for a C-section based on her recommendations, I should do it during the week 38 rather than around the due date. I asked why and she said that it is "international practice". Has anyone heard of such international practice before?

    many thanks

  2. #2
    barbwong_130 is offline Registered User
    Join Date
    Jun 2003
    Hong Kong

    In Canada I know that doctors don’t do C-sections early and even if you definitely need a C-section they still wait for you to start labour naturally.

    The problem with doing this is Hong Kong is that the C-section is then considered an emergency and so all the costs are that much higher – both the doctor’s costs and the hospital’s costs.

    However, especially from the baby’s viewpoint, there are reasons that it is better to wait. You know that the baby is ready to come and is not being born prematurely – scans and dates aren’t that accurate. The baby is likely to be much more willing to breastfeed.

    I’ve lots of friends who had babies by planned C-sections who had problems breastfeeding in the first week. When I saw them it seemed to me that the baby just wasn’t ready for the world yet. Who knows what another two weeks would have given them.

    Good luck with everything,

  3. #3
    jools is offline Registered User
    Join Date
    Apr 2004
    Discovery Bay

    My first baby didn't engage until late and my second one didn't engage until labour. Both my children were born naturally.

    Doctors in Hong Kong seem to prefer intervention over letting things run naturally. Some may say it has alot to do with money (a C-section is more expensive than a vaginal delivery). If you are really keen to have a natural delivery then I would try and stick to that. If you are like me, one of the things you will angst about after the delivery is could I have done anything differently? Both my children were assisted out with ventouse. With my first child I felt incredibly disappointed that I had to have assistance. It took a little while to get over this; as it turns out I had a twisted pelvis which caused them both to get stuck.

    I have learned one thing in Hong Kong that medicine here is about choice and if your doctor won't support your decision then you can find one that does. I know it's very late in the day for you and you may not be willing to change now, but it is something that you could consider. If it helps, my doctor went on a conference the week of my due date and I met the doctor who delivered my second child, mid contraction at the hospital; that really was leaving it late in the day. The labour of my second child was a wonderful experience, greatly assisted by my new doctor and I am actually using her again for my third child.

    I know it's alot to think about, but remember the memories of your delivery will stay with you for a long time and no matter how caring the doctor is, you are another patient on a long list. Does your insurance cover you for an emergency C-section should you need one? If so, you might want to try to do things yourself first.

    Good luck with everything


  4. #4
    dudu is offline Registered User
    Join Date
    May 2006

    many thanks, Barb and Jools. Your advice is very helpful. I think I will go for a vaginal delivery first and if it does not work out, I will do an emergency C-section.

    What has been really bothering me is that I am not sure whether my doctor recommended a C-section somehow for her own convenience or not. She basically told me that there are "no chances you will be able to have a vaginal delievery". If her advice is based on her professional judgment only, I will definitely listen to her and avoid the trouble of trying a V-delivery which has no chances of success.

    What has made me a bit suspicious is the fact that she seems to recommend C-section to quite a few persons whom I know for reasons which do not usually consititute reasons for a necessary C-section (I have read books about pregnancy). What makes me even more suspiciou is her talkings about doing a C-section at week 38 being an international practice. I have been searching on internet and reading books and could not locate any mentionings about this international practice. I also talked to a friend of mine who did a C-section in the US and she did it around due fate and told me that she had never heard of such things from her doctor.

  5. #5
    benjy is offline Banned
    Join Date
    May 2004

    38 weeks definitely sounds far to early knowing that a normal delivery can occur between week 37 and 42 ...

    I refused myself to be induced at 41 weeks when baby decided to come at week 42.. and I had a normal vaginal delivery..
    but some docs really have a net tendency to convince moms to go for a C-section when it would'nt be necessary.

    you can check the WHO website..

    good luck!

  6. #6
    yaffle is offline Registered User
    Join Date
    Dec 2004
    Sai Kung

    Dear dudu,

    I had my first baby by C-section just over a year ago because the baby was huge (almost 10 pounds) and hadn't engaged even 24 hours after my waters broke. If you are suspicious of your doctor, change now. It is better to change than to worry and wonder about your doctor's motives.

    My doctor was very very supportive of my desire to try vaginal first and I did a lot of reading in medical journals (not just baby/pregnancy books) about C-sections--they should NOT be done at 38 weeks. If your doctor is so wrong about what is best practice for C-section babies, do you really want this doctor taking care of you during labor and delivery? There are potentially serious consequences for both the mother and the baby during and after C-sections.

  7. #7
    joannek is offline Registered User
    Join Date
    May 2005
    Hong Kong

    dudu, get some advice from Gianna Buonocore, an Acupuncturist from Integrated Medicine Institute 2523 7121. She also works with Matilda Maternity Ward. She might have some genuine advice for you, whether u really need a c-section or she can help u w/ acupuncturing.

    gd luck.

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