Expert: Catherine Beier MS CBE - 3/11/2009

Question
Hi, I'm told I need an early c-section since I had a myomectomy. The doctors want to do an amniocentesis at 36 weeks. They said that if the baby's lungs aren't fully developed, they might let me go to 38 weeks. My question is, what is the point of doing an amnio, then? Rather, why not just schedule the c-section for 37.5 or 38 weeks? THANK YOU!

Answer
Laura,

The first question you need to address is why you are being told a c-section is your only option.  

There are many types of myomectomy and even in the case of abdominal myomectomy, a vaginal birth can still be an option.  C-section does not guarantee a better outcome and has risks of its own, especially if you plan on having more children.

If you did have an abdominal myomectomy and do pursue a vaginal birth, then you should not be induced by any artificial means, as this quadruples your risk of developing complications or having a uterine rupture.

There are significant risks to delivering a baby by c-section before 39 weeks.  There has been much research and controversy in this area recently.  

At a month premature, there is still a substantial risk that your baby's lungs will not be mature.  It's also possible to get a false positive result that indicates lung maturity when the lungs aren't truly mature.

At 34 weeks, there's about a 20% risk of a baby developing Respiratory Distress Syndrome (RDS) from immature lung development.  After 37 weeks, it falls to about 5% or less.

For these reasons, the American College of Obstetrics and Gynecologists encourages all inductions and planned c-sections to occur after 39 weeks whenever possible, to reduce the number of unintended premature deliveries since prematurity is the leading cause of infant mortality in the United States.

You need to ask exactly why they are wanting to take the baby a month early or "only let" you go to 38 weeks and why they aren't waiting until 38 weeks for the amnio.

Without the amnio or other fetal lung maturity tests, there is no way to know whether the baby's lungs are mature, and even with the tests, there's a risk of false positive results.

So, based on the information given, I'd ask why you can't try a vaginal birth, and why they are being so aggressive to try and section you before 39 weeks.


Best,
Catherine