Steroid injection prior to c section- what's your experience?

[AnnaCBH]

I am due to have my baby via caesarean at 38 weeks + 3 days. I have been advised by a registrar to have steroid injections prior to the birth as my baby will be 'premature' (not sure that I agree with that statement)and am booked in for these next week. I have seen that there is research linking early steroid exposure to ADHD and mental health difficulties.

I guess what I am wondering is have you had a planned caesarean at 38 weeks or around then and were you offered steroids? I know that NHS guidelines have changed and most c sections happen at 39 weeks these days but that hasn't always been the case. It's so hard to know what to do for the best, if the baby was coming naturally at 38 weeks I would not be offered steroids as my body would have sent the right signals to the baby to prepare for birth.

Thanks in advance for any feedback!

http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/newssummary/news_22-11-2013-17-5-31 - for the summary

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0081394 - for the full article.

[intexasatthe moment]

I don't suppose this is any help but I have to take steroids orally sometimes and I find they affect my mood terribly .

I know from other people that this isn't uncommon . Maybe just something to be aware of if you do have them .

Good luck - sorry you find yourself in this position ,so hard weighing up what's best . Hope others with more relevant advice come along soon .

[Ruth Campbell]

I've just had my 3rd ELCS and have had steroids before all of them. The chances of the baby having breathing difficulties are increased before 39w if you are having a c section.

I haven't had any bad reactions personally and so far the two eldest are perfectly fine, no signs of ADHD but them they are still young. All babies have been very calm to start with so it didn't affect them immediately when coming out.

Personally I would go with their advice. Rather that than a spell in special care.

As an aside, if you are at kings, do consider the kings cord scheme. So worthwhile.

[green bean]

I can empathise with your concerns - I was given this advice and elected, after much thought and research, to take the steroid injections prior to my elective c/s at 37 weeks (required due to low lying placenta). I think you need to read the research very carefully - looking at your first link, and the link to the original paper, the relevant bit here I think is the following:

Betamethasone and dexamethasone are long-acting substances (with biological half-lives ranging between 36 and 54 hours) [35], so it is unlikely that sGC treatment close to the time of birth could significantly impact fetal brain development as there would not be sufficient time for the drug to induce maximum effect. Thus, we excluded cases who had been exposed to sGC ≤4 days prior birth (n=11).

My steroid injections were less than 4 days prior to birth (99% certain of this, but it was over 5 years ago). Also the numbers involved in the trial linked to are very small.

I seem to recall accepting that the risk of lung development issues was significantly high enough to outweigh any other concerns and last thing I wanted was for my child to end up in ICU due to something I had been given the opportunity to prevent.

No signs of any issues with my daughter.

Best wishes with your decision making and with the weeks ahead for you.

[largeginandtonic]

Hi Anna,

It's a stressful time isn't it. I had my second child via c-section earlier than you. As soon as they knew that getting him out early was on the cards, I started having steroid injections to try to get him ready for birth. He was Ok, but clearly has weak lungs, has recurrent bronchiolitis, bronchitis and asthma. I watch him wheezing and taking his inhaler, worry about him feeling ill, watch him crying at night sometimes because he can't breathe, worry about the school days he has to miss due to illness, worry about him not gaining weight, worry about him being cold. I would do a lot to take that away. He's nearly 5.

Possibly not the story you wanted to hear. But I'm guessing they are offering steroids to avoid this.

(No sign of ADHD by the way)

It's a shame there isn't a better assessment of your particular child and whether they are ready to come naturally at 38 weeks or not. As you say, if the baby was ready to come naturally, they would generally be prepared. I did ask my consultant if weight was an indicator of "readiness" and he said no - it's about lung capacity. Perhaps they can't make any accurate assessment of lung capacity in the womb - I don't know.

Personally, I would take the steroids I think.

[Ruth Campbell]

Yes. Kings do a two doses, 24 hrs apart, with the last one either 24hrs or 48hrs before the section. (Mine was 48 as section on a Monday. As such they are all done within what is considered in your study as the safe period.

[AnnaCBH]

Thank you all. I had noticed the exclusion of the children that had received the injection less than 4 days prior to delivery, as my baby will, and felt slightly more relaxed about that. I agree, my child's health is the most important thing and the thought that I could prevent anything needs serious consideration. I'll call my consultant tomorrow, but thank you for taking time to share your experiences. Bubblebob I'm having my baby in Lewisham and haven't been asked about a cord scheme- I will ask though- thanks for the heads up.

[largeginandtonic]

He was quite a few weeks earlier than you - just thought I'd better make that clear.

[AnnaCBH]

Thank you largeginandtonic, sometimes it's hard to know how much to share to not scare but I do appreciate your response and hope your little boy will be well.

[Ruth Campbell]

Sorry, slightly drip feeding responses. The part of the reason that You wouldn't be given steroids with an induction is the physical process of birth squeezes the lungs in a way that a section doesn't. There is also a release of hormones at 39 weeks which helps mature the lungs which is why they go for steroids before that.

[Kes]

I don't know about early inductions but where premature labour looks likely then they routinely give steroids when a vaginal birth is likely too.

[AnnaCBH]

And I agree wholeheartedly with that, if the baby is prem all you can do to support that baby needs to be done, my concern is that is 38 +3 prem? I guess need outweighs risk with a tiny baby, it doesn't help when helpful scientists carry out research that throws my thinking in a spin!

[Saffron]

AnnaCBH, in addition to talking with your midwife/obs consultant about the steroid injections, have you thought about talking with your GP as well? Risk is not absolute, but on a sliding scale relative to maturation. What might the outcomes be if you don't take the steroid injections?

I think this is a really difficult choice. Steroids are a potent and life-saving class of drugs, but their overuse in many fields of medicine (possibly for lack of better drug treatments) probably contributes to a number of undesireable outcomes. What you have to do is weigh up the risks either way.

What type of lung function might your baby be expected to have if don't take the steroid injections, and what medical support would be offered?

Medical studies can highlight trends in groups, but ultimately the assessment of finite risk is down to the individual. Whatever choice you make, you need to feel confident that you'll be supported in the outcome one way or another. xx

[devsdev]

As it's something that definitely concerns you, are you able to change your date for the section to post 39 weeks? Would then hopefully remove any need for steroids at all.

[sillywoman]

Nothing to add re the steroids issue, just to say that the 'Kings Cord Blood' donation scheme is only available at Kings. Lewisham isn't a part of it. YOu can do it privately if you wanted, but it's something you'd need to arrange for yourself.

SWx