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ELCS at 38 weeks - normal for gestational diabetes?(27 Posts)
Can I insist it's delayed to 39 (or even 40) weeks?
Background is that I failed my GTT by a whisker (0.01 mmols above normal). I have been diet controlled since then, checking blood glucose 4 times a day, completely average/normal levels of glucose (apart from 2 where I was borderline hypo ).
My DS has always been bang on the 50th percentile for all his measurements (although he has little legs like his mum!) To my (admittedly untrained) mind, that means he is growing normally and is not affected by any high glucose levels that I may (or may not) have had during my pregnancy.
ELCS was agreed at 17 weeks and the reason for it is unconnected to the GD. I understand that they may want to get GD babies out early but having also had early problems with DS' lungs, I really want him to "cook" until at least 39 weeks. I have received an appointment out of the blue for admission for ELCS at 38 weeks, midwife says I need steroids at that gestation, I don't see the consultant for another 2 weeks and I am really wibbling!
Can I request a delay? Has anyone experienced an early CS where GD was being
expertly diet controlled? Do I really need it?? Help!!
Thank you in advance
38 weeks is early, especially when your diabetes is so well controllled. I was on insulin for mine (as neither diet nor metformin worked) and the hospital was still happy to wait till 39 plus 1 before inducing, and then induction took 2 days.
I'd ask the consultant to explain why you need 38 weeks as that is odd and it makes more sense to delay.
Always bear in mind you don't have to consent!
Unusual to do the CS at 38weeks if it's diet controlled. Inductions arent advised until 40weeks in diet controlled GDM so not sure why an ELCS at 38weeks would be advised. I would speak to you midwife.
I didn't have a CS but was induced both times for GD, at 39 weeks. 38 seems a little unnecessary unless there are specific concerns, which it doesn't sound like there are.
Not exactly the same I was insulin controlled GD dd and induced with at 39 weeks as my oldest son had a really important GCSE meeting at school and I wanted to go! They were happy to delay.
People saying unusual for induction etc at 38 weeks, it's because the instance of still birth/ new born mortality in GD pregnancy is the same at 40 weeks as it is at 42 weeks for non GD pregnancy.
Pretty standard in my NHS trust.
So paired with over average birth weight occurring in GD pregnancies, GD commonly occurring in women with bmi over 30, induction elcs is fairly sensible.
Thanks for so many helpful replies! I was starting to think it must be an admin cock up until poke's post. Maybe there is different practice between trusts. (In some trusts I would even be classed as flipping diabetic! Grr...)
I see the logic of not waiting until 40 weeks in GD with an older mother like me. I just think 38 weeks is too early for a baby with a neonatal alert in place because of his lung issues. Especially as my first consultant (pre-GD) insisted that 39 weeks was her preference.
I will discuss the risks with the consultant but my gut is telling me to hang on till 39 weeks rather than have steroids. Obviously if my GD is no longer controlled and/or DS starts growing abnormally then it may need to change but I would rather the birth plan took the optimistic approach!
Thanks for all the replies. MN is great for this kind of thing.
Poke my BMI is 22. DS is measuring average (or smaller than average) at every scan - and there have been loads because of his lungs. Obviously if he was a "typical" GD baby then I could see the logic in an early CS, but my blood glucose is rarely over 4.5 even on the post-prandial readings. I think my pancreas was just shit at dealing with that vile Lucozade concoction and went on strike for my GTT! Typical....
My experience with GD sounds similar to yours but I had no reason for a CS. I was meant to be induced on his due date, so 40 weeks but DS decided to arrive at 38 anyway.
Personally, I'm glad he did as despite the doctors and midwives being happy, I still feel he wasn't doing well in there. He measured 50th right through to 34 weeks and then he dropped to 10th. By the time he was 4 weeks old, he was back to 50th with no drop in weight after his birth.
This was my own experience though and if all seems well and your GD is well controlled then I'm surprised they want you to deliver before 40 weeks simply because my consultant was so insistent that I wouldn't if it stayed diet controlled.
younggirl they said dd was going to be 'hefty' in the sonographers words. She was 7lb and absolutely tiny, scrawny like a chicken.
I think there is a bit of a one size fits all approach to GD tbh.
Thanks changing - I guess things can change quite quickly and the diabetes consultant keeps reminding me that I have 7 weeks to go and may not remain diet controlled. I just find it surprising that they are planning for the worst case scenario. Glad to hear your DS is doing well.
poke a similar thing (well, in reverse!) happened to a friend of mine. She had a teeny DD1 and when she was 30 weeks with her DS they decided he was not growing enough and she had regular growth scans and got very anxious that he would be teeny tiny. What popped out was a whopping great 8lb 10 baby boy! I agree with you about 1 size fits all - I am sure there is a NHS protocol here that works great for those who are carrying big babies or are insulin controlled. It just seems a bit OTT in my case.
Feeling much calmer and less wibbly already. DH is going to speak to the consultant by phone this afternoon so will update after that.
Yes, please let us know! interested to hear what they say.
My NHS trust would say ELCS at 39-40weeks as per ELCS guidelines, GDM diet controlled wouldn't bring it any earlier. Definitely speak to consultant
Consultant's secretary has been very helpful - apparently 10 days before due date is their normal practice. However my admission date is 5 days before that! I am starting to think this might be a cock-up with dates...will update once consultant has confirmed.
Did your due dates change at all? Eg. Midwife may have initially written one dates in your notes based on your LMP and 12 week scan may give different date.
No change in EDD - and he's always measured in line with the LMP dates. (IVF baby so we could be very precise!)
The NICE guidelines were recently updated and say women with GD should be advised to give birth no later than 40+6 weeks
I accepted induction at 39+1 but I was taking insulin/over 40 years/ various other issues
OP, I just realised, both of my GD babies were born exactly ten days early.
DD took 4 days to come, so I was admitted exactly two weeks before my due date.
DS didn't take as long, but I was still admitted 12 days before his due date.
So it doesn't sound like it's far out of normal to me. If this is your first your induction could well take a couple of days - plus that gives them wiggle room accounting for things like holding back on breaking your waters if the labour suite is full, as happened to me.
No call back from consultant - I guess it will be Monday now. Bugger.
Remember they can offer you an induction date and you can decline
Even something as simple as "Monday doesn't work for me, can we do Thursday instead"
Then you can call on Weds and reschedule if you wish
That's true Ave - although it's section rather than induction so they may only have limited slots. I am fine with ELCS 10 days before EDD but I really don't want steroids...
yes sorry I missed that
I agree that steroids are best avoided and if there's no compelling reason for an extra early CS then best to wait a bit longer
Updating for everyone who was kind enough to comment and for any mums to be with GD who might look at this thread....
I got a response from the hospital and the early CS date is nothing to do with the GD. She said that if I remain diet controlled and baby measures normally there would be no reason to bring him out early. However, I have had previous abdominal surgery and there is a surgeon available on that date who is the tertiary expert on the previous surgery and my obstetric consultant wants him to scrub in with her. (Apparently they have cleared the elective list for that date and are only doing me - plus emergencies - so I feel a bit churlish to whine about steroids now!) It's great care and reassuring but I am slightly worried that they are expecting it to be so complicated!
Thanks again everyone
Glad you got the answers you needed. Good luck!
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