VBAC - induction and insulin dependant diabetes

[tigger15]

Is there anyone who knows anything about this.

I was induced in Feb had a successful first gel, waters broke naturally, too much pain, epidural, stuck at 8cm after 11 hours of labour and Em CS at 18 hrs. I had a doula with me who was great and whole thing was not too traumatic.

After birth was awful. DS had low blood sugar, nipple confusion, scar infection for me due to inter borough fighting over who we belonged to, readmitted for jaundice, sent back to hospital for vomiting and fainting with pain - me, still do not feel great at 6 months.

So the next time I would like: VBAC, to get home ASAP as hospital was awful, no low blood sugar for baby.

The hospital I was at, St Mary's Paddington was insistent on CFM once I had insulin drip in and restricted me in a few other ways so I don't think they'll be receptive to VBAC w/out CFM.

Does anyone know if any other central london hospitals will be receptive to VBAC w/out cfm? I know I'll have to fight for some things but I don't want to have to fight for everything.

Has anyone had a successful VBAC whilst on insulin?

[mears]

The issue here for me is induction and VBAC - not a good idea to be honset. It increases the risk of scar rupture.

It can be done though, but definitely would need CFM and NO prostin gel.

Spontaeous labour is always best for VBAC but the needs of your diabetes are paramount.

Usually delivery is around 38 weeks due to risks associated with diabetes.

Are you well controlled?

[tigger15]

I was incredibly well controlled. The model patient. HBA1cs were all well under what they wanted. Scans were on scale or bit under although ds was 8lb 5 (but part of that was swelling from fluid cos he was 7lb 3 when we left 3 days later and kept on losing his tag in the cot cos his leg had shrunk).

They kept on telling me they'd need to induce at 39 wks because the placenta deteriorates. I finally found the source of this. The NICE guidelines say that diabetics should be before 40 wks and everyone else by 41 wks.

I know induction increases the risk. I tried every natural method to induce (except castor oil) this time but I don't think ds was ready and that might be one of the reasons I couldn't dilate fully. I was induced at 38+6 so next time I'd at least argue to going to 39+6.

[mears]

tigger - I think you will need to weigh up what birth experience you want against what is ssfe.

I am all for VBAC with no continuous monitoring when it is a spontaneous labour. However, if you have an induction involving syntocinon, you will need continuously monitored due to the risks of syntocinon itself.

If your diabetes is stable and you go into sponraneous labour then I see no reason why you shouldn't be able to attempt VBAC.

If you do need continuous monitoring, you should be halped to remain as mobile as possible. You don't need to be in bed to be monitored.

Sorry I don't know any of the hospitals in London which will be receptive. However remember you cannot be forced to have anything you don't want but you need to have researched it all thoroughly before you can make a decision. Good luck.

[tigger15]

I told the midwife running the antenatal classes that I would have CFM due to insulin drip. She said that I could get into different positions when on it.

In labour they made me lie or sit upright on the bed as otherwise they lost the trace. They complained when I tried to change sides, because it felt more uncomfortable on one side than the other, that they lost the trace. I told them I wanted to be mobile but they said it meant they couldn't monitor me and was dangerous to the baby. How do you argue with that? It's irrelevant to them that in the evening when the midwife was running btwn 3 other women it was my doula who watched the trace and it would have made little difference if it was checked with a sonicaid as I only saw the midwife every 15 mins or so.

How do I know that any other hospital I ask about their policy will say one thing before and then point blank refuse once I'm in labour?

[canmummy]

Hi there - don't know if I can offer any useful advice but I'm insulin-dependent diabetic and attempted a VBAC with my 2nd.

Not in London I'm afraid but if I can be any help as to care I received just ask!

[tigger15]

Were you successful CanMummy? Do you want me to CAT you?

[canmummy]

No I wasn't successful but baby was 9lb 15oz!! Have since had another elective section so have both sides of the story to tell.

[mears]

tigger - what you could do is arrange to meet the manager of the labour ward and your consultant to discuss what you want to happen in labour.

You really should have one-to-one care with a midwife when in labour trying for a VBAC.

All hopsitals will have a policy for CFM. What you have to discuss is your individual birthplan.

You can contact the Supervisor of Midwives for your area if you are not given assistance here.

Is there a Consultant Midwife at the hospital your are booked with? You could speak to him/her.

[tigger15]

Canmummy can you tell me more about your vbac? Did you go into labour naturally? What was different about it from the first time? CAT me if you don't want to talk in public.

[Klaw]

I would be interested to hear more to as all experiences are very good to learn from and make me a better Doula.

[bojangles]

Hi Tigger - you sound like you had a a really traumatic time first time round.

I was desperate in my second pregnancy not to have a repeat of my hideous first induced labour and would regularly beg the consultant to give me a section! I hated being induced (I was only 36 wks) and I was essentially strapped to the bed throughout with CFM, the insulin sliding scale drip and a permanent blood pressure cuff. The counsultant assured me that I could have moved around if I wanted to but looking back I don't think it was possible and the staff looking after me preferred, I think, for me to comply and let them do their stuff.

I didn't want this second time round but I didn't feel able to go against the advice bearing in mine my obstetric history. However, I ended up on the labour suite about to be inudced again at 37 weeks with DS but was 'saved' the induction as the consultant didn't want to proceed as he thought DS was in distress. I had an emergency CS and for me that was far preferable to being induced again.

I always fought the medical professionals as I wanted to do things more naturally but in the end I accepted (reluctantly) that being diabetic was going to prevent it being my 'dream birth'. I would take an elective c section any day over my first hideous induction. I felt so much better 24 hours after my section than I did even a week after the supposed 'normal' delivery.

I was considered to have immaculate control through both my pregnancies - HbA1c of between 6 and 6.3 but in both my pregnancies my placenta started to show signs of failing around 36 and 37 weeks and in both pregnancies I developed pre eclampsia (severe in 1st and less so with 2nd).

I suppose I am saying by all means question the policies etc but perhaps you need to find a way to accept that being a diabetic presents you with challenges and any birth is always going to be quite 'medical'.

On the other hand, I did talk to one of the ladies who helped out during our NCT childbirth classes who was also a type 1 and she told me that after a grim first induction she refused it 2nd time and opted for a home birth with her husband being in charge of monitoring bloods, injecting and giving glucose. I don't think I would be brave enough for that!

[bojangles]

sorry, forgot to say that I also had a meeting with diabetic and obstetric consultant to agree a birth plan and whilst it might not seem a big issue they did endorse my notes to say that they were happy for me to have my own room post delivery contrary to their policy - only a small thing but I felt that I had achieved something and had some control over my stay in hospital!

[Bimblin]

I am type 1 and 25 weeks and have been v grateful be offered and to go for an elective c-section after similar with dc1.
However....everything I hear leads me to suspect that Kings is the most progressive hospital for everything d related. Try them

[tigger15]

I heard that Kings managed to lower their cs rate to 12% recently? What do they do for diabetics?

[Bimblin]

I only know this from talking to other diabetics but they seem to be ahead in terms of doing DAFNE, pumps, islet transplants etc so I expect they are good on d births as well. The only other hospital I've heard good reviews of from users is Addenbrookes.