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Gestational Diabetes and induction

(19 Posts)
Tazlet Tue 19-Jul-16 12:24:35

Hi all,

I have GD and have been told I have to have an induction at 38 weeks. I've read so many bad things and really really don't want an induction. My bump is weighing in absolutely normal, there are no issues at all so i don't see why they just can't monitor me rather than just do what feels like a tick box and give me an induction. What do you think?

Idontknowwhoiam Tue 19-Jul-16 12:32:18

I was induced at 38 weeks and had an emergency section in the end.
2nd time I had an elective section as baby was breach at 39 weeks.
3rd time elective section at 38 weeks as I ended up on metformin.
I was glad to get the babies out but I don't think they can force you.
The more pregnant you get, the more strain your body is under and the harder it is to regulate your sugars yourself.
As you probably know this not only leads to the possibility of a bigger baby but also the chance of the baby having problems with their blood sugars after delivery.
I think it's more to prevent the babys dependance on your sugar levels for longer than necessary.

Did you tell your consultant you weren't keen on an induction? It's easy to get swept along with their plans in the room!

Karmin Tue 19-Jul-16 12:51:57

I have GD and SPD and will also been induced at around then. My sugars are good all the time and I am managing so far with a strict diet (Results between 4-6)

I understand that it will get harder for my body to regulate the insulin and also the risks to baby if he/she has a hypo after birth due to my blood sugars. Talk to your consultant and diabetes midwife and see what they say!

skatesection Tue 19-Jul-16 12:56:27

What would you/they say to an elective caesarian?

frikadela01 Tue 19-Jul-16 13:00:42

Don't know much about GD but just to say you can refuse the induction. They can't make you have one.

Having said that not every induction ends in a dramatic fashion. I was induced at 39 weeks due to hypertension and obstetric cholestasis. I had the prostaglandin gel at 14:00 with midwife telling me my cervix wasn't even close to ready so would likely need to repeat the gel at least once and then they'd look at breaking waters and the drip. Was examined at around midnight after having mild period type pains, cervix was softened but still not ready. By 2:30am I was 7cm. Active labour lasted 3 hours 38 minutes and I delivered normally with only gas and air (not my choice, I begged for the epidural but there was just no time).

So for me induction wasn't such a bad thing. Lady across from me on the ward was also induced but for GD and hers was similar to mine, labour was just a bit longer. Not all indications end in the drip, forceps, emcs etc. But like I said you can reduce if you want.

JeNeRegretteRien Tue 19-Jul-16 16:20:28

How are your blood sugar levels? If they are under control with diet and the baby is a normal size, I can see why you wouldn't want an induction, but if you are on medication or finding it hard to control them, I imagine there would be a stronger case for it. (Bearing in mind that, as a previous poster said, they get harder to regulate as the pregnancy goes on.) I also had GD and was not keen on the idea of induction, but a small bonus was the relief at not having to follow the diet for an extra two weeks!

Another thing to bear in mind is that the baby can put on weight very quickly at the end (40g per day, like a newborn), so 2-3 weeks can be the difference between average-sized and very big. I think the rationale behind inducing big babies is that the complications caused by being large (especially if it's because of GD and not just because the baby is programmed that way) are potentially worse than the risk of complications with induction. That could be worth discussing with a professional if it might apply in your case.

Kalispera Tue 19-Jul-16 16:28:45

I had induction for GD twice. First was long, boring and ended in forceps, but all was fine.

Second was fast as hell and only needed gas and air.

I wouldn't fuck around with GD. Just my opinion though.

AveEldon Tue 19-Jul-16 17:16:51

www.nice.org.uk/guidance/ng3 The NICE guidelines say you should be able to go to 40w+6 if you have GD
They were only updated in 2015 so perhaps your hospital need reminding of them

I have GD & other issues and I am currently booked for 39w+1 but DH & I are discussing possibly waiting longer

Pregnancy & childbirth appear to still be dominated by medical staff telling preg women what they must do - the guidelines generally say "offer/advise" !

strawberrypenguin Tue 19-Jul-16 17:22:09

You don't have to have an induction but they don't recommend them for no reason. I've had 2 GD 38week inductions on was a slow start and the other fast, really neither was that bad.
Baby size isn't the only reason for induction with GD, the increased sugar levels you have can cause the placenta to start degrading sooner than it should so if you do refuse it please do make sure you have extra monitoring in those last few weeks

GruffaloPants Sun 24-Jul-16 00:29:23

Agree you need to consider the risk of the placenta deteriorating as well as the baby size.

Im diabetic. I'm about to be induced at 36 weeks as my placenta is showing signs of reduced function. You don't want to get to an emergency situation, which can happen easily as deterioration can be quick. I was fortunate that minor problems started emerging the day before my clinic appointment, not the day after. Even though I've got good diabetic control and awareness I don't think I would have rushed to make contact between appointments, the changes were too subtle.

The risks of placental failure and stillbirth increase after 38 weeks.

mummydoc123 Sun 24-Jul-16 11:09:38

GruffaloPants - would you be able to share what the subtle changes were? I'm 30 weeks on insulin and metformin (with fairly good control) and would like to know what I should be looking out for. Already on 2 weekly scans at moment as baby on 10th centile (small).

GruffaloPants Sun 24-Jul-16 14:17:12

My insulin requirements dropped - started having lots of hypos. This can suggest that the placenta isn't working so well. When they did a CTG (monitored heart rate and movements) there was some difficulty establishing what the baby's baseline was. Overall though the baby has been doing OK. This was mid week. More recently it has been less active.

I've been monitored for a few days, given steroids and am being induced tonight at 36+1.

If you notice any changes in your blood sugar patterns speak to your team asap. My experience is that midwives without a specialist diabetes interest aren't aware of dropping insulin requirements as a risk - lots of the ward midwives have been asking me about it and keen to learn more through my treatment.

ricepudding84 Sun 24-Jul-16 15:19:33

Risk of stillbirth increases with GD towards/post term which is one of the main reasons for induction. Of course you can decline as is your right, but important to know why they advise it. Makes a difference depending on how your diabetes is controlled.

mummydoc123 Mon 25-Jul-16 16:15:31

Thanks Gruffalopants. Hope all went well xx

GruffaloPants Mon 25-Jul-16 16:40:54

No problem mummydoc. Still waiting for things to really get going but I'm contracting and baby is doing well. Just distracting myself mumsnetting!

GruffaloPants Tue 26-Jul-16 22:30:26

Just reporting in to say that my induction went well. 5 hours from waters breaking to delivery. Only needed gas and air, to my surprise. DD is lovely.

Threesoundslikealot Tue 26-Jul-16 22:38:01

I had GD with DS. My blood sugars were controlled throughout and at 36 weeks, after a scan showed the baby, placenta and waters were all fine, I was returned to the low risk population. This had all been at my request, with a sympathetic consultant. I was seen at a leading GD clinic with far tighter guideline readings than many others (<7 an hour after eating and <5.5 fasting - ONE outlier reading saw you on Metformin and 90% of their patients were on medication).

I had a home birth at 40+3 and had a 7lb15oz baby.

Historically outcomes for GD have been confused a bit with those of existing diabetics, T1 and T2. Their risks are far higher.

There's a reason why the NICE guidelines have changed for well-controlled GD. A rare example actually of a risk being downgraded. Obviously this is all personal to you, but do discuss the NICE guidelines with your consultant.

mummydoc123 Thu 28-Jul-16 20:06:04

Congratulations Gruffalopants! Giving hope to the rest of us who will probably be induced. x

GruffaloPants Thu 28-Jul-16 22:20:29

Thanks mummydoc! I had a great midwife. It also helped that I planned to have an epidural but wanted to be mobile (as mobile as you can be with 2 drip stands and a CTG monitor!). I just kept telling myself, "I'll maybe have one more contraction, then ask for the epidural". Before I knew it it was too late and I knew the more I did what I was told regarding pushing etc, the faster we'd be done.

Don't accept being told you have to lie on your back like I was the first time!

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