Induction at 38 weeks - what do I need to know/ask?

[NoRoomForALittleOne]

I'm currently 28 weeks pg with DC5 and was told on Monday that I'll be induced at 38 weeks. I have gestational diabetes and am on insulin at nighttime for it which is keeping my blood sugars within target range. The policy at my local hospital is induction at 38 weeks for any woman with insulin controlled diabetes even if blood sugars are stable and well controlled.

All four of my previous births have been spontaneous vaginal births. I've been told by the obstetrician that they'll probably just break my waters to induce me but that is not a recommended method of induction in the NICE guidelines (although the induction guidelines aren't intended for diabetic women).

I'm nervous about being induced for a number of reasons but mainly because I'm worried about my body not building up to labour and then having a very quick lanour. Each of my labours has gotten shorter with my last one being 25 minutes.

Also, would you request an ELCS instead? My last baby was big and had a shoulder dystocia. I'm having growth scans that suggest this baby is fairly average at the moment but that was the case last time too. The baby has a particularly large abdominal circumference which I believe is an indicator of macrosomic baby. They don't want me to have an ELCS because I have "birthed well in the past" and the CQC have told them to get their c section rate down.

I am being closely monitored and there is a cut off point that means they will want to do an ELCS but because all of our babies are short in the leg compared to overall size and weight, the femur length of this baby being 'average' is the one number that is bringing the calculated weight of the baby down to an 'acceptable' level. I'm quite anxious to not have another shoulder dystocia going on but I am petrified of having an ELCS so I don't know what to ask for!

Any experience, thoughts or research papers to wave under the consultant's nose would be very much appreciated.

Anyone?

Hi NoRoom,

I had an induction with DC3 at 39 weeks which was fine. It sounds like you labour quickly as a general rule so there is no reason why you won't this time. My labours at term are always slow (days, not minutes!) and the induction was no different i.e. the gel pesseries were useless. Things only got going when i had a good moan at the consultant and she agreed to site an epidural, break the waters, ramp up the IV drugs etc. DC3 then took about 5 hours (fast for me!) but it was painless and I was able to rest iyswim. It did end in another instrumental delivery.

With DC4 I am having an ELCS (private) because I have just had enough of natural birth (three large babies, three instrumental births, lots of stitching and tearing over the years and uncertainty as to when the baby is coming). I am not fearful of the ELCS…a controlled operation in a controlled setting with controlled pain relief. I am most relieved not to have to labour for days before giving birth and actually begin the journey with DC4 relatively unexhausted. We have ensured there is a large support network around for 3-4 weeks after the birth and I am relieved to have an actual date so that family can accept/decline offers to help so we know where we stand!

It is a difficult one - given that birth has been 'easy' i.e. speedy in the past, I can see their inclination for an induction (my consultant was keen for me to have an ELCS as he felt that my birth history was more than likely to be repeated 4th time round!). However, I think given the uncertainty of the shoulder dystocia, the large size of babies etc, I would personally push for the ELCS. Too many what-ifs and maybes. And given they are saying that an ELCS might have to be an option anyway, means they should remain open to it?

I would write your concerns down and present these to the consultant and take someone with you in case you have a hormonal breakdown.

Good luck

Hmm difficult one. I have now had two inductions and one c section. First was by drip since I had an abruption and he was premmie. It was very intense, about 4 hours. Second was full term and all they needed to do was break my waters since I was dilating already and cervix was soft, didn't even get pessaries, worked great for me. Although had episiotomy and ventouse. Sounds like they have this in mind for you. Third was a sort-of emergency c section due to low placenta and five increasing bleeds, another premmie. Must say, in terms of the actual birth, c section was much easier, but in terms of recovery much longer, even compared with episiotomy. I did enjoy the feeling of accomplishment and bond with natural birth, not that I love ds3 any less! So those are my thoughts...

It's not an easy one, is it? I have contacted a supervisor of midwives to discuss my concerns and review options as it seems the only way to get a reasonable discussion going.