Geststional diabetes - concerned about induction failure

[Antonia87]

I've just been diagnosed with Gestational diabetes and I'm going straight on insulin due to high fasting numbers. Therefore I won't be having a nice water birth. I am very concerned that induction won't work and the baby will get stuck whereas a C section that has been planned will hopefully be safer for baby and leave me less traumatised. This is my first baby.
Has anyone successfully managed to get a c section under these circumstances ? Thoughts on induction ? Are my fears realistic?

I had GD and had similar fears of induction going wrong so totally get where you are coming from. However in the end I went into labour naturally at 36+6 anyway.

Do you know what gestation they would want to induce you? Is it before 40 weeks? Is your baby measuring big and will you have a late scan to estimate size nearer the time? What is your family history of childbirth (eg did your mum have problems) All these factors would play into the choice.

The rules are that if you request a C section for "non medical reasons" (eg not breech, not placenta previa) they will talk you through the risks and benefits of C section vs vaginal birth. But if you still want a C section after that talk, you are entitled to it and they cannot refuse. Annoyingly some hospitals are more resistant to implementing this rule than others, but if it's what you want, stick to your guns as you are in the right.

Yes, they will want to induce at 38 weeks and Im concerned that if my body isnt ready ill end up in an EMCS anyway or forceps. I just dont want that to happen. It just happened to a good friend and her baby was born blue ( fine now , thank God) and she is still suffering physically. Seems C section is safer for baby?

Usually they don't decide too early in a pregnancy about c sections on your first. My dfriend was on insulin for GD and had a vaginal birth so don't worry yet, a vaginal birth is still possible. Cs isn't always the safest option, they will talk you through your options in later pregnancy. The Internet is not a good source of research and will just terrify you (I've been guilty of it too), every pregnancy is different. It's too early in your pregnancy yet if you've only recently had GD diagnosed. Enjoy your pregnancy and step away from the Internet

How far along are you? I'm on my third GD pregnancy and have previously had two successful inductions at 38 weeks. Despite my body not showing any signs of labour beforehand, the inductions were really straightforward.

You'll find that as you are insulin dependent you'll get a whole load of extra scans and monitoring. Almost all the risks of GD can be mitigated by controlling your blood sugars so no reason for your baby to be big etc (provided you've been diagnosed early enough - ie closer to 28 weeks than 36 for example). If there is any risk that the baby would get stuck they'll do a section, they are very cautious about GD babies.

Yes, I do think CS is safer for the baby. My DD1 was born not breathing at 34 weeks - she got stuck in my birth canal - and it now turns out she has some brain damage, thankfully very mild but there none the less. If I'd had a CS it wouldn't have happened (though I suppose she still may have had issues just from being 34 weeks, hard to tell the cause).

Perhaps surprisingly I still think trying for a VB is preferable to CS in most circumstances - despite my experience with DD1 and the results for her - but that's when it's a natural VB vs CS, not when it's early induction vs CS.

So in your shoes I would be pressing for a CS yes.

Cross posted with the two previous posts. I am a bit scarred by my experience with DD1 so perhaps not the best person to listen to.

Im 24 weeks and I struggled to get diagnosed as my hospital follow American, not NICE guidelines. However days , five days after I convinced them I have it they are putting me on insulin !

Hmm what was your diagnosis fasting glucose level?

According to NICE 2015 guidance here you are only supposed to be put straight on insulin if your fasting glucose level was 7 mmol/litre or above at diagnosis.

Otherwise it's diet first for 1-2 weeks, then metformin if that doesn't work, then insulin if that doesn't work.

Also this guidance says induction at 40+6 (which is very different from 38 weeks!!) if there is only GD and no other maternal or fetal complications (which I think means eg huge baby or high blood pressure).

I would print this off and discuss it with them. I wouldn't be happy giving birth at 38 weeks - whether c section or vb - when the guidance says you can go to 40+6 assuming no complications...

Fasting has been over 7 so I think thats why im going on insulin which has fewer side effects than metaformin. I dont mind giving birth at 38 weeks due to the risk of placenta failure with insulin dependant GD. My hospital is sooooo not interested in NICE guidance unfortunately!

I wonder if they are treating you as having pre-existing diabetes as your fasting is so high so early on (that's been the case with me in pregnancies after my first too although technically my levels are only classes as prediabetic in between pregnancies).

I'm having this baby in the US and here they induce at 39 weeks. They also don't like giving metformin to pregnant women and surprisingly they don't offer as many growth scans. It's interesting to see how much the NICE guidelines changed in 2015. I know the new research showed that outcomes were better when babies were born after 39 weeks but I didn't know they suggested going past 40 weeks. Id have been happy to not be induced in my first pregnancy but it's what I'm used to now so I find the idea of going into labour spontaneously more scary now!