Big baby, GD, they won’t induce until 41+6

[Dorset2]

3 days overdue with my 4th baby. This in itself has been a new experience as my others all came at 39 weeks so mentally I’ve been preparing to have this baby for weeks now!

I’ve got GD, diet managed, and despite a scan a month ago showing baby looked smaller than my others (biggest was 10lbs at birth a week early) there was an expectation that he would come early too.

my Midwife is very laid back and has said they won’t do an induction until 41+6. I’m really worried and anxious about the effect on the baby- his size, the GD etc and can’t understand why they’d wait so long (having read a lot it’s usual with GD to induce around 40 weeks) her opinion was I’ve done it before so I’ll do it again in relation to birthing a bigger baby…yes but I’ve never gone this far on before or had full blown GD! I did say I wasn’t happy about it but maybe should have pushed more. This is NHS and I have a second sweep tomorrow. Should I be asking to speak to an obstetrician? Make more of a fuss? It’s against my nature to do so but 41+6 (and likely it will be in the days after that if they’re busy) just seems too long with the factors at play.

Not sure about guidelines for gestational diabetes and I have not had any GD with my pregnancies. But yes, I would ask to speak to obstetrician. I would not see this as making a fuss, but as seeking medical advice as you feel understandably concerned. Best wishes for the coming birth of your baby! 💐

Absolutely yes. At my Trust even diet controlled GD pregnancies could go to only 40+5 I think? This is because the placenta can be poorer quality for GD pregnancies. Perhaps look for the NICE guidance. Kick up a huge fuss and try and get induced early next week I reckon.

I was induced at 42 weeks with my last baby, and this time I've been told the NICE/NHS guidelines have changed to recommend induction 41 weeks. That's even without big babies / GD issues.

Obviously you don't have to accept induction, but if you'd be happier going earlier it might be worth checking how the guidelines have changed recently. Good luck!

They can’t decline you an induction post term. Ring your midwife on Monday and insist you’re booked in, if that’s what you want. They wouldn’t have a leg to stand on if they refuse. Say you are worried about shoulder dystocia, or the risk of a still birth. They literally can’t refuse you.

The midwife is wrong
www.nhs.uk/conditions/gestational-diabetes/treatment/ says they should offer induction from 40+6

Have you seen a consultant at all?

Ask to see an actual doctor. Midwifes should not have the last word.

I had gd and there was debate on how big ds would be and whether or not that would lead to me needing intervention. I was told I'd be induced at 38 wks at the latest as per their policy on gd babies so that seems very late. I ended up having an elected section at 39+4. I'd ask to meet urgently with your birth preferences consultant to discuss your options and agree a plan. If you have gd you should be consultant led and shared care with the diabetes consultant I'd have expected.

Also the last couple of weeks is when their growth really increases. Ds was measuring around 6.5lbs 2.5wks before he arrived at 9lb 2oz. So quite a jump.

If I were you I'd ask to speak to a consultant.

I was told (by an obstetrician) that your body can birth a big baby if it has made a big baby, but that in cases of GD it's the diabetes that has caused the big baby, which can therefore make it too difficult for your body to birth, which is one of the reasons that they induce early

Also do remember you can ask for an elective CS if you are worried about the size of baby.

Thank you for all your responses! They make me equally relieved that people agree with me and anxious about waiting- it’s the right thing to have an earlier induction date. I’m determined to stick my ground tomorrow and will ask to see an obstetrician asap. If my midwife isn’t forthcoming and tries to convince me otherwise- who do I go to next? I’ll be in the actual hospital tomorrow at the ante natal clinic so probably the best time to ask.

also my blood sugars have been hitting new highs these last 24 hours despite no diet change so an extra reason to be concerned x

If you're going to the hospital tomorrow then stand there demanding to see someone who takes it seriously is basically what you might have to do. I think I'd have been having kittens if I was as overdue as you are and I didn have GD. You can ask for another midwife if you're not happy with your current one. I nearly ended up doing this but she decided to leave so I got a new one anyway.

As above elective section is also a possibility.

100 percent of your sugars are irregular again they should be doing something now

This is taken from NICE guidelines so you have every right to be induced before 41+6. Hope you can get somewhere with getting something arranged x

www.nice.org.uk/guidance/ng3/chapter/Recommendations#intrapartum-care

Not GD, but I was measuring a big baby at growth scans. Not my first baby either. I was given a consultant who discussed options with me, who advised a Sweep approx 38 weeks and then got induced early at 39 weeks.

Sent my reply too soon.

So yes I would absolutely push for a consultant and go from there.

Yes, I had GD and a suspected large baby last pregnancy and was offered induction/c-section at 38 weeks so that does seem very late. Hope you get to speak to a consultant!

As previous poster has linked national guidance (NICE) suggests delivery at 40+6 at the latest. Don’t want to be alarmist but risks include shoulder dystocia and stillbirth. Having had one experience of induction myself I wish I’d requested a section

Yes I would ask to speak to a doctor and I would take a print out of the NICE guidelines with me too and keep quoting that

I had GD and a big baby. I delivered naturally at 40+5 but had a C section booked for 40+6. I had declined induction due to previous birth injury so was offered a section. They said there was a risk of poor performing placenta and of shoulder dystocia.

I'd push back hard. Make a nuance if you need to.

Follow your instinct, you know your body and your baby.

The guideline when I had my last baby, with GD, was 40 weeks on the nose.

I'd be concerned about your midwife to be frank. GD can lead to an increased risk of pre eclampsia and can also cause placenta deterioration (which is already a risk when you're past your due date). Overall, inducing from 38/39 weeks leads to less CSs than leaving nature to take its course or inducing later than 40 weeks.

Can you push hard for an induction?

Just saw your blood sugars are not controlled.

You need an obstetrician.

My 2 GD pregnancies were induced at 38 weeks! I would push for a second opinion on this asap!

Hi OP don't know what's been going on here but you should definitely be seeing an obstetrician. Our GDM ladies see a specialist diabetic nurse and midwife alongside obstetrician at the diabetes clinic.
You are classed as a high risk pregnancy and if your blood sugars are now becoming unstable this will put your pregnancy at even more risk. I can't understand how you have not been seen by a doctor and induction discussed.
Virtually all our diabetic ladies are induced unless they labour spontaneously before induction date.
If you are being seen at the antenatal clinic in the hospital tomorrow ask to see doctor. I'm just astounded through no fault of your own you haven't as you should be under consultant led care.

Thanks ladies. I’ll let you know the outcome tomorrow.

Your tolerances can change as your pregnancy progresses due to hormone levels. I started out diet controlled and then moved into insulin at night only and then for me I found I found tolerate more as the weeks went on but for some women they can tolerate less. You should be having a weekly consultation with the diabetic nurse to monitor that closely and if your sugars are over regularly should be on insulin. Ask your midwife for an appointment with the birth preferences consultant, that referral usually comes from the midwife. She'll probably ask your reasoning but she should make the referral.