Being Induced because Type 1 Diabetic - Can I have a c-section?

[LisaClapham]

I am 17 weeks pregnant and have type 1 diabetes. The hospital (St Thomas in London) have told me I must be induced at 38 weeks - which I understand the reasons why. However I have requested an elective c-section which they have refused. Does anyone have a similar experience. I am scared about being induced and having a long difficult labour resulting in intervention (highly likely I hear) and would prefer to have a c-section - at least I can mentally prepare for that and know what will happen. Any advice?

I think the reason for letting GD go further is because they are lower risk. They are often not on insulin and generally have less risk of things going wrong. But I don't know for sure.

The nice guidelines are quite interesting but take a while to get through.

Lisa I can't recommend one way over the other to you as it has to be your decision but consider these factors for both routes.

1. What are the risks to the baby?
2. What are the risks to you?
3. What can go wrong?
4. What is the best possible outcome for each method?
5. How can you achieve that outcome?
6. Do you want to have more kids? How will the method affect any future kids?

As you can see from my and Athene's posts, the response to a c-sec is very individual. In some people it means they will only consider future children by elective and others only want a vbac.

Inductions are usually more painful and likely to lead to intervention but can be quicker and sometimes even easier. It depends on the individual and no one can predict what will happen. Equally no one can predict how easily you'll recover from a c-sec. You might be bounding around within a couple of days or unable to walk round the corner for 5 weeks.

You've got to decide what is the best outcome for you that you will feel happiest with and then go after it. Athene is right that you can refuse consent for any medical treatment and an induction is one. But obviously you'll have more of a fight with a c-sec.

Try adn decide what's right for you. Ask the consultants specific questions on the risks and get them to explain in English.

Good luck.

I think Tigger's number 6 is well worth thinking about (and so are 1-5 of course ). If you want to have 6 kids, most people would think twice about laying the groundwork for 6 sections. That is not to say it's never been done. But, I wouldn't want 6 of them. I think, for me, 3 sections is a realistic ambition. I could probably manage 4 if I had to. But I wouldn't start out planning to have four. As it happens my shop has declared bankruptcy and closed down after two. And I knew I didn't plan to have many more kids when I asked for the second section. The first section wasn't something I asked for. It was more of a 3am crash variety under GA.

Oh, and speaking of GA someone mentioned they prefer not to give a GA because it passes to baby. I thought the reason was that it is better for mum. The rest of the day (post section) is much nicer if you have had a local than if yo had a GA.

Lisa, I am a diabetic, on a pump, currently 16 weeks pregnant. I am monitored at Kings. I gave birth to ds at Kings 4 years ago and had an elective. Was the best thing I ever did. It was fab.
I have already told te midwife that I would prefer to have an elec cs, rather than a VBAC.
Toigger makes some very good points. Other people who have commented may not have the understanding on how complicated a diabetic birth CAN be. Often, there aont nothing natural about it. Monitoring this, drips that.
There are many many diabetics who want and manage the most natural, beautiful birth. There are many that don't.
You will be able to come up with very good 'diabetic' reasons, for whichever form of delivery you choose.
I thought ST Thomas and Kings were linked, thus I am surprised at their resistence. Mind you, they haven't said categorically no yet. Talk to someone else.
Get back to me, if I can be of any more help.

tigger - just wanted to let you know that with GD, if insulin is required, 38 weeks is the cut off point just the same as for type 1. If controlled well through diet alone then 40 weeks is the cut off.

Lisa/Athene - my midwife advised today that the stillbirth rate has been cut dramatically since the 38 week cut off was introduced, so that is the reason for being induced at 38 weeks rather than any later.

i have type 2 diabetes & have been induced with both my pregnancies. ds was 39 weeks, at st mary's, & was a pretty long drawn out failed-ventouse followed by forceps delivery. my obs & diabetologist came to visit me the following morning told me i looked rough & had done well not to have a section . dd was born at the homerton 3.5 years later, at 38 weeks and was a much easier, shorter labour. i pushed her out in 5 minutes (she was a pound smaller than ds). i recovered really quickly each time, much quicker i'm sure than if i'd had c-sections.

i did have a fairly medicalised time, i think that's impossible to avoid if you have diabetes.

not sure what i'm adding to the dicussion, just wanted to tell you how it was for me. talk to your team, they should take your views into account.

I am T1 too and have 2 dcs. First time I was induced at 36 weeks and sorry to not sugarcoat it but it was horrendous and ended in emergency c. Second time I had an elective as they didn't want to induce with a previous c scar, and it was fine. As I understand it the 38 weeks thing is due to risk of stillbirth past that rather than baby size.
There is a mothers with diabetes group on yahoo which you could join, they know loads. A site to check out is diabetes123.com - they have a doctor's q&a page and you can search questions or add your own.
The drip thing is annoying but not the end of the world, make sure you do your own bms - they kept making me go hypo and of course you can't eat once you're due to have surgery. Anything I can help with - not from the medical technical side, but first hand experience please do ask. Good luck!

I had gd and birthed at home once, and in hospital twice. My SIL who has type 1 diabetes had three induced labours - all ending in vaginal birth.

I think that as one of your options you might consider getting an experienced doula to come in with you to hospital, to reassure you and help you remain upright and as mobile as possible while you are being induced. It IS possible. I know plenty of women who've laboured on a birth ball while being continuously monitored and with a drip in place! People are quick to suggest doulas to low risk mums (because they know that having one reduces your risk of c-section) but forget that the comfort a good doula brings is JUST as good for a high risk mum having a more medicalised birth.

Good luck

That's a good suggestion tbb. I have hired a doula (which I didn't have for my first birth) for this birth precisely because of the diabetes.

Waves back to Hoxtonchick, hi Hoxton, thanks alot.

Lisa where are you?
God I hate it when an OP doesn't come back. Especially re an issue that is very very close to my heart/ pancreas
Lisa come back and reply.

I've just found out that the whittington encourages you to go to term providing all ok with the baby. Does anyone else know what lengths the other london hospitals do?

As we've seen from this St Thomas' appears to be 38 weeks and St Mary's was 39 weeks (17 months ago)

I have type 1, and have had two vbs.

With my first, my waters broke at 37 weeks, so luckily didn't have to make the decision to be induced (at 38 or 39 weeks at any rate!) It was a very long, hard labour, and I did have an insulin drip, and an epidural, but he did eventually come out vag with the use of forceps.

He's fine.

With DS2 I similarly went into labour early (36 weeks and a couple of days) and because it was early I didn't know I was actually in full-blown labour.

By the time I got to hospital (Kings College) I was fully dilated so only had gas and air.

Especially with my first, I was mentally prepared to have to have a cs, and feel very fortunate to have avoided it (by one push...).

All the best

I think Kings is 38 weeks.