Anyone have experience of insulin-dependent gestational diabetes, induction and VBAC?

[FairyBasslet]

Sorry this is going to be fairly long as I get my thoughts in order...

I'm 34 weeks with DC3. DS was a natural birth, back to back so very painful and had an epidural but pushed him out with no assistance aside from a little snip. He was born at 41 weeks and was 8lbs 7.

DD was undiagnosed footling breech which was spotted when I was heading into transition (had only just got into labour ward - everything went very quickly) and necessitated a crash section with general anaesthetic. She weighed in at a whopping 10lbs 5 and according to several midwives and doctors, did me a favour by being breech as they reckon I'd never have got her out naturally (I'm only 5ft 2 and not of very big build). Again, she decided to appear at 41 weeks.

Anyway, fastforward to DC3 and whether to attempt a VBAC or not. I have been diagnosed with gestational diabetes this time and am on insulin 3 times a day for this as I have been unable to control it with diet alone. I understand that I would be on some sort of insulin drip to control my blood sugars throughout labour and, due to the prior c-section, baby would be monitored as well. Also, I would likely be offered induction at 38-39 weeks but I don't think induction is particularly conducive to a successful VBAC.

The Diabetes Midwife I saw last week is keen that I try a VBAC but I don't see the consultant or have a scan for another couple of weeks. Last time I saw her she made a comment about the risk factors mounting, and having done a bit of reading now, I kind of get what she's saying. Baby is looking to be just over 8lb at 38 weeks according to scans but I know there's at least a 15% margin of error.

Previously I was worried about the possibility of shoulder distocia but now I'm starting to think about the potential of uterine rupture as I know that this is more likely with an induction.

My main reason for thinking of attempting a VBAC is obviously to minimise recovery time, having a 5 year old and a 2 year old to deal with. I don't have a problem with the thought of having another section as I recovered very well last time - it's just the inability to drive etc that's worrying me.

Does anyone have any experience with the above combination of insulin-dependent GDM combined with induction and VBAC?

All thoughts and advice gratefully received as this is starting to keep me awake at night now trying to figure out what to do.

No advice .. but good luck

Not time to post a proper reply (really must go to bed!) but I'm diabetic - had an attempted vbac with dd2 but failed as she was so big! When you're diabetic you're at higher risk of larger babies, sure you know this. Keep blood sugars really tight and this will hopefully slow down growth.

I was induced at 38 weeks and it was horrendous. ended up with insulin drip, epidural (bp was rising and they advised me to have one even though didn't want), then couldn't wee so catheter, plus continual monnitoring. Found the whole experience awful.

However, I have got 3dc and recovery from 3rd section was fine.

Will try to get on again tomorrow if I can to make more sense lol

Thanks for the wishes Daffodill.

Canofworms - Thanks for sharing your experiences. I think that's why I'm starting to think more along the lines of having an elective section - I can just tell that the induction experience is not going to be very nice. I think I read somewhere that they'd give you an epidural as a matter of course just in case you end up with a section so I'd fully expect that, although that's no comfort to me seeing as with DS my epidural didn't work properly down one side.

Hi Fairy..just seen this thread. I am also pg with DC3 and I am an insulin dependent diabetic. I am currently having the same dilemna as you and am waiting to speak to my consultant about delivering this baby. I was induced with DC1 at 36 weeks because of pre eclampsia and it was a pretty horrid expereince but that is prob because I was very poorly. With DC2 I had an emergency c/s as DS was in distress. Any induction is likly to be quite a medical procedure and with the added complications of diabetes and VBAC you will probably have to resign yourself to the drips and monitoring if you opt for the 'natural delivery'. If it helps, I am thinking of asking for another C/s unless the consultant can convince me otherwise.

Hi Bojangles. I'm coming to the same conclusion as you. Although the two midwives I've seen in the last couple of weeks (diabetes specialist and community midwives) are trying to convince me there's no reason not to have a VBAC, I'm gradually coming down on the side of elective section.

Like you, I'll see what the consultant has to say. I must admit, this is one of the most difficult decisions I've ever had to make.

When are you due? I'm due 1st Nov but the Community Midwife I saw today reckoned baby would be out at 39 weeks.

I'm due 4th Jan and currently been told 39 weeks but with my track record (36 + 37 weeks) I am presuming sooner. I got pre eclampsia with both of mine and there were signs that my placenta was failing. Added into my current preganancy are a low lying placenta (may well move) and I have just tested positive for group B strep. I know it would be better for baby to be born 'naturally' but my emergency c/s was a far better experience than my induced delivery.

Keep me posted.