What would you do, induced vaginal or elective c-section?

[Gilliana1]

I'd really eally welcome everyones advice on a decision I have to make this week.

I'd 37.5 weeks, first baby, aged 35, and baby is over the 97% quartile in size, with a huge tummy. They have suddenly discovered that I've had some gestational diabetes that they hadn't detected. At the moment the scans estimate baby is 9 pounds. Before pregancy I was 50kg, size 8, petite frame, 5ft3.

The hospital have given me two choices. To be induced at 38 weeks 1 day, try for vaginal delivery and accept fact that in such large babies (with wide shoulders as disproportionatly big) I have 50% chance of emergency c-section. Or to have an elective c-section at 39 weeks.

My husband and I probably won't be able to have any more children (if that makes any difference to decision) as I have ovarian failure and this one was a miracle upon miracle IVF'd in America.

What would you all do? I keep swinging from one option to another. I'm scared of having major surgery but I'm equally scared about massive tearing, baby getting stuck and dying ;-(((

(The head in the sand approach, hoping the decision will go away isn't working!)

It is really tricky I'm 5' was around 7 stone!!!! Had delivered my 2nd at 10lb 6oz needing one tiny stitch because there was a nick that bled a lot. I don't think induction at 38 weeks would be fun, I've had 4 inducations ranging from due date to 17 days over and the due date one did not go well despite it being my 3rd dc.

Can you get them to wait a bit longer for the planned c-sec to give baby a chance?

Ususally with GD the weight is in the body tissue not them having a big head & broad shoulders?

It got in naturally and its your body that is growing a baby to fit your body. I would go natural all the way. elective cs is STILL major abdominal surgery and has just as many complications.

That sounds nice in theory MSTG but in reality obstructed labour is a common problem worldwide and in dveloping countries a very real danger to mums and babys. We are lucky that we have access to medical interventions that reduce risks.

The idea that childbirth is natural and therefore intervention is to be avoided at all costs is ignoring the fact that natural childbirth is associated with very real risks for many people. I could have died with my baby 100 years ago or indeed in many countries today.

MSTG did you read the OP? It's an IVF pregnancy.

There was definitely nothing natural about my pregnancy.

Piles and piles of drugs for stimulation, ripening the eggs, lowering my immune system, getting implantation hormones up... I'm just very lucky we are in an era where it is possible or I wouldn't have my bump.

Massive congratulations on your bump btw Gilliana

C Section, planned, calm, less stress, should have a quick recovery. They wouldn't have suggested it otherwise. Good luck!

Just to tell you my experience as I had a similar situation- I was same size, height weight as you; baby was overdue and they said he was big, especially a big head, estimated maybe 10 lbs. Head wasn't engaged at 42 weeks, etc. They didn't actually offer me a C section, just induction. Took pessary at 42 and a half weeks. Four hours later went into labour. When it came time to push (about 8 hours later) nothing happened. His head was too big for me to push out I guess. His heart rate dropped a few times so they rushed me in for a emergency C. They did try forceps first but they didn't work. My recovery time for the C was short, so it worked out OK and DS was fine. He was only 7lbs something though! Not sure what i'd do if faced with same decision again. I wasn't frightened at the time , but I guess looking back on it his heart rate was dropping and his head was stuck. Perhaps next time i'd choose elective C. God it's so tough to know.

If you are narrow of frame and little of foot as well, then yes to the elective imo.

I'm in a similar situation. DS was 11lb 5oz and current bump (due 14/12) measured 7lb at 30 weeks and is on 90th centile. I also have GD. Only difference is that I am 5'11" and am usually 10/11 stone, so I should really be able to push them out. DS was a natural birth, but incredibly long labour resulting in ventouse, epesiotomy and shoulder distotia. It took easily a year for me to fully recover and never properly established breast feeding as a result of his shoulder pain.
This time they have offered me induction or C-section. From what I have heard about induction, slower and more painful labour, less chance of pain relief etc I have opted for C-section at 39 weeks. Apparently with GD babies lungs develop a bit later, so they like to try to keep them until at least 38 weeks.
Can't give you any advice as a very personal decision, but hope the above helps a bit.

I would absolutely definitely go for the induction. Sure there was a thread a few months ago about induction vs c-sec for diabetics, where the risks were well discussed. Will have a quick look to see if I can find it.

Here. Haven't re-read it, but from memory is worth a look.

I just wanted to thank everyone SO much for all the advice on my dilemma. I've decided to go for the elective c-section rather then induction.

Of course all those worries about bleeding, bladder damage, months to recover, major surgery are forefront on my mind. However, all your stories of equally awful consequences of large babies, diabetes babies getting 'stuck' and tearing and recovery have swung it for me and I just want a calm (I hope), planned affair and to see my baby safe.

For anyone reading this thread, and who has to make a similiar decision - I'll post after my c-section and let you know how I did and whether I think i made the right choice!

Thanks again

Hiya,
Can't advise what to do, but want to tell you my story in case it helps in any way.

My first was 9lbs 6oz, and I suspect I had mild gd during that pregnancy which wasn't picked up.

Had gd in second pregnancy but it wasn't picked up until very late (I never had sugar in my urine). I couldn't face an induction or a hospital birth and decided to press ahead with my plans for a home birth. I was reasonably confident that I could get a big baby out vaginally as had managed with first (albeit with the help of forceps) and baby was born (at home) at 41 weeks weighing 10lbs 12oz. All was fine (ish - baby got a bit wedged on way out but was resolved calmly by brilliant independent midwife).

Third baby was diagnosed with gd early on in third trimester. I was diet controlled. I had lots of scans - was told that this baby was likely to be bigger than my second - head circumference was above 95th centile. I was determined not to give birth to a 13 pounder as second birth had been eye-wateringly painful. I went on a brutal diet at 32 weeks which consisted of the following foods: vegetables - especially green leafy veg, oily fish, nuts and seeds, small amounts of fruit. In small amounts: oats, basmati rice, dairy products, wholegrain bread. I only ate enough carbohydrates to avoid becoming ketotic. I took my blood sugars very, very freqently - felt like a pin cushion, until I worked out how my body was responding to the food I was eating. I supplemented with small amounts of cinnamon (not recommended in early pregnancy) to reduce blood sugars further.

I had my third at 40 weeks and he weighed only 9lbs 3oz, despite being by far the longest of all three of my children and the one with the biggest head circumference. At 3 years old he's the only one of my three children who is much taller than average. My oldest is average height and my middle child is tiny for his age. I have NO doubt that had I not followed this diet I would have ended up with a massive, massive baby.

Would like to add that at the end of that pregnancy I was thin as a rake, and my son was skinny at birth - he had legs like a chicken and loose skin. He went up through 2 centiles in the first 10 weeks - exclusively breastfed. Now he's a very lean, very muscular toddler, with a frightening amount of energy. I think my pregnancy diet was fantastic for his growith and development.

Would like to add that I'm 5 ft 6inches and normally a size 10/12.

Also would want to add that not all people with gd are treated in the same way - it depends when your gd developed in pregnancy (first trimester gd is more problematic) and whether your gd is diet or insulin controlled).

I chose not to be induced with either of my second two after my diagnosis. I went into labour spontaneously the day before my due date with my third - but only after two very vigorous sweeps (winces at memory).

"That sounds nice in theory MSTG but in reality obstructed labour is a common problem worldwide and in dveloping countries a very real danger to mums and babys"

It's actually not anywhere near the most common cause of maternal and infant death in developing countries. When it does happen it's usually because of the way position of the baby (ie transverse or shoulder presentations), or because many women in these countries have babies before their pelves are fully developed, or because mums who've experienced malnutrition in childhood have malformed pelves that won't allow them to give birth vaginally. True obstructed labour is unusual in the west.

"If you are narrow of frame and little of foot as well, then yes to the elective imo"

There is no good research backing up the view that having small feet makes you more likely to have a c-section. And you can't judge the size of your pelvic outlet from looking at the width of your hips. I know some incredibly skinny, modelly looking women who've sneezed big babies out!

Dear Gilliana: congrats on the miracle pregnancy

I read you have decided, been lurking before but want to wish you all the best now.

I've had an EL CS and it went very well. Given that this is a miracle baby I wouldn't leave it up to chance for the sake of the 2 of you. I felt very in control of my EL CS and the epidural even allowed me to wriggle my toes. I had great nurses around me after the birth and wonderful support from my Mum and DH. I did feel sore on the scar but it was worth it for the peace of mind knowing I'm in good hands of a Mr. and a senior anaesthetist and it was all mapped out.

I'm wishing you luck and hope to see you pop up in Birth Announcements!

C-section. Definitely, c-section.

OH wobblypig sound like you had a similar prob to me, your advice about pessarys and not drip invaluable! Thank you.

I have a similar dilema of first birth very traumatic for baby and me. I ended up in theatre after vaginal birth he whisked to resus and it was horrible.

Our next is due 05/09 too and have already told midwife I want a section. However they are trying to talk me out of it.

We shall see as they say.

Good luck with your decision Gilliana

Hi there,

I didn't read through all the thread so sorry if repeating what has already been said...

Since you say you were a size 8, I assume you also have a narrow pelvis...If I was in your position, I would choose an elective c-section as the thought of quite likely needing an emergency c-section would put me off.

I had a c-sec with dd 1 and it really wasn't that bad and as long as you have a supportive husband who will help then you will be fine.

Good luck x

You have had a lot of great comments here, but I just wanted to say good luck in whatever you choose, and I hope all goes well for you!

For me (having experienced long difficult painful vaginal delivery and wonderful calm though nerve-wracking elective CS) I would say elective CS.

You do have to take the recovery slowly, so you will need a lot of support but in many ways it was quicker than my recovery from 1st birth (emotionally and physically), and I was also in hospital for less time with the section (and got a private room which was a definite plus). I bonded with my baby much better, and I'm sure that was because I was depressed after the bad experience I'd been through.

If you do go ahead with the CS, don't feel bad if baby is not as big as you were led to believe- you would have made an informed decision based on the evidence you had at the time. I wondered whether I might have had a straightforward 2nd labour as 2nd babies are generally quicker and easier than 1sts, but I'll never know, and you will never know how it would have been the other way, so no point thinking about it.

Good luck whatever you decide. Let us know how it goes

I promised to post my outcome so anyone reading this thread in the future with a similiar dilemma can at least read my 'after thoughts' and hopefully it may help them.

I had an elective c-section in the end rather then opting for being induced at 38 weeks. I definitely made the right decision. The whole thing was extremely calm, organised and not stressful at all. Apparently, baby turned out to have very wide shoulders and tummy (I had gestational diabetes) and the surgeon said he couldn't see that she would have fitted through my pelvis.

In terms of post-operative recovery. Well, it isn't easy but I am on day 14 now and I'm up and about at home, on the computer, able to load the washing machine, fend for me and baby by myself OK. So it isn't as disabling as I had feared.

If anyone ever wants any advice feel free to contact me.

Back to my delightful daughter[smils]

Congratulations!