To demand a caesarean

[angel772]

I’m 33 weeks pregnant and have gestational diabetes. I’ve been discussing birth options with my midwife and she’s adamant they should induce me early if the baby’s getting too big, or let me go to 40 weeks if not. I suggested a caesarean but she said induction was the preferred route with an EMCS if required.

Having looked into this, I came across this link and am now absolutely panicking that my baby could have oxygen starvation during birth, leading to severe disabilities:

www.gestationaldiabetes.co.uk/ceiras-story/

I can’t for the life of me understand why the hospital are even considering making me try for a vaginal birth given the huge risks to my baby, who is already on the large side (5.5lb!!) and so could very easily get stuck. I feel women are offered caesareans for much less and can’t see why it’s not been put forward as an option for me. Why are they risking my baby’s health and WWYD?!

Hi OP

I've just gotten back from my twice weekly monitoring at the hospital and had an interesting chat with the midwife.

This is kind of specific to my situation as I'm going for be having a "premature baby" aka born under 37 weeks but you may find this information useful...?

All women 36 weeks plus are strongly encouraged to get to have a VB as the “stress” of labour is actually very important "good stress" which makes the baby produce prostaglandin (a natural steroid) which genuinely really does kick start them into life.

She thinks that may be the case with 34 weeks plus but isn’t sure and has no idea about babies under 34 weeks so I need to have another conversation with my consultant again - which was booked for next week anyway.

However she said “most” mothers with PROM have an induction and VB “which says something”. She was trying to say that even premature babies in their weakened state apparently do better with a VB.

This is very me specific and obviously GD is a very different ballpark but just thought this may be useful, well timed info.

It doesn't address the issues about forceps/instrumental delivery though so I will be specifically raising that next week x

There is an in depth discussion of the medical evidence for giving birth to a big baby here
evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/.

In relation to caesarians it states

'With a policy of elective Cesareans for all suspected big babies over 9 lbs., 15 oz., even more pregnant people would have surgeries found to be unnecessary in retrospect, because ultrasounds are even less accurate in higher suspected weight ranges (Chauhan et al. 2005). In order to prevent one permanent brachial plexus palsy in babies suspected to be over 9 lbs., 15 oz., 3,695 women would need to undergo unnecessary Cesareans at a cost of $8.7 million per injury prevented.

Such policies would increase rates of known risks from Cesarean, like serious maternal infections, blood clot disorders, postpartum bleeding (hemorrhage) requiring blood transfusions, and newborn breathing problems'

@MrsRose2018 thanks that’s really useful. What is PROM?

Sorry OP I thought it may have expanded the abbreviation like it does with lots of others.

Premature Rupture Of Membranes - my frigging waters broke at 25 weeks basically x

You need to go back to your Trust and ask to speak to the matron of the department. Explain your concerns. They should then book you an appt with another consultant to discuss further.
I had the exact same issue as you. I was declined a ELCS due to Covid19 pressures and changes in the department, and was advised I could birth vaginally despite my GD and medical issues so would either have to wait for spontaneous labour or be induced at 40+6. I refuse to be induced for personal reasons. The original consultant I saw did not listen to me and had a view of what she wanted me to do before the appt and would not take my choices into account, and told me I have no birth choices in the time of a pandemic. I had all my facts and figures ready and was very clued up as to why I wanted a ELCS and the risks and benefits of it. The new consultant was happy that I had weighed up all the options and was confident I understood the risks and then happily booked me in for a ELCS at 39 weeks. It may also help to speak to the lead consultant for GD in your unit. At the end of the day, you have a right to a choice and nobody can make you do anything. You need to show you fully understand the risks to make an informed decision. Birth Rights can also help you with what to say

BTW the 2nd consultant who booked me in for ELCS was a new and young consultant so authority doesn't really matter. Each doctor performs as an individual practitioner as they are responsible for their own decisions

@LuckyA In your view what is the advantage of ELCS over early induction? The only big worry I have with ELCS is respiratory distress syndrome, which seems very low risk from 39 weeks onwards anyway.

With induction I worry about the baby getting stuck due to the large head circumference (98th percentile!!) and large size overall, which could lead to oxygen starvation and brain damage. The hospital say the baby will have an immediate EMCS if there are any worries about this during labour but why even take the risk?! Every minute/second could be critical.

I’m also worried about the brutality of forceps (likely to be used for an early induction) and the major physical damage this can do to the baby. I read on an old thread how a baby was left with learning difficulties thanks to forceps - no wonder they’re banned in some countries!

I know recovery from ELCS isn’t a walk in the park but if induction goes wrong the recovery is so much worse and can last months or years with permanent damage in some cases.

despite my GD and medical issues so would either have to wait for spontaneous labour or be induced at 40+6.

@LuckyA My hospital have now said they won’t let me wait for spontaneous labour because even if blood sugars are okay, the baby will keep growing because of the diabetes and make vaginale birth v difficult or impossible. So they want me induced early, before 40 weeks.

They also said gestational diabetes can cause still birth, which I’ve since found out isn’t true - if it’s monitored then the risk isn’t any higher for mothers with gestational diabetes.

OP if you want to reads the actual evidence insead of the 'expets' on google look at the Cochrane reviews
pregnancy.cochrane.org/sites/pregnancy.cochrane.org/files/public/uploads/induction-for-macrosomia%20%28screen%29.pdf

I was worried about a vaginal birth too (and the potential life-threatening complications for the baby). I myself had my life at risk as my cord was twice wrapped around my neck at birth. After a number of considerations I would have preferred a cesarean too. It happens that in my case i have to have one for completely unrelated reasons, but I totally get where you are coming from and if it was me, I would definitely go for c-section.

There are many messages I haven't read on here so this may have been answered. But I'm just wondering. What about all the many women who have GD and have safe vaginal deliveries? Most women with GD do this? And what about women who don't have it but have 10 pound babies and it's fine? There are often big babies, with or without GD, surely. Our bodies are designed for birth. Big babies are often easier to deliver vaginally I've read. Big thing you can do is remain upright and wide legged during labour e.g. on all fours, kneeling etc as this will help the pelvis open up, so baby less likely to get stuck. Lying on ones back will make it more likely for baby to get stuck as pelvis can't open.

Babies also aren't 'breathing' in the birth canal, they get the oxygen from the placenta still, right? So it isn't like the tight space will block the air supply unless the placenta or cord are under strain? Which is relatively unlikely... surely there is a risk of this with any baby, regardless of size.

I think that you have got very anxious about a horror story but that ultimately I'm sure your baby will be wonderfully fine.

Another way of helping to prevent babies getting stuck is getting baby into optimal feotal positioning. The Spinning Babies site has info on this. Good ideas are bouncing on an exercise ball lots in the weeks leadng up to due date, swimming, walking and prenatal yoga.

@angel772 I personally wouldn't have an early induction as induction tends to work better when baby is ready/almost ready to come. BUT everybody is different. Early inductions on FTMs more often go through the pessary, prostin, drip etc and a higher likelihood of EMCS. My personal view is that I'd rather not put myself through that and go for an ELCS to begin with. ELCS has risks like you mention, along with risks to bladder/kidney, but its a risk I am willing to take after having weighed up induction for me.

Some people have a smooth induction and instrumental deliveries which are easy, but for me, its just not a risk I am willing to take. Disclaimer- I come from a family of clinicians who have seen and dealt with all the traumas associated with childbirth- yes its a biased view but its enough for me to choose a ELCS for my circumstances. My baby isnt measuring big either.