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?!

You do sound worried OP, and at the end of the day your preference should be taken into account.

Vaginal birth is the default option, all being well. I understand your instinct to protect your baby and it is very noble to say you will take on all the risk (of surgery) yourself and so on. It’s frustrating because no one has a crystal ball and can know in advance what will happen, but there is a very real chance of an uncomplicated birth - as well as the chance of a complicated one.

One thing I havent seen mentioned is that c-section increases the risks to future babies, future pregnancies, future fertility. Not so important if you are one and done. Very important if you want a large family.

I had GD, induced at 38 weeks because baby was measuring 10.5lbs.

Delivery went well and she was 6lbs 7.5oz, 52cms long.

I was up and about that day and home the next day - had to stay overnight for dds blood sugar to be monitored due to the GD.

My SIL had two sections, and really struggled after both. As did my friend. They had to stay in hospital for a few days, which they found hard, whereas I was home, comfy and had everything I needed.

I get that you read something that made you anxious, but thousands of perfect, uneventful births take place every day, lots of women have GD, tons are induced without issue - they just aren't newsworthy. Similarly there are plenty of horror stories about sections - you just happened to read an induction one. Had it been a section one this thread would be the opposite way round...

Stop reading other people's horror stories. Speak to your midwife and consultant. They're best placed to advise on your individual circumstances and also to help you with your anxieties about birth.

The weight measurements aren’t completely accurate. I hope my experience will reassure you as I’m further along. I’m currently 38 weeks and had a scan last week. Slightly increased amniotic fluid and baby weighing 7lb 6oz. She’d had a massive growth spurt in the 2 weeks between the scan before and if we go by the scan estimate she will be 9lbs+ at 40 weeks. The consultant was not concerned at all and I’m booked in again for another scan at 40w+1d. I will more than likely be given a sweep or induced the same day depending on the weight.

Admittedly, I am a little scared and also slightly worried that they are leaving it too late but I wholeheartedly trust the decision of my consultant. They will do everything they can to avoid a c-section and they avoid them as much as possible, unless it is completely unsafe to give birth virginally. They carry a lot of risks. Especially during this time when staff used for c-sections are being utilised elsewhere. However, this is my second child and I had an easy, fast first birth with minor internal stitches needed and no pain relief. My first was 7lb 13oz and I trust my body to be able to cope.

It can be very scary but please don’t rely on the estimated weight alone. It’s never going to be completely accurate. You can do it

I think you can ask to have an elective c-section at any point, but they can be pushed back. If you are not deemed to be a medical emergency, and someone requires an emergency c-section then obviously yours will be pushed back. They're usually booked for around 39 weeks I think so if you go into labour before your elective c-section and there are no theatres available then you could end up giving birth vaginally anyway. So that's something to bear in mind as well.
Also if you do try for an induction, then you will be very closely monitored on a delivery ward with doctors and more medical attention than a birthing centre/midwife led unit and any problems would be dealt with quickly because they will already be aware of any potential problems unlike if you weren't diagnosed.

I have had two large babies (9.5lb+). My 6lb15oz birth was the hardest (the third).

With a larger baby and GD, a cesarean is not the safest option. Especially not right now. The medical professionals who deal with cases like this daily know more than you.

Do remember that you are likely to need a lot of support and help in hospital after a cesarean birth and at the moment in most hospitals partners or other visitors are not permitted. You would rely on staff to help you and in my experience that can not be forthcoming.

OP, my 3 were 10lb, 10lb 5 and 9lb 10 and all labours were straightforward. Not all big babies have problems. Your midwife knows what she is talking about, try not to worry

Everyone saying c-section recovery is harder- it’s also worth OP finding out the chances of an emergency c-section from attempting vaginal birth in her circumstances. If it’s MORE LIKELY she’ll end up with an EMCS than successful vaginal birth then that’s perhaps one reason to consider having an elective given that they are generally safer, easier to recover from and less exhausting than labour followed by an emergency c-section.

Not saying this will be the case for OP but people seem to forget that attempting vaginal birth is just that- an attempt. It’s not a case of ‘normal vaginal delivery’ versus a c-section.

The reason they can’t just offer a c-section when a vaginal birth is still a safe option is there simply aren’t always enough slots. I had a breech twin pregnancy so had absolutely no option other than a c-section and I still had to wait a few days longer than my consultant would have liked to get booked in. They have to prioritise women who have no option other than cesarean. As others have said, it really is a very tough recovery too especially when you have a baby to take care of at home!
I would relay your concerns to your consultant but also maybe push them to explain to you why they deem a natural birth the best option for you, which may hopefully ease your anxieties here a little. I know it can be awful reading stories where things have gone wrong, I read a few about twins that terrified me, but they are so, so rare.

I was in your position exactly and trusted the consultant and went for natural birth. Like you I had read the horror stories and was fairly terrified. So had a couple of sweeps from 38 weeks and went into natural
Labour toward the end of 38 weeks and he was born day before induction planned at 38 weeks. Ended in c section but totally unrelated to the gd and baby was nowhere near as big as the scans measured. Lining up for baby no 2 now in September and will push for a c section but overall I think I would still have done the same thing again first time
Around and tried for a natural

• the c section recovery was horrendous for me.

I had an induction six weeks ago for high blood pressure.

One failed attempt (24hrs with balloon) and then a further 24 hours on the drip after waters breaking.

While on the drip, I had a midwife with me constantly. They also refused to take me to delivery suite until they had resources available to give me 1:1 care. I was monitored continuously, as was baby.

In my circumstances I did end up in theatre with forceps, however that was because the pushing stage went on too long and was subsequently found out this was because her shoulder was stuck.

There were further complications with my baby but these were due to meningitis, and not the delivery.

At all times I felt extremely well cared for and trusted my medical team implicitly.

While I know you have an instinct to ensure your baby is brought into the world in a controlled manner, I would not write off the medical team as not acting in your best interests because you read one horror story.

For every horror story there are numerous happy births, however at the end of the day you need to weigh up the pros and cons.

For what it's worth, both my sisters ended up with caesareans. One from a failed induction to EMCS due to fetal distress (cord wrapped around and also had a knot) and the other due to maternal distress.

Our postnatal recovery was extremely different, with mine being much, much easier (and I had two tears and a PPH).

The thing is OP, saying that there is a risk of something is basically meaningless, what you need to know is how high or low a risk it is. To put it bluntly, there is also a risk that you will be run over by a bus this year but quite rightly you aren't worrying about that risk everyday as it's a very low risk.
FWIW, I had a very straightforward vaginal delivery with GD, wouldn't have had a CS unless my consultant thought there was a need for it.

It sounds like youve already made your mind up OP, but here's my experience.

My daughter was over 11lbs, I didn't have GD, I was measuring 52cm on my bump, I was due for an induction until the consultant say me at 38 weeks and suggested a section.

I would say though I was in surgery for 6 hours with various complications, my next daughter was 10lbs again no GD but I had a vaginal birth, again complications.

In my opinion the perfect birth experience is few and far between, but safety is always the top priority.

I found the section a lot harder to recover from because I couldn't pick up my daughter for 6 weeks.

I know this is all new to you and it's very scary, but remember most big babies go on to be delivered very safely!

Stay off google.

I carried a big baby and had other risk factors, my consultant was vile to me and told me I wanted a csection for vanity reasons. 3 midwives all agreed with me that I needed a c-section, consultant finally allowed this.

The morning of my section she was still horrible to me, had me in tears and asked me if "I wanted to go home as I still had time to go natural"

During my C-section they needed forceps, baby was 10lb 1oz and stuck, I had too much water and afterwards she came over to me and told me "oh you definetly made the right decision"

I wanted to slap her, obviously I wouldn't. But I wanted to.

Do what fees right for you! You know your body

My baby was 7lbs odd at 33 weeks and im a size ten i got induction which failed so ended up with a section. 5lbs isnt that big so try not to worry xx

Is that really that big though? I had a growth scan at 31 weeks and she was estimated to be 4.5lbs, I had a perfectly normal delivery at 39+3 and she was 7lbs 3ozs. I think you’ve got yourself into a panic and need a few days to think things through a bit more rationally. Best of luck

Stick to your guns, I had an elective section because for various reasons I was fairly sure I would end up failing labour and having an EMCS anyway. The consultant was great to be fair, but even with my health reasons tried to talk me into a vaginal birth.

Your body, your choice... I didn't fancy having to recover in two separate body areas!

Turns out it was the right decision, my baby was almost 10lbs, back to back and had the cord round neck three times...

I was induced and delivered vaginally but when I got to 10cm dilated baby’s heartbeat faltered. Within three minutes I was in the theatre and told to bear down so consultant could use forceps and the baby was delivered with no oxygen deprivation.

I didn’t have gestational diabetes despite risk factors (I was on a preventative diet approved by my fertility consultant (who is an expert on pregnancies with severe pcos) and so weight gain was minimal) - but I imagine things would be the same.

Im not sure that your measuring particularly large are you?

My last scan was at 35+2, and baby measured 6.6lbs, which they said was +/- 1lb approx in accuracy. So would have been between 5.6-7.6lbs. If he was 7.6lbs at 35lbs then he's going to be fairly large at 40+
Head measurement at 99%+.

An induction or c section hasn't been mentioned at all. Im not in the Uk, and have private healthcare.

A section without labour considerably increases the risk of a baby being admitted to SCBU with breathing difficulties.

There is no risk free way to deliver a baby, but rather a balance of risks and benefits of each method.

You need to try and not fixate on one negative story. Sadly a certain (very small) numbers of births result in the injury or death of the baby and/or mother. This happens in vaginal and C-sections alike. That is something we all have to deal with and try not to think about.

Whatever route you go you will not have the same story as in the article. You do not have undiagnosed GD. The dangerous part of the ladies story was that the hospital didn't know what they were dealing with, if they did her length of labour would have been very carefully monitored and Maddox would have been whipped out sooner.

It is always going to be better to birth vaginally if possible (tonnes of evidence on everything from babies blood pressure and heart rate to bacteria in the stomach that protect them from diseases for life) so the hospital are doing their best to give you that option. Of the baby is too big and you struggle to get it out, they will give you a C-section. It is unlikely to be a crash section, because they will monitor you so closely that they would make the decision in tonnes of time to do it in a relaxed way.

Don't panic!

I would completely trust the midwife and consultant. A Caesarian is more dangerous to both of you in the current circumstances. Least of all because of the lack of partners allowed at hospitals.. The last thing I'd want would be to laid up for 2 days on my own on a ward having had surgery with a hungry baby and no one to help.

You are assuming 'probable' emergency c section after a failed induction. You should look at the stats to see how often that actually happens.

My baby's head was 90th the whole pregnancy, even with a high risk Pregnancy I followed their guidelines, was booked for induction but dd came of her own accord anyway 2 weeks early.. I was in and out in 6 hours. She was forecast at 8lbs and was 6.15. At 34 weeks she was 5.11 so barely grew a pound in 4 weeks.

You sound irrationally anxious about this and so regardless you need to talk to your midwife and consultant. Ask them to talk through the decision making process through induction and how they will
Monitor baby throughout, what point they would opt c section.

I really don't think you have anything to
Worry about - they are well practiced in birthing large gd babies, and given you only have 7 weeks to go and gain an average of one pound a month for the baby provided you keep sticking to the diet plans.

In the current climate you would be far, far safer to have a vaginal birth if possible - theatre staff are the ones with the highest acuity so many nurses and HCAs and anaesthetists are being moved from theatre and replaced by less experienced and more junior colleagues. If anything goes wrong with your surgery you won’t get an ITU bed as they’re all in use for COVID. And staff are much more reluctant to undertake surgery due to it including aerosol generating procedures.

@angel772 I cannot believe some of the naive simplistic responses on this thread suggesting VB is less risky as though it’s always that simple (even in an uncomplicated pregnancy).

There are degrees of risk with either birth - the risk of baby not being delivered safely, of course. There are also loads of risks of things like tearing, incontinence etc which aren’t life threatening. Sounds like your concern is life or death.

YOU have the right to decide which risk profile you are more comfortable with. If you decide that you aren’t willing to take the risk of shoulder dystocia, and that’s your priority, then absolutely have a section. Of course it’s major surgery, but it’s routine, and it avoids the risk that you’re most fearful of.

Shoulder dystocia leading to brain injury is rare but sadly does sometimes happen and if it does, the consequences are horrific. Unless your doctors can rule out the risk (which they can’t), totally reasonable for you to have a section to avoid the risk of it. It sounds like a small risk from what you’ve been told but if you’re worried about it, that’s a perfectly legitimate reason to have a section.

Doctors aren’t always right about these things, and as yes I can give examples.

They said my baby was measuring big for me too. But she came out much smaller than they thought. I had preeclampsia too so I had to be induced. I just put my trust in them. Her cord was wrapped around her neck so I had a episiotomy . Nothing ever works out the way you plan it to. You can’t be in control of everything. You should try naturally that is the safest option. They have procedures in case things go wrong. You can’t expect a textbook birth it’s just not realistic