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?!

Obstetrics in the U.K. is governed by evidence based practice. You’ll be offered a section if it’s felt it’s safest. But routinely even for someone with diabetes a vaginal birth is safer for you, the baby and future pregnancies.

You can of course request an elective section if you want one and your midwife should refer you to a consultant so they can discuss the risks so you can make an informed choice rather than be influenced by anecdotal stories on the internet.

Thanks @ChewChewIsMySpiritAnimal - totally agree with everything you’ve said. I did want a natural birth but now that’s not an option to me the caesarean is the best of what’s left. I don’t see an induction as a natural birth anyway - being hooked up to a drip and forcing labour early doesn’t feel natural in any shape or form. Plus there’s a good chance it will end in EMCS anyway!!

I don’t think you are understanding the risks of respiratory distress syndrome that can come from an ELCS.

The risk is reduced after 39 weeks but it’s still there. This doesn’t apply to an induction and vaginal birth and it doesn’t apply to an EMCS either.

Respiratory distress syndrome is caused by NOT labouring therefore the babies lungs are not primed ready to breathe and they can need assistance to do so or may never do so independently.

It’s a small risk but the risk of respiratory distress with an ELCS is HIGHER than the risk of oxygen deprivation during a vaginal birth. So to eliminate one risk you would expose baby to more risk.

If they felt a vaginal birth would likely end in problems they would be suggesting an ELCS. As it is the risks of a vaginal birth are currently smaller and therefore safer for you and baby.

But routinely even for someone with diabetes a vaginal birth is safer for you, the baby and future pregnancies.

I can’t find any evidence that supports this view online. Only news articles saying that many hospitals are under pressure to keep their caesarean numbers down.

The consultant is pushing for an induction as well as the midwife. I will ask to be referred to a different one if needed - and if they don’t agree then I will say that I will need to change hospital.

But the risk of say a baby getting strangled by your umbilical chord is higher in vaginal birth than c section?

@ChewChewIsMySpiritAnimal Unfortunately that no longer applies. With the CoVid dilemma and the resulting shortage of anaesthetists they can and do deny maternal request ELCS. NICE guidelines fall second to the CoVid emergency operating schedules.

@VivaLeBeaver then why does it differ between hospitals what you may be offered? Hospital A will offer c-section if woman has had one previously but Hospital B won’t for example. Surely hospitals have different guidelines and different values and even on an individual level different consultants may disagree on the best pathway for a woman. I think that’s why it’s so important for women to be the key decision maker once they have all the evidence, supported by professionals of course.

It’s a small risk but the risk of respiratory distress with an ELCS is HIGHER than the risk of oxygen deprivation during a vaginal birth. So to eliminate one risk you would expose baby to more risk.

@Indella but whilst the risk of oxygen deprivation may be lower with vaginal birth, surely if it does happen then it’s far more catastrophic for the baby than having a bit of mucus in their lungs that can easily be solved. Oxygen deprivation can cause permanent brain damage and with my baby’s big head, getting stuck is a very real possibility!

@angel772 And respiratory distress syndrome can cause death as well as permanent brain damage. If you’re going to use the absolute worst possible but really rare outcome of vaginal birth then also look at the worst possible outcomes of ELCS.

With the CoVid dilemma and the resulting shortage of anaesthetists they can and do deny maternal request ELCS. NICE guidelines fall second to the CoVid emergency operating schedules.

The midwife and consultant haven’t used this a reason for pushing me down the induction route (yet). If there’s a shortage of Anaesthetists does that mean I will have to have an induction without an epidural as well?!

“The midwife and consultant haven’t used this a reason for pushing me down the induction route (yet). If there’s a shortage of Anaesthetists does that mean I will have to have an induction without an epidural as well?”

That depends on how your hospital is affected by CoVid and how their anaesthetic staffing works. Some hospitals have a dedicated maternity anaesthetist, some share an anaesthetist with other wards.

I can’t find any evidence that supports this view online

Are you accessing medical journals? Nice guidelines?

I apparently it’s concerning but the stuff about hospitals being under pressure to reduce lscs rates really isn’t relevant. They’re under some pressure potentially to reduce unnecessary lscs rates but I’ve never seen an obstetrician take into account the hospital lscs rates when deciding whether a vaginal birth is safe or not for an individual. Any doctor would absolutely make a decision on what they thought was safest for the individual patient so please don’t be concerned that stats/budget would mean that the best decisions weren’t being made.

The nice gestational diabetes guidelines are available if you google and are worth a read. They are based on the best available research.

But please do ask to be referred to discuss your choices. The more reading you’ve done before hand the more likely the doctor is say that although a vaginal birth is safest for you personally you don’t feel the risks associated with vaginal birth are worth it. There are risks associated with Vaginal birth for anyone, diabetes or not. The same as there are risks associated with lscs. Individuals have different perceptions/weighting of risk and their views should be taken into account.

baby than having a bit of mucus in their lungs that can easily be solve

I’ve known babies die from respiratory distress syndrome following an elective section. So please don’t think it’s just a bit of mucous in the lungs which can be easily solved. This is why you need to talk to your consultant. They will know your individual circumstances as well such as your hba1c levels, growth and Dopplers.

I think it’s terrible that we have to argue our case to have the birth WE want. Isn’t pregnancy stressful and exhausting enough?!

And if there’s any possibility of an induction without an epidural and I’m not allowed a caesarean, I will have to wait to go into natural labour. There’s no way on earth I can do an induction with a drip and no epidural - I just can’t. My anxiety is through the roof over this.

@patronum all hospitals should have their local guidelines based on nice guidelines (if available for that area) and if they don’t they have to justify why they’re not following nice. Which is possible if there is more current, up to date stuff than nice which happens sometimes (I used to write local guidelines in a past life).

Totally agree that women should be able to make decisions which is what I talked about in my first post when I mentioned informed choice. Women should be supported to make decisions and that means giving unbiased information in a way they can understand.

Doctors should follow guidelines......the difficulty is in the fact that nobody follows a textbook pattern of a certain illness, etc. So grey areas occur. The guidelines can be subjective when applied to a certain individual. So someone has diabetes, is 36 weeks pregnant, Dopplers are raised, scan suggests a macrosomic fetus. Do we section now at 36 weeks and run the risks associated with a pre term delivery or wait a week, buy a bit more time? One doctor may think deliver now, another may think the Dopplers aren’t that bad, etc and be more focused on another week of lung maturation. Chances are they will be influenced by past cases they have seen which will vary from doctor to doctor.

Unless the current NHS situation changes soon you are unlikely to be given a maternal request section. At my trust we barely have capacity to do all the ones who have medical need and all maternal requests are being refused.

I’ve known babies die from respiratory distress syndrome following an elective section.

Even at 39 weeks plus? It’s far more of a risk in babies before 39 weeks from what I’ve read.

Please try not to think of it as arguing your case. It really should not be like that and hopefully it won’t be.

But it would be irresponsible to just say yes, ok without making sure you understand fully. So that does involve talking about the risks but it should be done objectively, not trying to pressurise you.

At 39 weeks. Yes.

@PleaseSirMyGoat is that because of Covid? My consultant hasn’t mentioned that in his reasons for pushing an induction. I’d have thought he would of if it was an issue?

@VivaLeBeaver I gave my reasons for not wanting an induction and was given a counter argument to each one. I was also told that gestational diabetes means greater risk of still birth, but since then I’ve read up via Mumsnet and found this isn’t even true IF you’re closely monitored! This is according to the SANDS website.

Yes, the main reason where I am is because the anaesthetists are busy elsewhere but also other theatre staff have been redeployed or are unable to work. We still have a dedicated team for obstetrics emergencies but elective capacity is reduced.

I’m just exhausted by the whole thing quite frankly. Its been a long and difficult pregnancy and now I feel brow beaten into giving in and having what’s likely to be a traumatic and difficult birth that I don’t want at all.

It’s even worse because I know people who have had elective caesareans for no medical reason whatsoever. I don’t begrudge them but I wish that my concerns were taken seriously and not just dismissed.

Have you actually had an appt specifically to discuss mode of delivery and stated that you want a section?

Because if you say you’re worried, etc and maybe don’t sound determined it might be that when you say you’re worried about x and then they come up with a counter arguement you then need to say ok, but you would still prefer a section. Otherwise they will think you’ve been convinced by their counter argument.

And yes someone who has gestational diabetes if it’s diagnosed and well controlled And monitored shouldn’t have a higher risk of still birth.