Hospital want to induce me this Friday (38+0) - help!

[worried88]

I was diagnosed with gestational diabetes at 36+0 weeks and am now 37+5. I've been monitoring my blood sugar levels at home since the diagnosis and have managed to get them under control.

At my 36 week scan the baby's weight was estimated at 7lbs 1oz and the head circumference was 35.5cm (97th centile), so the baby is already on the large side because of the GD.

My midwife rang this morning to ask how everything is going and then asked what my thoughts were on the birth. I said I was confused over whether to go for an induction or c-section due to the size of the baby's head, so she went to speak to the consultant to get his thoughts.

She rang me back 10 minutes later and said the consultant thinks an induction is the best option and that they could get me in this Friday to start the process. I was quite shocked as the phone call began as a routine chat about GD and ended with the possibility of giving birth in two days' time.

The midwife explained that the baby will just keep on growing from here on in, so it's better to induce sooner rather than later for a vaginal delivery before they get too big. She also said that if I did go for a c-section then that could be done at 39 weeks.

I said I'd think everything through and get back to her, but I'm so confused now. Should I take their advice and go in this Friday, wait another week (when I'll be 39+0) or two (when I'll be 40+0) to be induced, or ask for a c-section?

My head is spinning - if anyone has any advice it would be much appreciated.

Do you want a vaginal birth or a c section? If the former, go for the induction. We can't say what's best for you- do your research and see which sounds like the better option to you. For me, the salient arguments are:

Vaginal birth:
Usually a quicker recovery
Better for the body if you're planning to get pregnant again and might give birth vaginally then
Less risk of breathing difficulty at birth for baby
Less risk of allergies and asthma etc in baby
Usually a shorter hospital stay (may not be with an induction though)
I think it might make starting breastfeeding easier, but do check that as I might be remembering wrongly.

C-section:
Less risk of birth trauma to either you or the infant
Less of a toll on your pelvic floor
More easily planned for and scheduled
Quicker and less painful than most inductions

There will be points I've missed, so do do your own research. It's also worth knowing that your risk of intervention is higher for an induction.

@worried88 I wouldn't say 7lb 1oz at 36 weeks is that big my baby at same point was weighing 7lb 12oz and I don't have gestational diabetes and my consultant has said no need for induction or csection as best to go to 40 weeks he said many woman get babies out bigger not sure on process for DB but I would be inclined to wait as the % of woman who are induced end up having a emergency csection will they not let you just go naturally?

My DS was induced at 38 weeks due to my pre existing conditions.

At 36 weeks he was estimated 7lb4 with head on 97th centile. He was born at 38+2 at 7lb11oz.

He is my first and will definitely opt for induction for future pregnancies over a section as it was a positive experience for me.

Vaginal is better as pp has said, in terms of for baby and mum, but that doesn’t mean a planned section is the wrong choice if you decide to go down that route.

Thanks @Keyboard91 - your baby sounds almost exactly the same as mine in terms of measurements. Was he born with a large head in the end and did it cause you any issues with the birth? Also were you induced at exactly 38 weeks or 38 plus a few days?

I had GD was induced at 39 weeks but it didn't work so after 5 days I had a c section. My c section and recovery were fine (and baby was 10Ibs)

The midwife said my baby will continue to grow and grow over the next few weeks, which could make a vaginal birth difficult. But I thought that getting my blood sugars under control (which I have done) would help control the baby's growth rate?

I'd love to go to 39 weeks if I can, but obviously don't want to jeopardise my baby's health. Would the hospital even let me go to 39 weeks if they thought there was that much of a risk?

Where do you live? Are you somewhere with a high rate of COVID19? Can you ask them if they think you are likely to have a c-section & they would rather you have your child now as there is less pressure on the hospital now that there will be in 1-2 weeks?

@worried88 I went in at 38+0 and pessary was placed at 11:30am. My cervix was initially very high and thick. Could’ve broke my waters earlier but in discussion with midwife I opted for an extra pessary to make things more favourable- and in the end my waters went by themselves! He was born at 7:53am at 38+2

His head was/is a decent size but not massively so. He came out pretty easily, 21 minutes of pushing, and I came away with just a 2nd degree tear.

Thanks Keyboard. Just trying to know what’s best for the baby is so hard.

If it was me I'd personally go in for a planned section.
They are much calmer then emergency ones and I've heard people have much better recoveries.
However I'm basing this on having a failed 5 day induction where I didn't get any sleep, was almost delusional by the time they decided I needed an emergency section at 2am in the morning and the fact nothing seemed to go right for us after.
Breastfeeding didn't work, we were readmitted coz of babies weight loss- she was a lazy feeder and just wasn't interested!
It took me so long to recover that this time I'm having a planned section for my second due in 3 weeks.
Obviously my experience isn't a great one and I know some people have amazing inductions that work immediately but I'm not taking any chances this time.
My only advice would be is if you go the induction route and they use the drip - have an epidural first!

Surely head size wouldn't be affected particularly in the space of two weeks? If they're getting extra nutrition, they put on fat. There's no fat around the skull though. Unless I'm missing something blindingly obvious, I can't see why head size would be disproportionately affected.

I wonder if @sussexmidwife could advise (hope you don't mind the tag!)

My blood sugars were under control but he was still big (99 percentile - dropping to 25th within months of being born and staying at that for the last 3 years)

Tbh I'd want to be in and out of hospital as soon as possible with the coronavirus situation poised to worsen.

I'd insist on a planned c-sec though.

No right or wrong way to give birth - do whatever you’re comfortable with. I personally would take a planned section over an induction any day, but especially at 38 weeks when the chances of needing an emergency section or other intervention is higher. Others would always avoid having the surgery.

You might have an uncomplicated vaginal delivery induced at 38 weeks, but it’s less likely. You could ask your Bishops score if you prefer a vaginal delivery want to know how ready your body is for labour.

I had GD with my first I was induced at 38 weeks (pessary and waters broken for me) she was 8LB 9

With my boy I did not get GD but he was looking big on scans so induced at 39 weeks this time had the gel, waters broken THEN the hormone drip 🥶 he was born at 9 LB 9 oz!!!

Really enjoyed my second labour had a brilliant student midwife that coached me through right till the end on only gas & air!!

He was really hard to push out though not going to lie! But no rips or anything!

Every woman is different! You have to go for what feels right for you xx

Sorry forgot to say with DD induced at 10 AM she was born next day 4AM and with my DS I was induced at 10AM did not start to work until 8PM he was born the next day at 7.30 AM

I would personally take an induction over a C-section any day, the epidural scares me enough without the surgery 🥴

I didnt have GD, but did have a very positive induction experience at 40+11 with a 9lb2oz baby! Was put on drip with waters broken and he was born 4 hours later, using only gas and air.
With Coronavirus I would think seriously about having surgery and the risk of infection.
But every birth is different and there are no guarantees with any choices. Best of luck!!

Surely head size wouldn't be affected particularly in the space of two weeks?

I’m not sure - my baby had a growth spurt and head size increased quite a bit between 33-36 weeks if the scan measurements are correct. That was before GD was diagnosed.

The thing is though, I do now have my blood sugar under control - out of 28 readings this past week I’ve only had 3 over the threshold, and there’s been a bit of trial and error in terms of what to eat as I’m completely new to GD.

Today the midwife said the baby will continue to grow over the next few weeks regardless of this, which could make vaginal birth more difficult.

I think I was just a bit taken aback when they suddenly said induction this Friday, as they were saying 38 or 39 weeks before if blood sugar levels are under control. To be fair Friday is 38 weeks - 38+0!

Am I right in thinking it’s best for the baby to get as close to the due date as possible if there aren’t any other complications? I’m just wondering what difference it will make to wait until 39+0 in terms of the baby’s health and development - and trying to weigh that up against the risks of potentially giving birth to a very large baby.

I was induced at full term with a baby that had the same measurements as yours. An induction at 40 weeks is a far different thing than at 38 weeks - I didn’t need the drip as the pessary worked but it was still very painful and I needed an epidural. If the hospital can guarantee an epidural for you then go for it, if not take the c-section.

Why don’t you go in for the induction appointment and ask to speak to a doctor before they start? Then you can either stay for the induction or book something else.

I do have an appointment with a consultant at the Fetal Medicine Centre on Harley Street on Monday - I wonder if it would be ok to delay the hospital until next week so I can at least get a second opinion on all of this?

I’m nervous not to go in for induction on Friday as the hospital have suggested, but the midwife did say it’s ultimately my decision - and I think a second opinion would be really helpful as I’m so unsure about everything.

The midwife said she’d email some of the hospital consultants and ask if one could call me to discuss further, but she couldn’t promise if or when this would happen. At least with the FMC I know I’ll be able to chat it through with someone properly.

An induction at 40 weeks is a far different thing than at 38 weeks

Thanks @GrumpyHoonMain - I wasn’t really aware of this so it’s useful to know.

I was induced due to gd and size of baby from the scans. Baby need up being under 5lb, at 38 weeks.