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.

@RhubarbFizz what did the scans predict your baby’s size/weight would be?

8-9lb. They were wrong! Am sure most are correct and would definitely follow medical advice.

Mine was born at 38 weeks exactly - very long, very skinny! Was induced.

I had a positive induction last week with my little boy. Was induced at 40+2 due to ivf so I know a lot later than planned for you. However Pessary went in at 11am. Waters went at 1am and he was born at 6.30am natural delivery. I did have a third degree tear though but I’m not sure if this was related to induction or would have happened anyway. The actual induction process was positive. However I can see the benefits of a c section. Is this your first baby?

Oh baby was 7lb 4oz born

@Whatelsecouldibecalled Good to hear of a positive induction experience! Yes it is my first.

I would personally be cautious of induction at 38 weeks purely due to the estimated size of the baby. As a PP says, a couple of weeks makes a big difference to how favourably your body might respond to the induction process, and you’re much more likely to end up with a csection anyway the earlier you are. I would hold on for your appt with the consultant and see if you can get a clear picture of all the risks and benefits specific to you and your baby for the various options. It’s worth really understanding what the process of induction involves and what steps they will advise if eg one induction method doesn’t seem to be kicking things off - it’s not just a case of getting to meet your baby earlier (I know you know this). And the same for elective section - I know lots of people too who have had really positive birth experiences with elective section.

Also it won’t be the case that this Friday is your only chance to be induced and that’s it, they will be able to fit you in after your consultant appt if that’s what you decide. It’s a tough one because the scans have a big margin of error.

@worried88 what a lot of women do not realise is that GD can really effect a baby, every time you have a spike in your blood sugar the baby adjusts to that so when they are born you can struggle to get their blood sugar levels up anywhere from having to give formula when you want to BF to baby ending up in nicu (obviously this is severe cases)

My blood sugar was controlled but we ended up having to give DD formula 3 times as BF was not bringing her sugar levels up enough!

The biggest risk to you is that you could end up still having diabetes after the baby is born again but that is quite rare though!

The risks to you from having a large baby is emergency c-section, ripping down below, haemorrhage (I think there is more but these stuck out to me)

And to baby it is shoulder dysplasia (again probably more but this stuck out to me)

This is why the consultant will want to induce you if they think there is a chance of you having a large baby!

Also if you want to go and speak to a consultant you could ask them to give you a sweep and check your cervix this may give you a better idea if your body is ready 😌

what a lot of women do not realise is that GD can really effect a baby

@HT96 I’m hoping that now I’ve got my blood sugar levels under control, that won’t be an issue anymore? The dietician told me that eating a GD friendly diet makes a big difference to the baby, even at this late stage. From reading old threads on MN I know a lot of women are dead against giving their baby a bit of formula at the beginning - but is it really so bad? I’m ultimately hoping to breastfeed but don’t think a few early formula feeds will affect this.

@IvinghoeBeacon thanks. I didn’t realise that you’re more likely to end up with a c-section the earlier you’re induced - is that because your body may not be ready for labour? I think the appointment with the consultant will be hugely helpful - I’m just nervous about saying no to the hospital for this Friday. I’m also leaning towards an elective c-section over early induction though, so I doubt they’ll be happy with that either.

It’s Shoulder dystocia, just for clarity

I had GDM in my first pregnancy so I was coming from the POV of have well-controlled GDM via diet. I am well aware of the complications that can arise and was posting from that informed position. I still would have been cautious about induction at 38 weeks based purely on estimated size and there is nothing wrong with holding on a few days for a really good discussion of the risks and benefits of the options available as applies to the OP’s personal circumstances.

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?

OP it's okay to delay/refuse the hospital for any reason. It's your body and your baby. They're only advising you on treatment options, you can do whatever you want. My cousin refused an induction so many times because baby was measuring big and eventually they 'bullied' her into booking one - she was fed up of arguing so just didn't turn up to it. Ended up having a completely natural birth, no stitches, no pain relief at 41 weeks and baby weighed 8lbs. She didn't have GD, but my point is of course you can get a second opinion! You don't have to have an induction on Friday just because they've asked you to! The PP was right, could we be related to coronavirus pressures and they just want to get you through the system.

I’d go with planned c-section every time. My second was a planned section and it was a blissful experience (compared to the hell that was the three day labour ending in failed forceps and an emergency section with my first - fuck that for a game of soldiers).

My sister in law was induced recently. Took three hellish days.

Hey OP wanted to put in my tuppence worth.

Baby 1 I had GD but baby was measuring small around 5.5lbs issue I had at 37 weeks was I was also found to have obstetric cholestasis so I ended up having to go in and I chose to have an induction. After 3 days my induction failed (peasary/waters broken) it was pretty obvious baby wasn’t ready. I had a section after 3 days. That all went fine but sadly baby was born with breathing difficulties and we spent 2 weeks in NICU due to severe respiratory distress. The hospital failed me as they didn’t give me steroids as I was 37 weeks and needed to have a section they should have given me steroids.

Baby 2 - 38 weeks. I tried again for an induction. Again I had GD and OC. Baby was around 6.5lbs. Baby born with respiratory distress again - not as severe and I was given steroids so was in SCBU rather than NICU. My advice is forget the induction but I wish the doctors had told me how unfavourable my cervix was on both occasions - very unfavourable.
On my second baby I had a very brutal consultant break my waters under gas and air - left me very very bruised down below as he pushed so so hard to do it and he did manage to do it but it made no difference.

There is a higher risk of RD with GD babies - in hindsight wish I had just had booked a section and got it done with - but please do ask for steroids

They're only advising you on treatment options, you can do whatever you want.

Thanks @bluemoon2468. I guess it just feels scary going against their advice as they’re the experts, but I do need to have a proper chat with a consultant to decide on the best way forward I think. The thought of rushing in tomorrow for a sudden induction with no plan is making me so nervous!

@LemonFun thanks for sharing and sorry you had to go through that. Do you need steroids for an induction and a c-section? It’s likely my induction would be at 38 weeks but if I go for a c-section, that will be done at 39 weeks. No one has mentioned anything about steroids to me yet! What was the cause of your babies’ respiratory distress - was it all down to the lack of taking steroids?

Yes, they're experts, but they have more than just your personal safety/birth experience to consider when making decisions. They will offer you treatment options that are both safe for you and cost effective for the NHS, and will consider things like how many women are due to give birth each week and balancing that with covid pressures etc. I'm not saying that's wrong of them, but you have to remember that you are not their only consideration, so they won't necessarily give you a full picture of the situation. You are in a position where your only responsibility is to think about the best option for you and your baby, without those other concerns. Seeing as they said you could be induced now or wait until 39 weeks it doesn't sound like they're immediately concerned about some sort of emergency for your baby, so try not to feel the time pressure. It doesn't sound like you are in the right place mentally to make this decision today, so I suggest you give it at least a few days to clear your head and make a decision you feel comfortable with. Your baby isn't going to gain 3lbs overnight.

Hi @worried88, if it were me (and it soon will be as I have type 1 diabetes and am looking at a 38 week induction), I would wait until you speak to your second consultant on Monday, then you have peace of mind you have done all the research. If they are worried you will be brought in very quickly for an induction, its not this Friday or never. Just let them know you will give them your decision Monday after the appointment. Good luck!

I was induced on monday morning with pessary and left to sit until friday at 2am when they took me to labour ward and put me on the drip and broke my waters, after 23hrs in labour and 2hrs pushing I needed an emcs anyway. Baby obv wasnt ready to come out, was born poorly but that's irrelevant to the birth part. Go with what you want and think its your baby and your body x

@worried88 just a quick note to say that early formula feeds are one of the biggest reasons that women stop breastfeeding; they are not recommended before 6 weeks because your milk supply is still being established. Also, every time you give a formula feed you should pump so that your milk supply is not affected. This is not a breastfeeding is best comment, you can feed what you like, but just wanted to bring it to your attention so you were informed to make a decision.
Contrary to popular belief, breastmilk is full of calories and should be sufficient for baby, irrespective of his/her blood sugars.

Few things really - so with GD babies are at a higher risk of RD at birth. What compounded that was the early birth. I was booked in for an induction with both. The hospital admitted they had made a mistake the first time round that even with an induction as it was an early birth then they should have given me steroids.

So please discuss steroids with them as it’s likely baby will need them. If you birth naturally there is less chance of RD (GD or not as sections are another compounding factor) but deffo as for steroids.

Speaking from good and very sad personal experience, Follow their advice, they are professionals with experience and knowledge.
As you know diabetes and pregnancy carries a risk even at later stages.
Your baby is at term, all will be fine.

Forgot to say, c-section every time (personally speaking)

Thanks so much for the advice everyone - it has helped massively. I've just been given an appointment with a hospital doctor on the maternity unit tomorrow morning to discuss c-section vs induction. If I do decide to go down the c-section route I expect I'll need to be quite insistent. I'm glad the hospital are taking the time to talk it all through though.

Thanks @TwinkleStars15 - I do want to breastfeed ideally, but if it's just not working and the baby needs feeding quickly due to the GD, then I'm happy to use formula for the first few feeds. I don't actually have a pump yet - is that something I need to buy?

head size increased quite a bit between 33-36 weeks if the scan measurements are correct.
That's a big "if". Scan measurements are notoriously inaccurate.

If given the choice between induction or c section,I would choose a section. Induction can be very intense and painful. It may not even work. There is a higher incidence of interventions like forceps, which can cause injury, and quite a high likelihood of needing an emergency c section after all that anyway!