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.

The growth scans are not always accurate...Also, will they be inducing you straight away on Friday? if you're admitted and have to wait around for a day or 2 before they actually induce you (which is common and happened to me) I'd be a asking, is there an emergency? I'm not a firm believer in inductions on the basis of estimated growth, inductions are necessary for a lot of reasons but if it's just based on growth I'd hold off as long as possible and ask write a list of questions to ask before accepting x

Thanks @LemonFun - I will ask the doctor about steroids tomorrow.

Follow their advice, they are professionals with experience and knowledge.

@foodtoorder I do worry about questioning their advice, but an induction at 38+0 does concern me for a number of reasons. When I mentioned the possibility of an elective c-section instead, they said they would offer it at 39 weeks but seemed reluctant. It will be good to discuss both options properly with the doctor tomorrow anyway - hopefully I'll get a clearer picture then. I'm sorry about your experience

I was induced at 38 weeks exactly, it was a long and the examinations were very painful, in the end I needed a c section anyway. If I had my time at it again I wish I hadn't of had the induction, although saying that I know many people who have had positive successful inductions!

@worried88 if you want to breastfeed you don’t usually need a pump at all. However, if you are insistent on giving formula for the first few feeds (or any other feeds) you absolutely need to pump at the same time as giving the formula, otherwise this will impact on your milk coming in/affect your supply, which can then take a long time to fix and may well cause you extra stress. Don’t forget that for the first 2-5 days it will be your colostrum, which is amazingly important so definitely don’t skip these feeds, it’s baby’s liquid gold. Be mindful that if you have a section, sometimes this can delay your milk coming in compared to a vaginal birth, not majorly but might take an extra day or two.

When you go into hospital tomorrow ask if they have some syringes they can give you to express colostrum antenatally. That can then be given to the baby in place of formula to help with their blood sugar. Also there’s no point using a pump with colostrum - it will get stuck as it’s so thick. You’re best to hand express into a cup or syringe instead.

If it’s any reassurance, my first baby’s head was 99.8th centile and was born with no issues due to size (the knot in his cord was a different issue!)

@worried88 hi OP I commented on one of your precious threads, I had polyhydramnios with my first pregnancy although did not have GD. They were very keen to induce me due to the size of the baby (and particularly his head size). I personally didn't feel that was a good enough reason, but agreed to be booked in for the induction Consultation. When I went in they hasn't received the message I didn't want to be induced there and then and there was a bit of a fuss when I asked to actually talk to the consultant first! I was glad I did though as she assessed me and found that actually the babies growth had slowed which was concerning (I hadn't been told this previously).

When they put me on the monitor though they found I was already having contractions and was dilating. This meant they could skip the first stages of the induction and meant the odds were much more favorable of it working. I was allowed to go home for the evening as they were so sure my waters would break overnight. They didn't but I went in the next morning and was put on a drip and had my waters broken. Unfortunately I still ended up having an EMCS due to the position of the baby but i don't think the induction had an impact on that.

Basically what I'm trying to say but have waffled instead is that definitely go and talk to the consultant and get them to assess you in terms of how ready your body is and how favourable an induction would be at this point.

Also in relation to breastfeeding, although you should express if you give a formula feed you can hand express or use a hospital pump. There should be a specialist breastfeeeding advisor at the hospital who will be able to help you.

Thanks everyone.

@TwinkleStars15 Do you think it's likely that I will be able to express colostrum at this point (38+0) so I have some ready for the baby's arrival? Is it best to feed them colostrum only on day 1, then hopefully breastfeed from day 2 onwards? What do you do if your milk is delayed coming in due to the c-section and the baby's hungry?

@ClaraLane thanks for the reminder - I will definitely ask for syringes tomorrow.

That's really good to know, thanks @JassyRadlett. Was there any particular reason for your baby's large head size? The consultant thinks in my case it's mostly genetics and also the GD as well.

@Lazydaisydaydream How far along were you when you were induced? I will definitely ask the doctor tomorrow about checking how ready I am for labour. I shouldn't think I will be though, given that I'll only be 38+0?

That's really good to know, thanks @JassyRadlett. Was there any particular reason for your baby's large head size? The consultant thinks in my case it's mostly genetics and also the GD as well.

MIL cheerfully told me after the fact that DH’s head was absolutely enormous when he was born...

It's good that you've been offered an appointment tomorrow, it's an opportunity to ask lots of questions. Do write a list of questions before you go and don't feel shy about getting out your list and going through it! In my experience good respectful doctors are always happy to answer your questions and won't mind if you have a list.

If I were you I'd do some research about the guidelines and evidence on gestational diabetes, growth scan accuracy rates, and the benefits and risks of induction v ELCS.

Some links to refer to if you haven't yet done so:

www.nice.org.uk/guidance/ng3/chapter/1-Recommendations#intrapartum-care-2

www.tommys.org/pregnancy-information/pregnancy-complications/gestational-diabetes/gestational-diabetes-and-giving-birth

@worried88 as @ClaraLane pointed out, you can’t pump colostrum as it’s so thick and creamy, it will just get clogged up. You need to hand express and feed either from a syringe or a cup.
You don’t need to worry at all about having ‘no milk’ for the first few days, you will be producing enough colostrum to sustain baby until your milk comes in, it’s human biology. This is how much baby needs initially, it’s a small amount.

@worried88 It was my due date so yes further along than you are.

Colostrum is all your baby needs for the first few days. They literally only need tiny amounts at a time (a few ml!). Milk usually takes a few days to come in, and is triggered by your baby spending lots of time breastfeesing and sucking and having colostrum. Usually takes about four days I think for milk to come in.

I got induced at 37 wks due to the same think when my baby was born was only 6lbs 6 onz now have a lovely 6 month old.
My advice is go with what they say as waiting until 40wks could end up with problems thats why they want u in early.

This is a birth story from a woman who had GD and an induction which ended up as an EMCS (on the positive birth company blog, so it promotes them a bit, but not massively):
thepositivebirthcompany.co.uk/blog/birth-story-emma-and-baby-benjamin

Everything about things like feeding is just guidelines - in reality things aren't as black and white. For the first few weeks after my planned section, I mix fed by choice, sporadically using either method, sometimes pumping, often not, introducing a bottle within a couple of hours of birth etc. I later moved to ebf without any difficulty (accidentally really) and am still feeding a year later.

Personally, I think planned sections are wonderful, and from my own experience and friends who have had both, and vaginal births, I think the recovery is often easier for a section.

I had no health issues in my first pregnancy but did have a very long (7 day) labour an emcs and a bigger baby than they expected (and they scanned me less than a day before he was born). He wasn’t massive 8 12 but it was the big head

It was really hard to recover from the exhaustion of such a long labour. Had a very bad start to breast feeding with a re admission to hospital and formula top ups.
I’m pregnant again and they’ve easily agreed to a planned section. I have to say I’m not particularly looking forward to the actual section but it will be better than last time.
If your baby has a big head and you are slim of hip I would definitely go for a section. I would probably just have the section anyway at least you know what will happen and can plan

I was induced at 37 and 3 days didn’t work, failed to progress passed 2cm and ended in a section. I will not be accepting induction at all this time around if it was anyway before 39.5 weeks as I just don’t think everyone’s body can be ready at this stage and I would much rather a section. Was able to breastfeed straight away no need for hand expression etc , baby was fine and good size considering their initial worry. Best of luck for your appointment and making the best choice for you xx

@worried88 good luck for your appointment today, let us know how you get on xx

Hope useful appointment. I do not think steroids for a planned csection at 39 weeks is needed. I have had steroids for another baby that was born before 38 weeks recently. Obviously medical advice and recommendations do change over time.

Honestly, I can only speak from my personal experience but they induced me at 39+2 and I endured 5 days of induction before needing a c-section anyway. I heal ridiculously fast so bounced back from the section really quickly.

My induction was not good - a long wait and a lot of discomfort then when I finally got on the drip my epidural failed repeatedly so I never managed to rest which was why I pushed for the section - I'd had no real rest for my entire time in hospital so was just broken by it all by the crunch time.

If I knew then what I know now then I'd push for a section over the induction anyway. My body didn't respond to anything they did during the entire process.

However my relative was induced at 38+6 and had the baby within four hours of the first pessary so you never actually know!

Remember they told me the same thing RE growth, hence the need for an earlier induction. She was heading towards being 10lb+ and she was 8lb 10oz when born!

Hi everyone, I've just got home from the appointment, which has left me with mixed feelings. The doctor said he didn't think the head size (35.5cm, just over 97th percentile at my 36 week scan) ruled out a vaginal birth. I asked about shoulder dystocia and he said that because the rest of the baby's measurements are between the 50th-75th percentile, once the head is out the rest should follow. The baby's size overall is 77th percentile, so not massive.

He also said that because of the gestational diabetes and borderline polyhydramnios, I will be closely monitored throughout and if there's any sign that the baby's head won't fit through the pelvis, they will act very quickly.

He's pencilled me in for induction on Wednesday night next week, when I'll be 38+5, but said I can ring and change my mind/move the date by a day or two if I want.

I'm a bit concerned about being induced into labour so early - I had a quick check-up with the midwife before seeing the doctor and the baby's head is apparently still quite high and not yet engaged. The baby was very active and heartbeat was fine.

I'm also concerned that the baby won't have reached 39 weeks' gestation by the time I'm induced (although they'll only be two days short). I read that although babies are considered full term from 37 weeks in the UK, in the USA it's 39 weeks. I mentioned this to the doctor and he said they're keen to start early as there is a slightly higher risk of still birth with gestational diabetes, which really worried me.

I think he said they begin induction with a pessary, then another one if the first one doesn't work and then a gel. Does that sound right? He said he'd expect the baby to be born at the weekend - so the induction would take about 2.5 to 4 days from start to finish.

I came home feeling quite low about it all as I'm still not convinced it's the right course of action for all the reasons above really. I do have another appointment booked with a private consultant at the Fetal Medicine Centre on Monday, so could go to that for a second opinion if needed. It's just so hard to know what is right and most importantly, what's best for the baby.

God, that was such a long post - sorry.

Did you read the Nice guidelines on the link that I shared? They do mention that induction is recommended earlier for GD pregnancies than low risk ones, the reason for this is the slightly higher risk of still birth at longer gestations.

Personally I would give induction a go but ask about Bishop's score and if it's still very low after being given the pessary I would seriously consider requesting an ELCS. I would be very reluctant to have the drip without a high Bishop's score.

It's a very personal decision though and obviously my choice would be right for me and not others.

I would not be keen that they think it will be the weekend before you deliver. After 3-4 days you will be exhausted. Also, there will be less staff around meaning you may have to wait longer for an epidural or even having to go to theatre.

@NameChange30 I will have another read. Is it best to ask for the Bishop's score before the induction process begins, or after the first pessary? It doesn't sound like the baby's in any rush to be born if the head's not engaged yet. Also, I just found the below link on the Sands website, which is interesting. Apparently there's no greater risk of stillbirth for women with diagnosed GD to a pregnant women without GD - which is different to what the doctor said!

www.sands.org.uk/about-sands/media-centre/news/2019/03/new-study-reveals-stillbirths-are-more-likely-if-diabetes

@IHateMyPassportPhoto I was thinking the weekend would be nice because it might be quieter/calmer - the staffing issue didn't cross my mind but it's a good point!

I'm so confused now as to what's best. I can still change my mind - perhaps I should get a second opinion from the private consultant on Monday and take it from there.