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.

I'm afraid I don't know but would advise you to discuss it with the midwife and/or consultant.
That study is very reassuring (about no extra risk of stillbirth when GD is diagnosed and managed)
FWIW I think it's a good plan to get the second opinion on Monday and then see how you feel. You'll still have time to decide before Wednesday.

There is a lot of evidence that babies of mum's with diabetes do better if they are induced at 38 weeks, there is real risk to the baby between 38 (considered full term anyway) and 40 weeks. I worked in 2 different Obs/Med clinics for 15 years

Thanks @NameChange30. I thought that if I really insisted on a c-section due to the baby’s head size and concerns over induction that they would ultimately have to give me one, but it sounds like that might not be the case?

The hospital can only refuse to offer you a c-section if it has balanced all the factors and can show that there are good reasons for refusing and the effect on you is not disproportionate.

www.birthrights.org.uk/factsheets/right-to-a-c-section/

I’m feeling really anxious about the birth now because I’ve stupidly read so many horror induction stories online.

Like you say, it will hopefully be helpful to get a second opinion from the private consultant on Monday.

I got induced early, also for diabetes, but type 1. I was induced at 36 weeks so 2 weeks earlier than they are proposing for you!

Induction was quite lengthy (which adds to gestation time) but once they had broken my waters and put me on a drip it was 12 hours start to finish.

I would be inclined to go with medical advice. The way I reasoned it was, if I didnt follow it and thought I knew better and something went wrong I would never forgive myself.

General statistics on early term and term babies are not what is specifically right for your baby.

Good luck!

They can't do anything without your consent. So if you withhold consent for an induction, they probably won't want to do nothing (ie wait for you to go into labour naturally) so will be more likely to agree to an ELCS. Ultimately it is your body and your choice, and they would have to give you good reasons for refusing an ELCS.

However, it might be worth trying to find some positive induction stories! As it can work out ok.

Would you consider acupuncture (if you find an acupuncturist who is still seeing clients)? It is "alternative" but I've heard that it can help. ie have acupuncture before your induction and it can help you and your baby to be more ready for the induction and birth. Not sure if there is any evidence for it. But when I was well past my due date and wanting to avoid induction, I had an acupuncture session - I figured it couldn't do any harm.

There is a lot of evidence that babies of mum's with diabetes do better if they are induced at 38 weeks, there is real risk to the baby between 38 (considered full term anyway) and 40 weeks.

Hi @gingercat02 - I’m sure I read that is the case for women with diabetes as opposed to gestational diabetes. On the NICE website it says this:

Consider elective birth before 40+6 weeks for women with gestational diabetes if there are maternal or fetal complications.

I guess the polyhydramnios could be considered a complication, even though it’s only 0.2mm over the threshold?

Thanks @Wolfgirrl. How long did your induction last from start to finish out of interest? Did you have an epidural?

@NameChange30 That’s good to know, thank you.

@worried yes the risk is greater with diabetes but GDM babies do get extra glucose no matter how good your control is the risk isn't entirely size related. Not all inductions are terrible. I was dreading mine but it was almost exactly 12 hours from waters to delivery

Thanks @gingercat02. The doctor said if I come in Wednesday night he would expect the baby to be born at the weekend. Does that sound right to you? I know the process can take longer with first time mums, but it seems like a very long time!

Think its very individual how long (I don't have diabetes/GDM btw, I'm an HCP)

Thanks. Having googled inductions, it seems like barely anyone has a good word to say about them!

I just wanted to reassure you that for me, the birth of my 9lb6 baby was so much easier than my 8lb7 baby! Ask to remain active and let gravity do its thing.

Expressing colostrum by hand into some syringes to store in the freezer would be a good plan right now. Then if baby needs extra fluids it will be getting the good stuff.

Best of luck and follow your instincts.

It started on Monday 24 hour pessary, then another pessary Tuesday, then a 24 hour cook balloon on Wednesday which by thursday night had got me dilated enough to have ARM. Labour ward was full so I had to wait until 1am Friday morning to get a bed. When I got there they broke waters and put me on the drip. Baby born early Friday evening.

It didnt really hurt until I got to about 6cm, so didnt have anything until that point, not even gas and air. I was totally up for pain relief though so when it got worse I asked for an epidural. I was one of the unlucky ones it didnt work for, and there was no time for anything after that as I was 10cm dilated 20 minutes later and had to start pushing.

DD was a forceps delivery in the end but I can say hand on heart that was the nicest bit of the delivery! They gave me a spinal which took away every last bit of pain, and DD was out on the first push/pull.

MN is full of horrendous stories about inductions and assisted deliveries, but honestly most of the time they're not that bad. My best friend also had forceps and said she didnt feel a thing. Neither of us have any lasting problems.

I don’t think there’s any question of the OP not following medical advice, is there? especially given that she is actively seeking it out to make sure she is making an informed decision. I’m not sure why people are implying that she is trying to go against it.

I had GDM without the additional complication of large estimated weight or polyhydramnios so I followed the NICE guidelines for diet-controlled GDM and was booked for induction at 40+4 but delivered naturally earlier.

It sounds like the medical advice in your situation OP is quite clearly for delivery before 40 weeks, and you sound reasonably convinced by that? Personally I would now be looking at which birth method is likely to be easiest to recover from. From my POV, the high chance of an exhausting labour, additional interventions including csection puts me off induction before 40 weeks, and I would be inclined to push for an elective csection. It would be so much harder to recover from long labour + csection than “just” csection (and that alone isn’t a walk in the park), especially given the restrictions currently in place wrt birth partners. But the really important thing is that you are thinking this through carefully and making sure you are doing what is right for you and your baby.

And the post before mine is exactly why you shouldn’t just listen to one person (ie me!) because I haven’t experienced either type of delivery so it’s the accounts of others that have contributed to my own decision making

I can give you a positive induction story if it helps.

Induced at 37 weeks due to pre-eclampsia. First baby. No GD, but I was on course to have a big baby. Predicted just under 7lb at 36 weeks. Can't remember centiles exactly, but everything was at least mid 90s.

Bishop score was an almighty 1. And that solitary point purely due to the pre-eclampsia. Baby not in the slightest bit engaged.

Gel pessarys were placed Wednesday morning. Barely did anything. I had the odd contraction while power waddling, but nothing strong or continuous. Brought down to the delivery suite 1am Thursday morning since they had capacity, had waters broken and drip started. 13 hours later I had my baby. No interventions needed, and just a small second degree tear to be stitched up.

If I had the choice of being induced vs. a Caesarean, for a future baby I would take the induction again. But that's me. I work in the obstetric theatres and have seen literally hundreds of Caesareans. I don't want to ever have one. Unless I have to of course.

Good luck with whatever you choose to do.

Forgot to add, it was all very calm and I actually asked for an intervention as I was tired and uncomfortable. I must be the first person to have asked for one! If the epidural had worked I may not have needed it, so dont be put off. I would say I felt totally normal within 2 weeks

@worried88 hi thinking of you today! Are you going for the induction this evening?

Just to reassure you (although I haven't read the full post in all honestly) I have been induced with both my children and had a positive experience both times.
With the first he was more than ready to come, and I only needed one pessary, with the second he was more reluctant but still only needed two pessaries.
Both induced at 38 weeks and born within 12 hours. Obviously I don't know if it is any more painful than a 'normal' experience but I feel I had what can be considered a 'nice' experience.
I hope you have a positive experience whatever you chose. Good luck!

Thanks @Lazydaisydaydream!

To update on my situation - I went to see the consultant at the Fetal Medicine Centre on Monday and told her all my concerns.

She said the baby’s estimated weight is currently just over 8lb with a head circumference of 35.5cm (95th centile). She checked everything over, including the brain and placenta, and said everything looks fine. The baby’s movement is also good.

She said the baby will continue to grow because of the gestational diabetes and said she agreed with the hospital that I should go ahead with the induction sooner rather than later now.

I’m feeling reassured that the baby’s weight isn’t too big at this stage and that the head circumference is currently average size for a newborn - it makes me feel I do have a good chance of a vaginal birth if I go for induction now.

So, I’ll be heading in tonight to start the process - I’m very nervous about being induced but am also feeling relieved in a way, as the last few weeks have been one constant worry. It’ll be reassuring to get into hospital and know the baby will be in safe hands and closely monitored throughout.

The doctor has predicted that they will make an appearance this weekend!

Fab, glad you feel reassured and positive about the plan! Best of luck

Good luck, let us know how you get on

Ooh, exciting! Good luck. Hope it goes well.

I would go for a planned c section any day of the week. Many of my friends who had inductions were waiting for days and then had emergency csections. I was in hospital for 2 nights after mine, no recovery issues at all.

Just seen your update so my post was rather unhelpful! 😑
Good luck and glad you're feeling positive with your plan.