GD and under pressure to be induced - but want a natural birth!!

[BeanCan]

Hi everyone,

I'm wondering if anyone has had similar experiences to me and/or any advice and opinions about my predicament... (sorry for essay below!!!)

At 36 weeks I was diagnosed with gestational diabetes after a growth scan revealed extra amniotic fluid (baby measuring average though) and put on extra monitoring. They told me to do finger prick tests 4x per day and control the diabetes with diet. I did fairly well with this, cutting sugar and fruit juice etc and getting good levels most of the time.

A few days ago, at 38+5 I had another ultrasound scan that showed my fluid levels had dropped (yay!) but not enough to meet their threshold (damn) - I am 26.4 and the threshold for normal is 25. I was referred to a consultant who told me I should be induced in 3 days time, at 39 weeks. I felt shocked and upset at this, as I am feeling well, baby is active and healthy, and I am happy in these last weeks of pregnancy despite the usual discomforts.

The doctor was vague about the risks of not being induced but he mentioned the baby's shoulders could get big and get stuck. However baby is measuring normal still at 7lbs 8 at last scan.

Confused, I asked my midwife for more info. She mentioned that baby can put on fat quickly now. Also the water goes naturally it can mean a risk of cord prolapse- scary emergency situation for baby - due to extra fluid, but it's rare. She checked my cervix & it's firmly closed - not viable for a stretch and sweep. With her reassurance I have put the induction back to my due date and will have extra monitoring twice per week.

At 39+1 now, I am walking and eating spicy food and drinking raspberry leaf tea, with so far no signs of going into labour, but feeling really desperate for a natural birth.... I have read so much about benefits of natural labour for baby and me, and I dread the idea of pitocin and of days in hospital being monitored and frequent invasive checks. I understand if risks increase (eg if baby got very big suddenly) I may need medical intervention, but with just that tiny bit of extra fluid it feels like overkill to try and evict baby?? I'd love to hear anyone's thoughts on this or if anyone similarly feels pressured into an induction they don't want and they're not sure is needed??

Thank you in advance

Sorry you're in this predicament. I can't advise on your situation as such I did go through similar.t I had similar, diagnosed with GD at 34 weeks, I did opt for an induction at 39+4. I definitely felt similar pressure as I was

Sorry pressed send too early. I kept being told he'd be huge and I'd end in an emergency c-section as I wouldn't be able to get him out. So I did go ahead with the induction. HOWEVER I had a lovely induction experience and the drip was painful but opted for an epidural and all was natural and really lovely so an induction doesn't have to be terrible.
I'm now pregnant with DC2 and will resist longer this time if advised to induce especially as DS1 was far from huge at 7lb3. Good luck with whatever you decide but don't be too put off because of induction horror stories x

Yes I'm in a very similar boat to you. I have diet controlled GD with a baby who isn't measuring big and so I wanted to follow the NICE guidelines and only agree to induction at 40+6.

However the consultant at my last appointment was concerned my fluid was at 19 as their acceptable cut off is 22. She wanted to induce me at 40 weeks as excess fluid is a sign that despite my blood sugars being in range when I test, the baby is still getting extra sugar.

There's the risk of cord prolapse that you've mentioned and also it's easier for the baby to move in to a bad position for birth (transverse, breech etc).

We've reached a compromise that I'll have one more scan and as long as it's under 22 then I'll wait until 40+4.

It's such a big decision to make as you obviously want the baby to be safe but don't want to go through an induction unless you have to. I do think your fluid level is quite high though which needs to be considered.

For what it's worth, I was induced with my DS and my labour was under 2.5 hour with gas and air only so they aren't all bad. It just took 48 hours to start which was the most stressful part!

Just wanted to say - as someone who was pressed into an induction with my last baby for no specific reason - if you want to go with your instincts and refuse the induction that is completely yor choice! You have to do what is best for you as well as baby.

This comes up on MN a lot. The last thread i saw was deleted as the advice given was horrendous.

There will always be posters who ignored medical advice and whose babies were fine. Equally, there will be others who were not so lucky. Statistically more will be fine as the risk is relatively small.

However there is a risk with GD. Hence why they advise a certain route. They want to avoid the chance that things could go wrong quickly. Which it can with GD.

It is not an absolute science by any means. Yes try to understand what the risk is to you and your baby from not accepting the induction when offered. Equally the Dr is offering it for a reason.

FWIW I had my second induced at 38 weeks. There was a risk of infant mortality. I wanted her out where she was safer. It was fine. 39 weeks is pretty close to term.

Thanks so much everyone for the replies and reassurance. @Teakind if you are at 19 does that not mean your fluids are ok? That's interesting that their cut off is 22 and at my hospital it's 25.. maybe I have more fluid than I thought then 

Definitely feels like such a huge decision. Scared there could be risks for baby either way

@sebbiesmum I'm glad your induction experience wasn't bad  that gives me hope! @teaformummy how did you find your induction experience may I ask?

37 weeks is full term. GD has huge complications. Why put your unborn child at unnecessary risk?

I had GD. Couldn’t control it. Had the opposite of big baby and had a little baby. Baby was born via c section at 35 weeks.

There’s a reason induction is advised. By all means it’s your choice. But make sure you’re fully informed.

@BeanCan I thought that but 19 still puts my fluid levels at something like the 97th centile for my gestation. It was a fetal medicine consultant who told me 22 was the cut off but the GD consultant firmly thought 19 was too high. It’s hard balancing opinions and advice!

@BeanCan My induction was long and slow and ended up in c section , that being said DS and I were completely fine and healthy at the end of it! Inductions are completely normal. IMO, as a first time mum i think i was easily led into an over medicalised birth without being fully informed - better to have an honest open convo with your midwife/consultant and weigh up all the options. And if induction is the best path then at least you know you made the decision!

Also! (Sorry to add to my long post above) If you do go for the induction, you can decide options within that! For example, do they offer a balloon catheter instead of a pitocin pessary? You don't have to consent to vaginal examinations, although they offer them regularly anyway. With monitoring you can still move around a bit or you could request handheld monitoring. Each decision is up to you which might help you feel more in control! Doesn't have to be bad x

Personally if I was being advised to accept induction, I'd want to know about the possibility of an elective c-section so that I could weigh up the risks of all three (elcs vs induction vs waiting).

Waiting would probably not be an option at the top of my priority list unless I really felt they were being overcautious for some reason (and TBH I'd be wary of deciding this, as a layperson!) - if induction is being advised it is generally because there is a significant risk from waiting, so although waiting is the best choice in a straightforward pregnancy with no risk factors, it probably isn't if induction is already being advised.

So then it comes down to induction vs ELCS.

When you say you want a natural birth, is it that you want to avoid any c-section, or an emergency one? Because if you want to avoid any c-section, induction is still giving you a chance of a vaginal birth, and I would be looking at the conversation from that angle - what can we/you/I do to make this induction more likely to be successful? What should I expect, should I change my perspective or expectation about pain relief? If your birth is likely to be more medical and therefore rule out certain pain management options and/or be possibly more intense, more medical pain relief options might make more sense. Or you might still want to see how you go. Many people have a very natural, intervention free birth even though they were induced. It does not necessarily mean that it will be a long drawn out affair with loads of intervention and ending in an instrumental delivery or c-section.

Do you know about Bishop score and do you know what yours is?

If you're more worried about the induction being long, overly painful, or the higher chance of complications and EMCS, you might prefer to look at the option of ELCS - I think this might be where I'd lean towards, especially if I was told my Bishop score was low and therefore induction was likely to be long and involved and had a higher chance of ending in a crash section anyway. I would rather have a calm, low-risk experience of planned surgery than an emergency situation which is likely to be very stressful, and opting for an elective section would totally rule this scenario out. On the other hand obviously if you choose a section then you have no possibility (this time) of a vaginal birth, so it really just depends what specifically it is that you mean by "wanting a natural birth" and which of those aspects are important to you, if waiting for nature to take its course is off the table.

I was watching this earlier and I think it's really helpful for explaining the relative risks (although she doesn't go into ELCS as an option, and seems to assume that everyone would prefer vaginal birth to CS in all cases). It was informative and useful. Part 2 also explains the different induction techniques.

Do note in the UK syntocinon is used rather than pitocin and it is generally not used in quite the same way as it is in the US. Also in the UK, elective induction / induction for convenience is not allowed - only induction for medical reasons, so that part is irrelevant.

I had diet controlled GD diagnosed at 28 weeks and there was never even talk of an induction- I went 10 days overdue!

I would try not to base your decision too much on the estimated weight. I know plenty of people who were told they were going to have big babies, and they came out small and vice versa. If the baby was already 7lb 8 at 38.5w then it could easily be 8lb in reality and growing every day.

There is no guarantee that you will go into labour naturally at any point (many people are induced at 42 weeks). Every day that goes by, the baby gets bigger which then reduces the chance of having a 'natural' birth as they are more likely to get stuck. I would take the advice of those who are involved in your care rather than those on mumsnet. They will be able to tell you what is safest for you and baby.

I had GD from very early in my pregnancy and I was always told I "wouldn't be allowed" to go past 40 weeks. I was never really sure what I'd do as I was very against induction (probably too many stories on here!) but in the end I had an ELCS at 39+3 due to non-GD related pregnancy complications. DD was less than 7lb.

Ultimately it's your choice - you need to balance the (possibly conflicting) medical advice with your instincts. As long as you are being closely monitored and you're prepared to change your mind if the scans/checks show different things then delaying a few days doesn't seem unreasonable to me.

Shoulder dystocia and cord prolapse are no joke, they pose a serious risk to your baby. Please listen to the professionals involved in your care. People will pop along here and say 'of course you can refuse induction!' And yes of course you can. You can refuse all medical treatment altogether and go and have a proper natural birth in a field of wheat if that's what you want. But should you? This is the part of pregnancy where you start to realise the main objective for the medical teams is to get the baby out safely and you have to surrender some of your birth plan for the sake of your babies health.

Natural labour and delivery isn't more beneficial for your baby than going against medical advice and not taking an induction.

Sure the risks of waiting it out are tiny but the benefits of natural labour and delivery are also tiny and much less quantifiable. You'll probably be one of the lucky ones and be fine even if you don't get the induction but there's no way to know that in advance. Well there is some way, looking at risk factors. And your risks are higher because of the GD, which is why you've been offered induction.

If I had an induction I'd refuse to get the drip put in until I could have an epidural as well.

It's been a little while but just wanted to jump on and thank you all for your thoughts / experiences / advice. I did end up going with the induction recommendation (on my due date instead of at 39 weeks), went into labour that evening after pessary at lunchtime, and gave birth at 40+1. I have been in hospital for a few days since, recovering from what ended up being a slightly difficult delivery with forceps and some significant blood loss. It wasn't the all natural birth I wanted and I ended up needing an epidural, episiotomy etc but on the plus side I avoided an emergency section (and any tearing) and my little one arrived safe and sound and healthy (his blood sugar levels were normal despite the GD, and the polyhydramnios hadn't affected anything either) so that's the important thing

Ah brill :) Thanks for the update. How are you feeling? It's OK to feel that the birth was a bit traumatic or intense, even though on paper everything "ended up fine".

Great news OP! Congratulations!

Sorry you had a tough time but I’m glad the pessary worked quickly for you and that your son is fine

Sorry to hear of your situation and how you feel.
I didn’t have GD but with my 2nd my waters went at 38 weeks but I wasn’t having contractions and baby’s heart rate kept dropping, from my experience of natural labour with my first being induced was much quicker and straightforward.
My baby was born at 5lb and despite being small we were home the same day I had him it wasn’t much different from my natural birth.
I understand that you have different wishes just wanted to give my experience of an induction. xXx

Thanks everyone :) @BertieBotts the birth experience was definitely very difficult and quite scary at points, but I am kind of proud of myself for facing various fears of mine eg the induction itself, and the forceps delivery and episiotomy, and taking it in my stride (not that you have much choice but to get on with it, once it comes to it!)

Unfortunately since the birth things have also been very challenging. Due to the blood loss I have had anemia and so got very weak, breathless and dizzy and eventually couldn't walk or stand anymore. I had an iron infusion the day before yesterday and am starting to feel much better. More concerning is that my DS has been very lethargic and jittery and so has also been in hospital for tests and observation for a few days now. They thought he may have an infection but his inflammation levels have decreased today and he is finally feeding well (currently tackling the fun of cluster feeding tonight, hence the 4.30am post!) We are hopeful we might be able to go home tomorrow. Fingers crossed!!

@Mumoftwo2021 it's really interesting to hear of your experiences - labour is so unpredictable! I am glad you had a good induction and hope the birth of your second wasn't too traumatic. In the end I went into the induction process very hopeful that it wouldn't end up too medicalised and intense and that I could still have a lot of the birth elements I had hoped for like intermittent monitoring, moving around, avoiding epidural, maybe even being in the water for a bit etc - a family member had two positive inductions and shared her experiences with me recently, which set my mind more at ease - but unfortunately in my case it didn't go the same way. The contractions were so intense I couldn't even stand after a while let alone do yoga poses or whatever. I had to have constant monitoring for the baby's heart rate as it was dipping at times, and I ended up with an epidural which I really wanted to avoid (again was quite proud of myself for facing my fear of a big needle in the spine though! And for sitting still through a horrific contraction while they put it in and the pain relief was wonderful)

I guess I really learned that while we all have our preferences there is no real way to be prepared for / plan for labour - half the stuff in my labour bag wasn't touched eg relaxing oils, snacks, even my trusty birth ball... and everything I wanted originally went out the window in order to just get through it the best I could with the amazing support of my partner and the hospital staff. In the end all we can really do is focus on the end goal of delivering a healthy baby