31+5 with GD. Baby has a small AC but don't want an induction. Advice?

[LoyalFairy]

Having my first baby. Currently 31+5 and found out I have gestational diabetes at around 28 weeks. I managed to keep this under control through my diet for the past 3 weeks, but just found out that a low carb diet has meant high levels of ketones. From this I've realised I have to increase my carb intake and to just take walks afterwards which does bring my sugar levels down.

However, it now seems my GD could be affecting the baby's Abdominal Circumference to be smaller. The baby's head and leg growth is fine and so is is blood flow through the placenta, it's just the AC which went from 31st percentile to 12th after 2 weeks, and maybe even smaller based on today's measurement which was a week after that - although a proper growth scan will be done on me next week so I'm not sure what percentile it's in now.

My question is how worried should I be about the baby's health and should I consider an induction? They said if it doesn't improve over the next couple growth scans they'd want to induce at 37 weeks. I really wanted to avoid induction as I preferred to go into labour naturally so the pain would build gradually. I'm not good with sudden pain since my cramps just before my period are manageable, so the idea of induction bringing on quick contractions is scary. I actually wanted to try a birthing centre for a more relaxing natural birth compared to the hospital ward environment but sadly that plan may now be going out the window.

Has anyone found that their baby's growth caught up in the end and everything was fine? Or as they say, the measurement can even be wrong and everything may be fine with the baby's size once its born. I'm thinking that it may just be a lean baby and they're just taking extra precaution. Thankfully my baby's movements have been fine and they've even gotten stronger in the past week, I have good energy levels and feel better than ever in my third trimester thank god.

At the end of the day I have the right to say no to an induction but then could I be harming my baby? Here I was being told GD may cause my baby to be big but now it seems the AC is smaller. Funny thing is, they wouldn't have even spotted the small AC had they not required me to start doing scans every couple weeks after the GD diagnosis at 28 weeks. They would have just said everything was fine so long as I could feel the baby moving, so it has me wondering whether we'd be intervening for no reason?

For now I'll just keep eating more carbs and walking it off to keep my sugars down in case it delivers more nutrients to the baby. It's unfortunate that after I found a way to deal with the GD, I'm now inadvertently in nutritional ketosis which could be affecting the baby! Seems being more active is the way to go for me.

I didn't have gestational diabetes with my son but he was measuring small so I was induced at 39 weeks.

He was fine, the scan was wrong ( they aren't 100% accurate)

I don't mean to make you anxious but the induced labour was horrifically painful. Despite planning an epidural I never was given one and it was awful. I had my first child with an unmedicated natural labour and obviously it hurt, but the contractions help manage the pain. With an induced labour, those contractions are not natural and they feel forced. They don't offer the same pain relief when pushing, it felt like I was forcing my baby out. I would have rather had a c section then go through that again.

I am not a doctor and obviously you have to do what is best for you and your baby, but I strongly recommend you insist on an epidural with an induced labour. If you decide to take the induction.

I would wait and see how much the consultant is insisting on it, I suspect a lot of inductions happen to manage the work load on the ward. This was certainly the case with me.

I will probably get shot down with this post. I can only share my experience.

Good luck OP, go with your gut instinct xx

I had GD from very early on. The consultant endocrinologist agreed that we could wait til 41-42 weeks. However I stopped being able to manage the GD and DD had multiple reduced movement episodes. So I chose to have an induction at 37ish weeks.
The induction was smooth. I had gel. I woke in the night with labour pains. I took myself off to have a shower I put my playlist. After a bit I popped my head out got other half to call my mum and the midwife. DD was born not very long after my mum arrived.

Yes I keep thinking the scans might be wrong and who even knows how my baby is tucked away inside me to even be getting the accurate measurements. The baby moves around a lot whenever it is being examined.

I have heard induction can be painful so I also had the same idea that I would want an epidural if the contractions came on suddenly (they said it's usually administered within 30mins but wondering how honest they're being about that). They actually made out that induction wouldn't be as bad as I think since they would just try to force break my waters but then I'm thinking... wouldn't any kind of intervention cause pain because we're forcing the baby out?

Caesarean for me would have been a last resort for when baby was in distress, but I can imagine begging for one in panic from the pain!😬

Before the small AC diagnosis they suggested I could go up to 41 weeks with GD. Now I can't wrap my head around it possibly coming down to 37 weeks as it's only about 5 weeks away! So far third trimester has been my best one in terms of feeling energetic and having a full appetite again, so it's sad I now have to worry about the baby's growth.

Nice to hear from someone that their induction was smooth. I keep hearing bad things. My sister was given the gel after her waters broke because after 24hrs the baby still wasn't coming, she said her contractions came on quick and baby was out in about 3hrs. She had her first labour to compare it to where she did go into natural labour and had the chance for contractions to build up gradually.

If you go for induction and get the epidural the minute you get on the ward start asking about when they will do the epidural. Keep badgering. My experience was awful I kept asking for it and it was in my birth plan but I was fobbed off each time i asked and then it was too late. Looking back I should have complained.

If you have a natural labour and birth you will cope fine, it is hard but your body finds a way to cope with the pain. The contractions do hurt but once you start pushing they offer pain relief. Our bodies were designed to go through this process and if you can have a birth partner that will offer mental support it helps.

Also on a different note, and again this is only how it was for me. During labour with my second,my husband leaned his forehead against mine only very briefly, but in that moment the pain was manageable. ( I kept leaning forward for him to do it again but he never got the hint). Later on ( months ) I watched an episode of greys anatomy where they discussed the release of oxytocin as pain relief and the doctor encouraged canoodling during labour! Too much for me personally but definitely some truth to it!

I did do a hypnobirthing course prior to birth. As it became clear baby would need to come out I listened to "make baby come out" hypnosis. I also listened to a labour hypnosis for a bit in labour too. Then afterwards I listened to a post birth one. I think the really helped me stay calm during the lead up to and during the birth.

I had a small baby and asked for a caesarean as I really didn’t want an induction! I’m sorry that your in this situation, I felt very trapped when it happened to me as I hadn’t wanted an induction at all but felt I had no choice because obviously I was also worried about my baby.

As it’s your first baby and they are inducing you very early at 37 weeks i would ask what percentage of first time mothers induced at 37 weeks go on to have an emergency C-Section.

In my trust it was higher than 60%.
Induction is very different if it’s your second baby, but as it’s your first I would recommend researching C-Sections to at least get comfy with the idea (they are not that scary promise!) as the stats are against you.

Oh and at 37 weeks they are very unlikely to be able to break your water immediately. They will need to do the gel/ pessary for a while first, to get your cervix to dilate to 2cms at which point they can break your waters. It will be a long process!

I’d also ask what the antenatal ward is like as that is where you will probably be until you are in active labour. Is it single rooms or a ward? The ward, in my experience, is dreadful! Nobody gets any sleep so you start labour exhausted and then are a dead zombie by the time the baby actually arrives. Not the best start to being a mother.

I don’t mean to be so negative but these are all things I wish I had known before my induction. I didn’t ask the right questions so found the whole thing very traumatic and developed Post-Partum Anxiety as a result. My second birth was so much better mentally as I knew what to expect.

I think they’re super quick to offer induction. I would do your own research and decide what you think is the best option. They were quite pushy to book me in for induction at 40 weeks based on having IVF but when I did my research and called back and said I didn’t want to they were completely fine. Ended up 11 days over mind but she came of her own accord with no problems!

Based on a birthing workshop I went to for our local hospitals, they're supposed to listen to the patient if we request an epidural. I mentioned to them that a few years back when my sister asked for an epidural after the induction brought on intense contractions, the midwife fobbed her off (basically lied that it was coming) since she felt my sister could do it naturally after watching her progress - workshop guys said that was wrong and they should have listened to her request. They said the only time it should be refused is if it's too late to administer one.

At the local antental birthing fair they said they have two anaesthetists on the maternity ward and another available upstairs if those two are unavailable so they usually expect someone to turn up in half hour. I may have to say to them that unless an anaesthetist is available in 30mins then they can't start the induction process yet.

Just like you everyone has told me birthing naturally is possible. I wasn't even considering the birthing centre before and always thought I would have done the epidural after my waters broke naturally (which may not be given a chance to happen now of course). And yes I've also been hearing of simple hugs and touches helping with oxytocin and endorphin levels. I know my husband would try plenty, I just hope I don't push him away in agitation without thinking lol.

If your probability of section after induction is 50% or higher (there are calculators for this online) I would go for an elective section in your position.
However, having had a healthy baby after being given a 5% chance of survival at 20 weeks I would always follow exactly the suggestion of the doctors. My gut didn’t go to medical school and I don’t rate my natural instincts when there’s nothing more natural than infant mortality.

Are you on the gd fb page? Lots of women on there are induced early. The stories are a mixed bag.

Im 32 weeks, diagnosed 28. Got my next scans /midwives next few days but suspect I've got ketones as I have had keto breath and wee so tried to add more carbs. My last scan was fine at 28 weeks, baby on 50th percentile.

I've found my gd fine to manage so far, but my fasting levels are creeping up so I imagine with next few weeks I'll be started on meds, and from what I gather they usually induce 37 weeks ish in that case. Its not ideal but I don't have that much anxiety about the process, I'll just go with what's recommend. (I'm more go with flow, then worry / regret it at the time 😂)

I was told that gd babies go two ways, big or small, and I think the reason for smaller size is placenta not functioning properly, I've seen on the groups them being advised there is higher chance of placenta failing, hence wanting out sooner. Some women have ignored and opted for close monitoring and everything has been fine, some have listened and been told that post birth they could see the placenta was beginning to fail, therefore letting things happen naturally could be dangerous. Though, a failing placenta doesn't always happen suddenly, so if you 'risk it' and monitor movements etc properly, intervention can mostly be given in time.

If I've got to be induced I'm just going to try all the tricks to make it easier, yoga, raspberry tea, bouncy ball, unfortunately can't have dates cos of gd.

If you decide to wait past 37 weeks, there will be plenty of women who made same choice and it worked out great for them, but unfortunately if you are hoping for complete reassurance you are in the right to let things go past this date then that's impossible to do, as it's a very personal decision.

I think an induction with GD is quite likely anyway as they won't let you go past your due date.
I had GD and booked two sweeps for 39 weeks and an induction for 40 weeks but ended up going into labour naturally at 36 weeks (which is also quite likely with GD!). Low birth weight baby but he measured small all the way through pregnancy.
My GD was completely diet controlled - high fat diet and exercise after every meal so I think that's why they were willing to let me go as far as 40 weeks.

With induction the pessary didn't get me to labour, it started contractions, had around 10 hours of those and then it all just stopped, waited for 4 further days to have my waters broken due to staffing shortages. When I did go round to labour ward which was due to her heart rate dropping rather than finally getting a slot, they broke my waters in theatre and offered me the epidural at the same time as starting the syntocin drip, I actually declined the epidural, semi regretted that as like others have said the contractions on the drip are far more intense than they would normally be, had my first on the birthing centre, lovely calm birth. The induction was for my second, but whilst I regretted saying no to the epidural and demanded it around 4 hours in, she arrived 1 hour later without it at 6.30pm and I was home by 11pm that night. I would still recommend refusing the drip until they start the epidural, but that's just me, I know others that have been fine with it.

They’re quick to offer induction but a small baby is a significant risk factor especially if there is any hint of placenta issues. OP for a first baby at 37 weeks I would ask for a csection.

I actually do need to try hypnobirthing. I plan to sign up to some online classes about it. Will look into the one you've mentioned, thanks.

I get what you mean because at the end of the day I'm so worried about experiencing pain but then it could be at the expense of my baby. Now I'm sat here thinking about my plan in case an induction does happen.

Thanks I'll note to ask. I know they release stats every month which includes unplanned caesareans but they haven't mentioned it specifically for first-time mothers.

I'll have to look into the induction process. I've been so preoccupied thinking about it all that I haven't had the nerve to look into the actual process after they provided me with an information link. Makes it so real.

At the information fair I attended they mentioned there being 13 rooms with 13 midwives at the hospital but I'll have to find out at what point I'm allowed into those rooms after being on the ward. Thanks I wouldn't have known to ask!

@LoyalFairy when I had my small baby I initially went in for induction. The process was to get to a point that I could have my waters broken with a gel or balloon. But once they had used that to open my cervix by 2-3cm I wouldn’t move to the labour ward until they had a bed free. Some women had been there for over a week waiting, even those who had been told they urgently needed induction!

There is a really great podcast on induction on the birth-ed podcast which talks about this issue of women being called in for urgent inductions but then being kept waiting for days in hospital.

With my small baby I didn’t want to delay delivery which is why I asked for the csection instead.

Good to hear your baby made it!

I wasn't aware of the online calculators so I'll have to look into this. Thanks!

Ah so you're the same as me in terms of GD and current gestational age.

The antenatal workshop I went to actually did mention what you said, that we can refuse induction and request closer monitoring. They said doctors don't tell you this and you have to ask because it's a hassle for them. If in a few weeks time things are still not better and they suggest the induction I'll ask for closer monitoring for a short while unless it becomes a bit more clearer that I should go for the induction. I'll need to join the Facebook page you mentioned.

I too am looking into what I need to start doing now in case induction is imminent. I have the birthing ball and am going to buy some raspberry tea. I can eat dates and as long as I walk them off. I found that squats have been very good at bringing my sugars down, or even lifting small weights or knee support press ups if your stomach isn't too big. Even wondered if I'll get the chance to do colostrum extraction, if I go for the induction I may as well start it close to the time, some say it can increase the chances of going into labour which wouldn't be a bad thing if it's around 37 weeks.

I guess I'm hoping I go into labour naturally anyway the closer I get to 37 weeks. Even thinking about what I can do to make that happen safely.

My GD has also been diet controlled so far but now thinking lack of carbs may have caused this new issue for the baby. I've increased my carbs in the last few days and am exercising after meals (squats, lifting small weights, knee support press-ups) which brings my sugar levels down.

I didn't even know it was possible for contractions to start and stop like that. 4 days are ridiculous I would be fuming if they insisted on an induction and then stretched it out! I also really want to avoid the drip but definitely plan to ask them to have the epidural ready.