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 had an epidural before the induction drip was even started.

I need to look into this podcast. I didn't know women could be made to wait that long! I'll have to insist there's no point calling me in for an induction if they can't make room for me. If I'm in distress waiting around at the hospital that won't be good for the already delicate pregnancy either.

Seems the best way.

Having to wait around on the antenatal for induction is really common. I wanted to self- discharge so I could go home as after 24 hours with very poor sleep I had had enough and they said that I would lose my place in the queue. Plus it would be against medical advice so if anything happened to my baby it would be my fault.

Even though they hadn’t even started the induction process yet and they weren’t monitoring me at all, I was just sitting in a bed which I felt I could do much more happily at home!

This was a busy London hospital so it might be better somewhere less busy? But definitely another question to ask your midwife.

I had GD and my baby was small for gestational age. She was born at 38 weeks 5lb 7oz. They said she had IUGR which is intrauterine growth restriction due to GD.
She came out and gained weight very quickly.
my placenta looked healthy on the scans, Doppler levels etc but on examination after I gave birth it had deteriorated slightly.
all of my sugar levels were controlled by diet.
I would listen to their advice.
a lot of people will come on and say re your body, your choice.
But…..for me everything looks good on scans…..but my placenta deteriorated

Sorry if I've missed it but given the failure rate of inductions / horror stories is there a reason you wouldn't go straight to elcs?

I had GD in my pregnancies. I needed a slightly early birth for one (37+5 and I had an elcs it was a great experience)

I don't mean to alarm you but i know a lot of women who had inductions (nct push them as the least bad alternative for women who fail to "breathe well")
3 of those womens experiences were so bad not one could contemplate a sibling despite wanting one.
we are talking 2-3 days then EMCS, one thought she was actually going to die. Another ended up with 3 degree tearing that reopened at 7 days pp 😵‍💫. She was promised an epidural but it never happened and They also stitched her with no pain relief despite her requesting it repeatedly. They basically said of she was going to be fussy and insist they'd have to get the meds signed off etc and she might not be stitched until the next day...
Just awful! We are london though so maybe its better elsewhere.

I am sure it does happen somewhere but i don't personally know anyone who had an induction and said yes that was a positive birth experience.

I said no to the induction for the same reasons as you , I was booked in for a c section at 39 weeks in the hope I would go into labour naturally before then, my waters went at 36 weeks so I had the section at 37 weeks

I’m one of those women who only had one baby. I was 2 cm dilated after 22 hours of the drip and had a late-night emergency C-section. In the OP’s position I would ask for an elective C-section.

That sounds like a good plan.

I guess i can also do dates if I do a bit of exercise after. I haven't really tried that yet. However I think im breech too so my preference for a natural birth seems to be going out window so all these methods may be pointless for me, but ill still give it a go just in case she turns in time.🙃

Apparently colostrum is especially good for gd babies so ill be doing my best to do that. I'll probably start at 36 weeks anticipating it takes a few days.

From the gd group plenty of babies are born at 37 weeks, and after the 24 hours of sugar monitoring have been fine to go straight home.

It's hard enough giving birth, it's sad that on top of that they don't even bother trying to make women comfortable. I lived in London all my life but I've moved to the North now and have no idea what the reputation is like at the hospital I'll be at. I do know they've been working lately to make improvements to the maternity ward after asking mums who had babies there for feedback. They make the place sound so inviting at the fair I attended. I'll be asking my midwife more about this.

Yes I don't want to completely disregard their advice either. It's like you said, with scans it may not show if something is wrong with the placenta. I'm going to keep an open mind about the induction while asking them to monitor me closely.

I just don't like the idea of being cut open to get the baby out. I'm not totally ruling it out but I would consider it if the epidural was unavailable to me.

Gosh after reading everything you've just told me, I don't understand why they think it's okay to ever put women in this position! Pain relief really needs to be a priority. They say our bodies are made to give birth but it only makes sense to apply that idea to naturally occurring births, not the baby being forced out!

I guess in my head I'm thinking maybe I won't let it get past 38 weeks just in case. I know I'm thinking ahead because I have to wait to see whether things get better, worse or stay the same. Still praying baby's AC growth will catch up though.

I never wanted a caesarean but I am going to discuss it all with my midwife just in case.

I used to think having a c section would be the worst thing in the world, no idea why but I was dead against it. Anyway second baby ended up in an EMCS after a difficult and painful labour and it was absolutely fine, I couldn’t believe what a none issue it was in the end so can now completely see why people advocate for ELCS ones in situations like this. It’s definitely worth discussing.

I really hope it all works out for you and your baby. I'm going to do some research on colostrum extraction to see how GD mums found it the closer they got to inductions.

My baby is face down everytime they do my scans and is postioned very low down - so part of me has this feeling that even the baby wants to come earlier. He/she sits so close against my cervix that sometimes it gives me an inkling of what I think the very early stages of labour might feel like.

Also I checked FB and can see there are several support groups. I may as well join multiple!

I do remember someone once saying they personaly recommended it, they had GD at the time and said at least it meant their birth plan was clear since they knew exactly when the baby was coming. I guess with an ELCS there is just recovery time to consider.

I had GD with my second and third. With my first I had a natural labour and found it manageable with gas and air. The contractions come on more naturally and the body finds a way to cope. He was born 6lbs 12oz.

With my second she was measuring small and I was induced at 41 weeks. It was horrific. I had the pessary which didn't do anything for me so the very next day they put me on the hormone drip. I still feel like today, 3 years later, I have some trauma from her birth that I haven't managed to work through. The pain was unbearable. The contractions came on so fast and each one more painful than the last. I just couldn't take it anymore. I was fobbed on when I asked for an epidural. In the end I only had gas and air to manage the pain and it felt like I was dying. I feel sad when I think back at her birth and how much pain I was left in. She was born 6lbs 8oz.

With my third, he was also measuring small. I was induced as towards the end he was losing weight each week and failing to grow. I actually remember crying to the midwife saying how much I didn't want another induction after my last experience. I 100% refused to have the drip again. This time the pessary did work and unfortunately the labour was very much painful. Nothing like the easier natural labour of my first. He was born 6lbs.

Thank you, you too.

This is the main group. Some nhs hospitals have started directing women here too

10 years ago now when I had GD with a first baby. Regular scans and no problems identifield.
discussing with consultant and midwife whether to have c section or induction I suggested that they book me in for elective c section but if leading up to it I was favourable for induction, as in likely to be succesful, I would have that instead. Think the calculation was bishops score. Consultant said that waa a very sensible plan.

It never was favourable even the day before c section so I had c section at 39w3d.

That seemed the best approach to me as c section seems the best way to get a baby out early when they are showing no signs of wanting to make an appearance.

DS was 8lb 9

@LoyalFairy Please remember that people are far more likely to take time to write about a bad experience than a positive one 😊

I had an early induction with my son (no GD but other growth issues). I have no natural labours to compare pain levels to but honestly, it was fine and I’d do it again if it were necessary for my child’s health. It was incredibly painful obviously but it was manageable.

My cervix was completely closed at the start so I had to have 3 pessaries. Cramping started within an hour of the first one being put in and felt like intense period cramps that were gradually getting stronger. After 3 pessaries I was 1.5cm dilated and they moved me to the delivery suite to break my waters and then start me on the drip. I had an old cow of a midwife who shouted at me and told me that I had to sign consent and get an epidural right after they’d broken my waters because I’d never cope with the pain of the drip 🙄 she actually stood beside me with her arms crossed refusing to give me the drip until I gave consent 😂🙈
So after getting rid of her and refusing her as my midwife they sent me an absolute angel of a midwife who was 100% happy to go with my preferences. I wasn’t a fan of the idea of an epidural and wanted to try without.

The drip definitely took things up a notch and the pain was intense but I actually felt ok with it as I could feel it getting stronger and could tell my body was making progress if that makes sense? 😅 My body pushed the baby out itself. I had absolutely no control over that 🫠

I used gas and air for pain relief and induction lasted about 54 hours in total. I had no other interventions at all. I had a tiny internal tear that needed one dissolving stitch. Baby was born at 3am and I was home climbing in to my own bed with him by 3pm.

Honestly, the only negatives I can pick out of the whole experience were that -

• I didn’t get to experience that excitement of labour starting naturally which id been looking forward to.
• It was during Covid and my hospital had some pretty ridiculous rules in place at the time so I spent the first 50 hours alone before my husband was eventually allowed to join me for the last 4hours.

My advice would be -

• don’t dismiss the recommendations of medics because of your own fears. Do all your own research and look at all the stats.
• do a quick online hypnobirthing course.
• make sure your birth preferences are written down and that your birth partner knows them. And do not be afraid to advocate for yourself in any kind of labour!

This is why I'll be insisting on the extra examinations from doctors. They can't simply be using scans showing a small AC to be suggesting an induction for me.

Appreciate the positive story. Not sure I've ever heard anyone say things were okay for them with the drip so it's good to know. I really do want contractions to have the chance to build whether it be an induction or natural start to labour because I want the chance to manage the pain (but let's see if I'm fortunate enough to get that chance). Like you said, a natural start to labour and the experience itself was what I was looking forward to (while also being apprehensive of it course).

If I end up with a terrible midwife I'll be expecting my husband to advocate for me if I'm unable to do so for myself lol. I'll be discussing the birthing plan with him once I've had a chance to discuss all options with my local midwife.

Hypnobirthing and gas and air was supposed to be a part of my plan so I'll still be aiming for it if possible while keeping all other options open.

@LoyalFairy I didn’t do a hypnobirthing course until 36 weeks so you’ve got time 😊 I used the digital pack from The Positive Birth company.

I really did find it manageable but I went into it with such a negative attitude sure that it was going to end in intervention and be a disaster and I do wish I’d not been like that.

I do think as well, just to manage your expectations, that it’s worth remembering that a lot of people don’t get that slow build up of intensity of contractions. Some people’s waters go and the contractions are intense immediately. I have a friend with 2 DC who woke up each time because her waters had gone and then suddenly she was having intense contractions - like she was screaming within minutes! Her first baby was born about 2 hours after her waters went. She’d planned to labour at home as long as possible but left the house within 15 mins as it was so intense. She delivered him about 40 mins after arriving at hospital. With the second she was the same - woke when her waters went and got straight in the car because of how intense it had been last time. She almost delivered him in the car. He was born in a little side room in the maternity hospital within 10 mins of getting to hospital as she didn’t even have time to get upstairs to labour and delivery.
I have another friend who had a completely natural labour but was too far gone to have an epidural when she arrived at the hospital. She needed a ventous delivery as she kept passing out when having a contraction!

You just never know what kind of delivery you’re going to have or how your body is going to respond in that situation or how you’ll cope with the pain.
Speak to your midwife or your hospital and ask about the induction statistics as others have said. Do research into all forms of pain relief and see what you’re happy with. I personally didn’t want anything that affected my baby (some make baby very drowsy) so that was put in my birth plan and DH knew that was a big no no. Don’t take other people’s stories on board too much - just look at the facts and decide what you’re happy to do.

I didn’t have GD, however I had a polyhydramnios - just a tiny bit too much water at 40+4. I originally planned to birth naturally and did not want to be induced. At 40+4 I had to stay in the hospital and consider my options, I chose to have a C Section and I refused to have an induction even though consultant was slightly pressuring me and was a bit awkward chat, however I just said I don’t want it and that’s it. I didn’t go into any details. It’s totally up to you OP. You know what is right for you and your baby. They cannot make you do what you don’t want but you need to stand your ground! Good luck 🍀