Gestational Diabetes & VBAC

[where's spot]

I had my first baby last year and had gestational diabetes. I was told I was a border line case and I managed to control it with diet alone. Although my last growth scan estimated my baby as being over 90th percentile, he was in fact much smaller and when he was born he was 50th percentile - so very much Mr Average (I was so chuffed!).

Anyway, my baby was also breech and because of this and his anticipated size they recommended I have a planned caesarean. So that's what I did and it was horrible. The hospital didn't care for us properly and I very much felt my initial bonding with my baby was affected by how upset I was about how I was treated in hospital. A complaint taken as far as possible has yielded limited results - I've had a copious number of apologies, but I'm not convinced the same things wouldn't happen again.

Anyway, my questions revolve around what will happen when I have a second baby. Because of my expriences, and because of the long recovery time, I really don't want another caesarean. However am I correct in thinking that if you have GD once, you're likely to have it with all future pregnancies?

Also, is it correct that if you have had a section previously then they can't induce labour?

The hospital I went to last time said I would have been induced at 38/39 weeks if I'd not needed a section - so how would this work for a second pregnancy? If they can't induce me is there any chance I can go for VBAC delivery?

Is there any chance they would let me go later into pregnancy to see if I go into labour naturally? Or is it just inevitable that I'll end up having another section?

 

[Northerner]

Hi where's spot, welcome to the forum 🙂 Great user name I'm sorry I can't answer your questions personally, but hopefully one of our mums will be along to help soon. Did your blood sugar levels return to normal after your pregnancy?

 

[Babysaurus]

Hi Where'sSpot,
Sorry to hear about your horrible experience. I am not that clued up re the ins and outs of GD, but I do know that inductions do happen after a previous c-section as it has happened to a friend of mine. I am not sure if you will get GD with a second pregnancy, but I think it may be more likely. It sounds like you managed really well with it though, if you managed to control it with diet alone.

Re the size thing. Some would disagree with me, but I am starting to think that there is SO much margin for error that it really needs to be taken with a pinch of salt. There seem to be many ladies on here who have been warned that their baby is huge only for them to have a perfectly normal sized baby at the end. While there is 30% margin for error on estimating size, and obviously this can mean over or under estimating size, I have been told, when I raised this very point, that the error tends to be more on estimating larger babies as there is more room to scan and see with smaller one's.

I am also, (and realise that some may disagree with this too) starting to think that hospitals err on the side of caution so much with diabetic pregnancies that they perhaps over medicalise things to the point of causing problems in other areas. Inductions, after all, carry their own risks and potential problems but nobody seems to tell you this, instead you are told it is the only safe outcome due to reasons such as the big baby scenario (which doesn't often actually turn out to be the case.)

I think, if you decide to go for another, read up on as much info as you possibly can first and see what conclusions you come to. The British Medial Journal, for example, publishes the latest, or relatively recent, research. Obsteticians (I know that's spelt wrong, I can never spell it!) also seem to have contrasting views from one another so a second opinion may sometimes be worth looking into. (Apparently at the hospital I am due to go to, the previous obs insisted that the only safe way for all diabetics was to try and induce at 36 weeks - and over 90% resulted in emergency secitons; I am SO glad he's not the one trying to call the shots with me! The one I am seeing now is far less gung ho about things, which is a relief!)

Can I ask, why was your planned section so grim? I have been told that there is a 60/70% chance of needing one anyway so am wanting to hear all points of view.

 

[Ellie Jones]

Every pregnancy is different..

So on the next pregnancy a C-section won't be an automatic conclusion, but like your last one it will be determined by several factors, such as anticipated size of baby, position of baby etc...

Same as with getting GD again, yes you'll be be at higher risk of it happening again, but again various factors will either decease or increase the risk of GD..v.

As to inductions...

Yes if you'll diabetic they will be looking at inducing the pregnancy at 38 weeks, various reasons behind this, such as a baby put's on around 1oz of weight per day in the last fort-night of the pregnancy, when diabetes is involved, the baby can store the excess weight partly within their muscles this includes the heart muscle... Leading to an higher rate of still births... The actually increase in weight can cause problems for mum in many ways, and in itself lead to an emergency C-sections..

38 weeks isn't set in stone, what happens they start monitoring around 34 weeks checking scanning information, your bloods etc, etc to pin point the best time to induce the pregnancy, so may well go slightly beyond the 38 week mark...

Will you face the same situation as you did with your last child..

Hopefully not..

I know that with my children, it was slightly different each time, really based on the staff attitudes..

out of my 3, it was when I had my son (no2) was an utter nightmare for various reasons, but I didn't have to make a official complaint because the Nursing Director had come on the ward, and had seen it for herself so she kicked off, starting of a disciplinary😱

 

[Babysaurus]

This may be useful - http://www.nice.org.uk/nicemedia/pdf/CG063Guidance.pdf

 

[where's spot]

Hi where's spot, welcome to the forum 🙂 Great user name I'm sorry I can't answer your questions personally, but hopefully one of our mums will be along to help soon. Did your blood sugar levels return to normal after your pregnancy?

Thanks for the welcome! Yes, my blood sugars were normal after pregnancy. I have to have a GTT annually as obviously I'm at increased risk of type 2.

 

[where's spot]

Hi Where'sSpot,
Sorry to hear about your horrible experience. I am not that clued up re the ins and outs of GD, but I do know that inductions do happen after a previous c-section as it has happened to a friend of mine. I am not sure if you will get GD with a second pregnancy, but I think it may be more likely. It sounds like you managed really well with it though, if you managed to control it with diet alone.

Re the size thing. Some would disagree with me, but I am starting to think that there is SO much margin for error that it really needs to be taken with a pinch of salt. There seem to be many ladies on here who have been warned that their baby is huge only for them to have a perfectly normal sized baby at the end. While there is 30% margin for error on estimating size, and obviously this can mean over or under estimating size, I have been told, when I raised this very point, that the error tends to be more on estimating larger babies as there is more room to scan and see with smaller one's.

I am also, (and realise that some may disagree with this too) starting to think that hospitals err on the side of caution so much with diabetic pregnancies that they perhaps over medicalise things to the point of causing problems in other areas. Inductions, after all, carry their own risks and potential problems but nobody seems to tell you this, instead you are told it is the only safe outcome due to reasons such as the big baby scenario (which doesn't often actually turn out to be the case.)

I think, if you decide to go for another, read up on as much info as you possibly can first and see what conclusions you come to. The British Medial Journal, for example, publishes the latest, or relatively recent, research. Obsteticians (I know that's spelt wrong, I can never spell it!) also seem to have contrasting views from one another so a second opinion may sometimes be worth looking into. (Apparently at the hospital I am due to go to, the previous obs insisted that the only safe way for all diabetics was to try and induce at 36 weeks - and over 90% resulted in emergency secitons; I am SO glad he's not the one trying to call the shots with me! The one I am seeing now is far less gung ho about things, which is a relief!)

Can I ask, why was your planned section so grim? I have been told that there is a 60/70% chance of needing one anyway so am wanting to hear all points of view.

I have to agree with a lot of what you have said. They made me feel awful when I had the last scan and they were saying my baby was macrosomic - I was in tears because I had tried so hard. They were telling me he'd be over 9lbs, but he was 7lb 11oz! So they were completely off. It makes me wonder whether they would have pressured me to have a section even if he wasn't breech.

I was also concerned that they seemed to be using a 'one size fits all' approach to managing women with GD. When I was diagnosed I went to a workshop and they just handed out the metformin like confetti and told every woman in the room they should take it. There was no consideration of individual circumstances. I decided not to take it when my sugars were ok without. It just seemed to be a big box ticking exercise: "you have to take metformin" "you will have a big baby" "you will be induced at 38 weeks".

In terms of what was horrible about my section - I wouldn't know where to start (my complaint was 7 pages long!). The actual surgery was ok, it was pretty much everything that followed that was awful. It wasn't as if anything major went wrong, it was just all the basics that were missing. I wasn't allowed to hold my baby in theatre, so I had to wait until he was nearly an hour old to hold him. I could bearly even see him before then, because of the position they made my boyfriend sit in the theatre (he was holding our baby whilst they finished with me). When I did get to hold him the midwife realised she'd clamped his cord too short and had pinched his skin, so the paediatrician had to come and see him and he had to be taken off me whilst they sorted it out. They then didn't have the right scissors to sort it and it took them about 20 minutes to find them.

I had major problems breastfeeding, to which their response was to demand he be formula fed (because of the GD). I had migraines on the day he was born and I couldn't see him properly, which obviously really upset me, but they didn't understand at all and said in my notes that I was being "demanding". They refused to move me to a room that would be better for me to recover from my migraines. They left me alone pretty much constantly on the first night, even though I was bed-bound and struggling to breastfeed. Staff would come and help for a minute, say they'd come back and then I wouldn't see them again for hours - whilst the whole time my baby was screaming hungry. The next day they kept saying they'd move me to a single room, but then it never happened. They refused to bathe my baby because they were busy, but they then bathed every other baby in the bay. They left bloody towels and jugs of urine in the shared bathroom all day. They left me without surgical stockings on for several hours, even though I kept asking for help to put them on. They didn't bother to tell me that I had lost quite a lot of blood during the surgery, they didn't bother to tell me that because of the feeding problems we would have to stay in hospital at least one extra night.

Despite all their promises to move me to a single room, after getting no sleep on the first night, they left me in the shared bay for a second night, because they didn't need my bed for new admissions and it was easier for them to have as many people in shared bays as possible. They only moved me to single room when I'd had a second night with no sleep whatsoever and was so exhausted I couldn't get out of bed.

A lot of the issues were not directly related to me having a section, but I think were exaccerbated by how long I had to stay in hospital. I also found out afterwards that the ward I was on (which is just for women who've had sections) is notorious in the local area for poor care. So next time I really just want a normal delivery on the labour ward, and to be able to come home as soon as possible.

 

[Babysaurus]

Where's Spot, your experiences sound absolutely awful. No wonder you are desperate to go the 'normal' route if you decide to have another. I'd be furious!

The 'big baby' thing is starting to be a bit of a bug bear of mine. Some of the ladies on this forum have had babies who may be slightly on the larger end of things, but they also may have done regardless but it is still blamed on blood sugar. Also, there seems to be a large number, including yourself, told that the baby is huge only for it to be perfectly normal. I realise it is more than possible for babies of diabetic patients to be huge, dangerously so, but for the well controlled this doesn't seem to be a given, although to listen to the various HCP's you would think it was a lot of the time. While I realise the medics themselves would be the first to point out that, if something did go wrong, the patient would blame them I also think a bit of balance may be called for.

All I can say, again, is to arm yourself with as much info as humanly possible to make your own decisions and also get a clear picture of the risks, and also how likely these risks actually are. You sound as if you managed fine last time re glucose control and your baby was fine too, other than the **** up with the cord (grr) so this will hopefully stand you in good stead if you go down the path again. I have had a reasonably good team of obs, endocrinologists and midwives to see but I have still, more at the beginning, felt as if I was on a conveyor belt and my actual circumstances were brushed aside and it became more a question of box ticking. Due to this, I suspect that this may be the case with a lot of conditions and pregnancy as it surely can't be just diabetes! Hopefully, once the staff get to know you (and this is if you develop GD again) they'll realise you have a brain in your head and this will, fingers crossed, help things considerably.

I had a look through the NICE guidelines last night and it says that a VBAC after induction is possible after a previous c-sec so it is possible under the right circumstances.

Good luck!

 

[Monkey]

I had my first baby last year and had gestational diabetes. I was told I was a border line case and I managed to control it with diet alone. Although my last growth scan estimated my baby as being over 90th percentile, he was in fact much smaller and when he was born he was 50th percentile - so very much Mr Average (I was so chuffed!).

Anyway, my baby was also breech and because of this and his anticipated size they recommended I have a planned caesarean. So that's what I did and it was horrible. The hospital didn't care for us properly and I very much felt my initial bonding with my baby was affected by how upset I was about how I was treated in hospital. A complaint taken as far as possible has yielded limited results - I've had a copious number of apologies, but I'm not convinced the same things wouldn't happen again.

Anyway, my questions revolve around what will happen when I have a second baby. Because of my expriences, and because of the long recovery time, I really don't want another caesarean. However am I correct in thinking that if you have GD once, you're likely to have it with all future pregnancies?

Also, is it correct that if you have had a section previously then they can't induce labour?

The hospital I went to last time said I would have been induced at 38/39 weeks if I'd not needed a section - so how would this work for a second pregnancy? If they can't induce me is there any chance I can go for VBAC delivery?

Is there any chance they would let me go later into pregnancy to see if I go into labour naturally? Or is it just inevitable that I'll end up having another section?

Hello, where's spot?! I love your username too.

Firstly, sorry to hear you had sucha horrible time after your first birth. I know so many folk who've had great care in labour but hideous postnatal care, it makes me really sad.

I think GD is more likely in subsequent pregnancies, altho I'd also think there's something you can do to minimise the risk (if you've got weight to lose, losing it, and general healthy eating - I'm not saying you need to do either of those, but if anything reduces the risk I'd guess at those being top.)

I've been told by a mw friend that vbac is possible after c-section, but the things they can do to induce labour are far more limited. I think (from hazy memory) they'll sweep and use prostin, but not use a syncto drip - something to do with the risk of bringing on contractions too quickly and risk of scar rupture.

Again, all guesswork based on the experiences of people I know, but I think if you were keen to try and go into labour naturally you might be allowed - but might need to agree to go in for daily monitoring and only be allowed to go to, say 40w (rather than 41+ which seems normal for non-d here) before induction.

I think you should automatically get referred to a vbac clinic with a 2nd pregnancy, so a chance to chat it all thro with someone. Something makes me think that having GD controlled by just diet would make a vbac far more likely that being controlled by insulin.

Hope that's vaguely helpful - it's such a minefield, isn't it?

 

[where's spot]

It's good to hear that induction is not completely out of the question - when I went in to discuss my complaint, they led me to believe that it wouldn't be possible. They did say however that if I had GD again and it was well controlled they could take a more "individual" approach to deciding when to induce me - which seems to suggest they're not usually interested in an individual approach at all.

I do need to lose weight - I have a very high BMI, but I have really struggled. I actually lost loads of weight having my baby, 7lbs lost during my pregnancy, mainly due to morning sickness, and then about another 2.5 stones in the month after the birth. But I then went back on my migraine medication and put all but 7lbs of it back on. I've changed my medication now, but the weight's not shifting.