VBAC for diabetics

[MrsMushroom]

I was induced for my last pregnancy at 37+5 which ended up in an emergency c-section.

It's obviously really early at this point to be even thinking about this, but when I spoke to my obstetrician last week she asked me what I would like to do this time around and I immediately said planned section at 38 weeks (my induction experience was horrible) but I've since been thinking about it and I wondered, if everything goes ok with my pregnancy, what are the chances of them leaving me to 40 weeks to go by myself?

Is this pretty much unheard of in diabetics? I am going to the hospital again next week for my early scan and an appointment with my midwife/diabetic team and so i'll chat with them then, but I just wondered what everyone's thoughts/experiences were on this?

 

[Kerry Type 1]

i think the problem may be is the size of the baby ? maybe being too big if left until 40 weeks? thats from what i gathered from my conversations.

..... I was told that hopefully come 39 weeks they will be happy with me and will be induced .... now im worried ! i havent really thought about it but i suppose i should really try and find out more about how enduced works etc ...

maybe you could shed some light on something for me ... i was told that my baby would be taken to special baby unit after being born .... is this normal for diabetic mothers ?

 

[MrsMushroom]

This is kind of what i thought, that baby may be too big to go to 40 weeks

My last pregnancy actually wasn't too bad, I had polyhydramnios which meant that i was absolutely HUGE and I was induced at 37 weeks as my son was quite big. When he was born he was 9lbs 10z, they said had he been left any longer in there to cook, he would have probs been around the 11lbs mark!

I had a few other problems like sciatica and SPD but these weren't really related to the diabetes, more because baby was big and the amount of fluid that I had.

The care I was given was second to none, they were absolutely amazing at my hospital! I had extra growth scans and from around 33 weeks I was seen every week at the joint diabetes/ante-natal clinic. They were very reassuring and I absolutely trusted my obstetric consultant 100%. He did advise at one point that i may need to have a planned section as baby was breech and with all the fluid I had, i was at risk of pre-term labour but I was never convinced baby was breech to be honest, he was kicking me in all the wrong places for it to be! Haha!

At my 37 week appointment they decided that baby (and I) was too big and because i'm also quite petite and with the SPD etc, they didn't want me to risk going any longer so I was induced at 37+5. I'll be honest, it didn't go well. Baby wasn't ready to come out and although the pessary worked and broke my waters etc, the actual rest of my labour was quite bad, i caught an infection and stopped progressing. My baby got into distress, his heart stopped and I was rushed for an emergency section.

I'm sure you're aware that as your pregnancy progresses your insulin requirements will be become much higher than normal and this can pose a problem for baby as obviously their pancreas works perfectly fine and produces its own insulin. Basically, the day after my son was born he was taken to the neonatal unit and was kept there for a few days as his blood sugars dropped really low (because of the amount of insulin in his little body) and he had to be tube-fed. He was very lethargic and sleepy and couldn't feed from me or a bottle and so he needed a little help.

He stayed there for a couple of days and then we were kept in a ward together for a few more days after just for observation. He perked up quite quickly and he was perfectly fine afterwards. He is now a very boisterous 15 month old and honestly you would never know how poorly he was.

The thing was at the time, we were told that it "may" happen and we were never given any more information than "after delivery he may be taken to the 'nursery'". I found out later from the midwives in the ICU that it happens to the majority of babies from diabetic mothers. He was just there for a couple of days but it was very worrying at the time as it was never really explained to us that it most likely would happen and we really weren't prepared for it.

The only advice I would give to you is ask as many questions as you can and make then explain everything to you, all the possibilities, don't let them sugar coat anything. They told us it was the 'nursery' but it was actually the neonatal ICU and although he wasn't as sick as all the other little babies in there (he wasn't in an incubator or on any breathing equipment, he just had a tube down his nose into his stomach for feeding) it just wasn't a nice experience seeing all those poorly tiny babies. This time around we are preparing for the same to happen again and we now know what to expect and that it is just really a formality for a diabetes baby, if it doesn't happen, its a bonus.

I really truly hope I havn't frightened you by telling you this, that's honestly not my intention, but I so wish someone had been honest with me and had explained all of this to me at the time and it wouldn't have been such a shock.

After delivery was quite a difficult time with all the hormones etc and i had quite a few hypos in those first few weeks so your insulin requirements will drop dramatically after birth but it settled down quite quickly and even though I had a section, I was out walking with baby pushing a pram or carrying him the week after birth. My recovery from it was brilliant, I was off painkillers after a couple of days and although i was sore and stiff, it was no where near as bad as I expected. This is the reason I am thinking of going for a planned section this time around, i'm just not sure i could go through the induction process again just to end up with a section anyway, you know?

Obviously though, these are just my experiences of my last pregnancy. There is nothing to say that this one will be like that, or anyone else's will be like that and I hope that i've been honest enough but also that I havn't been too honest and frightened you xxx

 

[SweetAmerican]

Hi there is nothing wrong with diabetics going the full 40 weeks. You may have to fight them over it but as long as you and baby are healthy it should be fine. I had my first at 40+3 and my second at 39+4(ish). Both were perfectly fine and didn't need special care. Unless your baby absolutely needs to go into the NICU, there is no reason to be separated from him/her just because you are diabetic. they will need to check the baby's sugar of course and if it's low you may need to top up with formula (I had to do this with my second but this happened quite a few hours after the birth)

I hope it all goes well for you ladies! It's hard work but well worth it 🙂

 

[SweetAmerican]

I think we were posting at the same time 🙂

I'm so sorry you had such a hard time with the first. Each pregnancy is different though so hopefully things will be better with your next one. Diabetes is tough but with pregnancy it's amazingly difficult!

Good care is so important too. I had an absolutely horrible time with my first but switched hospitals for my second and the care was GREAT!

 

[Monkey]

I've been having conversations about this recently, as my team are fairly keen on me attempting a vbac.

I'm really torn, tbh. I was induced at 38+1 with C, which was very positive - one lot of prostin got me to 3cm, had waters broken, brief bit of time on synctocin drip, fully dilated, pushed for 2hrs, positioning worries so went to theatre to be re-exmained and possibly try forceps. His position wasn't great so we went straight to cs. It was all ok tho, really - start to finish was 20hrs, which is quick for a first time, pre-term labour! He was 10lb 11oz tho, despite good control.

I've been told that your chances of a successful vbac are increased the more of labour you've done, which makes me think I should at least consider it. The greatest risk is scar rupture (I've been told 7/1000 if you go into labour spontaneously compared to 15/1000 if you're induced) and at the first sign of fetal distress they'd section, for fear that the scar is causing problems.

So, no decision here yet. I'm leaning slightly towards an elcs, but we'll see.

Kerry, SCBU isn't a given for babies of diabetic mums, and it certainly isn't a formality here. C did have a few low blood sugar issues but I'd hand expressed colostrum before my induction so we were able to syringe feed that and keep offering breastfeeds to get him sorted. It WAS hard work, and I only think it worked because I was so clued up in advance and stubborn, but it's doable.

 

[Kerry Type 1]

Mrs Mushroom ! thank you ... you have not scared me ! it seems so much easier to hear when someone who has been through it tells you rather than a doctor telling you what it may be like.

I havent really found a lot of info on Diabetic pregnancys so its great hearing from woman who have been through it ! it doesnt seem as scary !

I have this picture in my head that my baby will be about 15 lbs !! the way the doctors talk about BIG babys !! im imagineing this baby taking over me in size !! seems a bit mad but when you said 9lbs 11 ... i though jeez i know of girls who dont have diabetes having babies that weight !

( not so scared now ) 🙂

 

[Kerry Type 1]

Monkey your post brings me to another thing that has been nagging me ....

Breast feeding .... did you cope with breast feeding and how did it alter your sugars? ( if you dont mind me asking )

I am terrified of breast feeding incase my sugars go all over the place , and the stress of that along with being new to motherhood I am scared that i wont cope ... ( also terrified of post natal depression )

Does anyone else find that when your sugars are not right it is sooo easy to slip into a depressing stage ??

 

[Urbansoulpie]

Diabetics are often induced at 38weeks due to the risk of the placenta failing, that's why we should all watch out for lots/bad/unusual hypos towards the end of the pregnancy, as this coud be an indication of the placenta struggling.

Although you could hold out for 40 weeks if you really wanted to get there and all could well be ok!

I think they side on the edge of caution with us type 1?s!


I hope to breastfeed but know that this will cause havoc with my bg's!

 

[MrsMushroom]

Now that you've said that, I do actually remember being told that last time I was pregnant.

I think I'll just stick with my original plan of planned section at 38 weeks. I would never risk anything happening to baby for the sake of having a natural birth.

 

[rachelha]

Now that you've said that, I do actually remember being told that last time I was pregnant.

I think I'll just stick with my original plan of planned section at 38 weeks. I would never risk anything happening to baby for the sake of having a natural birth.

Hi

I asked about this when I was pregnant for a second time after induction and csection the first time round. I was told if I went into labour naturally before 38 weeks I could have a vbac otherwise it would be a csection. They would not induce me after a section.

I breastfed for 9 months with Nathan. My bloodsugars were a bit all over the place, but it was managable. I just had to eat lots, no chance of feeding helping with any weight loss!

 

[trophywench]

B/F is an extension of hypo-city from what I read on this and other forums! - and SCBU certainly isn't a given unless your baby actually needs it - which could be for any number of reasons and not 'just' low BG.

The colostrum harvesting DOES help, even if they have to give formula anyway (which they do by syringe same as the colostrum or a 'lappy' cup) and shouldn't cause a problem with then subsequently introducing B/F later than would have been the case if the baby hadn't been whisked off the SCBU. Ladies have been worried that it would affect the baby's response to 'attach' but it hasn't been the case usually - although of course some babies do have trouble with attaching anyway, nothing to do with diabetes!

 

[rachelha]

B/F is an extension of hypo-city from what I read on this and other forums! - and SCBU certainly isn't a given unless your baby actually needs it - which could be for any number of reasons and not 'just' low BG.

The colostrum harvesting DOES help, even if they have to give formula anyway (which they do by syringe same as the colostrum or a 'lappy' cup) and shouldn't cause a problem with then subsequently introducing B/F later than would have been the case if the baby hadn't been whisked off the SCBU. Ladies have been worried that it would affect the baby's response to 'attach' but it hasn't been the case usually - although of course some babies do have trouble with attaching anyway, nothing to do with diabetes!

Nathan was not sent to SCBU at all, he was only away from us for the routine checks that was it. I did do express colostrum prior to being induced but found it v v difficult and hardly got any. It still took a while for my milk to come in so he was topped up on formula to start with but I dont think that affected the bfing.
He was also given formula on his first night as after the long and difficult birth I was in no fit state to feed him myself, I was falling asleep mid sentence.

 

[Monkey]

I bf C for 13m, and it was mostly straightforward from a diabetes perspective. I followed the advice of going straight back to pre-pregnancy doses/ratios after he was delivered, and did find they needed cutting back further once he was feeding well.

I did get ravenous, and used to keep a basket of snacks and a water bottle with sports lid next to where I sat to feed in the early months, altho that seems pretty normal for bfing mums regardless of diabetes. In my experience, testing plenty and not getting too hung up on the out of target readings were the best thing. Yes, my hba1c slipped from low 6% in late pregnancy to low 7% within about 6 weeks, but for me that was a compromise I was willing to make!

 

[Lizzzie]

Hi. I had a planned section at 38 weeks, not because I was diabetic (they said would have induced around then anyway, and the reason they gave was the placenta potentially breaking away closer to term) but because I also had a placenta previa and would have bled a lot without one.

That said, it was a very pleasant experience. I'd sat on the antenatal ward for 3 weeks by then ( they were worried I might start bleeding randomly so wanted to watch me) and met women who'd gone through inductions, long traumatic labours and then ended up having c-sections anyway once exhausted.

For me, if was easy: i felt a complete fraud. the most painful thing was having the cannula in the back of my hand. There was no excitement, no drama.... She came put at 8.6 lb though, and that was 2 weeks early! I think I'd have one again, although do get nostalgic for the idea of a 'proper' birth.

 

[Lizzzie]

Am shocked that so many babies went to special care after birth.... i must have been very lucky. They tested her Bg straight away and it was ok luckily. Will have to ask about that at my new hospital and be prepared for it this time round.....

Breastfeeding does confuse your levels but you know, after getting through 9 months of roller-coaster pregnancy, it was a minor irritation. It helped me to loose weight very fast which felt good.