birth choices

ladies

i need some help

my midwife has told me to decide what birth i would like, and i can choose

im high risk becasue of my BMI and also gestational diabetes

with those factors there are their own risks.

i will be induced at 38 weeks so i can either be induced and try a vaginal delivery or go straight for a c section

can you tell me how you chose and why, and if you would do anything differently?

my main concerns for the vaginal delivery are my higher risk of shoulder dystocia

the giving birth bit doesnt scare me, its how the birth progresses

anyone with GD, what birth did you have and did your GD effect the birth ?

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  • I had GD but was a low risk GD patient - not overweight and GD controlled fairly easily by diet. I had several growth scans in the last eight weeks, and was told that I would be induced if the baby got too big. If this didn't happen I was to be induced on my due date. The baby's size stayed fine, so I went in on my due date. The induction failed, labour didn't progress, and the baby's heart rate wasn't great, so I had an emergency c-section. The baby's cord was round his neck which was why his heartrate was dropping. I don't suppose GD directly affected this, if I'd not needed to be induced would I have had the same end result? No idea.

    Next time I'm planning to go for an elective c-section. I'm high risk for GD again, and that in itself means more chance of interventions. Add that to the previous c-section and I'd rather just go straight for the section. I'm not planning more than one more child, and have no desire to experience natural childbirth when the odds are a bit stacked against me.

    Each patient is different. When do you have to decide by? Will they be offering regular growth scans later on? If possible I'd keep an open mind if you're not 100% sure either way and not commit too early. The rest of the pregnancy could be completely smooth, or something might come up that makes the decision for you.

  • thanks queen crunchy

    iv got my growth scans now at 28,30,32,34 &36 weeks with inducement for 38weeks.

    midwife wants me to have an answer by my next midwife appt 12th feb

  • I don't have any advice re having GD and giving birth, I was about to ask about extra scans etc but you just answered that. Could you go with induction and labour as long as your scans don't show a huge baby- and if the baby starts getting bigger have the option to change your mind maybe? I think it's very harsh of your MW to want a decision that soon when lots of facts aren't available to you yet (in regards to potential size and how your GD is managed).

  • i think for a vaginal delivery im petrified of the shoulder dystocia, and i know that even if the baby is a good size my BMI can be what effects that :-(

    all i can think back to is that episode of OBEM where the baby was stuck and not breathing, and it seemed like an age until they got her out.

    its scared me so much

  • From what you've said I'd go straight for c-sect personally.

  • Monnie,

    First let me say I don't have GD but other neuro problems and although they weren't expecting it now a baby expected to be 10lb+ at term.

    I'd be surprised if the hospital will accept a decision this early. From my 12 week scan and appt my consultant was talking about a C Section, the same consultant has seen me at least every 4 weeks with a scan (sometimes more) and still wouldn't agree on whether it was a C Section or not until sometime after my 28w (although they didn't tell me then), they eventually told me and booked me in for it at 32w and I do my consent etc.. at my 36w appt. Hospitals are measured on the number of C Sections and are encouraged to keep numbers low because of the risk. My MW always said it would be a C Section but the consultant made their own mind up armed with all the info they wanted from different specialities (are you under a diabatologist?). Putting it politely they had no interest in my MW's thoughts on the matter.

    In the end the biggest issue for them was they wanted my consultant to be on call, and the 'right' paed to be on duty and now they're trying to arrange it for the 'right' anaesthestist to be on duty (yes I'm that complicated). This made their decision and obviously influenced the date. I'm sure they'll be full on panic if I dare to go into labour early!

    My advice would be think about what you'd prefer if the circumstances don't get worse and then talk/influence the hospital to your point of view. Maybe things are different in your area but don't be perturbed if they are not singing from the same hymn sheet as your MW it doesn't mean the end result won't be the same.

  • the midwife who asked me to decide was the one i see before i see my consultant at the hospital, he said in my last appt that ill be having my anesthetist appt shortly to look at the chances of me having an epidural, i dont even know yet if i would have to have a GA for c section :-(

    i feel really pressured,

    i dont know if i can have the epidural

    i dont know the size of the baby

    i feel even without ante natal classes unequipped to make this decision :-(

    my consultant wanted me to make the decision, and he and the midwife said they can tell me the risks and benefits to both choices, but cannot tell me the risks in a percentage as they cant be held liable

  • Well at least it's clear that the consultant is on board. I do think it's a bit rubbish that they're not giving you the time you need you feel to make the decision. I can't see what the rush is, even at 32 weeks I was the first on the list when they booked it for that week as they said most elective CS's are decided much later.

    There's a few of us at the minute that are facing a possible GA. I'm not sure why they think that for you, but for me the anaesthestist appt was rubbish, he put me right off a GA, with not being awake, poor pain relief, OH not being able to be in room etc.. but then said he couldn't say whether it'd be a GA or an epidural for sure as it will depend on what they felt on the day. Afterwards I found out my brothers friend had her 3rd child via GA CS and she found it to be a positive experience. Also it my be a bit early or not applicable but on the 3rd tri thread today Isis has posted a link on BFing after GA as one of us was told that we couldn't do it for 24 hours afterward which appears not to be the case.

    Good luck with it all

  • babylonglegs, m going to be harvesting my colostrum at around 36 weeks so the breastfeeding wont be an issue for me as such,

    thank you xx

  • It seems very early to be committing to anything. You sound pressured, and that's unsurprising. It sounds like there's a lot of unknowns still. Is there a specialist GD midwife available at your hospital, if you're not already seeing one? I was immediately referred as soon as I was diagnosed and she took over my care. She'd seen hundreds, if not thousands, of GD patients and I felt very comfortable with her. She acted as the go-between and I never actually saw a consultant, although one was in charge of my case.

    I'm sure you'll come to the right decision at the right time, and junior will arrive safely. Whichever way you give birth will be the best way for you.

  • Oh love. I am faced with a similar decision but it is much further away for me.

    Try not to get too bogged down. Maybe just ask the midwife what she recommends as you have no strong preference either way? Both have pros and cons. Ask her/the consultant what the stats are for someone with your particular risk factors achieving a natural birth after induction. Perhaps if they say 40% of those have a vaginal delivery and 60% have an emcs, it might persuade you to choose an elective c section.

    If the stats are really good, and despite your risk factors, 80% of woman like you get their vaginal delivery after induction, then it will really give you focus that you can do it too.

  • Can’t you ask your midwife/cons to delay your decision until after the first growth scan? It’s not that many more weeks. I wouldn’t be prepared to make a decision without some idea at least of the baby's growth.

    My uncles wife is due a day after me and their baby is over the 90th centile, she’s not got GD or anything but she is 43 so classed as high risk. She will not be allowed to go over due date, and has been told she can’t have a water birth due to the risk of the shoulders getting stuck, but she is still planning on going ahead with a vaginal delivery. I suppose what I’m trying to say is even though the risk is higher, try to remember that doesn’t mean it WILL happen. You could have a perfect vaginal birth, and someone with a tiny baby could get stuck and end up needing help. There’s no way to know for sure how any of our births will go.

    If it was me I would refuse to decide until I knew where the baby was on your chart.

    If our baby had stayed breech and I had been given a choice of planned section or try naturally I would have chosen a planned section, as in my mind that is much more likely to go smoothly than if baby was halfway down and I ended up needing an emergency section anyway. But then I didn’t have to think about possible GA. Why would you not be able to have an epidural?

    It’s a tough decision, and personally I think you need a few more answers (size of baby, GA vs epidural etc) before making it.

  • I've no GD experience Monnie, but I would write down all your questions and take them with you to the next appointment. Don't let them force your hand if you aren't ready to make the decision - there really is plenty of time and there's no saying that the plan wouldn't change anyway as pregnancy progresses. Is someone going with you to the appointment who can support you if you are feeling pressured?

  • i think their concerns over the epidural are placing it becasue of my BMI, to be honest my mum is a theatre midwife and she said thats normally just what they say as a precaution and she has seen huge women go in with epidurals,

    a few weeks ago 2 extra staff had to be in theatre to hold the womans tummy up so the surgeon could do his thing, and im no where near that big !  but it is something i have to take into consideration

    i am seeing a normal midwife at the drs, and a diabetes midwife at antenatal clinic plus a endocrinologist and obstertrician.

    i have even asked my mum what she thinks (being a midwife) and she said there is no way of knowing what will happen, and she said i should try a vaginal and be prepared to have a c section, but i dont want an emergency, i dont want my choice to put any stress on the baby

  • hubby will be with me, but he is set on me having a c section

    im thinking of asking my mum to come along as well as she knows this stuff

  • Taking your mum sounds like a good idea, especially if she is open to both options and your H isn't. I hope you can get some answers and make a decision you are happy with x

  • Hi monnie, In your situation id gone straight for a section, because id be to worried to go through labour and then the baby get stuck. 2nd time round my bubs was 9.3 at 39 weeks cos of gd, i was having an elcs anyway but the surgeon said to me that she was so wedged in she would never of come out naturally . im so glad i didnt try to vbac, go through all that labour for  nothing.

    Am i right in thinking you live near me, if its you im thinking of , your under basildon hosp? iv had 2 sections in there now and they have both been very positive experiences.

    The midwife will not be the one booking a section, you would have to see a consultant who would book it, Mine elcs wasnt booked until 36 weeks, so you have plenty of time.

  • I agree with margot they can not force you into a decision and you obviously don't feel ready to make one! Take your mum and H with you, may be worth researching epidurals and high BMI, if your concerned about the EMCS I have had one and it wasn't as bad as I thought, maybe you could discuss having the epidural put in early on during labour in case you needed a c-section. Your mum may be a good person to discuss fully with and put you in right direction to do your own research. Please don't feel rushed into a decision you might not be happy with. As I think QC said what does your GD midwife recommend?

  • mrs clarke i am basildon :-)

    iv got my anesthetist appt coming up shortly where i think they will make the decision about the epidural then ,

    GD midwife just keeps saying she cant advise me,

    :-( i feel abit let down by basildon hospital, they havent been great from the start :-(

  • I'm sorry your having a bad experience, awful that she won't advise you. You would she could just give you pro and cons for each side!

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