Bit of a moan/advice?! Anyone vbac'd with gestational complications?

[Bonnie11]

Hi ladies!

Bit of a moan today (is third tri anything but? ). Long story short. Failed induction last time at 37.5 due to GD and they were worried baby was getting too big. 4 pessaries, nothing happening, couldn't break waters, 4 days in hospital before a c section in the end. Swore blind I would never be induced again but here we are..

This time around GD has been insulin controlled (not well controlled I may add but getting there!), I have mild polyhydramnios, baby is starting to grow on the larger side but they are not too concerned as it's within ok levels, SPD. So with a VBaC only induction I can have is sweeps which did nothing for me last time. Saw the consultant today and he wants me to have a section at 38 weeks. If I insist on a VBaC he will sweep me from 38 weeks and see what happens but he wasn't hopeful as if I need the hormone drip then he said chances of having a VBaC are best if you go into labour naturally and once they start inducing by any means your chance of emcs are much higher. With insulin controlled as well the chances of still birth /placental problems after 38 weeks increase a lot and he wouldn't want me to go much past 38 weeks, maybe push to 39.

So now honestly I don't know what to do. I had my absolute heart set on a VBaC but the thought of an emcs is terrifying, would rather have a planned. I feel like I'm being silly taking any risks at all and should just have a section at 38 but I really really want to go naturally. My husband doesn't really understand why I don't have the section and I think he thinks I'm putting the baby at risk (which I guess is true) when I don't need to just because I want a natural birth.

I just don't know what to do, I have another appt in 3 weeks where he wants to make a firm plan so I guess I will see where I am in 3 weeks time but I want to at least have an idea so I don't get pushed into anything I don't want. I'm so confused!! 😫😫😫

Sorry for ramble ladies, my head is spinning with all the decisions!

 

[Missbb2591]

Ultimately the decision is yours. I’ve worked with women who have gone for an induced vbac and some have been successful and some have ended in emcs. Because of your previous section the doctors will bow out a lot more quickly with an induction than they would with someone who had never had a section as the last thing they want to do is put pressure on the scar or risk yours or baby’s health. That tends to be why it would result in a emcs because if you don’t progress exactly how they would want they will just section.
It’s definitely possible to do but the added complication is it being an early induction so a sweep is less likely to work unless your body is getting ready to labour anyway. I think you need to weigh up how important the vbac is to you vs how you would feel with an emcs vs a planned one.

It may be worth discussing with your midwife. Good luck.

 

[krissie328]

I have never had a c-section, but I can definitely understand your hesitation especially after your last one.

I agree with Missbb that you really need to weigh the vbac against a planned vs emcs in this case.

I think with being so early (38 weeks) that it is going to be harder to induce your body into labor vs if you were overdue. But I also have diabetes and I would not risk going any further than you have to. My son was delivered at 39+5 through an induction and it really never should have gone that long before they induced.

With that said, I also get a lot more scans and monitoring to check on baby, so maybe they can keep an eye on the placenta and make sure things are going well if you choose to go longer? I had a weekly scan the last six weeks with him. One week was a biophysical profile and the other week was a growth scan.

 

[Fire_fly]

If it helps at all, I was induced because of GD with my first (ovbs not a vbac but I did get the hormone drip) also had 4 peccaries then they were able to break my water. Went in at 39+5 and the whole process took 2 days with baby being born on due date.
I did give birth naturally with the drip but it wasn't the best experience if I'm honest. Baby's heart rate was all over the place, contractions 10-30 seconds apart towards the end and almost ended up in a emcs but as I was 9cms, they did a epistomy and ventouse delivery instead. That doesn't mean that'll happen to you though, my body and baby just couldn't tolerate the drip and i guess the main point of me saying that is not everyone that has the hormone drip ends up having to have a emcs although the number is certainly higher. I'd definitely suggest though, I'd you do go for the inducement, to get an epidural, the contractions are incredibly painful without pain relief with the drip. I left it too late to ask for it as i was managing at first and I had a short labour when my waters were finally broken.
It's a difficult decision really, only you can weigh up what you think is best. I can see were your constulant is coming from but I can also see your point of view on it too. I think it would really question of, if you went for the inducement, would you be okay if you had to have a emcs as apposed to a planned one? I hope it all goes smoothly for you whichever way you decide! x

 

[Fire_fly]

Can I ask, are you in the UK? I only ask as I've recently started insulin myself with 4 weeks to go till my elcs at 39+1 (was only on metaformin when this was booked). I bought my section date might have changed because of this but it's still staying the same, I was worried myself about what could happen after 38 weeks with insulin GD but my nobody else seems concerned about it.

 

[Take2]

Not quite the same as I’ve never had a c section but my last baby, dd3, was born 10 days over at 10lb 7oz and I had polyhydramnios, they wanted to do a c section but I convinced them to let me try induction and they only had to break my water and she was born after a 3 hour all natural labour with only a mild graze no stitches required. Given her size and the fluid they suspect I had late onset GD that went undiagnosed.

 

[WackyMumof2]

I had my second successful VBAC last October (1st GD baby) no problems. I didn't need to be induced or have a section though and when it was brought up by the specialist I told them straight that neither option was happening. Fortunately, as me and my midwife expected, I went into labour at 38 weeks.

If you really, really have your heart set on a VBAC, have the sweep done and then when you get home, place a couple of Evening Primrose Oil caps up by the cervix as it's got a good reputation to starting contractions. Best of luck that everything goes as you hope it to.

 

[Bonnie11]

Thanks for the advice ladies!

Am feeling a bit better about it today, think I was just in a bit of shock yesterday as it was the opposite of what I had planned in my head!

Firefly yes am in uk, think it depends how well your sugars are controlled. Mine have been terrible and can't find the right dose to get them under control. My trouble is the fasting sugars as my daytime ones are fine but it's harder to control the nighttime so they have given me long acting insulin at night to try and help but it's been 4 weeks and still haven't got dose right. And the fasting sugars being high are more dangerous for baby as it's over a longer period rather than spiking quickly in the day and then going down again. Baby is starting to grow bigger (though still in normal range) but my polyhydramnios are creeping up so all signs that it's not ideal to push baby too far, so he's saying section at 38 weeks, poss 37 depending on what the next scan shows and how my sugars go over next few weeks. But if your baby is measuring fine and they aren't concerned about growth they will let you carry on (my consultant said with no extra complications he would have let me go to 40 weeks), but I would def mention it if you end up on insulin

My other issues are with a section before I can't have pessaries and they aren't keen on hormone drip as it can overstimulate uterus. So my options for induction are so limited! Just sweep and break water if they can but if nothing happens then will end up with emcs. Also with my SPD they advise (though you can if you choose) no epidural as it's easy to stretch your hips too far and cause permanent damage if I can't feel how far I'm opening my legs. At the moment I can barely lift them. So yes everything against me

When I'm thinking rationally I know a section is best option I just need my heart to catch up with my head! Just feel so disappointed that i will never have a natural birth that I wanted. But a healthy baby is worth a million sections so I need to just face it!

 

[Fire_fly]

Thanks for the advice ladies!

Am feeling a bit better about it today, think I was just in a bit of shock yesterday as it was the opposite of what I had planned in my head!

Firefly yes am in uk, think it depends how well your sugars are controlled. Mine have been terrible and can't find the right dose to get them under control. My trouble is the fasting sugars as my daytime ones are fine but it's harder to control the nighttime so they have given me long acting insulin at night to try and help but it's been 4 weeks and still haven't got dose right. And the fasting sugars being high are more dangerous for baby as it's over a longer period rather than spiking quickly in the day and then going down again. Baby is starting to grow bigger (though still in normal range) but my polyhydramnios are creeping up so all signs that it's not ideal to push baby too far, so he's saying section at 38 weeks, poss 37 depending on what the next scan shows and how my sugars go over next few weeks. But if your baby is measuring fine and they aren't concerned about growth they will let you carry on (my consultant said with no extra complications he would have let me go to 40 weeks), but I would def mention it if you end up on insulin

My other issues are with a section before I can't have pessaries and they aren't keen on hormone drip as it can overstimulate uterus. So my options for induction are so limited! Just sweep and break water if they can but if nothing happens then will end up with emcs. Also with my SPD they advise (though you can if you choose) no epidural as it's easy to stretch your hips too far and cause permanent damage if I can't feel how far I'm opening my legs. At the moment I can barely lift them. So yes everything against me

When I'm thinking rationally I know a section is best option I just need my heart to catch up with my head! Just feel so disappointed that i will never have a natural birth that I wanted. But a healthy baby is worth a million sections so I need to just face it!

Glad your feeling better! It's hard when you can't have the birth plan you wanted but as you said, it'll all be worth it when baby is here and healthy
Yeah, I know what you mean, it's my fasting levels too that were going too high, the insulin at night seems to be helping though. Baby is on the 95th percentile, was estimated 6.5lbs at my last scan (35+1) but I think as the insulin seems to be helping, that's probably why their not too worried doesn't stop me though lol.
Ah I see, it really is limited isn't it when comes to induction, planned section definitely seems like the best choice. Ah the dreaded SPD, i didn't see that in your first post, definitely don't get an epidural with that. It's far too risky, my consultant was trying to push me into an induction with my SPD that's chronic (on crutches since 23 weeks and painkillers useless now) plus a big baby (not to mention my traumatic first induction) as he doesn't count SPD as a medical condition. No way was I agreeing to that. Baby has to be delivered at 39 weeks though so elcs it is.
Totally normal to feel disappointed but just think when you have baby in your arms, all that will matter is that both you and baby are healthy and well x

 

[krissie328]

Bonnie- I am on NPH to control my morning numbers. It has seriously changed everything!! I do have to take it in the middle of the night (1-3 am) but I naturally wake then to go to the bathroom. But my numbers are 95% within target now.

It is a mid-acting insulin that peaks between 4-6 hours I believe. Long acting alone was never enough to keep my numbers in check with my son and I was constantly out of target.

 

[crazylilth1ng]

Hi, I didn’t have gestational diabetes but I did have an induced vbac earlier this year. I didn’t need pessaries but i did end up with the hormone drip being cranked up to the highest setting to actually kick labour in. Same dose as non vbac inductions. It worked very well. So it can be done if the hospital is willing.

It’s up to you in the end. If my baby had looked like he was going to be big though I know I would have gone for a section due to a past shoulder dystocia (I had one random big baby amongst 3 other small/average ones).

Good luck with your choice

 

[Bonnie11]

Thank so ladies, krissie that's interesting to know about the overnight levels, if things aren't any better over the next couple of weeks I may ask about it x

 

[EmmaFTM]

With my second I tried for a VBAC and it ended in emcs. They broke my waters but she was 10lb 10oz and not coming out- I had been told she was 8lbs at 36 weeks and they let me go to 42 weeks, gave me 7 sweeps and agreed to a water birth as I was adamant I was having a natural birth. I was wrong and shouldn’t have pushed for it.

I am now pregnant for the third time and will be planning an elective c-section for 39 weeks. My consultant told me I need to stop at three babies and will listen to that advice as he also worried me about scar rupture etc.

It’s such a huge decision for you and I was so sure I was going to do it last time but it worked out the other way. Hope you manage to work it out and all goes well. X