Induction - do I have a choice?

[ArtemisBow]

When I saw the consultant two weeks ago, I was told I would be induced at 38 weeks. At the time I felt a little shell shocked so didn't ask many questions on that day, but since then have done some reading so that when I had my midwife appointment today I was ready.
To say I am disappointed with what I found out is a bit of an understatement.... Basically I will be admitted to hospital when the induction happens, they'll give me a pessary and I will then live on the ward for a few days until labour kicks in. They may break my waters manually, and put me on a syntocin drip to force contractions. The entire process feels anything other than natural, it sounds stressful for me and the baby.
Given my diabetic consultant has been so happy with my results on that front, I'm surprised that at the end it comes down to "you're diabetic, you have no choices". I was hoping even if I had to be induced I could go home afterwards and be as comfortable as possible until things were more established.
Do I have a choice about this? I want to do what's best for the baby and me, I'm just not sure that induction is the best solution.

 

[kitty55]

@ArtemisBow - I was in the same situation last week when I planned to enquire at my antenatal clinic whether or not I could get around induction in any way. My diabetes has been very well controlled all pregnancy long (I was 27+4 last week when I went) and the baby sits around the 50th percentile so is definitely not huge.
I spent a couple of weeks trying to get facts and figures as to why exactly diabetics seem to be induced automatically and I couldnt find anything and neither could my hubby. I heard that the stillbirth risk increases after 38 weeks but I couldnt find any figures showing how much it increases so I was a bit clueless whether this is actually all true.
So went to clinic and asked my obs if there was any way for me to avoid induction and said I searched the internet for weeks but wasnt able to find any actual evidence of any increased risks. And she said that she would let me happily go to term and labour naturally if everything carries on going as well as it currently does. I am aware things can obviously change or baby can suddenly have a mega growth spurt or something else could happen that baby has to come out but if all goes fine she doesnt have any issue with me labouring "like a normal person" . I was delighted to hear that, have to say though that my diabetes consultant isnt aware of this yet. To start with everyone talked about inducing me and the more I researched induction the less willing I was to give it a try.
What I think I want to say is - it is your body and your baby and your choice! Do your research like I did - my obs told me I in fact couldnt find anything as all this having to induce diabetics is based on old research when the possibilities to control diabetes as well as you can now weren't there. I was happy that she told me this like that. She also told me they will obviously monitor me closely towards the end then and we'd talk about how to do this best at a later point which is fine with me. I dont have an issue going for scans/CTG every other day or however much is necessary as long as I can avoid induction.
Good luck to you! xx

 

[1Sarah1]

Hi @ArtemisBow and @kitty55 glad to hear your sugars are doing well. My understanding is that diabetic placentas age faster than normal placentas. I'm tagging @azure as think she knows more than me on this one.
They will want to monitor your sugars throughout labour from induction and also continuous monitoring of baby-you may even be on a sliding scale. I know it's pretty rubbish but think you need to do what is suggested in discussion with your OB team as best. First time I was induced with my daughter (age2) but had to have an emergency section (good job I hadn't gone home!) and had section with my twins (now 8m). Both times was in hospital for 2 weeks. I hope everything works out for you both (suggest ear plugs and a tv package to help before baby comes) xx

 

[kitty55]

Hi @ArtemisBow and @kitty55 glad to hear your sugars are doing well. My understanding is that diabetic placentas age faster than normal placentas.

But as far as I am aware that can be monitored @1Sarah1? And to be fair I heard that as well but as long as my obs tells me she is happy for me to do it all naturally then that's okay for me. If she said I'd need to be induced I'd ask her to show me the scientific evidence showing the reasons why. And up to date reasons please and not 10 years old I dont think such evidence exists as otherwise I am sure my obs would know about it. xx

 

[azure]

@ArtemisBow You always have a choice in childbirth. No one can be made to have their baby induced or in hospital. My lovely first midwife told me I was entitled to give birth in a coal shed but she woukdnt advise it!

It's up to you. I completely understand how you feel. I hate inductions as I don't respond properly to the drip. I would have preferred to go into labour naturally - by a million times over.

BUT - the evidence shows diabetic placentas age faster - about 2 weeks faster. Just as a non-diabetic isn't allowed to go overdue by too much (because it increases the risk of stillbirth, I believe) duabetic ladies are induced early because of the placenta being 'older'. 37 to 38 weeks was chosen as the optimum time.

I asked and I researched - there's currently no test that can show the if the placenta is failing. The only clue is an increase in hypos.

Of course, not all diabetic placentas will have deteriorated, just as not all non-diabetic ladies will have perfect placentas. But we won't know if our placentas are ok or not. Good BS is fantastic but, as far as I understand, it doesn't guarantee a perfect placenta.

Excuse the haste - baby calling! Only you can decide. I know it's not easy {{hugs}}

Edited to add that you can still have a good birth experience even if you're induced Remember the pessary might push you in to natural labour anyway, and even if it doesn't you can still have a special birth experience. Mental preparation and approach is everything - read up, be prepared, be confident and know you can do it

 

[azure]

But as far as I am aware that can be monitored @1Sarah1? And to be fair I heard that as well but as long as my obs tells me she is happy for me to do it all naturally then that's okay for me. If she said I'd need to be induced I'd ask her to show me the scientific evidence showing the reasons why. And up to date reasons please and not 10 years old I dont think such evidence exists as otherwise I am sure my obs would know about it. xx

No, I don't believe it can be directly monitored. I specifically asked the Obstetrician that and she said the is no way to check the health of the placenta. Obviously, they can check other things, but they can't check for the placental deterioration. From memory, the placenta can calcify and that's what's meant by deterioration - it becomes less able to do its job.

I read and read and read over the last few weeks of pregnancy. My HbA1C was perfect, my baby was on the 50th percentile, and I was in excellent health. Could I have gone to term if I'd kept my nerve? Yes - maybe, or even probably. But I wasn't prepared to take the risk, even if it was tiny. We all have our comfort level, and we all make numerous decisions in pregnancy. Diabetes is just an added complication, an added thing that needs a decision. I wished there was a way to monitor the placenta. I'd happily have paid to have that peace of mind. But there wasn't, so I chose to be induced.

The only person who can make that choice is you - and there's no right answer and most definitely no easy answer.

Hugs and best wishes to you both. XX

 

[1Sarah1]

Hi I was told that they could tell retrospectively that everything was OK-like growth etc and they can do dopplers checking blood flow but it's only a snapshot and doesn't give the full picture -all mine were born prem so didn't really have much choice as the OBS felt it was far too risky and they needed to come out. It's definitely your choice to do what you feel is right for you and baby. You never know when you might go into labour either! Although I was so glad with my twins I was in a hospital setting as my little boy nearly didn't make it as he had a rare condition-had to be resuscitated for a long time and had to have emergency surgery (nothing was picked up ante natally and I had loads of scans). I feel really lucky that he pulled through and my hba1c was perfect throughout and had normal scans.
Big hugs to you both and great about hba1cs x

 

[ArtemisBow]

Thankyou all for your great advice and kind words. Yesterday I was feeling quite upset as it felt as though all choice had been taken away from me. At my next consultant appointment I will ask to go through what the options are given current situation etc - I expect at the end of it I will decide to be induced in exactly the way they are suggesting because it is probably the most sensible, but at least I will know it is MY choice and not something being forced on me, which I think for me is important psychologically.

Thankyou again and good luck kitty55 - let's hope for happy and healthy babies, however they arrive in the world!

 

[jade88]

Hi Artemis I was induced at 38 weeks by pessary my body responded well and within 24 hrs I had my baby naturally with only gas and air! Not all inductions are tough just depends how your body responds!
I don't think the growth scans are accurate enough - my 36 wk showed baby was 6lb 10 but when he was born 10 days later he was 9lbs! I'm glad I was induced when I was otherwise he could have been a lot bigger which may have led to forceps or C-section! Your absolutely right tho it is your decision and you shouldn't let anyone force you to do anything your not comftorble with! Good luck! xxx

 

[azure]

@ArtemisBow Absolutely - make it your choice. Own that decision. The same goes for labour. You are in control.

If you're looking for inspiring books, I'd suggest Active Birth by Janet Balaskas (old but empowering) and Mindful Hypnobirthing by Sophie Fletcher. Your mental attitude is everything.

Even though diabetes means we have an added burden during pregnancy and labour, it does not mean our births are any less special. Remember that and take control. Write your birth plan as you want it, prepare mentally and enjoy every minute of labour (yes, even the life-giving pain). It's the most wonderful and amazing experience in the world.