Planning a vbac with mild gestational diabetes - induction with baloon or scheduled C-section if overdue?

After a stressful labour ending in emergency c section with my first in lockdown on 2020, I’m dreaming of a vbac in the MLU with the option of a pool this time. I’m currently 36 weeks.

With my first I had constant monitoring after my waters broke due to GDM and I ended up having to labour on my back for hours in awkward positions as they had trouble keeping the sensors working when I moved. This was obviously not ideal and I believe it added to mine and therefore my baby’s stress.

This time I’ve been diagnosed with GDM again but again very mildly and am able to manage it with small changes to diet and exercise. The problem is the usual advice in this case is not to go over 40+4 and at this point they would like to have me scheduled for a C-section or induction (starting with balloon).

If I go into labour before 40+4 I’ve been cleared for MLU and we’ll be able to move to labour ward for monitoring should we feel we want it, so that I’m happy with.

If I go over, I’m really undecided. I don’t want another section due to the recovery and having a 3 year old to care for now too, but induction means labour ward, greater risks if balloon doesn’t work and we have to try hormones, constant monitoring, and all the stress from past trauma coming back, but could still mean I end up with a vbac, albeit not the dream scenario.

Anyone else in/had a similar situation? I’d love to hear from you! 🙏🏼

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As a midwife I personally would avoid induction and recommend against induction after a c-section. It’s important to know the risks - it increases the chance of uterine rupture by three times and decreases the chance of a successful VBAC by about 20%. Especially with an induction, it would really be encouraged that you have monitoring of baby in case of rupture.

I’m in the same boat - pregnant with my second and want a VBAC. My birth plan is hopefully spontaneous labour and a vaginal delivery but if I get to 41 weeks without going into labour, I will have a c-section. And I’m advocating for myself that I will give myself the full 41 weeks and no earlier

thank you for this, I’d also like to push to 41 weeks if the GDM is easily managed and he’s measuring fine so will be asking more about this. I’ll also be asking about the effectiveness of the balloon induction but I’m swaying more towards c section after 41 weeks too.

I have had five VBAC’s and I was actually induced with four of them. They all went quickly and smoothly each time. I don’t know if I’m in the minority, but my midwives were comfortable inducing me and I had zero issues. I didn’t get an epidural either. I was able to work through the pain with the assistance of a doula and natural coping strategies.

wow that’s amazing! What type of inductions did you have?

the balloon and a low dose of pitocin. Many midwives or doctors won’t induce, so I was fortunate to find a midwife who was willing to induce me if it came to it. I didn’t want a repeat c-section at all, so the risk was worth it to me.

great to hear. My consultant is open to me choosing induction so it’s really up to me

Currently reading the “Vaginal birth after caesarean handbook”! I recommend as it shares a lot of scenarios/options/data to help decisions

ooh thanks, I’ll check that out

I was induced at 42 weeks with my VBAC using dilapan rods, so similar to the balloon method as it’s mechanical and not hormonal. They did use pitocin drip on a low dose for a little while but turned it off cause my son’s heart rate was showing some distress during contractions. I did have forceps and an episiotomy, however had a successful vaginal birth through induction x

I’m not sure how do you work through that kind of pain without an epidural I had a doula and the pain is still a lot ?

did you get epidural ?

yeah Id been contracting in slow labour for over a day since I first arrived and the dilapan rods were inserted, so I’d had no sleep in hospital prior to going on the labour ward and I was exhausted lol

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Anyone else up feeding their Bebe?

As above. Trying so hard to keep my eyes open

Is this normal??

I’m 29 weeks pregnant and having really aching legs and they’re all lumpy and swollen. Above the knee and behind the knee . Should I be worried ? My legs have never looked like this up until a few days ago. ??

Induction experience

I just wanted to share my experience with being induced as I wasn’t sure what to expect and thought it may help others.

I opted for the foley balloon which was inserted at 8am Saturday morning, I had to stay in hospital due to hypertension and protein urine however usually you can just go home once this has been done. The insertion of the balloon was not painful, was slightly uncomfortable as there was slight pressure. I actually found having the cervix checked prior to be worse (again not painful at this point just uncomfortable) The balloon had little effect and after having it removed I was still only 1cm. Removal also was pain free and hardly even noticeable.

I then had my first dose of the gel and definitely noticed a difference, I started experiencing period like cramps almost immediately however they were light and manageable. After 6 hours I had another cervix check and although my cervix was soft it was still only 1cm and was only open at the front. I had another dose of the gel and felt an increase in pressure and more intense cramping where I now required pain relief (codeine). After another 6 hours I had another cervix check and I had now dilated to 2-3cm however was still quite difficult to get all the way through so a third gel was recommended which I agreed to.

Almost immediately I noticed the difference and was in considerable pain, I had paracetamol and codeine however the contractions had now become intense and a lot closer together (around 3 minutes apart). After a couple of hours I had my last cervix check and was 4cm and taken down to the Labour ward to have my waters broken and an epidural.

I had been in my room for approx 20minutes when my waters broke by themselves and I was now 10cm and actively pushing…. There was no time for the epidural and my beautiful girl arrived into the world within 2 minutes of pushing.

All in all I would say the cramps/contractions were manageable up until the third gel where it became pretty unbearable however it was for a very short time a gas and air helped take the edge off. The worst part about any of it was actually the later cervix checks where after stimulating the cervix my contractions were at their most painful.

If I had to be induced again I would skip the balloon and opt for the gels immediately as thy had a quicker effect and I would have been out a lot sooner if I had done this to begin with.

One more thing, I’ve never believed when people say “you forget the pain once they’re here” but I can honestly say this is true. It’s been 4 days and I would do it all again in a heartbeat.

Anyone else experiencing this?

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