I’ve been corresponding with one of my gang who is having to navigate hospital policy around a Gestational Diabetes diagnosis and the issue of induction of labour. I think it would be really helpful for others to read:

Thank you again for your advice previously about diabetes – I was formally diagnosed with GD in the end by the diabetes consultant at UCLH but have been very successfully controlling my glucose levels with diet only and genuinely believe that mine is such a borderline case, with absolutely no symptoms of GD in either baby or me, so don’t really think the diagnosis applies to me! I did however, have to have some extensive discussions with the consultant midwife and diabetes consultants so that the birth centre would still accept me (rather than the labour ward)…I do believe that your course set me up with the confidence to ask the right questions and not just accept hospital policy without trying to discuss things further. So thank you.

I am currently 40 weeks +11 days – and due to the diabetes, the consultants did not want me to go over 40 +6 (nevermind the usual 40+14 which I am now approaching!). I was offered a sweep at 39 weeks and have been offered a sweep and asked about booking an induction at every hospital visit since, which in the last two weeks have been every 2-3 days…I’ve declined every time.

Scans and CTG monitoring on Friday, Monday and Wednesday show baby/ placenta/ amniotic fluid/ blood flow are all perfect, I have another appointment today and then Monday morning for the same again…consultants are asking me “how long will you let this go on for?” and “you need to tell us what date you will have an induction”. And repeatedly talk about the risk of stillbirth increasing, the longer I let this go on for…

I’m not at all uncomfortable/ struggling (I’m actually having a lovely time, apart from the pressure from the hospital making me question everything) and am very confident that my baby and body are able to do this birth thing all by themselves. I feel very strongly that I do not want an induction, regardless of how many days tick by, unless there is a genuine concern about the health of my baby. I know that the birth centre will not accept me from 42 weeks, even if my labour is spontaneous, but not having an induction is more important to me than being in the birth centre/ pool. UCLH have confirmed that I’ll need to be admitted even for the pessary since because of the diabetes they need to monitor the baby when I start having contractions and so they won’t let me have an outpatient induction. The idea of encouraging my body to get going with labour in a labour ward with all that medically pressure, rather than in our cosy home environment goes against all my instincts about what this is about.

So I’m considering a sweep today for the sole reason that it may mean I do not need an induction, and will likely ease the pressure from the hospital…Dom is very confident that my body does not need any intervention whatsoever, sweeps included, but I’m the one gearing myself up to say “no” again, and listen to the risks, again, and I’m wavering…

Thank you Kat for listening (reading!). Any thoughts appreciated! But I do think it has already helped being able to write all this down 🙂

I replied with: 
Sounds to me like you’re very grounded and tuning in to your instincts, you’ll do what’s right for you. A sweep really is only going to ‘do’ anything if your body / baby are getting ready. 

Here’s some interesting thoughts on sweeps from a midwife pal. I’m a big believer that you can make pretty much any environment a comfortable one by dimming lights, using the recordings and all the things we talked about so even if you agree to wait and be on the labour ward IF baby waits til after 42 weeks you can make that your space. One thing I’d question (personal opinion!) is monitoring throughout birth. GD is not a reason for doing this and in fact constant monitoring is shown to do nothing other than result in more intervention. If there’s a desire to keep a closer eye on the baby, for whatever reason, then a midwife should be with you and she can listen intermittently and regularly. A machine requires a person to interpret the results anyway.There’s a really interesting piece on this that I’ve scheduled to share on social media next week: https://www.researchgate.net/publication/308113941_Electronic_Fetal_Monitoring_Cerebral_Palsy_Litigation_and_Bioethics_The_Evils_in_Pandora%27s_Box
and I’m attaching a couple of resource sheets that you might find interesting…

Good evening Kat,

Thank you so much for such a prompt reply! I actually read this while still in the hospital – because there are a few doctors getting jumpy about me, various different assessments end up being organised and I was there for a while…I spend the time waiting between assessments people watching from the windows of UCLH while listening to your hypnobirthing recordings – invaluable to help me stay calm! All the checks today showed baby is still perfectly happy and healthy, as am I. Which although not fun hanging around in the hospital, does give good ammunition for me continuing to turn down induction!

I’m definitely feeling my body gearing up now, pelvis getting more uncomfortable as baby is lower every time they check, some surges, back ache etc, so all is moving in exactly the right direction. I particularly liked your fact sheet about induction and dates. I’ve never been sure of my dates as my cycle times have never been regular and always longer than the “average” anyway so why would my pregnancy be suddenly bang on the 40 week mark…

And although a pool in the birth centre would be ideal, everything you’ve said about creating our own safe space whereever we end up makes perfect sense to me too. Ive previously discussed the need for constant monitoring on the labour ward vs intermittent on the birth centre debate due to the GD. They ended up settling on regular “spot checks” and then a continuous belt only if concerns, hopefully they can stick to that in the ward as well. Something I’ve been really clear about is that I need to be able to move around between various positions and not be tied to a bed on my back so that’s something I must keep making clear I think.

I’ve unfortunately got three different appointments/ checks on Monday morning, so the links/ docs you sent will be really useful to refresh myself with again before another session of turning down induction on a few fronts! I suppose that’s only if we get to Monday though – tomorrow Dom and I have planned a lovely day of a big long walk and a long lunch and a wander round a couple of antiques shops. Enjoying the time just the two of us as you say! And encouraging the oxytocin 🙂

Thank you again for your support. It’s so good to hear views and info from someone with experience that isn’t having to follow hospital policy. I completely understand why the policies and guidelines are there and really respect the incredible wealth of medical knowledge surrounding us, so it’s tricky when you’re the individual being put into a bucket of average risks and your gut instinct is telling you that you don’t fit!

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