Dr. Vijaya Krishnan

VBAC with Gestational Diabetes

Gestational Diabetes in First Pregnancy

This is the #BirthStory of a mom who had a VBAC with Gestational Diabetes.

She says that she came to know about us from her colleague, just after the birth of her first daughter, 6 years ago. In that pregnancy, she was induced with a drip at 38 weeks due to Gestational Diabetes (GDM), as they said she had a large baby. Induction failed and she had a C section.

This pregnancy she comes to us for care at about 8 weeks of pregnancy. Her Random Blood sugars are already at 148. We start her on a strict program of diet and exercise. In between, she goes and checks out many corporate hospitals, but does not find the personalized care, with good informed consent that she is looking for. She returns to us for care around week 15, and never looks back.

This time at The Sanctum

She is quiet by nature. Most check ups, she comes in smiling, asks 1 or 2 questions, gets her check up done, and leaves. She works like a warrior in the whole pregnancy – Diet, at least an hour and half of walking, Prenatal Yoga. Yet, by 22 weeks her sugars show a rising trend. We send her for an endocrinologist consult, and she gets put on diabetes medication. From here on, she will keep track of her sugars daily. And with periodic endocrinologist check ups, the medication dosages will get adjusted upwards from time to time. And sugars will remain in excellent control till the end of pregnancy!

When complex needs exist, we need to use all tools at our disposal to make sure that Mother and baby remain safe. Thus, we get growth scans and Dopplers done at 36 weeks and at 39 weeks. Both scans show that all is well, except that she may have a big baby – the last scan puts baby’s weight at 4 kgs +/- 400 gms. She is a bit fearful whether a baby that size can be born naturally. Yes Mamma, you can birth your baby vaginally – just keep working towards it, we say. She is already enrolled into our Prenatal Aerobics class, and is working hard to help her baby move down into her pelvis.

The Final Stretch (but we were in for a long haul)

We get to 40 weeks plus 1 day – with multiple factors of Gestational Diabetes on medication, Mom trying for #VBAC, and placental aging, we discuss pros and cons of natural induction versus waiting further for labor to start on its own. Mom chooses to go the natural remedies route.

24/9, 25/9/18 – Natural induction. Few contractions, but then at night it spaces out and disappears.

26/9/18 – We do evening primrose oil cervix massage and find it way posterior tucked behind baby’s head. Long, and almost closed. With this kind of cervix, we know her body will take a long time to even get ready for labor. We get a co-consult with our back-up ObGyn, and finally after all pros and cons explained, with Mom understanding the additional risk, we start a combination of natural remedies and medical induction. That night, with minimal progress of labor, and further explanation of pros and cons, we stop medical induction. Cervix is barely beginning to open up, and baby is still high. Mom gets some rest.

27/9/18 & 28/09/18 – We throw in ALL the methods of natural induction at Mom. Cervix starts to thin out a bit. Contractions happen till night and then they stop again. We ask Mom if she wants to continue to try for vaginal birth versus repeat C section. Her answer is unequivocally yes. But she has answer let down of tears. Why is my body not responding, she asks. We tell her that we have no answers yet, most likely her body is not ready, but we must try to bring on labor because of your GDM and placental aging, we say. After that conversation and release of tears and fears, her body starts to getting labor contractions every 5 to 7 mins!! She looks happy, and we ask her to continue to augment with natural methods to keep the momentum going. She works hard till 1 am the next morning!

29/09/18: But by 10:30 am, contractions have vanished one more time. Cervix is still tucked in posterior, but it has now opened up to 3 cms, although a lot of thickness remains. Few more rounds of natural induction, and nothing much kicks in. By 1 pm, we discuss a options – try one more round of medical augmentation, with its slightly increased risks, OR, go in for a planned C section. We tell her that we feel natural induction has finished it’s work in her case. Today, we are at 41 weeks complete! Mom says she needs a few minutes to think it over and discuss with her husband. An hour later, she signs an informed consent for further medical augmentation.
3 pm: Start of augmentation.
7 pm: contractions start weakly.
7:30 pm: Contractions are 5 mins apart, 40 seconds long, strong
11 pm: Mom is working hard through her contractions. She wants to be checked internally – status quo. For the next 2 hours we work with exercises, positions and homeopathics. And then she rests between contractions for the rest of the night. We monitor Mother and baby like a hawk.

Now the true Final Stretch

30/09/18 – 41 weeks and 1 day: Contractions are 3 to 4 mins apart and strong. We ask permission to check internally. In our mind, we are ready to take a call for a repeat C section, if there is no progress. But, there is a dramatic change – cervix has moved forward and thinned out and is now open to 4.5 cms. Baby still needs to come down. We go over more positions, but an hour later, Mom says she is feeling dizzy. Her vitals are fine, baby is sounding great – we ask her if she is feeling drowsy or dizzy? And how can we continue to labor if she is unwell? We nourish her with foods, run a drip and let her figure out how she feels. Some encouragement, some counseling and options discussed – Mom shakes herself, gets a shower, and says “Let’s do this. I am going to do this” πŸ˜‡ For good measure, we get a hemoglobin check done, and Dr. VijayaLakshmi, our OB/Gyn comes in and does an intrapartum scan – all is well.

Mid-afternoon, we hold the cervix forward through 3 contractions. 5.5 cms dilation. We stop medical augmentation, as her body is now picking them up on its own!! Mom by now, looks like she wants to give up. In co-consult with our back up ObGyn, Dr. Jayanthi, we offer to do an artificial rupture of membranes – we know that she carries excess fluid due to her GDM. She agrees, and once that happens, baby descends and she dilates rapidly to 7 cms!

Now pressure and contractions peak. Few more positions to encourage baby to rotate and descend. By 7:30 pm, we have kept the Watertub ready for her. And, 40 minutes after she enters the tub, we hear the unmistakable sounds of her involuntarily bearing down!! 8:20 pm. And, finally she gives a small smile, knowing that she is finally pushing!! ☺😍☺

8:43 pm: Strong pushing

9:02 pm: Birth of her second daughter. Beautiful & chunky as can be.
Birth Weight: 4.20 kgs!

Finally, she has done it! 6 years after she was given a C section for her 3.8 kg older daughter, she has given birth vaginally to a baby who weighs 400 gms more! πŸ‘πŸ‘πŸ‘

Had her #VictoriousVBAC with Gestational Diabetes; At 41 weeks and 1 day; 5 days after the start of natural induction procedures; With a slow to start, slow to progress labor; Giving birth to a big baby; AND Ultimately Saying “I never really knew pushing could be so easy!” πŸ˜ƒπŸ€—β˜ΊπŸ€—πŸ˜‡


Congratulations, Dad – Your strong, silent support was exactly what she needed! πŸ’ͺ

Congratulations, grandparents who waited all these days with some worry, but putting full faith in your daughter! 😍

Finally, congratulations older sister, who lovingly encouraged Mom with kisses and hugs daily, and jumped for joy as soon as she saw her baby sister πŸ’žπŸ˜˜

If you or a someone you know has had a prior c-section and want to try for a natural birth with Gestational Diabetes situation we would be happy to guide you. Contact Us here with your details for an appointment if you are in Hyderabad or for a Skype Consultation if you are based outside Hyderabad.

Click here to see more Birth Stories.