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VBAC Cubby - vaginal birth after cesarean

So You Want to Have a Diabetic VBAC
by JanB
Part 5: My Experience

Now that I've shared some general knowledge, I'll talk about my successful VBAC birth. My first baby arrived via c-section. My doctor had wanted to induce labor at 38.5 weeks because I had what they thought was gestational diabetes. I was terrified of medical induction, so we tried nipple stimulation with a breast pump at home. I don't know if that's what did it or not, but my water broke later that evening. Unfortunately, my water broke well before active labor began, and because I was Group B Strep positive, my OB wanted me to come to the hospital immediately to start antibiotic treatment. Once I was there, labor didn't progress much, and they began Pitocin to speed things along - again, because I was GBS+, so they didn't want me to take longer than 24 hours to deliver the baby after my water had broken due to the chance of infection. After a day in labor, the baby had still not descended into the birth canal or turned into the correct position, so I had a c-section. My son was born with signs of prematurity (covered in vernix, a weak latch, extremely jaundiced) and also contracted a severe viral infection at the age of one month that led to his being hospitalized for three weeks. At the hospital, all the doctors kept asking if he'd been premature, because premature babies are at higher risk of developing these infections. We told them no, he was full term, but now I wonder.

When I got pregnant with my second baby, I knew I had pre-existing Type 2 diabetes. I went to the diabetes and pregnancy clinic at the University of Washington three months before trying to conceive, and was immediately started on insulin therapy to bring my fasting and post-meal levels into the target range for tight control. Three months later, we did conceive.

Things progressed more or less normally with the pregnancy, except that my doctor's appointments were much more frequent than they had been with my first baby. I kept a close watch on my insulin requirements and blood glucose levels, and survived through the 9-12 week period when my glucose levels kept bottoming out. At around the third month of gestation, my doctor suggested that I try the insulin pump. My insurance covered it, so I agreed, and found that I loved the convenience and smoother control that the pump gave me. I also liked not having to carry around needles whenever I wanted to go out to eat.

The first major ultrasound at 16 weeks revealed that the baby showed no signs of birth defects, which was a major relief. It also showed that the baby was measuring exactly on target for her due date, which was another major relief, as my first baby had measured 4 weeks ahead consistently throughout the pregnancy.

Halfway through the pregnancy, we moved across the country and I had to find a new provider; luckily, the one I found was not only an expert in care of diabetic pregnant women, but was also relatively pro-VBAC. As my due date approached, I asked him what his thoughts were about labor and delivery. I told him my feeling, which was that I would prefer a VBAC delivery if possible, but that my number-one goal was to let the baby develop naturally in utero as long as possible. He agreed that that goal sounded reasonable, and said that we'd keep an eye on things and see if I went into labor naturally. The baby was still measuring exactly right for her due date and didn't look abnormally large, and my blood glucose control was still excellent.

At my 39-week appointment (which is the latest cut-off date for many providers) my cervix was only 1cm dilated and 50% effaced. My doctor said that I'd made some progress, but that if I hadn't gone into labor on my own by the next week's appointment, we'd have to decide what to do. He was reluctant to try inducing if my cervix had shown no change at the next appointment, but if it had progressed somewhat, he said we could try a mild induction. I went home feeling optimistic.

About three days later I woke to regular contractions. After a full day of mild, 15-minute-apart contractions, they finally started to speed up the next morning. I spent the day laboring at home and at my sister's apartment (she lives closer to the hospital than we do), waiting for active labor to begin. Finally around 8 PM I got tired of waiting, and we left for the hospital, although my contractions were still only about 5-6 minutes apart. However, in the car on the way there, they increased to 3 minutes apart. At the hospital they discovered that I was 5cm dilated and fully effaced.

I need to digress for a moment to highly recommend that you spend as much of your early labor at home as possible. If you have a labor that is very slow to progress, as mine did, and you show up at the hospital at an early stage, they're probably going to want to speed your labor with induction drugs, or to simply whisk you off for a C-section for "failure to progress" after a certain period of time. I spent a full two days in labor before progressing to 3-minute-apart contractions! It's a good thing I didn't go to the hospital at the first sign of regular labor pains.

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At the hospital, the only intervention they made to speed my labor was to manually break my water when I stalled at 6cm of dilation. This kick-started things again, and the rest of my labor progressed very normally - a nice change from my previous baby, who never even entered the birth canal. After about 7 hours at the hospital, my second child entered the world, vaginally, and with her fist alongside her head. I did tear a little, but the experience was well worth it.

I hope that the information in this article is helpful to anyone out there looking for information on diabetic VBACs. Good luck!

   • General Pregnancy and Diabetes Information
   • Complications and How to Prevent Them
   • VBAC Considerations
   • The Birth
   • My Experience

Additional Resources:
   • Diabetes and Pregnancy
   • StorkNet's Pregnancy Complications/High Risk Pregnancy Center

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