‘I have to have an induction because I’ve got gestational diabetes’

Debunking this myth!

Rebecca Newell

4/16/20244 min read

It may be a good idea to read my 'What is Gestational Diabetes?' post as a Part 1 for the background on Gestational Diabetes, why the label is problematic and why there is a lack of evidence to demonstrate that labelling and treatment improves outcomes.

I want to write my conclusion first because reading the below may feel a little daunting, but it should be known THERE ARE PLENTY OF AMAZING POSITIVE PHYSIOLOGICAL BIRTH STORIES INCLUDING HOMEBIRTH ONES BY PEOPLE WITH GESTATIONAL DIABETES. (sorry for shouting)

Consider joining Samantha Gadsens Homebirth Support UK Group on Facebook to find inspiration for refusing an induction and doing it your own way. There's also some handy suggestions below for having a physiological birth (including an induction). And lastly Sara Wickhams book In Your Own Time is a phenomenal source if you need help advocating for yourself.

So where does this absolute MYTH come from?

The main concern with having Gestational Diabetes or high blood glucose levels in pregnancy is ‘a larger than normal baby’ medically known as macrosomia. A baby is considered ‘too large’ if they weigh more than 4 kilograms at birth. This happens because the excess sugar in the mother's blood reaches the baby through the placenta and makes the baby's pancreas produce more insulin and too much can make the baby store more fat and grow larger.

This can increase the risk of several issues;

- Shoulder dystocia, where the baby's shoulder gets stuck during delivery, causing potential nerve damage or bone fractures. Evidence suggests that the incidence rate varies between 0.58 and 0.7%. This is often used as the reason for recommending induction. It's important to note that not all babies of mothers with gestational diabetes will become too large. Several factors can influence the baby's size, including how well the mother manages her blood sugar levels, her weight, age, ethnicity, the baby's sex, genetic factors, and the duration of the pregnancy.

- Low blood sugar levels (hypoglycaemia) after birth, which can affect the baby's brain function and may require hospital treatment

- Jaundice, a condition that causes yellowing of the skin and eyes due to high bilirubin levels, a waste product of red blood cells.

- Breathing problems or other health issues that require intensive care

The most recent Cochrane review for ‘Induction of labour at or near the end of pregnancy for babies suspected of being very large’ found that induction decreased the chance of shoulder dystocia from 6.8% to 4.1%. Not really a big difference at all. This could be because a baby is likely to be smaller before the 40 week mark, so less likely to get stuck.

However, they also found an increased rate of severe perineal tearing in the induction group of 2.6% vs 0.7% in the spontaneous labour group; and an increase in the treatment of jaundice for the baby (11% vs 7%).

“The findings of this trial highlighted no clear difference between the babies of women in either group in relation to the number of large babies, baby’s shoulder getting stuck during birth or babies with breathing problems, low blood sugar and admission to a neonatal intensive care unit. No baby in the trial experienced birth trauma. In the group of women whose labour was induced, there were more incidences of jaundice in the babies.” (Biesty et al 2018).

Their summary: There is no evidence to support induction of labour in women with gestational diabetes and no other complications.

In 2018, The WHO recommend that “induction of labour should not be offered for gestational diabetes unless there is evidence of other abnormalities occurring, such as abnormal blood glucose levels. Even then, there is no evidence that induction is beneficial.”

And the relevant NICE guidelines state that “induction (or elective caesarean) should generally not be considered before 40+6 weeks for women with gestational diabetes. The exception to this is if either the mother or baby is experiencing complications”

NOTE- complications are not the same as risk factors. A complication could be having preeclampsia, a risk factor could be you have previously had a baby who weighed 4.5kg.

In her blog post ‘Gestational Diabetes – Beyond the Label’ Dr Rachel Reed makes the following suggestions for people with abnormal BGL who are having an induction or wanting a physiological birth.

  • Maximize pelvis size and movement, avoid restrictive positions.

  • Promote baby's ability to rotate, encourage mobility (e.g., water immersion), and provide resting periods between contractions.

  • Manage blood glucose (BG) for insulin-dependent people during labour.

  • Avoid interventions causing wounds (e.g. C-section or episiotomy) due to higher BGLs' impact on healing and infection risks.

  • Support instinctive pushing behaviour; gentle directed pushing after the baby's head reaches the perineum; avoid pulling the baby's head immediately after birth.

  • Maintain continuous mother-baby contact after birth to prevent glycogen depletion and support metabolic balance during resuscitation.

  • Prolonged skin-to-skin contact stabilizes baby's heart rate and temperature, reduces stress, and encourages early breastfeeding for maintaining BGLs.

  • Promote early and frequent breastfeeding to provide nutrient-dense colostrum for glucose support.

  • Monitor the baby's BGLs during maternal BGL adjustment, keeping mother and baby together.

  • Observe the baby for jaundice during the first week, particularly if they had high insulin production during pregnancy, and consider light therapy if needed.

Sources