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I have gestational diabetes. Can I still have a vaginal birth?
Probably, especially if your gestational diabetes is under control. Having gestational diabetes does increase your risk of needing a c-section, but most women with the condition are able to have an uncomplicated vaginal birth.
The size of your baby is the main factor your healthcare provider uses to determine whether you can have a vaginal delivery. Gestational diabetes can make your baby grow larger than normal, or be large for gestational age (LGA).
A newborn is considered LGA if the baby's birth weight is greater than 90 percent of other babies born at the same gestational age. (Macrosomia is another labor complication related to a large baby.)
If you have gestational diabetes, your baby may also have large shoulders and extra upper body fat. This increases the risk of the baby's shoulders getting stuck behind the pubic bone during birth (shoulder dystocia). This condition is uncommon but can lead to injuries, such as a broken collarbone or damage to the nerves in a baby's neck and shoulders (brachial plexus injury).
These injuries almost always heal well. Occasionally, very large babies and babies with shoulder dystocia don't get enough oxygen during birth, which can have serious consequences.
Giving birth to a big baby can also cause problems for you during delivery: You may have a greater risk of perineal tears and blood loss. Having a c-section is the alternative, but this also has risks.
Talk to your provider about the potential risks and benefits of a vaginal birth as opposed to having a c-section.
Is it likely that my baby will be born early?
Gestational diabetes raises the risk of high blood pressure and preeclampsia, which makes an early delivery more likely. However, many women with gestational diabetes have their baby at full term.
If your baby looks big on an ultrasound scan, or if you have another health condition (such as high blood pressure), your doctor may recommend inducing labor. This usually happens when you're between 37 and 39 weeks pregnant.
Does gestational diabetes mean I'll need extra monitoring during labor?
In general, yes. Your provider will monitor you and your baby more frequently to make sure that you're both doing well.
If your diabetes is controlled through diet, you probably won't need glucose monitoring or insulin therapy during labor. But if you're diabetes isn't well controlled or you're taking medication, you'll be monitored more closely and may be given insulin intravenously.
Your provider will probably monitor your baby continuously to check how he's coping with your contractions. This is usually done through electronic fetal monitoring (EFM), also called continuous cardiotocography (CTG).
Your provider will ask you to wear a belt that measures your baby's heartbeat and your contractions. You usually need to lie down while wearing this belt and won't be allowed to get up unless your provider removes it. Some hospitals have wireless monitoring systems, which allow you to move around a bit more.
After your water breaks, your provider may also attach a small electrode to your baby's scalp to monitor his heartbeat more accurately. This won't hurt your baby, and it can give your provider helpful information on how your baby is doing.
What happens after I deliver my baby?
Your provider may encourage you to breastfeed your baby because breastfeeding helps blood sugar levels return to normal after birth. It may also help balance your baby's blood sugar.
Because there's a risk that your baby will have low blood sugar after birth, she'll get blood glucose testing after delivery. If these tests are out of the normal range, your provider will monitor your baby closely.
It's possible that your baby will need to spend some time in the neonatal intensive care unit (NICU). This is more likely if your baby was LGA during pregnancy, had breathing problems, or was born with low blood sugar. Your provider will monitor your baby's blood sugar levels for 24 to 72 hours after birth.
The good news is that most women recover fully from gestational diabetes and don't have any other problems. Though sometimes gestational diabetes doesn't go away. If this happens to you, you'll be diagnosed with type 2 diabetes.
Visit the Society for Maternal-Fetal Medicine's website for more information and to find an MFM specialist near you.