VBAC with Gestational Diabetes: A Guide to Your Birth Options

Can you have a VBAC with gestational diabetes? This diagnosis is not uncommon, and it’s important to manage throughout your pregnancy. But if you are hoping to avoid a repeat c-section, there is the additional worry that you might not get the birth experience you wanted.

Gestational diabetes is a type of diabetes developed during pregnancy and typically resolves after the baby is born. Gestational diabetes occurs when the body does not produce enough insulin, causing high blood sugar levels. It can cause complications for pregnancy and birth, but with effective treatment, the risks are low. 

According to the American Pregnancy Association, gestational diabetes occurs in 2-5% of pregnancies. For those who have a higher risk pregnancy, the chance may raise up to 9%. Although it’s most common for insulin levels to return to normal after the baby is born, if you have had gestational diabetes, there is a chance of getting type 2 diabetes after birth. 

But how does this affect your VBAC success rate? 

This article covers some complications you may find with gestational diabetes and VBAC. We’ll also address what the end of pregnancy may look like if you’re planning a VBAC and managing gestational diabetes. 

Gestational diabetes complications

If you are diagnosed with gestational diabetes, you will begin care with a maternal fetal medicine doctor, dietitian, or your provider to maintain healthy blood sugar levels. 

During your pregnancy, you may need to monitor your blood glucose and take insulin. Physical activity and a well-balanced, healthy diet will help decrease your chances of future complications and help your levels stay in a healthy range. 

Below is a list of some of the common complications that may arise with gestational diabetes.

Hypertension and Pre-eclampsia 

People who have gestational diabetes have a higher risk of developing hypertension (high blood pressure). This can cause complications to both the parent and the baby. 

If you have high blood pressure, you may notice swelling in your hands and feet, protein in your urine when you attend your prenatal visits, headache, and even spotty vision. More severe complications of high blood pressure are seizure and stroke. 

It is possible for high blood pressure to turn into a condition called pre-eclampsia. This condition usually requires giving birth sooner than planned. 

Low Blood Sugar

People who take diabetes medication or have to receive insulin may find that their blood sugar becomes too low. Low blood sugar can be frightening and even become fatal if not discovered quickly. If low blood sugar occurs, the baby may need to be watched closely for low blood sugar after delivery. 

Higher chances of a larger baby

Big babies are sometimes viewed by providers as a concern, especially with VBAC. Let me be the first to tell you though, it is possible! Having a big baby is not necessarily a complication. 

Julie and I have both seen big babies come out vaginally (like 10 lb 6 oz babies) in our work as doulas, and we’ve put together an entire article about delivering a big baby vaginally. Try not to let someone bully you into a C-section if a big baby is the only reason.

Induction

If everything is managed well, a provider may not encourage induction. However, a majority of providers will typically encourage an induction with gestational diabetes, to avoid a big baby or blood pressure taking a turn for the worse. 

C-Section

There is a chance that a C-section will be suggested if insulin levels are not managed well or if it becomes medically necessary. Your VBAC birth plan might have to change, but managing your gestational diabetes is the best way to improve your chances of having a vaginal birth vs. repeat cesarean.

Can I have a VBAC with gestational diabetes?

Although some providers may not suggest a vaginal birth or induction with gestational diabetes, it is possible. However, there is little research on the true success of natural childbirth with gestational diabetes. 

There is little research on the true success of natural childbirth with gestational diabetes, however, one study has shown that women with gestational diabetes have a lower chance of successful VBAC compared to women without diabetes.
The study has found that mothers with gestational diabetes were more likely to need induction or operative delivery than a control group who didn’t have the condition.

Gestational diabetes should be treated the same with every parent, whether or not they have a previous c-section scar on the uterus. If gestational diabetes is not managed and other risk factors come into play, there is a chance a cesarean may take place. 

With gestational diabetes, there is a higher chance of induction, which may affect the way your provider views your chances of VBAC. Some providers do not support induction for VBAC patients.  

Evidence based birth put out an incredible blog, stating that people who were induced at 38-39 weeks were less likely to have a C-section, develop high blood pressure, or even pre-eclampsia. The research showed that fewer babies were shown to have a birth weight above 4,000 grams. 

Just like any induction, whether or not it is a VBAC, it is most important to know your options and have a provider who is truly supportive. If you have gestational diabetes, chat with your provider and discuss what future possibilities may come into play. Ask them if they support induction with VBAC and what type of induction methods they suggest. 

What to do if you have gestational diabetes

If you have been diagnosed with gestational diabetes, there are things you can do to give you the best possible chances of a vaginal birth. First and foremost, it is important to have a supportive provider who will support you during this pregnancy and labor journey with gestational diabetes.

When you are diagnosed feel free to ask all the questions you have:

•  How can I manage my sugars in the best way?
•  Does this change anything for delivery?
•  What can I do to help lower my chances of induction if it becomes necessary?
•  Will you induce me knowing I am planning to have a VBAC?
•  Will there be any extra testing at my prenatal visits? 

Good management will truly benefit your chances of having a vaginal birth with gestational diabetes, while reducing the risk of complications. 

Certain foods can help your blood glucose levels stay where they need to be. Be mindful of your protein intake by making sure that you have some sort of protein with every meal. Protein can help balance the levels in your blood sugars. Include healthy carbohydrates like vegetables and fruit. 

Nutrition is something that I feel helped me during my pregnancies. Although I didn’t have gestational diabetes, I suffered from kidney stones during pregnancy. My body creates stones when it is pregnant and everything I ate impacted those stones. 

During my first pregnancy, I ate very large portions and did not make super healthy food choices. I gained a ton of weight, became swollen, and felt miserable. I also stopped physical activity because I was scared to do much being pregnant. 

With my second pregnancy, I turned my nutrition around, exercised more, and had a much better experience, even though it ended in a repeat family centered C-Section.

Eating a healthy diet can help improve your chances of a healthy pregnancy and delivery with a vaginal birth. Staying physically fit or including some sort of activity in your daily routine will also contribute to a healthy pregnancy and birth. ACOG suggests at least 30 minutes of exercise per day. 

VBAC is possible with gestational diabetes. The message we hear again and again from the VBAC stories on our podcast is that being respected and listened to has the most significant impact on birth experiences. Being informed and involved in birth choices makes for an empowering birth, regardless of the outcome, so you can remember the experience in a positive light. 

For more education and support in preparing for your VBAC, check out our Ultimate VBAC Course for Parents.