My first child weighed 9 pounds 1 ounce, and broke her collar bone during delivery and my placenta had to be manually extracted I am now pregnant again, have gestational diabetes (I seem to be controlling it well through diet), and I am worried about a large baby and the same complications as the first delivery. What are my chances of a repeat delivery?

One of the major risks of gestational diabetes to the fetus is excessive growth and subsequent complications with delivery which you have experienced. Another term for difficult delivery is dystocia (pronounced dis-TOE-sha). You may have heard of “shoulder dystocia”. In one sense, you were very lucky that your child only had a broken collar bone. Dystocia can lead to severe nerve injury and even death when a baby is too large to fit through the birth canal. Dystocia is not always predictable and can occur with relatively small babies.

Babies of mothers with gestational diabetes are at particularly risk because there is a tendency for the fetal abdomen to be excessively grown. Thus, the head can fit through, but the shoulders and trunk get hung up behind the pubic bone. There is not an absolute reason for you not to labor and have a successful, uncomplicated delivery. However, given your previous experience, your obstetrician should be following the growth of your baby very carefully. You may have to weigh the risks of labor with an unknown outcome at the time of delivery versus the risks of an elective cesarean section. The cesarean would be done only because you might have a problem with delivery.

OWJ