I'm 41 years old and 38 weeks pregnant with our first child, a daughter. I've been a type II diabetic since 2003, easily controlled with diet and exercise. I had to go on insulin at 10 weeks (which was nowhere near as awful as I feared) and have had excellent blood sugar control throughout. The pregnancy has been very easy so far.
My initial hope was for a home birth with a midwife, but I was not accepted into the midwifery clinic so my only alternatives are an unattended birth (which I am not comfortable with) or a hospital birth. There is only one maternity hospital in my area and while it is very mother and baby friendly in some respects (rooming in, no pacifiers) it has extraordinarily high intervention rates (30% induction, 95% epidural for first time moms, 50% for second and subsequent babies.)
I very much want to have a natural birth with as few interventions as possible. I have a doula. My family doc and OB are as sympatico as I could hope for (my family doc delivers and had all three of her children without pain medication, including one with pit); my OB trained in England and is known to be extremely non-interventionist. Unfortunately, if I go into labour when neither of them are on call, I will likely have a stranger attending the birth.
Diabetic moms tend to get even more interventions than other women, so I read extensively on labour and delivery during my pregnancy. Even in obstetrics texts devoted to diabetes, there is not a great deal of detail to help assess the real risks and benefits of various interventions. Most studies do not distinguish between diabetic moms in excellent control and those with mediocre or poor control. The general consensus is that there is a relationship between control and complications but diabetics face higher risks of many complications even with near perfect control.
The main complications of a diabetic pregnancy are large babies, shoulder dystocia, and unexplained stillbirth, possibly due to placental degradation. Babies of diabetic moms are also more likely to have low blood sugar and to develop jaundice.
Our daughter was about 6lbs at 36 weeks, so there are no concerns about a large baby and less concern about shoulder dystocia. My OB indicated that the background rate of stillbirth is 1/1000 for non-diabetic mothers, 2/1000 for those who go to 42 weeks. For diabetic moms, this risk doubles to 2-3/1000 at 40 weeks and 4-5/1000 at 41 weeks. My OB tells me that some older studies have shown an increased risk of stillbirth even in diabetic moms who were hospitalized and monitored daily.
The current standard of care for diabetic moms is to induce by the due date to avoid higher risk of these complications. Because my pregnancy has been going so smoothly, my docs are okay with the idea of me going a few days past my due date and into the 40th week. After that, they may recommend induction.
Everything I've read about induction makes me not want to have it. I am especially concerned about labouring with pitocin and attracting a cascade of additional interventions, up to and including a c-section. My primary concern on the other side is the thought of having up to a 1/200 chance of losing my daughter, even with a careful watch and wait strategy. That risk feels unacceptable to me.
So I have some difficult decisions to navigate in the next two or three weeks.
Mother's Cordial?
My first plan is to do as much as I can to encourage labour naturally over the next few weeks (walking, sex, acupuncture, red raspberry leaf tea, evening primrose oil, etc.) My naturopath recommended something called mother's cordial (a mixture of partridgeberry, black cohosh, blue cohosh, and false unicorn) 15 drops 2x daily at 38 weeks, increasing to 6x daily at 39 weeks. I haven't been able to find out much about it - has anyone tried this? How did it work? Are there any risks or downsides to using it?
Self-Management of Blood Sugar during Labour?
I would love to hear from diabetic moms who self-managed their blood sugar during labour. I want to avoid an IV principally to encourage free movement, use of water, and to minimize the risk of low blood sugar in the baby. My OB is fine with this as long as I don't need an IV for other reasons and can keep my sugars between 4.0 - 7.0 (72-126). That may be hard to manage if I eat or drink during labour, which I do want to do.
Induced Labour
My general approach is to accept the lesser evils of membrane sweeps by 38 weeks and prostaglandins at 40 weeks in hope of avoiding the bigger evil of pitocin.
If I need more, both of my docs recommend AROM over pitocin as the more natural option. I am on the fence about this. AROM is irreversible; pitocin can be turned off. But they say once started, pitocin is seldom turned off, and if it is, it is normally late in labour (e.g. 7-8cm). Henci Goer seems to suggest going with pit and waiting on AROM until at least 5cm. As between the two, which would you choose and why?
If you were induced with pitocin and needed pain relief, what would you choose and why?
Many thanks for your thoughts and advice.
My initial hope was for a home birth with a midwife, but I was not accepted into the midwifery clinic so my only alternatives are an unattended birth (which I am not comfortable with) or a hospital birth. There is only one maternity hospital in my area and while it is very mother and baby friendly in some respects (rooming in, no pacifiers) it has extraordinarily high intervention rates (30% induction, 95% epidural for first time moms, 50% for second and subsequent babies.)
I very much want to have a natural birth with as few interventions as possible. I have a doula. My family doc and OB are as sympatico as I could hope for (my family doc delivers and had all three of her children without pain medication, including one with pit); my OB trained in England and is known to be extremely non-interventionist. Unfortunately, if I go into labour when neither of them are on call, I will likely have a stranger attending the birth.
Diabetic moms tend to get even more interventions than other women, so I read extensively on labour and delivery during my pregnancy. Even in obstetrics texts devoted to diabetes, there is not a great deal of detail to help assess the real risks and benefits of various interventions. Most studies do not distinguish between diabetic moms in excellent control and those with mediocre or poor control. The general consensus is that there is a relationship between control and complications but diabetics face higher risks of many complications even with near perfect control.
The main complications of a diabetic pregnancy are large babies, shoulder dystocia, and unexplained stillbirth, possibly due to placental degradation. Babies of diabetic moms are also more likely to have low blood sugar and to develop jaundice.
Our daughter was about 6lbs at 36 weeks, so there are no concerns about a large baby and less concern about shoulder dystocia. My OB indicated that the background rate of stillbirth is 1/1000 for non-diabetic mothers, 2/1000 for those who go to 42 weeks. For diabetic moms, this risk doubles to 2-3/1000 at 40 weeks and 4-5/1000 at 41 weeks. My OB tells me that some older studies have shown an increased risk of stillbirth even in diabetic moms who were hospitalized and monitored daily.
The current standard of care for diabetic moms is to induce by the due date to avoid higher risk of these complications. Because my pregnancy has been going so smoothly, my docs are okay with the idea of me going a few days past my due date and into the 40th week. After that, they may recommend induction.
Everything I've read about induction makes me not want to have it. I am especially concerned about labouring with pitocin and attracting a cascade of additional interventions, up to and including a c-section. My primary concern on the other side is the thought of having up to a 1/200 chance of losing my daughter, even with a careful watch and wait strategy. That risk feels unacceptable to me.
So I have some difficult decisions to navigate in the next two or three weeks.
Mother's Cordial?
My first plan is to do as much as I can to encourage labour naturally over the next few weeks (walking, sex, acupuncture, red raspberry leaf tea, evening primrose oil, etc.) My naturopath recommended something called mother's cordial (a mixture of partridgeberry, black cohosh, blue cohosh, and false unicorn) 15 drops 2x daily at 38 weeks, increasing to 6x daily at 39 weeks. I haven't been able to find out much about it - has anyone tried this? How did it work? Are there any risks or downsides to using it?
Self-Management of Blood Sugar during Labour?
I would love to hear from diabetic moms who self-managed their blood sugar during labour. I want to avoid an IV principally to encourage free movement, use of water, and to minimize the risk of low blood sugar in the baby. My OB is fine with this as long as I don't need an IV for other reasons and can keep my sugars between 4.0 - 7.0 (72-126). That may be hard to manage if I eat or drink during labour, which I do want to do.
Induced Labour
My general approach is to accept the lesser evils of membrane sweeps by 38 weeks and prostaglandins at 40 weeks in hope of avoiding the bigger evil of pitocin.
If I need more, both of my docs recommend AROM over pitocin as the more natural option. I am on the fence about this. AROM is irreversible; pitocin can be turned off. But they say once started, pitocin is seldom turned off, and if it is, it is normally late in labour (e.g. 7-8cm). Henci Goer seems to suggest going with pit and waiting on AROM until at least 5cm. As between the two, which would you choose and why?
If you were induced with pitocin and needed pain relief, what would you choose and why?
Many thanks for your thoughts and advice.
