GD, non reactive babe and possible C/S? HELP!

[juliebird]

I'm freaking out a little here. I'm 39w 3d and because of Gestational Diabetes I've been having non stress tests weekly for 6 weeks or so. Yesterday, my doctor said the baby was non reactive (or actually he said "sleepier than I'd like") based on the non stress test (heart rate was averaging around 135/bpm versus a usual 155/bpm).

So he sent me for an ultrasound that showed that everything was fine. Baby looks to be just over 7 pounds right now, with a "rind of fat developing", plenty of amniotic fluid, all other markers for movement were fine.

Having said that, he asked me to go in tomorrow for another non stress test. He also mentioned that we'd have to talk about what to do if I don't go into labor soon. I've had one c/s and 2 VBACs previously. I'd never heard this before but he said something about how being induced isn't a good idea for women who've had c/sections before.

I did a little research and found that there is indeed an increased risk of uterine rupture for women who've had c/s before.

HOWEVER- I am not convinced I should be inducing early- or is this non reactive thing a genuine worry?

I'm so scared. Does anyone have any advice/thoughts/ideas of things I can research?

[Maprilynne]

The call as to whether or not it is safer for the baby to be out or in is ultimately a decision you are going to have to make by connecting with your mama's intuition and your baby, but IF you do decide it's time for him to come out, I have seen a fairly high rate of success with breaking water as a form of "induction" that does not bring on the hard contractions (and thus the higher risk of rupture) that pit does. Would your doctor consider that? How about a Foley thingy (why yes, that IS a technical term!) Some of the other mamas probably know more about that than I do.

There is also, of course, all the natural labor helps like walking sex, cohoshes, castor oil, etc. which all have their own pros and cons.

Also, the fact that you do not have an "untried" cervix should work in your favor as you present alternatives to your doc.

Good luck!!

[Jodie8]

Oh I'm so sorry that you are going through all of this!!! My cousin just had a baby after a dx of GD and her first doctor was very against a natural delivery, preferring to induce at 39 weeks/weekly U/S etc. We researched alot (former RN here) and found that early inductions/ extra monitoring were not necessary due to GD. At 36 weeks we found her a different practitioner who believed that an induction wasn't necessary (nor did she believe that babe needed non-stress tests or regular ultrasounds as per the evidence). My cousin delivered completely naturally at 40w4days. So I guess what my long winded responses is that different practitioners have different beliefs in regards to the management of GD.

I don't understand the concern about your baby's heartrate-it is very possible that he/she was sleeping during the assessment and the heart rate was still well within a normal and healthy range. It sounds like your physician is quite an interventionist. Please google Marsden Wagner, Henci Goer, and Sarah Buckley as they all have wonderful articles about GD that are research based that you could share with your practitioner.

Also, if you are going in for another stress test/U/S I would recommend that you have a bunch of sugar (orange juice??) 20 minutes prior and jiggle babe around a bit prior to wake him/her up

[birthdancedoula]

Re: Induction in VBAC mamas...

Your doc is partially correct. Induction with prostaglandins is strongly discouraged; things like Cervadil and Cytotec shouldn't be used to induce someone with a scarred uterus, however, a slow induction with Pitocin in a VBAC mama can be safe when weighed against the risk of repeat c/s and the reasons why the babe needs to be born before natural labor kicks in.

mama. I know that it wasn't easy to hear this news today. Have they been doing biophysical profiles on the babe or just NSTs? One NST where the babe was a little sleepier than usual is hardly a reason to start talking induction, let alone c/s.

[Frisbee]

Not an expert on any of this stuff by any means, but is 130s actually "low" for a fetal heart rate at this point? I just had a midwife appointment today (and these are midwives who practice in a hospital and have to abide by those policies for what it's worth) and my baby's heartrate was in the high 130s and no one seemed at all concerned.

[juliebird]

thank you so much for your replies. They've definitely given me more to think about. I'm feeling a bit calmer now.

brithdancedoula - yes they did a bio physical profile and found that the baby was fine, all markers were good. So maybe you're right the baby might've just been sleepy. The only thing that scares me is that the baby is definitely a lot less active in the past 5 or 6 days (could that just be the typical getting ready to birth decrease or something else?)

Jodie- i'll definitely google these researchers and inform myself for tomorrow's appointment beyond just passively saying 'uh ok'

Maprilynne- in my freaked out state, i hadn't even thought about breaking my water before I jumped right to chemical induction or c/s! thanks for reminding me I'll also suggest a foley thingee

Thanks again mamas!!

[juliebird]

Frisbee- since I posted that I did a little more reading about what constitutes a non reactive test and found that it's not solely the heart rate (which is what I thought when I wrote the original email). It also has to do with how the heart rate accelerates with movement or contractions, so maybe that was the issue. I'll find out more tomorrow- wish me luck.

[birthdancedoula]

A reactive NST is one in which there are at least 2 accelerations of the fetal heart rate of at least 15 beats per min above the baseline in 20 min of strip. If a babe isn't reactive in 20 min it is typical to see NSTs extended to 40 min.

There are many reasons why an NST might not be reactive, sleep being an obvious one. I'm glad to hear that they did a BPP and that it was normal. That is a really good indication that things all is well.

Hopefully your babe will be more active tomorrow.