38 wks and dr recommended a C-Section

[mleigh23]

Okay.  I just had my 38 week appointment with my OB practice today (Friday) and the doctor I saw recommended a C-section because I also had an ultrasound which measured the baby at 9 lb. 15 oz.  I have gestational diabetes this pregnancy and haven't gained any weight during pregnancy up until the last 3 weeks.  I've actually been losing weight.  Of course, I started out this pregnancy overweight so that is the norm for me.  Anyways, my husband wants to go the C-section way because of the what if something happens to the baby, then we wouldn't be able to live with ourselves.  And, his thing is that we have an OB practice with like 2 midwives and you get them if they are on call but that's it.  So, you don't know what experience any of these doctors have with shoulder dystocia.  Because that's the thing that the doctor scared us with.  I of course refused the c-section right now.  But the doctor said to just think about it and if we change our minds before our next week appointment to just call.  So, can I get some advice?  And I've read so many stories on mothering about shoulder dystocia.  I read them to my husband as well.  I also went to the ICAN website and read him the list of what can happen with a C-section also.  I just need some kind of support.  TIA.

[macha10]

I can't advise on the shoulder dystocia part. But I do know that late ultrasounds are not very often accurate for determining size of baby. He could actually be 7 lbs or something normal. I also am not sure how the diabetes plays into it. Personally, I would avoid a c-section at all costs, and would not agree to one in this case. As I understand it dystocia is pretty rare. But let's see what some more experienced mamas say.

[dejagerw]

Has your gestational diabetes been under control this pregnancy?  Ultrasounds are notoriously inaccurate at predicting birth weights.    

[dakotablue]

DDC hopping, have you read ina may? just so you know she talks about shoulder dystocia. She says that the most effective way to unstick a baby is to turn onto hand and knees.

Hope nothing happens but great info to know otherwise!

[danipoppins]

I've heard too many stories of GD mommas (on the ICAN e-mail list) having c-sections for their "giant" babies because of the DOCTORS fear of dystocia only for their babies to be 8, 7, some even 5 lbs.  Late term u/s is notoriously inaccurate for determining fetal weight/size.  I was the doula for a friend of mine who had "GD" and her baby was just shy of 8, full term.  It got a little tricky for her because she was on her back the *whole* time, but her being on her back the exact reason why it got a little tricky at the end.  

If you're moving around in labor and switching positions a lot (esp while pushing) you'll do yourself a favor, regardless of what size your baby is.

What makes me nervous is obviously your care provider is nervous, which is going to make YOU nervous, and I wonder how that will impact your birthing experience. 

I also know several women who have very big babies (10, 11, 12+ lbs) who have perfect deliveries without nary a sign of dystocia.  Very few big babies get stuck and even some small babies get stuck.  There is no crystal ball. 

Any chance you have a doula or access to one?  Someone to support YOU in labor the whole time (rather than a nervous provider swooping in here and there)?

[palmgal]

I had a shoulder dystocia with my first birth.  It was quite scary, and we almost lost DD.   I did not have GD, and in fact had an u/s the day before because my fluid was low that estimated her weight to be 7 lbs 4 oz, she was over a pound heavier at 8 lbs 6 oz.   It is important to remember that although the u/s can over-estimate weight, they can also underestimate as well.  With my second pregnancy I still wanted to try a normal vaginal birth, I was GD with my second (actually turns out I have type 1 diabetes).  As I approached the end, I finally caved into the doctor's preference that I have a c-section.  My son was 8 lbs 7 oz at 37 weeks and born by c-section.  This third baby will also be born by c-section.  I still am sad that I had to have a c-section, and that I am having another one.  However, quite honestly the shoulder dystocia was so scary that I decided never wanted to experience that again.  I would have never forgiven myself if I had tried a vaginal birth with my second and had another dystocia knowing ahead of time that it was a real risk. 

That being said many women are able to birth babies far larger than mine without any difficulty.  There is no way to know in advance that you will have a dystocia, doctors can only give you risk factors such as GD, large sized babies, baby is a boy (generally wider shoulders).  Good luck with your decision, it is a very difficult one to make, and I wish you the best. 

[QuestionGal]

hmmm,

  DS was born at 39 1/2 weeks and weighed 9lbs 6oz. I did NOT have GD just have big babies (assuming this baby is big as well).  Had a natural, out of hospital birth (free standing birth center) and we did have shoulder dystocia.  They flipped me onto all 4's and both midwives jumped in to get him out, they thought they'd broken his clavicle but as it turns out they hadn't. 

I've mentioned his weight & shoulder dystocia to every care provider and no one has batted an eye or suggested there would be a repeat of the dystocia. My understanding and research has indicated there is no accurate way to predict shoulder dystocia and that the best way to handle it is to get mom onto all 4's. 

My question would be how would your OB handle dystocia should it occur? Would they flip you onto all 4's and deliver that way or would they go straight to a c-section (can't imagine there is enough time to get to an OR for a section in the even of dystocia). if you have an epidural you won't be able to get onto all 4's. 

Whatever you decide make sure YOU are at peace with it.  Good Luck!

[gemasita]

Weight and shoulder dystocia doesn't actual correlate THAT well.  It can happen with smaller babies too.  It is not evidence-based OR ACOG-recommended to have a c-section based on suspected big baby with a late ultrasound.  Do some research.  Doctors are of course scared of shoulder dystocia but it seems to me like the only way to absolutely prevent it is to perform c-sections for 100% of births.  They just haven't found an accurate way of predicting it.

[danipoppins]

http://www.theunnecesarean.com/blog/2010/12/12/sheris-really-big-hbac-story.html

Big (really big) baby born at home.  No dystocia.

[SumnerRain]

My old doula just attended the home birth of a 12lb 4oz baby without distocia or GD.  Just anecdotal.  Oh, and my DS was estimated to be 9lbs by birth by 37w u/s and he was 6lbs 13oz.  And my GD baby was 6lbs 10oz.

Follow your heart.

[myk]

ultrasounds are pretty notorious for being inaccurate at this stage. is it an option to try a vag birth and move to c/s if medically necessary? i mean you're talking major surgery. birthing on all fours (gaskin maneuver) would be a much less invasive solution if dystocia is an issue.

[littlecityfarmer]

DDDCC, but if I were you, OP, I wouldn't consent to an induction or C-section before 40 weeks, unless your baby is in distress. Even with the GD, you might want to negotiate with your doc to do regular non-stress tests (an intervention for sure, but much less invasive than a c-section!) until you and baby are ready for birth.

Hope all is well :)

[sosurreal09]

DD was 8lbs 6 oz and my MW feared she was closer to 10lbs I had her un-medicated and she came out just fine, no shoulder dys. either.

IMO OBs are afraid of being sued and wasting time, C-sections are so much easier for them and it shows they are doing "all they can" and "what's best for the baby"

I mean he has no real proof that anything will go wrong...had ay issues with other births?

[mleigh23]

Thanks for all the advice everyone.  I am so upset over this coming up in the last few weeks of my pregnancy.  It's just so stressful trying to make this decision when I know what I want to do but not sure what i should do because of having an OB instead of a midwife.  I mean, there's a midwife in the practice but you get whatever person is on call at that time.

Anyways, to answer some of your questions....the diabetes has been under control.  I take insulin at bedtime to control my fasting sugars in the morning.  So, when I do go to the hospital I will have to be hooked up to an IV so they can administer insulin if I need it throughout the delivery.  So, I won't be able to labor in the laboring tub or get in the shower.  I will have to labor at home as much as possible which I want to do anyways.

Yes, I've read Ina May's book.  I've heard of the Gaskin's maneuver already.  It's not that I don't think there are ways to avoid shoulder dystocia if it does occur.  I just don't know how my provider will handle it.  I will ask the doctor next time I see him but I may get another doctor who is on-call or the midwife.  But, mostly I'll get a doctor.  So, just not sure.  

Also, just to let you know I haven't had any issues with my other pregnancy as far as delivering. I birthed my other one naturally with an epidural on my back.

As far as a doula, no I don't have one.  I wish I did but we can't afford one.  I've looked at some of the prices for one around here and they run about $500 or so.  I know some will work with you but I just can't ask someone to do that.  It would be really hard.  And to find one at this late notice would be very hard.  My husband will help as much as he can but it's pretty much up to me I guess.  And he's leaning more toward having a C-section because of the what if something does go wrong, we wouldn't be able to live with ourselves.  And I totally agree with him on that but I still want to try for a natural vaginal delivery because I know that's what God has made my body to do.  I'm just worried how my provider will be when I want to push this baby out a different way that he wants me to.  KWIM?  Anyways, again, thanks so much for all of the replies.  It has really helped me just deal with this.  I'm still no closer to a decision though.  I keep telling my husband I just want to go ahead and go into labor.  So, I don't have to worry about scheduling a C-section and talking with the doctor again in the office and listening to the stuff they have to say.  I just want to have this baby naturally!  

Thanks again!

[dejagerw]

Here are a couple more options too.  If you decide on a c-section, you could still wait until you go into labor naturally.  That way, you at least get the piece of mind that the baby came when it was ready.  Or, if you don't want the c-section, but are still really worried about the baby's size you could always just get induced sooner than later.  That way your baby doesn't get any bigger.  (I'd be sure you have a good bishops score before before doing this though).  Good luck with your decision. 

[sosurreal09]

if you get induced chances are you would need a c-section anyway since induction seems to end that way a lot...

[danipoppins]

Originally Posted by sosurreal09 

if you get induced chances are you would need a c-section anyway since induction seems to end that way a lot...

Yup, at least 50% of the time.

[Pirogi]

I think it would be interesting to run a study where the doctor who "reads" the ultrasound is blinded to the specific conditions of the patient.  I am convinced that doctors often see what they want to see in ultrasounds, even if subconciously.  I would bet that the number of big baby scares for GD/overweight mothers, the number of low fluid/aged placenta scares for postdates, etc would drop dramatically if a doctor didn't know which patient belonged to the ultrasound he/she was looking at.

I haven't looked into the issue much, but I have never heard of insulin during delivery for a mother with GD.  Is that standard?  Even if it is, you can have a line put in with a hep lock so that you can move around more.

What are you/your DH afraid could go wrong?  Shoulder dystocia only, or something else too?  Think about what fears you have surrounding the birth, being diagnosed with GD, the ultrasound estimate of weight, and the uncertainty of who will be providing care during your birth.  Think about what you can do to mitigate the fears/risks associated with those issues.  Read and research as much as you can.  Follow your heart.

[mleigh23]

Basically, they check your blood sugar every so often, can't remember from last delivery, and if you need insulin then they administer it.  They want to keep you below a certain level I guess.  I didn't need insulin at all last pregnancy but I was induced early because of Pre-E.  And, when I was at the hospital, if I wasn't exactly in the range where they wanted me, they gave me insulin.  Mind you, they don't know how to let a pregnant GD person eat either.  That really bugged me about that last time.  Anyways, I'm rambling.  

The thing I'm most afraid of is shoulder dystocia coupled with the ultrasound estimated weight and this baby is definitely bigger than my last.  I'm sure.  And that's kind of scary.  And, I didn't go through my last delivery without pain meds.  I had an epidural.  I was at the hospital for 5 days and in the bed and not able to get out of it for most of those 5 days.  So, I'm just not sure how much I'll be able to move around.  I think that's my number 1 fear.  Not being able to move around as much as I want.  But I think, if I don't change my mind again, that I'm going to have this baby naturally, the way God intended.  I think that's where He's leading me, to walk through the fear and trust in Him.

[MCatLvrMom2A&X]

I would never consent to a c section based on u/s weight. I hate u/s for the very fact they are not that accurate where weight is concerned especially in the last stages of pg.