Is there a point where size would influence your birth choice? - Page 2

[Plummeting]

No, there are multiple studies showing that normal glucose levels during pregnancy are significantly lower than they are in non-pregnant individuals. The one study you're referring to, AmandaMamma, is a meta-analysis. A meta-analysis is a study that takes the results of multiple studies and draws conclusions based on those. The numbers cited by the PP are definitely wrong. No non-diabetic person's blood sugar should regularly reach 140 at the one hour postprandial mark, even when they aren't pregnant, but most especially when they are. It's not outside the norm to have the occasional 140 at one hour after a meal, but to do it regularly is a sign that there is a problem with blood sugar regulation. I can also link to information on what is normal in the non-pregnant state, and those numbers should be higher than what's normal during pregnancy, because the increased blood volume of pregnancy results in lower blood glucose numbers, but I feel like we're getting a little off topic for the OP to turn this into a GD discussion. (But over 120 at 2 hour pp is also not normal for non-pregnant people. The ADA has been roundly criticized by pretty much everyone for suggesting that 140 at 2 hours pp is even remotely normal.)

If you follow the link I posted, you will find the link to the article from the magazine. There you will find this quote:

Despite the variations in methodology and settings, there was some consistency in the results. Pooling the results, the weighted average glucose values (± 1 SD) were 71 ± 8 mg/dL fasting, 109 ± 13 mg/dL at 1-h postprandial, and 99 ± 10 mg/dL at 2-h postprandial.

So no matter how you slice it up (where you test, how you test, when you test), these are the results they get from non-diabetic women. Here's the link for that article: http://care.diabetesjournals.org/content/34/10/2331.full

Then you can look at the first citation, which will take you to the study. In the study, you will read this:

Twelve studies met the criteria for inclusion with a total of 255 pregnant women with normal weight and glucose tolerance (Table 1)

That's twelve, not one. Here's the link: http://care.diabetesjournals.org/content/34/7/1660.full?ijkey=fae7b0055d9b45230d6982a48f00f541a5c98037&keytype2=tf_ipsecsha

There's just literally no evidence at all to suggest that 140 is a normal 1 hour PP blood sugar for a pregnant woman.

Also, I forgot to address the whole issue of ketones on a low carb diet. If the only way a woman can maintain normal glucose levels is to eat such a low carb diet that she goes into ketosis, many providers will recommend eating more carbs and taking medication to reduce insulin resistance or using insulin. That way blood sugar is normal and ketones aren't being produced. It's not an either/or thing with GD. You don't have choose between ketones and high blood sugar. You can have neither. What each woman is comfortable with will vary (so some women will want to choose one or the other), but it is simply not true that we have to weigh the risks of high blood sugar against the risks of ketones, since you can manage GD without having either of those things.

I'm sorry I keep editing, but I was trying to find a way to include the information I thought was necessary and relevant without completely derailing the thread. I'm pretty sure I haven't succeeded at all, but I just think this is such an important topic that it's hard to condense it.

Edited by Plummeting - 5/31/12 at 5:07pm

[AmandaMamma]

Hopefully the OP won't mind the derailment. So this begs the question why the heck are we all still being told the higher numbers? Very frustrating! Thank you for all the info and the bit about ketosis. I'll be taking to my CNM about it with some printouts.

[Monkey Keeper]

Originally Posted by Ninetales 

I plan on getting another near 36 weeks, yes.

I personally think the accuracy of late term ultrasound directly relates to the skill of the technician. I have had 2 late term u/s, both within 48 hours of birth. One of them estimated the baby to be 14oz larger than she actually was. The other was off by a single ounce. In comparing experiences with other women, those who had the same tech as I did for the second u/s had similar results--very, very accurate estimates in close proximity to birth. Incidentally, the tech asked me to report back when the baby was born so he could "keep score", so to speak. It was a point of pride for him.

To answer your initial question, is there a number? Yes. I am a VBAC mama who (very, very easily) pushed out a 9lb 5oz baby. Multiple care providers have said that I have a very roomy pelvis and could birth a baby much larger. Knowing this and knowing the potential inaccuracy of u/s, I think I am comfortable up to the mid-11lb range. 12lb is kind of my tipping point, I think.  I know with conviction that a 10lber would be no big deal for me, positioned correctly of course. I feel much, much less confident thinking about hearing an estimate near 12lb. And I think that part cannot be discounted, the visceral reaction. That seed will have been planted, and it can (and likely will) impact your birth. 

Good luck to you! Hopefully your lower weight gain will help you grow a smaller baby and you will have an amazing VBAC!

[1stTimeMama4-4-10]

To respond to your original question, I am not scared of anything below 10. Above 10 and I would be intimidated.  But no matter what I was told, I would give labor a try and if baby won't come out, only then would I consider a section.  But then, I haven't been through what you have, and so any choice you make would make sense to me.

[phathui5]

Are you watching your carbs this time around?

[Quinalla]

Unfortunately, there really is no accurate way to tell what the baby weighs late in the pregnancy. They estimated 7 lbs or so for mine at my last U/S (at 37w2d) and she was 5lbs4oz (born at 38w). My SIL just had a baby and they thought the baby would be 7 or 8 lbs and hers was over 10lbs.

I can definitely understand your fears though! I think if it were me, I would have a trial of labor at least before doing a c-section, but I haven't been in that position myself and don't have doctors/midwives advising me, I'd talk to your care providers about it more.

[Ninetales]

So I had another big weight gain and my doctors don't seem very concerned.  The cynic in me thinks that they have already decided I'm going to end up sectioned so they don't really care how big the baby gets.  I've got my own glucose monitor now, and I am confused about doing after meal tests.  Do I eat, then stop, then test one and two hours after I started?  Like, do I start fasting again after I eat my meal, or do I go about my day like normal?

[Plummeting]

Yes, you eat a meal. You wait an hour after your first bite. Then you test. Then you can test again two hours later, but if your one hour number was normal, that's not really necessary. You need to do it after several meals though. Fasting blood sugar is only taken first thing in the morning, before you eat anything at all.
 

[loveandgarbage]

This thread is a little old, but just in case Ninetales will read, here's my story! DS1 was a c-section and he was 11lbs 14oz. Not as large as yours but still up there. I didn't have GD. I was induced (first mistake) and he wasn't in a good position for labor, and never descended. I was afraid to VBAC because of DS2's possible size. But he ended up being just over 8lbs. I think you've gotten some good advice about palpating and GD and I hope you'll be able to VBAC. I am a little scared of birthing again because what if this baby is larger-- I am smaller and don't think I could physically birth a 12lbs baby. But I'm going to try and of course hope for an average size baby!

[Ninetales]

Thanks for sharing! 

A little update.  The last three appointments I think I gained two pound each.  However I have been measuring quite far ahead - 44 cm at today's appointment, when I am 36 weeks 4 days.  But I gave my records of blood sugar numbers and other than the few issues I did find - I needed to tweak my breakfasts and cut out some things, which I've done and the numbers went back down after that - they said my numbers were not something that would be concerning.

So essentially, there is nothing they can find that I'm doing to make this baby big, and there's probably nothing I can do at this point to stop it.  We will go ahead with the ultrasound in two weeks (being fully aware of the huge range of inaccuracy), I won't schedule a section, and we'll see how things go.

I've gone now from being scared of vaginal birth to being anxious about another section.  I'm afraid of having another huge baby and having to feel guilty and listen to everyone's comments and jokes and judgments.  And another section means that VBACs with future babies will likely be a battle, and maybe I'll never get to experience a natural birth.  It doesn't help when I'm dealing with my jealous feelings toward my husband's cousin who just gave birth naturally, after being induced no less, 45 minutes of pushing and a perfect 6.5 lb baby. 

[Ninetales]

An update for anyone who might be interested.  I had an ultrasound today at 38w3d.  The tech thinks he is 14 lbs right now.  Not at term, now.  I know about the inaccuracy, but even if you factor that in, that's just bad news all around.  I see my doctor again next Monday and I'm praying that either I'm favorable for some kind of induction process, or I go on my own before then.  Otherwise I've agreed to a scheduled c-section next Tuesday.  If I'm having a section, I need my doctor to do it, not whoever is on call that day, and I am not willing to wait past that time because he is only going to keep growing.

Sucks.

[olive&pimiento]

I'm so sorry you are not getting the VBAC you've dreamed of.  You did everything right and sometimes these things are just beyond our control.  Natural birth isn't always a great experience either.  I separated my pubic bone giving birth to my first, a 9#4oz girl.  I couldn't get out of bed for 3 weeks and couldn't walk without a walker for 6 weeks.  It's rough sometimes, but you have a beautiful baby coming and that is something to be excited about!  I don't mean to make light of your mourning right now, but there is a light at the end and maybe putting some energy into what you want your baby moon to be like might help.  I wish you lots of luck!
 

[fayebond]

To the original question, I wouldn't scheduale a CS for any weight estimate but I can totally see why you would want one.   I would rather give it a go, even at 42 weeks I'd prefer to be induced in some way (ideally, after a pedicure and some TTC with DH, just to get myself all relaxed).  There is no such thing as an easy birth, just remember that.  Come back and give us an update when you can!