Need Some Honest Advice-Long

[alicia9178]

Ok....I am faced with a dilemma here and I don't know how to feel or how to react to it. As most of you know who have read any of my previous posts, I am planning a homebirth. I however am considered medically "high risk" because I am diabetic. I found one midwife who is willing to attend my birth as long as I deliver between 36-40 weeks. I do also have a Dr though who I have been seeing throughout the pregnancy. Pregnancy has been ok....I am on oral medications for the diabetes, and have not had to take any insulin this time. Past some RANDOM increased BP readings and one bout of preterm labor, all has been well.

HOWEVER....I was at the OB yesterday for my weekly NST and she started asking me if we had discussed induction. I had told her we had, but that I would prefer to wait and see how the pregnancy progresses with the understanding that 40 weeks would be my cut-off because of the diabetes. Now though she is starting to suggest 38 weeks and I have to have a u/s done this week to measure the baby again because it is measuring 2+ weeks ahead by belly measurements. When I had my u/s done at 31 weeks and 3 days the baby measured 5 pounds 2 ounces....pretty big. I am aware that they are not 100% accurate, but this baby is big....I can tell just by the position and feel of carrying the baby.

The problem is that for a diabetic patient it is reccomended that a C-section be done if the baby is above 4000 grams. So I have this huge fear that I might end up with a C-section.

So to make a long story short....here is my dilemma. I want to have this baby at home and I know I can probably put my Dr off until 39/40 weeks, but am I just increasing my risk of a C-section if I do so do you think?? If I don't go into labor by 40 weeks and end up with a 10 pound baby I am screwing myself. Though if I agree to an earlier induction to guarentee the baby won't be to "big" I am afraid I will regret giving up on my homebirth.

I really wanted the end of my pregnancy to be relaxing and enjoyable, not so stressful. I have already ordered a few things that are supposed to put you into labor just to atleast try to get things going on my own, but we all know that those are NO guarentee.

Any advice is great
Alicia

[EllasMama]

First of all, {{{HUGS}}} to you for having to contemplate all this.

I've measured ahead by 3-5 cm the whole time, and also measured ~3 ahead with my DD, who was very average in size (7.5). So, don't let the belly measurement scare you. I think I just tend have a lot of amniotic fluid, and DD was a pretty long (skinny) baby. Hopefully the ultrasound you're getting will give a smaller indication. Isn't it irritating how the medical community acts so sure of their measurements when they're at best guesstimates?!

I think if it were me, I'd hold off until about 38.5 weeks and work with my midwife to induce naturally. Sounds like you're already thinking along those lines, which is great. Induction will only work - hospital or home - if your body is ready, so why not try inducing for the homebirth you really want, rather than going with the hospital route? If you try all that for a few days and it doesn't work, you can always try hospital induction in the 39th-40th week (depending on what your doctor thinks re: size, etc.).

Also, when the time comes, talk to your sweet baby and let him/her know that if it's safe, coming out asap would be much appreciated and easier on the both of you.

Best wishes, I'm not sure I've added anything here but I at least feel for you and hope all goes well.

Carol

[Dreaming]

One thing to keep in mind is that the earlier the induction and the less the cervix is dilated, the more likely the induction will fail and you will end up with a c-section anyway.
I just talked with my OB about inductions last week and he said he never does them before 39 weeks and the cervix has to be dilated 2-3 cm.

What about trying some other home methods (nipple stimulation, sex, etc)?

Gotta go. Fussy kid.

[3 Little Monkeys]

nothing at all to add because I think EllasMama hit the nail on the head, just wanted to say good luck and I hope you get the birth experience that you want to have!

[aguacates]

s Mama. I was going to pretty much say what Carol said, but she said it better. Also, having a ten lb baby does not automatically equal a c-section. Fat is squishy. My dd (first child) was 9lb14oz after her first poop. I pushed for an hour. It was hard work, but doable. Even if your baby does weigh 10 lbs at term, you can do it!

[damyen's mommy]

I with what everybody else said. Sorry I don't have anything new. I'm sorry you have to contemplate this. I will send you good birthing vibes. I hope it turns out how you want.

[ShellyK]

I want to echo what everyone else has said and add one more thing to the mix. With my DD, I was totally focused on a natural childbirth and I felt devastated when she was breech and didn't turn after weeks of trying every turning technique known to humankind - including TWO external version attempts. A c-section was NOT the experience that I wanted AT ALL. However, it was a lot less horrid than I thought it was going to be.

I would much rather have a planned c-section with a good birth plan than a failed induction resulting in an emergency c-section. We walked in well-rested first thing in the morning, brought the staff doughnuts, asked for and got our doula in the OR with us to take awesome pictures, my hands were free after the initial incisions so I got to hold the baby right away and kept her on into the recovery room and we nursed with no problems. It was a happy day.

With an emergency c-section, you may have to do general anesthesia, not see your baby for a while, you would very likely be exhausted from many hours of labor and therefore have worse reaction to the drugs and/or just feel less able to think clearly and enjoy your new baby. It's just less relaxed and more complicated.

All I'm encouraging is that you try the natural induction techniques at home, and if they work great! Your body and baby were ready. If you get to 40 weeks and your doc wants to do a section, well, I would never want to push someone into a c-section, and I'm going for a VBAC myself this time around. But the c-section is not the worst experience in the world, and having some time to deal with it as a possibility and visualize yourself happy and enjoying your new baby despite it can help you have a better experience overall. I hope this makes sense, and I hope you go into labor before it becomes an issue and that you have a nice, healthy sized baby!

[april77]

You've gotten great advice from the other mamas!! I wanted to second that having a 10 lb baby doesn't always mean c-section. One of my friends, who delivered a little after I had dd, had an 11 lb 2 oz baby vaginally and only had 2 stitches. And she did it on her back with an epidural. My ob thinks that this baby is big, and I agree that he feels bigger than dd who was 7 lb 12 oz. I figure if my friend can push out an 11 lb-er I can definitely do a 9 lb baby!

[alicia9178]

"Also, having a ten lb baby does not automatically equal a c-section."

Oh I 100% understand that for a "normal" pregnancy, but being diabetic adds risks to increased size....specifically increased shoulder size and risk for a shoulder dystocia. That is why the doc go so crazy about it. Thanks for all your advice though, I am still feeling very torn and sensitive about it all.
ALicia

[AndiG]

Alicia, I'm so sorry you're having all this to deal with.
We just recently went through a signifcant series of scares ourselves (a bad blood sugar reading resulting in a dr being convinced I was certainly GD, after a bad placental position, and a cancelled home birth, concerns about induction, csection, csection recovery etc etc etc) So I really do know how you feel about being torn about all of this.

I think Carol made some great points about u/s being wrong. Our first, was u/s to be well over nine pounds, so big, so big. Every nurse that touched me in labour kept rambling about how big she felt. She was the skinnnest 7lb 13oz baby you ever saw.

Yes, the shoulder dystocia thing does indeed sound scary. My dh is of a realy broad shouldered family too so I was quite scared about this risk.

I think some excellent points were made about early induction vs later (the rate of failure being lower the longer you wait to induce, so the body can be ready) and also about the emotional and physical advantage of a planned c-section vs an emergency one.

I also understand your anxiety about the potential loss of home birth. This birth was supposed to be a home birth. I had dd in the hospital which was a 100% natural and positive experience. Ds, was an unplanned homebirth with no complications. So this time we thought 'lets do a nice PLANNED homebirth, sounds like it could be a lovely thing'. All was going according to plan until 25 weeks when I got hit with a marginal placenta previa diagnosis launching a lot of c section fears for the 8 weeks while I waited for a follow up u/s ... It has moved off so that I can have a vaginal birth. BUT I have been advised by the midwives not to attempt a home birth because of the increased risk of post partum hemorage. (the placenta hasn't moved all that far I guess)
At 25 weeks, I made a choice, even before we knew the status of the placenta, I had to decide, for my own sanity, to let go of my home birth plans. It was heartbreaking. I wanted my dd, 4.5 to see the baby for the first time at home, in my arms. I wanted to not have to be in a virus filled hospital in the dead of winter with a newborn, I wanted so many things for that birth. But, I also had to make peace with the idea that life does not always go as planned and that the best gift I could give to the entire family was a safe and healthy delivery for the baby and I. In my mind I kept seeing my best and worst case scenarios, best, my children lovingly with me and the newborn in our home, the worst, an emergency transfer to the hospital in front of those same children... the idea of me being taken out on a stretcher, or having some other complication at home was so scarring to me that I decided to move on from the home birth. I've had a positive hosptial birth. I can have another one.

You need to decide something, whatever that might be, and stick with it. For me the uncertainty of 'what about if this happens" just about drove me mad. I needed to let go and decide what mattered to me most. What mattered to me most was that I would be healthy following the birth and that the baby would be too. I'd have had the planned c-section in a heart beat if they'd told me I had to....
BUT I'm most certainly not saying that's the best choice.
Not at all.

Talk to your partner. Talk to your mw and care providers. And try to come to a decision you can live with and stand by it. Good luck. I truly know how hard it is.

[Sleepymama]

Hmmm, I think I see 3 options here:

1. You go with what the docs want and get the 38 week induction. Your body might not be ready and you'd end up with a c/s anyway after a nasty labor. This wouldn't be my first choice.

2. You put off docs until 40 weeks and do all kinds of natural induction techniques (already mentioned). You do a trial of labor at home, and hopefully (likely) everything goes OK. If you have to transfer the chance that it will be an emergency is slim. Most likely what would happen is that you'd stop progressing (if the baby is indeed just too big and won't engage). I'd also talk with my MW about what she would do about possible shoulder dystocia which is the other concern with a big baby (already mentioned). At least you had a chance at homebirth--this would be my first choice.

3. Schedule a c/s for 39-40 weeks or as late as they'll let you go. The benefit of a planned rather than emergency c/s has already been mentioned. I personally think this would be my second choice.

Good luck! Maybe baby will get the hint and decide to come out sooner rather than later

[Honeybee'smama]

I am sorry the end of your pg is turning out so difficult. I think a lot of mamas have already pitched in some good thoughts and advice. So I won't repeat what has been said already. What does your mw say/think about the situation? What are her guesses about baby size? For me that would hold a lot of weight as well as what the doctor said.

[MAMom]

I read a little online and it sounds like the major concerns are, like you mentioned, the distribution of size for babies of diabetic moms (more weight in upper part of baby's body) thus risk of shoulder dystocia. And premature aging of the placenta due to high blood sugar increases fetal risk in last weeks of pregnancy.

The premature aging of the placenta part scares me, b/c I don't think that shows up on BPP's (biophysical profiles).

Have your other children been born before/around 40 weeks? Have the others all been born vaginally?

I would definitely try natural induction techniques, though your body is unlikely to respond if it's not ready. And honestly, I would spend your energy investigating hospital/medical induction techniques to decide what you would want and writing a really thorough hospital birth plan so if you do have to go that route, it can be the best experience for you as possible.

If they do induce, will they want you confined to bed to continuous monitoring? If so, that will certainly increase the risk for C. How much of a hastle will they give you if you don't want an IV & want to eat & drink during labor? Does the hospital have a birth tub? Will your midwife accompany you to the hospital? I would hash these types of things out with your doc ahead of time (get her to sign off on your birthplan incase she isn't there for the actual birth) - even if you don't end up going in for induction.

If you do go in for induction, make sure you are really well hydrated & nourished -- I was not on the day I went in for my unscheduled induction, and I think that is part of what led to my C.

Sending you lots and lots of labor vibes

[alicia9178]

"Have your other children been born before/around 40 weeks? Have the others all been born vaginally?"
Yes, my last 2 I was diabetic with and my water broke at 35 and 36 weeks and both were born vaginally. The first time at 36 weeks it was after not going into "labor" end ending up with an 8ish hour induction, then my daughter who was born at 35 weeks I also did not go into "labor" and ended up with one failed induction one day and then the next day it finally worked and she was born 41 hours after my water broke.

"If they do induce, will they want you confined to bed to continuous monitoring?"
Yes....I have had all inductions and the most I have ever gotten to do was get out of bed and stand next to the bed or sit on the ball or a rocking chair while still being continuously monitored.

"Does the hospital have a birth tub? "
Yes and I can use it if I go in with intact membranes but it cannot be used at all for an induction.

As far as the IV goes and eating during labor....they will push for an IV, but if I am not being induced I will refuse, and as far as eating it is a big no..no...but I will say I do it anyways. I am thinking that if I do end up gong for an induction I will let them induce me, but as soon as I get into a normal labor pattern I am going to demand that the Pit be turned off and the IV removed and I am planning on getting up and trying to finish labor on my own. Maybe just the jumpstart will be enough. It may be a fight though to get the IV removed, but hey if they don't want to remove it I am more then capable of doing that...lol.

Alicia

[EllasMama]

Just wanted to add, if homebirth is still in the running, ask your midwife if she's familiar with the Gaskin maneuver for overcoming shoulder dystocia. I'm not a midwife, but from what I've read I think you basically turn over on hands and knees and the midwife hooks one of the underarms and eases the shoulder out. Supposedly works great; Ina May learned it from indigenous women in Central America or somewhere. When she asked them where they learned it, they looked at the sky and said, "from God." Come to think of it, if I were planning a hospital birth I'd like my doctor to be familiar with the Gaskin maneuver if shoulder dystocia were a worry, also!

Best wishes,
Carol

[MAMom]

Just wanted to let you know I've been thinking about you...it sounds like such a tough decision & I'm honestly not sure what I would do in your shoes.

Keep us posted