Help! May need induction

[Sofiamomma]

I'm due tomorrow and have Type II diabetes. I've been on insulin for the pregnancy and have been in very good control. My bp is great, my weight gain is fine, she kicks and wiggles, and *I* don't think my baby is "too big." However, I have had to see an OB this time, because I'm diabetic. I couldn't find a midwife to take me on. So this has been very different from my previous experience birthing at home with a DEM. (No diabetes last time). I did find an OB who was willing to "let" me go to 40 weeks, even though the standard of care for diabetics is induction at 38-39 weeks. I was scheduled for cervidil last night and induction this morning, but I managed to get it changed to this coming Monday and Tuesday. This OB has been great as far as me declining stuff, but I am pushing her past her comfort level going past 40 weeks. She is worried the baby is "too big" and about shoulder dystocia. How she knows this I have no idea, she's never even touched my belly and I haven't had an ultrasound for size. (Not that they are accurate anyway, but then neither is palpation by someone who doesn't even know how to do Leopold's maneuvers : ) She just looks at my belly and says "That's a big baby in there." Sigh. I don't think there is going to be any talking her out of this and if I out and out refuse it could get ugly. She knows how many concessions she's made and is expecting one from me, albeit a *really big* one! Also, just to make things more interesting, I'm an L&D nurse and we work together!

Anyway, I have tried talking to the baby (the whole pregnancy) about the need to come "on time", PN6, EPO, sleeping with a heating pad on my breasts, nipple stim, orgasms, hot showers, hot baths, castor oil packs, walking, Caullophylum, Black Cohosh tincture, and taking castor oil internally. Nada. I actually had an hour or two's worth of contractions last weekend after a huge burst of energy and nesting activity. They felt like the real deal, but they went away. I'm getting desperate and very panicky about having to have cervidil, maybe AROM, maybe pitocin. That goes against everything I believe and want for my birth. It's a huge compromise to even birth in a hospital, let alone spend my whole labor there, and then risk the gamut of interventions.

If anybody has any suggestions, I'm all ears. Oh, and my baby's head is so high my membranes cannot be reached to be stripped, or I would have tried that, too. My first baby came right on time and I am 100% certain about my dates (alternative insemination). And one last thing, my mother is my main support person and she has a big gem and mineral show this weekend that she is charge of, and cannot get away from for more than a few hours. How's that for pressure? sigh

[owensmom]

Wow, I don't know anything you can do to get around it - you are doing everything I did to get the baby out and I went 43 weeks! Anyway, I hate when people try to tell you how big your baby is just by looking at you - I had someone ask me if I was eating right because they thought I looked small. I know I was carrying the weight weird, plus I sorta look 4 months along without being pg... : Anyway, I ended up with a 9 lber!

Is there anyway that you can tell her you know the risks, but it is up to you to decide? Or any research you can do on the web about babys born to mamas with diabetes after 40 weeks? Did you ask on the midwife boards?

Good luck to you! Try jumping up and down!

[Quirky]

Sofiamomma, I am sorry to hear you are still pregnant! On the other hand, I believe that babies know best when they need to be born. If she's still so high up, does that mean she hasn't engaged? In that case, isn't that a good indication she's not ready to be born?

I'm certainly not the expert, but I've read so many stories on these boards of women giving birth to some awfully big babies without it being a huge crisis or anything. I would trust your body to birth this baby, whether she's big, little, or somewhere in between! And I would definitely not take this doctor's word for how big this baby is going to be - how on earth would she know?

And I also encourage you not to go along with medical procedures that you're not comfortable with, just to please your OB because she thinks you owe her or because you have to work with her in the future. This is your body, your pregnancy, your baby, and your life, not hers.

Is there any chance you can get a midwife or a doula to help you out in addition to your mom, to try to run interference on all the interventions?

I'm sending strong labor vibes your way!

[Sofiamomma]

Thanks for your support! I also strongly believe that babies know when to be born and I am very adverse to pushing this little one out. However, I am not low risk, so that must be considered. There is a higher chance of complications. I'm not worried about pushing out a big baby. The problem is that her chest may be abnormally large, as babies of diabetic mothers tend to put on their weight there, which leads to a higher incidence of shoulder dystocia. Also, there is a higher incidence of stillbirth for diabetics if they go past term. I'm not worried about that, because she is happily rolling around in there. It's mostly a political issue at this point. I'm not really sure where I would draw the line. How late is too late? (just a rhetorical question, I'm not expecting anyone to know the answer to that!) At this moment, I feel good about my baby coming when she is ready, but I do want to avoid a showdown about whether or not I get induced, and of course, being induced. That's why I'm trying all these things. I'd like to labor at home, and just go in at the last minute. I do know what the risks are and I feel with my blood sugar being as well controlled as it has been, the risks are still quite low. I'm just not sure how far to push the envelope. Where is the point that I'm no longer sticking up for myself, my baby, and my birth, and I start being foolish and not doing what is in our best interests because I'm being too idealistic and stubborn?

There's also the consideration of the psychological impact on my labor and birth. Which is worse, going thru with an induction I don't want or need, or being under the care of someone who is angry and resentful toward me for refusing to do what she is recommending?

[MysticHealerMom]

Sofiamama - i hate to be the lone voice of descent here, and usually i'm all for less intervention, and i hate the thought of the medical industry compelling you to do anything you don't want to - but, it seems you've already had some big challenges, and some of these challenges can cause you to go over your due date w/o the baby coming on time. I know you know about the placenta getting 'old' and those things from going over. But, I can't help but wonder in this case if you don't need to give in to the doc. If you want to try more things, try moxibustion, chiropractic, accupuncture and homeopathy w/a classic homeopath - it might be difficult to find these practitioners this late in the game if you haven't already, but the thing is that sometimes it just doesn't go the way we want to and we have to accept some things to help the babe. She'll forgive you if the birth is traumatic, you'll be a great mama and be there for her afterwards.

it's hard for me to suggest this because I'm always so 'stick it out and let nature take it's course', but you've had some many big challenges already, you may just be at the end where this is the biggest challenge and you'll have to go for it.

blessings, whatever you decide.



Lori

[stayinghome]

Hi! Well, it sounds like you are doing everything possible to naturally bring labor on... keep up with that over the weekend. With your mom being being away, do you have someone else to lean on? It may sound last minute, but have you considered a doula? Some will do it for free if they are working on certification.

Keep us posted- I'm sending good vibes to you and your baby! Warmly, HeatherE

[homebirthing]

Hello! I just PMed you but wanted to add that I really think you answered your own question as far as how late is too late by saying "going thru with an induction I don't want or need". It is never to late to stand up for yourself. I think that Dr.s use scare tactics. It is unfortunate that we as mama's are caught in the middle. It is so hard to say trust in yourself. I think that is a long process when it comes to birth. I have had a long journey getting where I am today. You can fight. You can request an ultrasound. Remember there is a 2# difference in reading a babies weight. How big is too big? I know mama's who have 11#ers just fine. What is the REAL percentage of shoulder dystocia? Less then 1%? I am not sure. Find out. What are some things that you could do if you were in that situation? Is it worth it to you to possibly end up in a c-section because of failure to progress (by the way, stay away from cytotec!! ) or deal with a small percentage. Only you can make those decisions. As long as you know that you have a choice. It is Never the Dr.s choice. She can give you choices, but because she will be "upset" or "uncomfortable" with it, isn't a good reason. DO NOT !!! let them break you waters. MAKE SURE that they don't do vag exams unless absolutely needed. EAT!! Get cervidil and go home with it. There are options. You are the consumer. You and only you make the decisions. If something were a true emergency, you would know it. You have time, even while going through an induction, to make choices.


If you don't know your choices, you have none.

[Sofiamomma]

I have decided to refuse the induction. The risk of shoulder dystocia is minimal. And even for a diabetic, *with a big baby* (and there is no way of knowing for sure if she *is* big), the highest percentage I could find was "one-third", which I wonder is overblown. A couple of other sources said the overall risk of sd is 0.3-0.5%, which is increases 2-4 times for diabetics, so that's still only about 2% at the most. All the lit I could find that was aimed at docs stressed the importance of avoiding a *lawsuit*, but still advised it was not worth it to perform elective C/S, because even if there is a shoulder dystocia, the chances that it will cause even temporary harm are minimal, and even less so that there will be serious and/or permanent harm.

Now my question is: Do I really have the ultimate choice and decision-making power here? What are the possible legal consequences of my decision? I've heard of people called in to DFS for refusing eye ointment and vitamin K, and of women having court-ordered C/S, and of police showing up at the home of a woman refusing a "medically necessary" induction.

[Quirky]

Good for you for doing the research and making a decision you think is right. That takes courage!

As far as the cops showing up to drag you to an induction, someone would have to go to court to get a court order to force that, and I can't imagine it happens frequently - I would think there'd be too much risk of a lawsuit against the instigator for pain and suffering, emotional distress, etc.

There would have to be someone powerfully motivated to force you to induce, plus get cooperation all the way down the line from social services, the courts, etc. Plus they can't have a court hearing for something like that and not let you know, so heaven forbid your OB or someone should take it upon herself to try to get a court order, you get a lawyer and fight it tooth and nail (and I think it would help a lot that you're an L&D nurse and can produce the research to back your case).

Please don't stress too much!

Hang in there, and gather all your energy for a strong healthy labor!

[lorijds]

Sofiamomma--

Okay, you are in a tough spot. Beings that you are an L&D nurse, are you birthing at the hospital in which you work? Who is your doc? Did you ever contact Dr. Brooks' office, I think they are in Overland Park? (I remember you from previous correspondence). If not, it might not be too late to switch. I was just at an all day CEU event at SHMC, put on by the Doulas of Greater KC, and Linda Herrick was one of the main speakers. She is a nurse who works in his office, and provides doula services to their clients. She gave a presentation of homeopathic and herbal therapies. Obviously with the diabetes, one needs to be careful, since some herbs can mess with your blood surgars, but she might be able to help. She is also a member of Doulas of Greater KC, and might be willing to give you some advice, even if you don't or can't transfer care.

One thing she recommended was the Bach flower remedies. The one it sounds like you need is Walnut. You take it (after having diluted it, if it needs to be done) 3-6 gtts SL every time you think of the induction or the need to have the baby. Another mw I know also recommends taking them with positive affirmations, like "I am ready to give birth" "I want to see my baby!" That sort of thing.

Accupressure and accupuncture also sound like the way to go.


If today is your due date, I'll bet your doc will "let" you go one week over. Compromise with that, to buy yourself more time. Let your doc know that you are not questioning her authority or judgement....that you very much value her skills and her input, but that it is very important for you to have a labor free from as many interventions as possible, and schedule the induction for the end of next week. You have the studies...let her know this is a decision made after much thought and research. Taking the stress of that off will certainly help, for a while.

Good luck! Think positively!! Get a doula, if you haven't already. See if Sally Reily herself will take you on--she is up to the challenge...she is like the Ina May Gaskin of Doulas in the KC area, kwim? Keep the faith in your body!

[MysticHealerMom]

sofiamama, you've got some good info, and some great advice. you should be able to share this with your doc and she should be receptive to it. if you can't xfer care, you could ask the other doc if she can at least consult w/your doc. you do have the right to refuse treatment. but, doctors also have the right to refuse care - which sounds so totally absurd (first, do no harm, hyppocratic oath, gr). best wishes to you, your baby and yours, you'll be in my thoughts. I look forward to reading your birth story. more power to you, mama.

Lori

[homebirthing]

What I recommend for you to do today is this....
Run a nice warm bath.
Brew up some raspberry tea.
Grab a good book.
And relax.
Everything will be just fine.
You will be just fine. And babe will be in your arms very soon. Enjoy your baby in your womb. And take some nice long deep breaths.

You can do this naturally. If can keep the interventions down. You have the control over your body and your baby.
Everything is going to be OK.
I know that is it so stressful and scary to have to go through this. It will make you a better mother. It will make you a better woman.
Trust your instincts. Trust your BRAIN.
B- benefits What are the benefits
R- risks What are the risks
A- alternitives What are the alternitives
I- instincts What do your instincts say
N- next/nothing What happens if you go with A,B or C? What happens if you do nothing?

[MysticHealerMom]

hey, I had heard that one as "BRAN", but I like yours better