Big mom, type two diabetes

[azjen43]

This mom is a very big lady and has type two diabetes...she is in her late 30s. She has had several miscarriages in the last five years and so is very nervous about this pregnancy. She has been working really hard, excellent nutrition and exercizing daily and has, in fact lost weight during this pregnancy since becoming so much more healthy in her habits.

Because of her health issues, she has been seeing an OB who specializes in high risk pregnancies who has been very supportive of her wishes to have a natural, non-interventive birth. So recently, she had an appointment with a neo-natologist who tells her (1) She is further along than she thinks...3 weeks further along (Mom was pretty sure about her dates) and (2) He is not willing to "let" her go past 37 weeks. That she "needs" to be induced at 37 weeks. When she asked why, he said "because you have diabetes."

She was frustrated and discouraged and left the office and said she will discuss this with the OB, who is more willing to talk to her in a respectful way. She hasn't gotten back to me yet, but here's my question: Specifically, what might be the reasons for inducing at 37 weeks? Is it just so the baby doesn't get "too big"? This mom is 6 ft tall and strong, she's not afraid of a big baby! Might there be concerns about mom's and baby's blood sugar? (She is controlling it with diet beautifully as of now)

Thanks in advance for any info you can share!

[onlyboys]

Oh that's hard. Is she willing to resist the OB? If so, then helping her see which battles to fight and which to concede would be helpful. Also, I don't think that the changing of her due date based on US is a good idea at all. Especially 3 weeks earlier, which puts them inducing her potentially at 34 weeks. Not good at all. I'd say no to that in a heartbeat!

Is she insulin dependent?

[azjen43]

Originally Posted by onlyboys

Is she insulin dependent?

Nope. She's been able to keep her levels good with diet.

[onlyboys]

Then honestly, I don't really see what the huge issue is about. If she can control her blood glucose levels with diet only, she can certainly do that when not pregnant! How would that even be considered diabetes? Maybe someone who has experience in this area can enlighten me. I get it if blood glucose is out of control, and I get having the chronic condition, but how is that dangerous if you can control your blood sugar with diet alone?

Ah, me. I hope that she finds some peace about this.

[pamamidwife]

oh, egads, I'd totally steer clear of a high risk OB. she's not high risk, esp if she's not on insulin!

this woman is fat. she's not dangerous.

http://www.plus-size-pregnancy.org

[azjen43]

OK, here's an update on this mom. After another U/S, the doc revised his guess as to her due date again and reverted to the original date.

The reason he gave for inducing at 37 weeks is that she is on oral medication (I didn't write down the name) that has a tendancy to cause the placenta to deteriorate early ... So now the past couple of days, she's having more difficulty controlling her blood sugars and may be switched to insulin.

I'm really having a hard time with this situation. The mom is very intelligent, well informed, been doing all her research, etc and really wants a natural birth (well, she really doesn't want a c section!)

And it turns out the OB who seemed so supportive at first is not really so. But she's been to three different OBs and has settled with someone who I think is literally abusive. Every one has told her she's high risk, because of her weight, her diabetes, and her history of M/Cs. The currenth high-risk OB sent her to the neonatologist because he "didn't feel qualified" to deal with her "issues" alone.

This man has told her to "stop fixating" whenever she has asked questions about her labor and delivery (and not in a gentle, reassuring manner) has told her she's high risk because she's so fat (his words) and when she reminded him that she's lost 50 pounds during this pregnancy he said "well you sure didn't need to gain any more weight! "

I have mentioned a few times to her that it's never too late to change care providers and even told her outright that I think this guy is disrespectful and unprofessional. She was approaching tears this week when she was describing her last OB appointment and even another student in class said, "Have you thought about changing? " But for some reason, she seems set on continuing "care" with this team.

Sigh... You can lead a horse to water, ya know? I have her for 3 more weeks....

[homebirthing]

Ahhh...the old bait and switch care providers. Don't you just love them?!