Balancing risk of stillbirth vs. risk of induction- advice needed - Mothering Forums
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#1 of 23 Old 02-23-2004, 01:04 PM - Thread Starter
 
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This is long, and I apologize...I'm 39 weeks and looking for advice. I'm a frequent lurker and this is actually my first post. I'm due with my first next week 3/3/4. I currently live in an area where methods of delivery are quite medically intensive, and I wasn't brave enough to try a homebirth, living so far from a hospital. I started out with an OB, but switched to a midwife at 32 w. I'm much happier with her, but she is still somewhat constrained by the rules of her practice.

At 30 wks I failed the 1 hr GTT with 181. I anticipated I would fail because my body responds dramatically to all things/chemicals it is not used to. Even taking aspirin at night can give me hallucinations and nightmares. My husband said I seemed almost manic after drinking the sugar solution. I didn't want to put my body through the 3 hour so I agreed to test my blood twice a day and go on the diet. So far my numbers have been great...in the 100-110 range after meals and 80-90 after fasting. I've never had an abnormally high number (over 140). I have had ketones in my morning urine a few times and also spilled sugar once or twice. I have had NST every week since 35 weeks and the baby has passed w/10 each time. Placenta has some calcification but is still registering a 2. At 35w5 days, the baby measured 35w5 days at 5lb8-11 oz, so he is not measuring large.

I have read and been told that the risk of stillbirth is greater for GD patients, so at my last appointment my midwife advised me to try sex to induce labor. She is concerned about my going past 40 weeks because of the risk of stillbirth. She said that the induction method she would probably try is cytotec. Ina May Gaskin has pretty much turned me against cytotec. The midwife is not going to try anything until 40 weeks so I have another week or so to progress naturally. I have no signs-no contractions, lost mucus plug, etc., so I'm not optimistic about going early.

I feel as if I am trying to balance my health needs against my baby's. I certainly don't want a stillbirth because I was deadset on a natural birth with no interventions, but I also don't want any unnecessary interventions.

Does anyone have any stats on stillbirth? Any experiences to share or suggestions? Thanks for any advice you can share.
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#2 of 23 Old 02-23-2004, 01:51 PM
 
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I'm really sorry for what you're going through... It sounds like you're stressed out and want to do what's best.

I don't have any information at hand, but I would strongly urge you to investigate cytotec further before you consent to its use. It's very controversial, and dangerous side effects have been documented. I really hope you can find some numbers, because I suspect that you'll find that the risks of cytotec outweigh the odds of stillbirth.

At the very least, can you ask your midwife to provide you more info on both cytotec and stillbirth? Informed consent, you know....

Again, I'm really sorry... we all want to do what's best for our babies, and everyone knows that. I'll go out on a limb here--it almost sounds like your mw (or the backup dr.?) is using this to pressure you to do what they want to do.
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#3 of 23 Old 02-23-2004, 03:05 PM
 
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Wow, I never heard of stillbirth being a problem with GD. My SIL just had her baby last week, and she had GD with her pregnancy. The only reasons I know of for them wanting to induce her was to prevent the baby from being too big. She went into labor on her own a week early, and her baby was 19 in 7lbs10oz. Chubby little thing.

Anyway....I think I would avoid drugs if possible for induction. But I don't know anything about stillbirth and GD. Have you thought about trying natural stuff on your own between now and then? Start taking Evening Primrose Oil capsules right now according to the instructions on the package. This helps ripen your cervix. It contains some of the same chemical makeup that semen has to induce labor. You can also break the capsules and stick them right on up there for some direct contact.

There are lots of natural ways to try to induce on your own, for instance you could take castor oil (blech) but it does work for many people. You'll spend the start of your labor on the toilet but at least you avoid nasty meds.

That being said, you dn't really know how big your baby is getting, and bigger babies can have more difficult births. If your baby gained weight normally, he is almost 8 lbs now. If GD is affecting it at all, he could be bigger. Also, since your glucose levels are fairly nice, I wouldn't think you'd have a big problem (but I am not a medical professional). ANd don't forget just because your midwife wants you to induce doesn't mean you have to listen to her! Also, do you think you could see her and have her strip your membranes? That could help as well. Good luck!

Amy, USCG wife and homeschooling, ebfing, homebirthing Mama to M (8), L (6), L (2.5)
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#4 of 23 Old 02-23-2004, 03:35 PM
 
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The rate of stillbirth is not higher with GD.

It is higher for those with diabetes before they get pregnant.

For more information on both topics, I highly recommend Henci Goer's Thinking Woman's Guide to a Better Birth. You can probably find at your local library - or go to a bookstore and read both chapters on induction and also Gestational Diabetes.

You deserve to have evidence based statistics. What you're being given is not evidence based. You are being coerced into an induction with horrific fear tactics.
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#5 of 23 Old 02-23-2004, 03:37 PM
 
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I was induced with Cytotec. It SUCKS. Don't do it.
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#6 of 23 Old 02-23-2004, 04:02 PM
 
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I'm not a medical proffesional and can only speak from my experiences. I was diagnosed as a Type II diabetic two years before I was pregnant.

I controlled my bloodsugars through diet and meds. When I found out I was pregnant I got off the meds and controlled my blood sugars through diet alone. This was a challenge because originally I ate a very restricted carb diet to keep my sugars under control (and lose weight) that my physician reccomended but I couldn't be in a ketosis state during pregnancy I had to find the right exact balance of carbs enough that I got needed carbs for nutrition for the baby but not so much that my sugars rose. (The ADA diet was to high in carb for me)

Anyways I controlled my sugars through diet all through pregnancy. I switched from my former OB a Birth Center at 30 weeks because she was insisiting on induction at 38 weeks. I only had a handful of high readings the entire pregnancy. When I switched to the midwives I thought the induction battle was over. I continued monitoring my diet but they said the back up OB wanted me to induce at 10 days past my due date rather than at 42 weeks like most women that went to the center... I did a lot of research and really felt that it was a bad option for us. They also suggested cyotek which is not approved by the FDA for use in pregnancy. I was doing NSTs every week from 32 weeks and everything looked really good. Nick was actually measuring small.

So when I reached my due date DH and I were discussing what we'd do. We decided we would refuse induction at our next appointment. We never got to that appointment because I went into labor litterally a few hours after we made the final decision not to induce. (Sometimes I don't think its a coincidence)

Nick was 6 lbs 15 oz at birth so i was really glad that we didn't induce at 38 weeks because he was smaller than average to begin.

Anyways In short I went through something similiar so I can relate to what you are going through. In my case I chose not to induce because all signs showed that Nick was doing really good in the womb.

I did have to get another NST done during labor before being admitted to the birth center... If the NST had been bad The midwives would have done my delivery in the hospital but since it was fine this wasn't a problem.
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#7 of 23 Old 02-23-2004, 04:47 PM - Thread Starter
 
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Thank you for taking the time to respond to my post. It really helps to hear others' opinions, and the fact that there is only increased risk of stillbirth w/pre-pregnancy diabetes is really good news. I'll check out Thinking Woman's Guide... and just hope that I see some signs of labor in the next week. My husband and I are open to pretty much any type of "natural" induction.. we're already working on sex, walking, pineapple (probably useless), spicy foods, bouncing on birth ball, visualizations, etc. Haven't tried EPO or nipple stimulation yet and would probably try castor oil before facing induction. I've been drinking red raspberry leaf tea for weeks in hopes of helping my uterus function better during labor. Any other natural induction ideas?

I've been pretty set on natural birth the entire pregnancy, but the stillbirth threat does make me think twice about refusing the cytotec. I will definitely try all other natural methods before that, and I hope I will get some good news at my pelvic exam tomorrow (some effacement or dilation or something). Hopefully it won't come to that and something will happen before then. I don't think stillbirth is talked about very much, nor are the reasons for it discussed- deteriorating placenta, lack of fluid, etc. If he looks fine on ultrasound, how quickly can the fluid or placenta deteriorate? It's that fear that refusing intervention could cost the baby his life, and fear can be a powerful motivator.

Thanks again for listening and for your advice.
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#8 of 23 Old 02-23-2004, 04:59 PM
 
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Nosy~ thank you for posting your questions...I did have a stillbirth and it was not related to GD or anything else...just fate. I am glad you are taking a proactive stance with your research...a few good websites are the following: www.rti.org , and www.stillnomore.org. You always can google stillbirth and find other resources. Good luck to you and your baby and may you have a happy natural birth with a happy and lovely child to raise.
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#9 of 23 Old 02-23-2004, 06:07 PM
 
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Nosy,
I had GD in my first pregnancy. I was also induced, but not because of the GD, but because my water broke and I never went in to labor. I had pitocin. It was no big deal. They actually turned it off after a little while because I didn't need it anymore. Other than that I had a short, natural birth. Good luck. (:

, mama to DS(7/)22/02) DS (8/14/04) , and an angel (3/10/10)nursing a broken heart...loving my boys.
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#10 of 23 Old 02-23-2004, 09:24 PM
 
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Good for you for doing all the research. Definitely try all that you can to get things rolling naturally before 40 weeks. But, I say, don't dismiss your MW's knowledge - these people have been doing this for a long time and, although it may turn out that inducing is not necessary -- if there's even a question about baby's health if he/she stays in there, I would induce. But that's just me.
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#11 of 23 Old 02-24-2004, 01:35 AM
 
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One thing to throw into the mix: failed inductions are a major cause of c-sections. If you have a c-section, your odds of having a stillbirth during the next pregnancy are doubled (although odds are still very, very low). Inductions and c-sections for "failure to progress" have their own risks.

I was facing getting kicked out of my birth center at 42 weeks, so I tried a lot of what you are trying to get labor going. The only thing that really worked was 3 increasingly vigorous strip-and-sweeps of my membranes over the course of 3 to 5 days (don't remember exactly now). I would do that, or even try castor oil, before I would try cytotec. In fact, I would never consent to cytotec. If I had to have a medical induction for some reason I'd go with cervidil and then pitocin, but cytotec is way, way scary.

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#12 of 23 Old 02-25-2004, 03:27 AM
 
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talk to your baby and do your kickcounts and be cool happy and calm.

love casina
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#13 of 23 Old 02-25-2004, 10:41 AM
 
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I want to reiterate what pam has said - "GD" is *not* a risk for stillbirth. Ask to see evidence that it is if your MW is saying so. If she shows you something that says "diabetics", know that this research was done on women who were diabetic before pregnancy. As far as I know, the only thing that women with "GD" are more at risk for is a large baby. Since 90% of women who fail the one hour subsequently pass the 3 hour, we don't even KNOW if you have "GD" (a one hour over 200 is presumptive of "GD"), and most likely DO NOT! So to my mind, this is just beyond overkill.

FWIW - my SIL was badgered into a primary c/sec due to "large baby" and "GD". Her water broke at 38 weeks, so had the section and the baby was only 6-12. : So glad she got all that "high risk" care that she needed.....
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#14 of 23 Old 02-25-2004, 05:02 PM
 
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I just want to post the link to my birth story. I had a wonderful cytotec induced waterbirth. When i was researching cytotec, i found many horror stories that scared me and had me dead set against it, but after my blood pressure became a more pressing concern, it changed my mind. Also my dr has a strict protcol he follows, of dosing, monitoring, who cant have cytotec, etc. I also told him I would take no more than 25mcg at a dose, and no more than 2 doses.
I read many stories of drs starting with doses of 100mcg! This sounded like way too much to me!

Anyway, heres the link, and i hope it gives you some insight to the other side of the story.
good luck with your decision.

http://www.mothering.com/discussions...hreadid=118771
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#15 of 23 Old 02-25-2004, 05:51 PM
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CYTOTEC???? CYTOTEC???????

Is your midwife insane????

That drug has killed women and babies! It is not even supposed to be used by pregnant women for any reason.

Look it up.

The reason why doctors and midwives love it is that a little pill - less than a dollar - will start labour unlike other drugs which can cost 100's of dollars. They are experimenting on women and killing them and their babies with this disgusting off label use.

Saying that Cytotec is dangerous is the same thing as saying that jumping out of a plane without a parashoot is a fine sport.

I am so mad right now I could spit.
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#16 of 23 Old 02-25-2004, 06:12 PM
 
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Quote:
Originally posted by Boobiemama
Anyway, heres the link, and i hope it gives you some insight to the other side of the story.
good luck with your decision.

http://www.mothering.com/discussions...hreadid=118771
I read your birth story and I'm so glad that it worked out well for you.

However, I work as an L&D nurse and want to point something out - you were given cytotec orally. Had it hyperstimulated your uterus (which is always a risk with cytotec) causing contractions so hard and so close that the baby doesn't get properly oxygenated, there is no way to "turn it off" so to speak. Your only option would have been an emergent c/sec. Other drugs like cervadil (an expensive, *licensed for OB use* prostaglandin) can be pulled back out and IV pitocin can be turned off. If you take oral cytotec, you are committed 100% to whatever effect the drug has on your uterus. This is NOT a flame - just trying to point out that it doesn't always work out as well as it did in your case.
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#17 of 23 Old 02-25-2004, 07:55 PM
 
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No surprise that I agree with Chava ( ) - also, if it's inserted vaginally, there's no turning it off.

Chava, around here, many women get prost gel that is not wrapped and able to be removed. It melts and that's that. Is that mode cheaper than the one that can be removed?
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#18 of 23 Old 02-25-2004, 08:02 PM
 
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Quote:
Originally posted by pamamidwife
Chava, around here, many women get prost gel that is not wrapped and able to be removed. It melts and that's that. Is that mode cheaper than the one that can be removed?
I don't know - we haven't used prostaglandin gel in ages. Cervadil is very expensive as it is still under patent. Last I heard, it is about $300 a dose.

Also - cytotec vaginally actually can often be removed. It doesn't "dissolve" terribly quickly. But I'm still very uncomfortable with it and we hardly ever use it.
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#19 of 23 Old 02-26-2004, 01:36 AM
 
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Nosy,

I just wanted to say I think you are very brave; please don't sell yourself short. You are powerful and strong. I'm feeling really sad that you're having to deal with so many negative, scary emotions and possible scenarios right now. I just wanted to send you some positive birthing energy. I just want you to know I believe in your ability to make good decisions. Don't give in to fear-based tactics. Gather your information and be strong. Listen to your body, your baby, and your instincts. You and your baby are not alarm clocks---and you don't have "sell by" dates! Listen to those you trust who are working with you or if you don't trust anyone, find someone who you can trust. Let us know how you're doing!

Warmly,

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#20 of 23 Old 02-26-2004, 02:56 AM
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Perfect Explanation Georgia! I agree 110%
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#21 of 23 Old 03-09-2004, 09:31 PM - Thread Starter
 
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I wanted to thank all for your thoughts, especially Heather. I'm sorry for your loss... I feel like I came close myself, and I can't imagine the reality.

When I went for my next ultrasound, the fluid level was 3.2 and the ultrasound tech said the placenta was a 3 (mature). We have had issues with the ultrasound tech the whole pregnancy and basically didn't trust her judgment, but the back up ob insisted they induce. I managed to have a 3 day induction b/c the midwife and I kept hoping I would go into labor naturally. Started w/cervadil (2 days) and nipple stimulation, and ended w/pitocin (very small, slow dose on the 3rd day). I really was crushed at having to have a fetal monitor the whole time as well as a hep lock (and IV the 3rd day), but I had no pain meds, no tears, and a successful vaginal birth. There will always be some doubt in my mind as to whether the baby was in danger, but I am happy that I was able to have a vaginal birth with no pain meds and a healthy baby. Baby is now 12 days old and sleeping peacefully next to me.

Again, thanks for all your replies and support.
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#22 of 23 Old 03-09-2004, 10:39 PM
 
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congrats on your birth and little one! thanks for posting to let us know---glad things worked out so well!!! enjoy your babymoon!

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#23 of 23 Old 03-10-2004, 02:52 AM
 
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You are so welcome Nosy! Congratulations on your precious baby. I am so proud of you for going natural- even after having pitocin!!!!! What an amazing woman.
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