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#31 of 55 Old 08-23-2013, 08:21 AM
 
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I just looked at a new (aug) practice bulletin from ACOG saying that it seems GDM moms with good glycemic control don't necessarily need to be induced at 39 weeks. It's not some crazy reckless idea.
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#32 of 55 Old 08-23-2013, 08:26 AM - Thread Starter
 
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Thank you, katelove. I will definitely check that out.

I am thoroughly depressed this morning. I screwed up last night and had literally a BITE of cake that everyone but me enjoyed at my baby shower. Even with fast acting insulin my blood sugar went up to 155. Then this morning it was 100. I realize these are not astronomical numbers but I feel like if they are not perfect I'm going to have a really hard time convincing everyone that the baby is fine. I was up half the night. I'm confused and scared. I'm angry. To be honest, I don't even know if being on insulin is a good thing. I just don't know anything right now.

I wish I was more scientifically minded. I know I'm not dumb, but I have a hard time getting through these studies.

I know all this stress is not good. I just want to have a peaceful pregnancy. I'm really sad right now.

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#33 of 55 Old 08-23-2013, 01:21 PM
 
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I wish I was more scientifically minded. I know I'm not dumb, but I have a hard time getting through these studies.
 

Not dumb at all. Scientific studies are written for people who are in the field studying the same thing. And even when you are reading studies related to your discipline it can sometime be hard to understand a study. Scientific studies are very difficult reading. I worked in medical research for 12 years and I still sometimes have a hard time. 

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#34 of 55 Old 08-23-2013, 01:49 PM
 
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Thank you, katelove. I will definitely check that out.

I am thoroughly depressed this morning. I screwed up last night and had literally a BITE of cake that everyone but me enjoyed at my baby shower. Even with fast acting insulin my blood sugar went up to 155. Then this morning it was 100. I realize these are not astronomical numbers but I feel like if they are not perfect I'm going to have a really hard time convincing everyone that the baby is fine. I was up half the night. I'm confused and scared. I'm angry. To be honest, I don't even know if being on insulin is a good thing. I just don't know anything right now.

I wish I was more scientifically minded. I know I'm not dumb, but I have a hard time getting through these studies.

I know all this stress is not good. I just want to have a peaceful pregnancy. I'm really sad right now.

 

Maybe this will make you feel better... one morning I made pancakes for my DD. I couldn't help myself and ate them with her. Not just a bite, 3-4 pancakes WITH maple syrup. It was just that one time. Sheepish.gif  My 1-hour postprandial sugar was in the mid-200's!!!!! Woops. I didn't care because it was fun!!! I felt fine, didn't have any symptoms. Later in the day I was back to "normal". Should I have done that? Probably not. Oh well. I'm a rebel!!

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#35 of 55 Old 08-23-2013, 02:20 PM - Thread Starter
 
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Maybe this will make you feel better... one morning I made pancakes for my DD. I couldn't help myself and ate them with her. Not just a bite, 3-4 pancakes WITH maple syrup. It was just that one time. Sheepish.gif
  My 1-hour postprandial sugar was in the mid-200's!!!!! Woops. I didn't care because it was fun!!! I felt fine, didn't have any symptoms. Later in the day I was back to "normal". Should I have done that? Probably not. Oh well. I'm a rebel!!

Oh... What I would do for a pancake RIGHT NOW!!!!!!! Salivating....

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#36 of 55 Old 08-23-2013, 04:28 PM
 
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One or two high numbers won't do you or your baby any harm.

There is some controversy about whether treating GDM is useful or not. FWIW, my view as both a former GDM mum and a midwife is that it is beneficial. I did a huge amount of investigation while I was pregnant and I was satisfied that the current best practice is to maintain tight glycemic control whether with diet or insulin. I see a lot of people on MDC saying that the only risk to babies is macrosomia but that's not true, it's just the thing which is talked about the most. Babies of mums with poor glycemic control are also at increased risk of lung and liver immaturity. You're doing well Mama. I know it's hard and miserable at times but you're doing well.
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#37 of 55 Old 08-23-2013, 10:51 PM
 
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I'm sorry you're feeling so stressed. I would think that any reasonable person would see a bite of cake and one high number as not hurting your baby. I guess what I'm saying is that I can see how stressful it must feel when you feel like everything you do is to "prove" yourself to other people. It seems like you're not worried within yourself, just worried at how other people are viewing things. I don't want to add to any worry and if anything I say stresses you out in a bad way then ignore me. But can you get rid of these people (your ob)? Just from what you've said on this thread it doesn't seem like your ob wants you to have a vbac.

I understand the idea of possible benefits to induction in some cases but if he wants more testing than other docs seem to, and doesn't want you to go past 39 weeks then I just can't see him as being invested at all in the idea of you having a vaginal birth.

Also, I can tell you've done research, are still seeking out opinions, and I believe you know what is best for your baby. Studies and doctors and other people can be immense help but I believe you are the foremost expert on your baby.

I'm wishing you a peaceful gestation and birth.
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#38 of 55 Old 08-23-2013, 11:02 PM - Thread Starter
 
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Thank you katelove and salr. <3

Lately, my numbers have gone up inexplicably in the evening. I'm getting them back down but I'm frustrated. My doctor says he considers them controlled but they are not perfect. I do get a few higher numbers a week, but nothing astronomical. He doesn't see it as a problem but for the next two months I want them to be perfect. I want them to not have a reason to try and deny my wishes.

My OB is the best chance I got in the town I live in. I may try and see about going to another town, but my GD case is something that concerns me. My doc has done well with helping me manage it and is very knowledgeable in that area. It's just this other stuff that has got me bent outta shape. Especially the not going over 39 weeks. I really see my VBAC slipping away at that point...

I still have a lot to think about. Thank you all for your input. Anything is appreciated! <3

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#39 of 55 Old 08-24-2013, 12:42 PM
 
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I am so sorry you are feeling sad. I am generally a healthy eater, and I still felt soooo deprived during my GD pregnancies. I seriously love my carbs. It is really hard and sounds like you are being conscientious. I too had a occasional super spike but I figured it showed what a good job I was doing the rest of the time. Evenings are harder. I found that going for a walk right after dinner or anytime I anticipated a higher number helped somewhat.

I do think that it's becoming clearer that your OB has already decided what he wants and may be simply testing as much as possible until he gets an excuse to do so. NSTs and ultrasounds are so open to interpretation that he will have lots of opportunity. The upside to determining this, though, is that you can be more confident in taking his words with a grain of salt.
Sometimes I find if I ask enough questions, I will eventually catch a glimpse of an ulterior motive to the providers recommendation. When I see that, it is such a relief, because I can more confidently decline (or accept and still feel informed) and maybe clarify to them what my goals are.

For example, with the NST (41plus wks) I mentioned previously that was showing contractions, they recommended immediate Pitocin. Like, you can't even go home and pack a bag. But when I expressed extreme concern with that, the OB seemed puzzled. She said this way I could 'get this over with and not have to come back later'. Um, surprise induction instead of natural labor to save a drive? I was SO glad she flashed her true colors and I went home. It was also a Thursday, so it occurred to me that she could see labor was coming, and figure if she Pitted me now we could be done by the weekend, vs. labor was obviously likely to start going into the weekend.

She wanted to section me at one point in labor based on the EFM strip, but couldn't show my husband what had changed, and we noticed it was dinnertime on a Friday. That made refusing the section a much easier decision. I'm getting off topic, I know, but my point is just that you might be able to more confidently communicate with your doc now that you know where he's coming from.
Sometimes a more transparent provider is easier to work with than one who is very medically minded but trying not to seem that way. Wishing you some mental peace and healthy convos with your doctor!
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#40 of 55 Old 08-24-2013, 02:05 PM
 
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Just wanted to chime in how sorry that you are dealing with this.

I didn't have gd but with ds1 the ob was concerned about iug and I went into preterm around 28wks, then bp shot up abot 35wks. What was going on though, starting at my preterm was the nsts weekly. They were extremely stressful for me. Then two level 2 u/s and they were wrong on size by delivery. Big surprise there. Like Myra1, they didn't give us the chance to go home, but induced us at40 (I think they were off) and as first time parents we had no idea we could refuse all those u/s and nsts. They didn't help at all, but lent toward more intervention, and so much stress, I think it was the real reason my bp went gigh. Almost ended up emergency cesec.

My understanding is a nst tells how baby responds to ctx, which I guess can have the dr decide to do surgery, even if baby is doing well. So why do a nst with no ctx? My sis had gd and they did inductions-kids were 10-11#, but there are women who just have 10#+ babies with no gd.

Have you looked on ican? I'm wondering if they will have more answers for you regarding vbac and tests you can refuse, with gd? You don't need to be stressed out at this point, shame on that dr and nurse. You could always go to the appt for a check up, ask them to use a fetascope? They can't force you to do a nst I wouldn't think.
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#41 of 55 Old 08-24-2013, 06:12 PM - Thread Starter
 
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Thank you Myra and Hippie Mum. I am going to try and see if I can get a consultation with the other practice on Monday. My problem is I'm scared. My GD is pretty well controlled but my need for insulin goes up all the time. It was going really well and then the third tri hit and all of a sudden I am having a tough time keeping the sugars down. I still don't think this should be an excuse for more intervention. I still believe that my baby is doing well. I just don't know how this will change the opinion of my providers. It sucks being in fear.

I really appreciate all the information and kind words I am receiving. This has been a real challenge. I have found myself depressed and losing sleep. Even though I don't believe what my doc says 100%, even hearing the words "stillbirth" is so hard. Why does he do that? Why does he have to put me through this?

I just need to know that everything will be okay. Nobody cares more about this baby than me. :'-(

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#42 of 55 Old 08-24-2013, 11:40 PM
 
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All of my VBACs have been induced. Its not ideal, but don't lose heart if you end up facing that. With my first VBAC I was induced at 38 weeks. Honestly, you can count yourself lucky that your OB is wiling to induce a VBAC. Many aren't and it takes a viable option to allow a woman a VBAC off the table. Of course its better to go into labor naturally, but if that can't or won't happen, I am glad to have pitocin as an option rather than a scheduled C! There are lots of things you can do to still have your VBAC even if you're induced. Stay mobile, use a doula, avoid/delay epidural, make sure your bishops score is favorable, etc. 

 

Also, IME midwife practices are not necessarily more easy going about testing that OBs. I used OB practices until my 5th baby, and was really surprised and alarmed at how many tests the new midwife practice wanted to do due to my AMA (I was 37). We got in quite a few tense discussions about it! I totally know that feeling of defeat where you feel like your body isn't quite yours anymore. Its hard and it hurts. I have shed tears of frustration in many a doctor's office. Something about pregnancy makes me feel this strange mix of total vulnerability and fiery defensiveness. 


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#43 of 55 Old 08-25-2013, 06:28 AM
 
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My understanding is a nst tells how baby responds to ctx, which I guess can have the dr decide to do surgery, even if baby is doing well. So why do a nst with no ctx? My sis had gd and they did inductions-kids were 10-11#, but there are women who just have 10#+ babies with no gd.
 

An NST has nothing to do with contractions. It tests if the baby's heart rate changes in response to its own movements. 

 

 http://americanpregnancy.org/prenataltesting/non-stresstest.html

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#44 of 55 Old 08-25-2013, 09:11 AM - Thread Starter
 
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An NST has nothing to do with contractions. It tests if the baby's heart rate changes in response to its own movements. 

 http://americanpregnancy.org/prenataltesting/non-stresstest.html

I thought this as well but when I had my NST they also put a sensor on me to monitor contractions. I can't remember what she said and I need to find out. I don't remember that from my first pregnancy...

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#45 of 55 Old 08-25-2013, 10:51 AM
 
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They probably just do that to see if you're having any or not, but if you're not having contractions the NST can still provide useful information. 

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#46 of 55 Old 08-25-2013, 10:57 AM - Thread Starter
 
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They probably just do that to see if you're having any or not, but if you're not having contractions the NST can still provide useful information. 

Thank you, erigon. I just have done lots of research on the NST and have discovered that it's very flawed in most everything aside from leading to unwanted/unneeded intervention. Not to mention additional exposure to ultrasound, which I didn't want. What has me really up in arms is that they tell me I have a choice of whether or not to get one, but if I make the choice not to they try and scare me with statistics that actually don't reflect the evidence. I am infuriated at my lack of choice.

Anyway, I'm looking for alternatives. Hopefully either I can work it out with my doctor or find another one who is more in line with what the evidence reflects.
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#47 of 55 Old 08-25-2013, 03:17 PM
 
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An NST has nothing to do with contractions. It tests if the baby's heart rate changes in response to its own movements. 

 http://americanpregnancy.org/prenataltesting/non-stresstest.html

I thought this as well but when I had my NST they also put a sensor on me to monitor contractions. I can't remember what she said and I need to find out. I don't remember that from my first pregnancy...

In Australia we call them cardiotocographs (CTG) and they do both. I believe in the US non-stress test is the term used when they are done while the mother is not in labour. In that case, as Erigon said, it is about how the foetal heart responds to movements.

When there are contractions it is more about how the heart rate responds to them. It is *not* an effective way to monitor contractions, except to mark when they start and finish if the machine is picking them up ok. So your care provider should still palpate them by hand for a minimum of 10 minutes.

They should also always put the toco transducer on even when you aren't in labour, to see if the baby responds to any Braxton Hicks you may have and also so that there is a complete record and it is obvious to someone looking at the trace in the future that there was no contractions. The toco transducer is a pressure monitor and is usually placed somewhere near the fundus.

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#48 of 55 Old 08-26-2013, 10:45 AM
 
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Hey dalia,
Hang in there! You seem to trust your ob as far as management of gd/insulin goes. I just wanted to point out that maybe a new provider will also make you feel safe by showing themselves to be very medically competent. And maybe with less pressure put on you.

Even if that's not the case and this ob is the best option for you, I'm guessing that you'll feel more confident just from taking control and double checking your choice. Sometimes just taking action, no matter what it is, makes me feel more free.

You're right. There is no one in the universe who cares more about your baby than you! Thank you for sharing your thoughts and feelings. It makes remember those awesome mama bear feelings that were so strong during pregnancy and with a newborn. I had a few moments recently where I learned again how powerful intuition is.

You can do it, mama!
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#49 of 55 Old 08-28-2013, 10:21 AM
 
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Good for you for doing your research, I think your compromise with your doctor was a good idea, but it sucks when they lay on the pressure! With my twin pregnancy, I felt like I was constantly doing things to reassure the OB which got annoying at times, but I did go with the flow when I could as I felt like it gave me more bargaining chips when I wanted to go against their recommendation, so I definitely feel you there. I didn't have concerns about ultrasound/NST hurting the babies, but I did feel they were mostly a waste of time. My baby boy was actually having decels, but we never caught them on the NST's. It wasn't until I was being continuously monitored for hours after I had a too high BP (that was reverified) and +1 protein that they finally caught them because my babies were apparently "perfect" on the monitors at all other times. Not sure what that means, but it must mean something cause every nurse, OB & resident said it to me smile.gif

I hope everything works out for you and that they calm down a bit on pressuring you. And if the new practice can take you and works out, that's awesome, but if not it sounds like you can work with your current OB. I hope you get your VBAC!
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#50 of 55 Old 08-28-2013, 10:34 AM - Thread Starter
 
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Thanks so much! The other practice is all booked up. :-(

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#51 of 55 Old 08-30-2013, 10:42 PM - Thread Starter
 
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I thought I would give you all an update, :-)

My wonderful midwife/doula actually called my doctor (I did not ask her to) and spoke to him about making a compromise. He said he would feel fine letting me go to 40 weeks,
and they talked about non-invasive ways to try and induce labor. He agreed to once a week NSTs beginning at 34 weeks, and is not pushing me for more ultrasounds, though he would like to see one more at least. I am sure she talked to him about pulling the "dead baby card" because he told me today he wouldn't do that anymore. He also admitted that there was no evidence suggesting that women with controlled gestational diabetes are at a higher risk for stillbirth. :-D

I just want to give kudos to my midwife for being such an awesome advocate, and my OB for being so flexible and understanding. A lot of OBs would NOT be "letting" me be in control. Thank goodness mine does not have a God Complex and is able to admit when he is mistaken and also let me take the reigns.

I also feel proud of myself for sticking to my guns. It's been a tough couple weeks but was SOOOOOO worth the struggle!!!

:-)

Thank you all sooooo much for your help. I really and truly appreciate it.

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#52 of 55 Old 08-31-2013, 12:04 AM
 
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What a great update. Good on you for being such a great advocate for yourself and your babe. And great that you have a good team to work with as well.

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#53 of 55 Old 08-31-2013, 09:42 AM - Thread Starter
 
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Thank you, Katelove. I can't believe how much better I feel today. The whole things was affecting my mood more than I realized. It's like a huge weight has been lifted!!!

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#54 of 55 Old 08-31-2013, 12:47 PM
 
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That is fantastic!
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#55 of 55 Old 09-01-2013, 04:31 PM
 
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That's great! Good for you!
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