Please Help me to Refuse a NST - Mothering Forums
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#1 of 55 Old 08-20-2013, 10:51 AM - Thread Starter
 
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Hey folks! I need some assistance here. I am trying (as if they can forced me!) to put off taking a NST for a few weeks. I am only 31 weeks right now and don't see the need for it. I'm considered "high risk" because I have gestational diabetes but its very well controlled with diet and insulin. At this point I don't want to start exposing the baby to so much Doppler because I honestly don't think it's worth it. I think we should save up that exposure for when we need it, closer to my due date.

The catch is I am trying for a VBAC. I feel like everything I do is me "bargaining" for how I want to give birth. I'm incredibly frustrated right now. I keep trying to cancel the NST and they keep saying we will call you back... There is something wrong with this system where a mother can't decide what she wants to do regarding her pregnancy. Nobody cares more about this baby than me!! Ugh.

I need some research on how the Doppler should be used conservatively during pregnancy. I barely have any time before they call back and I'm so flustered right now.

Anything helps. :'-(

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#2 of 55 Old 08-20-2013, 11:08 AM
 
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Don't stress, not good for you and not good for baby.  First, what is the reason the doctor wants to do the NST? If you are high risk (for whatever reason) maybe it's time to re-consider that it may be safer to do the test? ........The NST is a belt that goes around your belly and monitors the fetal heart rate, right? So what's bothering you about the doppler? Do they do ultrasounds too?  Is it the idea of sound waves that has you concerned? But again, go back to the reason your doctor wants this test............has baby been moving less? Is doctor having a hard time getting heart beats? And curious, where are they doing the test? Mine were always done at the hospital, so that if there was a problem, we could go into the OR immediately.........(or is the doctor having the test done in his/her office?).....Again, don't stress out......baby picks on it. Breathe and  it will all work out.
 


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#3 of 55 Old 08-20-2013, 11:15 AM
 
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Do you have any other birthing options, or is this the only practice that will consider doing your VBAC? 

 

If I were in your situation I would firmly tell them, "I'm canceling my NST appointment.  I'm also contacting my insurance company and letting them know I'm canceling so you cannot bill me for 'skipping' an appointment."  I would then call my doctor and ask him what his specific goals are for the NST test and try to give him the data in other ways.  For example, if he's worried about the baby moving then supply information on number of kicks during an hour.  If he's worried about baby size due to out-of-bounds blood glucose levels I would provide several week's worth of BG numbers.

 

Is your doctor able to use a fetascope?  That would help to cut down on the amount of doppler used.  Best of luck to you.


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#4 of 55 Old 08-20-2013, 11:15 AM
 
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You have the right to refuse any test that you want.  That is your right as a patient.  Even if they schedule the appointment for you, you don't have to go.   If they say, "Well, what time works for you," you can say, "No thanks," and hang up.

 

With that said, I would want have a conversation with the doctor about the NST.  Ask why s/he thinks you can't put it off for a few more weeks.  If you get the NST and get good results, how frequently do you need to have them?  What are the statistics on stillbirth in mothers with well controlled GD?  

 

If your doctor is an obgyn or mfm specialist, it's pretty unlikely that you will convince them that dopplers are so unsafe that it's more risky for you to have NSTs than not.  So I would take an emotional, rather than a scientific, approach to trying to get a compromise you are happy with.  You are worried about your baby's safety.  You are worried that dopplers will expose your baby to harm.  You are worried that if you don't comply with their recommendations for getting NST, you will lose a degree of autonomy and choice in how you will be able to birth.  Of course you want the best for your baby.  How can you work together?  What would help you feel like the doctor has really heard your concerns and is addressing them thoughtfully?  Would the doctor be willing to talk about alternate ways of monitoring the baby, or alternate protocols for NST?  Why is this the protocol, why do they think this is the best way to handle this issue? 

 

 

Legally, they can't force you to do anything, but they are not obligated to approve of all of your choices either.

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#5 of 55 Old 08-20-2013, 12:23 PM
 
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Why is your doctor recommending the NST's to start at 31 weeks?

 

Mine started around the last month or so back when I was pregnant with DS, a few years ago. They were weekly and I did weekly ultrasounds too... separate appointments.


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#6 of 55 Old 08-20-2013, 02:24 PM - Thread Starter
 
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I think he is requesting it because I am considered "high risk" and probably also because I am a little overweight although I have only gained 15 lbs so far.

My concern is exposing the baby to more ultrasound than necessary. I know that the closer we get to the due date the more they are going to push for NTSs and ultrasounds. He also doesn't want me laboring at home at all, and wants me on the monitor the whole labor. :-/ Much of this I am not going to argue about. But I just don't see the urgency for the NST at the moment. And it is driving me nuts they are making it difficult for me to cancel.

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#7 of 55 Old 08-20-2013, 02:32 PM - Thread Starter
 
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And I did just flat out say, "I'm canceling the appointment" to which the reception said, "I'm not gonna do anything till I talk to the nurse and have her call you back." Ugh. Then the nurse called. She was very nice and understanding, but said, I need to speak to the doctor first... >:-(

I'm not trying to be difficult, I'm just trying to take care of my baby. Thanks to all of you who have posted. I still haven't heard from the doc yet...

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#8 of 55 Old 08-20-2013, 02:48 PM
 
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From what you have said, it does sound too soon. I was no more or less high risk than you, still didn't start those tests until the last month or so.

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#9 of 55 Old 08-20-2013, 02:55 PM - Thread Starter
 
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I am not a happy camper right now. They STILL will not cancel the appointment. They want me to come in and talk to the doctor so that I "understand the ACOG recommendations" and everything, and they will have the appointment ready "just in case I have a change of heart". I told her I do not want to feel any pressure about this, and she assured me she understood and that they can't force me to do it, but if they pull the "dead baby" card on me how am I not being forced? How is this my choice?

So frustrated. I swear, if men gave birth it would not be this way. Sorry but I'm so upset right now. Someone said to me that I make it difficult for myself. That's not true. THEY make it difficult. :'-(

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#10 of 55 Old 08-20-2013, 02:57 PM - Thread Starter
 
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Quote:
Originally Posted by erinmattsmom88 View Post

From what you have said, it does sound too soon. I was no more or less high risk than you, still didn't start those tests until the last month or so.

Thanks for saying this. Were you on insulin as well?

Must find ACOG recommendations....

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#11 of 55 Old 08-20-2013, 03:33 PM
 
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Go to www.pubmed.com and look for the research you want. I honestly went into an appointment when I was diagnosed with gestational diabetes (a diagnosis I disagreed with) with a stack of papers and a request that my doctor point me to even one peer reviewed study about gestational diabetes with a decent sample size. At that point my argument was that based on my blood glucose levels I was not willing to go on insulin as requested. I explained that I was more than willing and happy to be convinced but that the research I had found on my own did not convince me of the need for the specific intervention they recommended. I explained that If they couldn't come up with some convincing research on the topic I would have to respectfully refuse against medical advice and I was okay with that. My doctor looked at me and told me that I had educated myself and while she still didn't agree with me should could respect that my decision was well thought out and she was okay with me not going on insulin.

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#12 of 55 Old 08-20-2013, 06:04 PM
 
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My NSTs started at 32wks. One per week until 36 wks and then two per week until birth. I didn't really have a problem with it. I thought it was an easy way to put the drs at ease, because I knew everything was okay, but they needed evidence, and it was no sweat off my back to get the tests done.
It was a completely different story when they scheduled me for induction at 39 weeks. Uh... No way in hell was I going to be induced! There was no legitimate reason they could give me for induction, so I just didn't show up! It was difficult when they pulled the dead baby card, but I knew ds was moving a lot, was a good size, and was going to come soon enough. I went into labor in my edd, and all was fine.
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#13 of 55 Old 08-20-2013, 06:15 PM - Thread Starter
 
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My NSTs started at 32wks. One per week until 36 wks and then two per week until birth. I didn't really have a problem with it. I thought it was an easy way to put the drs at ease, because I knew everything was okay, but they needed evidence, and it was no sweat off my back to get the tests done.
It was a completely different story when they scheduled me for induction at 39 weeks. Uh... No way in hell was I going to be induced! There was no legitimate reason they could give me for induction, so I just didn't show up! It was difficult when they pulled the dead baby card, but I knew ds was moving a lot, was a good size, and was going to come soon enough. I went into labor in my edd, and all was fine.

I think this is exactly what they are wanting to do with me. But I'm not even 32 weeks yet! I will not be doing one tomorrow and we'll see about next week. I don't think I'll ever do the twice a week thing. We shall see...

I think what is really bothering me more than anything is my lack of choice. They say I have a choice, but attached to it is a LOT of pressure to do what they want. I'm considering changing providers...
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#14 of 55 Old 08-20-2013, 07:37 PM
 
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I did not start on insulin right away. I told them I was going to try to control things with diet first. After 2-3 weeks, my first AM sugars were still high. So, they gave me oral glyburide, just once a day before bed. I got the lowest dose available. Had one pretty severe hypoglycemic episode so I started cutting the pill in half. That worked out pretty well. I barely took it the last week of pregnancy. Day after DS was born I was back to normal.

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#15 of 55 Old 08-20-2013, 07:57 PM - Thread Starter
 
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I did not start on insulin right away. I told them I was going to try to control things with diet first. After 2-3 weeks, my first AM sugars were still high. So, they gave me oral glyburide, just once a day before bed. I got the lowest dose available. Had one pretty severe hypoglycemic episode so I started cutting the pill in half. That worked out pretty well. I barely took it the last week of pregnancy. Day after DS was born I was back to normal.

Thanks for sharing. We shall see what the doc says tomorrow. I'm just feeling so defeated today. I bet my blood pressure went up from all this...

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#16 of 55 Old 08-21-2013, 05:41 AM
 
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Sorry you are having a tough time with this.  hug2.gif

 

Sometimes change is scary, but maybe looking for a new provider is the best thing for you.  It sounds like a ridiculous amount of pressure...  Refusing to cancel an appointment?  Hm....

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#17 of 55 Old 08-21-2013, 06:23 AM
 
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Ask a lot of questions. I'm sure you are keeping a log of your blood sugars, don't forget to bring those. From my experience, as long as things are under control, putting off the weekly tests should be a reasonable request.

 

Now, I have to caution you, however, about seeking another provider so late into your pregnancy. Since you are high risk, yes, GD categorizes you as high risk, you may find that it is near impossible to find someone who will take you as a patient this late in the game. I wanted to change providers half way into my second pregnancy, this was before the GD diagnosis, simply because I was wanting to see someone closer to home. NO ONE would accept me as a patient. They cited me being halfway through my pregnancy as the cause for not wanting to accept me into their practice. So I was stuck with the 35-minute, one-way commute for the rest of the time.

This was really hard with those twice-a-week NST's and ultrasound appointments, on top of regular OB visits. Oh, and I had to bring a 2-year-old too. Fun times!!

 

Don't be too hard on the secretary not wanting to cancel your appointment. She has to answer to the nurse, who has to answer to the doctor. I'm sure the doctor has made it protocol that he be notified if a patient cancels or reschedules important appointments. I have been in her shoes before.


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#18 of 55 Old 08-21-2013, 07:51 AM - Thread Starter
 
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Thank you, EMM88. I was nice to the secretary and the nurse. :-) I told the nurse I understand that the doctor is in a precarious position. But I did tell her I did not want to be pressured.

In going to try and see what's available. There is a wonderful place just a ways down the road that I wish I would have gone to first. Ugh.

Wish me luck today!
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#19 of 55 Old 08-21-2013, 08:02 AM
 
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That sounds like a great idea to at least check out the place just down the road that you have positive feelings about!  Good luck!  Sending relaxing vibes your way.

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#20 of 55 Old 08-22-2013, 02:42 PM - Thread Starter
 
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Just wanted to give you guys an update. I went to my appointment yesterday and really hashed it out with my doc. He was very kind and respectful but he said he doesn't agree with my choices. Here are the questions I asked him:

1. What are the risks of complications in a pregnancy with CONTROLLED gestational diabetes vs. a normal low risk pregnancy.

He didn't have a number for this and said he had to look but that he was sure serious complications were much higher with controlled GD. Okay... Would need to see those numbers...

2. Is the number of complications lowered with the use of non-stress tests? In other words, does this tests actually make a difference in outcome?

He said he did not have an answer for this and that he never will, because it is considered unethical to not offer the non-stress test because it is available.

Uh, okay... So... Here's this tests which exposes the baby to ultrasound, which could possibly have some negative effect on the baby but we just don't know because there are no studies... The test is notoriously inaccurate, and can lead to other intervention which may not be needed... And we don't really know if the test actually will change anything regarding your baby's welfare.

"But this is the best we got," my doc said...

So, in the end I agreed to do one test yesterday and not do another one until 34 weeks. And I will do them once a week after that. He wants me to start 2x a week starting next week which I refused.

Then he handed me an ultrasound order and told me to schedule it because he needed to check the size of the baby... I told him I would think about it. I did and I'm not doing one till later...

So, the stupid NST was 40 minutes instead of 20 because at 31 weeks my baby is still small and the tech couldn't find a baseline. Of course my baby passed. But I never wanted him to have that much ultrasound exposure at this point. :-( I feel like I shouldn't have given in but I had to make a "deal" with my doc...

Someone is making a lot of money off these NSTs... >:-(

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#21 of 55 Old 08-22-2013, 03:20 PM
 
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His answers to both questions are bollocks IMNSHO lol.gif

Question 1: when I had GDM I was teetering on the brink of needing insulin. I told the Diabetes Nurse Educator and the endocrinologist that I was really keen to manage it with diet because using insulin immediately put me in the high risk category. They were both really perplexed and basically said "why???" My research backed that up. It seems that regardless of how it is controlled it is good control which matters. I wonder if your doc is getting confused with pre-existing Type I diabetes which does have increased risks associated with it.

Question 2: actually there is all manner of research to show that routine CTG does not improve outcomes.

I'm sorry he is being a pain.
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#22 of 55 Old 08-22-2013, 04:16 PM
 
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31 weeks is really early. My practice starts NSTs for GDM moms at 34 weeks and that seems to be standard of care. More and earlier tests= more opportunities for false positives which require more and more tests and interventions.

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#23 of 55 Old 08-22-2013, 04:36 PM
 
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Having "gestational" diabetes only means that you are at risk of having a larger baby. It's a lot different than standard diabetes.

 

This is a great article about gestational diabetes:

 

http://evidencebasedbirth.com/does-gestational-diabetes-always-mean-a-big-baby-and-induction/

 

Now, seeing an OB for your gestational diabetes does increase your risk of interventions and complications. Do you have a midwifery practice in your area that you could use?


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#24 of 55 Old 08-22-2013, 04:39 PM - Thread Starter
 
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Unfortunately, since I have to be controlled with insulin and am trying for a VBAC, I have no choice but to go with an OB. Those are the rules in my area.

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#25 of 55 Old 08-22-2013, 04:46 PM - Thread Starter
 
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31 weeks is really early. My practice starts NSTs for GDM moms at 34 weeks and that seems to be standard of care. More and earlier tests= more opportunities for false positives which require more and more tests and interventions.

Yep. Exactly!!

The following contains triggers:

I would be really interested to know what the stats are in regards to stillbirth with GD moms vs stillbirth with low risk birth. My doc kept pulling the dead baby card on me, but could not give me numbers. If anyone has this info I would so appreciate it!! P5, I am going to read that article right now!! Thanks. :-)

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#26 of 55 Old 08-22-2013, 05:15 PM
 
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I had diet controlled GD, but was not a VBAC (although it doesn't sound like your VBAC status is part of his concern in the NST issue).

Anyway, my OB/Midwife practice did not require NSTs until 40 weeks, then it was 2x a week. With the 34 week recommendation, I have to wonder how serious your doctor would be about actually inducing you that prematurely, considering the high false-alarm rate of NSTs.

My 1st NST, baby was sleeping so they wanted to induce. I went for a walk, then sat up instead of lying back and the reading was better. The 2nd NST, they wanted to check my cervix and start Pitocin because I was showing contractions. No way did I want to be in the hospital that early in labor though, so I went home and started labor in 24 hours, had him in 36.

For that one they did do a late term ultrasound for size, and it underestimated the weight by 2.5 lbs. Even being a big baby, though, everything was fine. Just my experience.

Once again, if your doctor is doing an US for size, I would ask him if he plans on inducing based on a big-baby diagnosis, since I believe that is not considered an appropriate standard of care. What is more likely with that ultrasound is that you will be told your fluids are low, which is a whole other issue to research. Hoping your numbers stay low! Keep us posted...

ETA: I think I was advised to have NSTs a bit before 40 weeks and declined. I remember it was non-negotiable at 40.
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#27 of 55 Old 08-22-2013, 06:22 PM
 
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I had diet controlled GD, but was not a VBAC (although it doesn't sound like your VBAC status is part of his concern in the NST issue).

Anyway, my OB/Midwife practice did not require NSTs until 40 weeks, then it was 2x a week. With the 34 week recommendation, I have to wonder how serious your doctor would be about actually inducing you that prematurely, considering the high false-alarm rate of NSTs.

My 1st NST, baby was sleeping so they wanted to induce. I went for a walk, then sat up instead of lying back and the reading was better. The 2nd NST, they wanted to check my cervix and start Pitocin because I was showing contractions. No way did I want to be in the hospital that early in labor though, so I went home and started labor in 24 hours, had him in 36.

For that one they did do a late term ultrasound for size, and it underestimated the weight by 2.5 lbs. Even being a big baby, though, everything was fine. Just my experience.

Once again, if your doctor is doing an US for size, I would ask him if he plans on inducing based on a big-baby diagnosis, since I believe that is not considered an appropriate standard of care. What is more likely with that ultrasound is that you will be told your fluids are low, which is a whole other issue to research. Hoping your numbers stay low! Keep us posted...

Do not allow your doctor to induce you for macrosomia (big baby). That happened to me with my first. I had to be followed by a perinatologist last two months of pregnancy for unexplained bleeding. I had had marginal placenta previa, which resolved on its own, but I continued to have random bleeding so I had to see the peri. At around 34 weeks, their high-tech ultrasounds were measuring DD at 8 lbs. They nearly freaked out. They pretty much told me to stop eating!!! Yeah right. So they were all concerned and convinced me (although my gut told me otherwise) to be induced at 38 weeks for feared large baby. I was barely 1 cm dilated the day before induction. Day of induction I never made it past 7 cm dilated before they started talking about C-section. I wasn't progressing at all hardly at 9-10 hours into it. Why? Because my daughter wasn't ready to be born. Grrrr. Terrible experience. Typing that makes me mad all over again. So, I had a damn C-section for failure to progress. BTW, my DD was born at 38 weeks and was 8 lbs 8 oz, 20 inches. Hardly the monster they thought she was going to be.

 

Yeah, low fluids are a totally different animal.

 

Sorry to go off on a tangent about my experience. I guess almost six years later I am still angry about it.FIREdevil.gif

 

Sorry your doctor didn't really have any answers. Glad you stood your ground.

 

FYI, I did not have GD with my first. I had it with kid #2.

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#28 of 55 Old 08-22-2013, 06:45 PM - Thread Starter
 
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Thank you so much, ladies. And yeah, my doc told me yesterday that he didn't want me to go past 39 weeks. I told him that I will not have this baby before 40 weeks if he's not ready, and even if I end up having to have a cesarean (and I know before I go into labor) that I wanted to go into labor.

I will be honest and say that I am not good at research. I have been trying but my brain does not work that way. ANYTHING that you ladies can provide or steer me toward really helps. I am very interested in hearing about the low fluid thing, because it has been mentioned as a concern. Everything is a concern. Everything is worse case scenario. It's driving me mad.

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#29 of 55 Old 08-22-2013, 06:47 PM - Thread Starter
 
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And p5, I read that article and it nearly brought me to tears. Everything I had a hunch about was confirmed. Thank you SO MUCH for posting that. Made me think of this image I found on Facebook yesterday:


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#30 of 55 Old 08-22-2013, 09:08 PM
 
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I can't link at the moment because I am on my phone but if you go to Google Scholar and search gestational diabetes + risk of stillbirth there are a few articles which may be useful. One is part of the big Australian trial.

When I have more time later I will do a proper search for you and link some articles. I did all this last year when I had GDM. The hospital where I had my babe's and work as a midwife is pretty good but do get a bit more picky once you're on insulin.

And, FWIW, I was planning a VBAC as well and they didn't make any difference to my antenatal care.
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