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Discussion Starter #1
Can anyone who has had gestational diabetes and been on insulin during previous pregnancies share with me their experience going past their due dates? What was your midwife/OBs opinion on this? What was your care like during this time (frequency NSTs, etc.)? Did anyone get to 42+ weeks?<br><br>
I'm 39 weeks today and I'm trying to inform myself as best I can about what to expect for the coming week/s. I've been on insulin to help control my morning fasting blood sugar (a small dose). My post-meals numbers have been fine all along (with diet). I actually just stopped with insulin because my numbers came down dramatically when I hit 37 weeks (is this really a sign of the placenta aging?), but I was on insulin for about 5 weeks there.<br><br>
Anyways, I feel pretty sure my HCP won't hassle me about getting to my due date (induction hasn't even been mentioned yet), but I know that things can be different with re: to GD w/insulin pregnancies and I was looking to hear others' experience (BTDT moms). I have an appt. later this week when I'll be 39.5 weeks.<br><br>
For the record, my first DC was over 10 pounds at 39 weeks (I wasn't diagnosed with GD during that pgncy, but very well may have developed it later on). During my 2nd pregnancy, I passed the 1 hour just fine and had an 8 pound baby at 38.5 weeks. And actually, I passed the 3-hour this time, but asked to see a nutritionist (b/c of family history w/diabetes) and sought help monitoring my BS. Turns out, my fasting sugars started to climb there after 30+ weeks. Regardless, I'm not particularly concerned about my ability to birth a large baby (nor is my HCP). I'm just concerned in general and would like to make the best decision for my health and the health of my baby.<br><br>
Are there any other reasons why the topic of *inducing* comes up with regard to GD besides the concern for a large baby? I've seen a few places mention that insulin may actually age the placenta...Has anyone heard this before? Right now, I'm going in for weekly NSTs. Should that be enough to give me peace of mind that all is well if I go past my due date?
 

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I believe that the placenta breaking down is the issue. I will link this thread to a friend who had GD diabetes twice.
 

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Discussion Starter #3
That would be very helpful, LolaK. I'd like to get some clarity on the "placenta" issue before meeting with my OB tomorrow.
 

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Lolak came to get me <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"><br><br>
I was on insulin with both pregnancies. For my daughter, it was just nighttime insulin, and with my son, it was 4x/day. I had different OBs for each pregnancy, but both were extremely supportive of low intervention, natural birth (and I had what I would call perfect, respectful, drug free hospital births with both). The first OB founded a freestanding birth center, and when I had to move, I was lucky enough to find a similar OB, who does vaginal twin and breech births, as well as taking a more midwife-like approach to the birthing process and being fully present for births.<br><br>
They both drew the line in the sand at 40w5d, though my second OB said I could push it out to 41w0d even though it made her "edgy."<br><br>
She explained it this way--GD's who need insulin, and cannot maintain control though diet and exercise, are more extreme cases, and the concern is that the placenta is an "end organ" (like the eyes and liver), and end organs tend to give out first with diabetic issues. She said she sees more calcification (not sure if that is the term she used, where it turns white/grainy) in some placentas of GD mothers. This is less of a concern for you, I'd guess, since your blood sugar was fine through the second trimester (with my second pregnancy, I was on insulin 4x/day at 5w pregnant). She said most providers will induce at 39 or 40w, and she was obligated to tell me that the ACOG recommendation was no longer than 40w, but that we were mutually agreeing to go to 41w.<br><br>
My daughter was 9-9, my son 10-3, and neither OB expressed concern over size/shoulder dystocia issues, though my second OB did want some sizing u/s to plot growth and check for IUGR. She never held the fact that he measured 7-5 at 34w against me. . ..she just wanted to make sure he was growing and not growth restricted, since it was unclear whether or not I entered the pregnancy with diabetes.<br><br>
So I'm not sure if that explanation is thorough enough (she had a bunch more to say that I can't recall) but as an OB who supports a more non-medicalized model of birth (and who labored with me for 6+ hours) I do trust her opinion.
 

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Discussion Starter #5
thanks so much katie_mama. it's good to hear you ended up with respectful, hospital births as well.<br><br>
i'm anxious in ways about how that talk will go tomorrow. until now, OB hasn't even uttered the word "induction". i really hope this baby decides to come before this weekend, that's for sure.
 
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