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I had planned to give birth in a birth center but was risked-out at 30 weeks due to gestational diabetes. I like the OB/GYN that the midwives recommended except that he wants to induce at 39 weeks because of the baby's lungs not developing enough to support a possibly large baby. At 34 weeks the baby is average size (5.5 lbs. according to u/s) and all vitals are normal. My blood sugar levels have been controlled well with diet and insulin except for a few times here and there. Any advice? I am already not happy with having to deliver my baby in the hospital, let alone with continuous monitoring, IV and everything else that comes with induction. Please help.
TIA April
 

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Quote:

Originally Posted by AustinAmber View Post
I had planned to give birth in a birth center but was risked-out at 30 weeks due to gestational diabetes. I like the OB/GYN that the midwives recommended except that he wants to induce at 39 weeks because of the baby's lungs not developing enough to support a possibly large baby. At 34 weeks the baby is average size (5.5 lbs. according to u/s) and all vitals are normal. My blood sugar levels have been controlled well with diet and insulin except for a few times here and there. Any advice? I am already not happy with having to deliver my baby in the hospital, let alone with continuous monitoring, IV and everything else that comes with induction. Please help.
TIA April
How could a baby's lungs at full term not be capable of supporting the rest of his body? I would think that the lungs would develop just as the rest of the body does. Many women have large babies just fine! Some 10 lbs. Especially those that go natural at home without the threat of being induced and intervened upon and most were just fine. I think in my own opinion that this is a rediculous excuse and that induction is a dangerous and painful activity from what I hear. But I'm not a midwife or a medical person and I'm not you so I can't tell you what to do.

What kind of help do you want? It sounds to me like you don't want all of these interventions and not wanting them to begin with can actually be a dangerous thing for you emotionally and physiologically and even physically according to some people. But what do I know? (If I were in your situation -which I kind of have been faced with the hospital and not being able to afford a midwife and not wanting to go to a birth center after doing research and thinking about my personal needs and needs of my family -Edited from saying "if I were you") I'd be delveing deeply and franticly into alot more info about natural birth and the pros and cons of interventions. I'd hang out in the UC forum alot and even the birth pro forum (which duh, on my part is where you posted without my realising it- but look here for posts on the subject.) and go check out midwifery today to read about what other midwifes say. There are lots of threads I've found here at MDC about gestational diabeties and there was a very educational article in one about how diabeties in pregancy is actually normal and healthy. Some women who have non pregancy diabetes even deliver at home have healthy babies! I've read those ones too! It is possible! One birth is something that you only go through one time, but it can shape your whole life and change your attitude about birth forever and it's important that you are wholey comfortable and come out of this whole and empowered about your experience.

You do have the right to decline any and every intervention that you do not want, which it sounds like you don't want all this stuff. It sounds like You wanted a birth center because you felt safe with that... Now because of their medically oriented rules that they have to operate by, you are being put in a situation where you have no choice but to UC or hospital or possibly find a home birthing midwife that is more willing to go with your wishes. Whatever you choose is up to you, but If I were you and I wanted help... I'd say read read and read some more and educate yourself on others opinions and experiences. Ask more specific questions about this condition they've diagnosed you with. Not just from mainstream medical practice but other sides and make your choice from there. I see now after typing most of my post that, It looks like you've made a good first step posting here asking other professionals their opinion. I'm not a professional but I have read everything I can get my browser on. Opinions and studies vary widely but I've found that the more open minded and less fear oriented and more evidence based the info is, then the more it makes sense. Alot of what the medwifes and medical community goes by is not nessecarily evidence-based, from another standpoint on birthing. So ultimately it is up to you what you want. Bottom line is, this is about you and your body and health in all aspects and what you feel is best for you and your baby. It's not about what rules others have to live by or what opinions and fears they've shaped for themselves.

I'm sorry I don't have the link to the article/study or whatever it was that I read, readily available, but do a search and I hope you'll find the thread with the question about how accurate the prenancy diabetes test is/isn't and why they are concerned about it to begin with and what interventions can be even worse than what the origional concern/fear is about that puts you into this situation of possibly getting the intervention in the first place. (in other words it can be a domino effect that just gets riskier and riskier in the opinions and experiences of others that I've studied) It makes me wonder why people can't just leave well enough alone and I wish you the best of luck and the most peaceful birth possible for you. If anything doesn't feel right, stick to your feelings and most importantly back them up with knowledge so that you have a small chance of being taken seriously... and Say NO NO NO as many times as you have to.
 

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do you have Gestational diabetes or diabetes -- there is a difference - and some diabetics are not found until they are pregnant- so there is overlap between GD and D-- the problem is that true diabetics have a higher incidence of still birth- it is not well understood why this happens--
talk to your doctor more about options to wait-- many doctors have a standard reaction and a flexible reaction depending on the mom.

not pregnancy related but an example from my life- I don't like alot of medical treatment and rarely see a doc and if I go it is for an OPINION not for someone to take over my health care--- so I went in and had a lump on my ankle looked at- (before I saw the doc they asked if I would see and intern for educational purposes) well the intern who is green and up for new experiences says to me well I think that we may have to do surgery!!! EEK no way and my doc comes in after a little bit of a conference between the 2 my doc proceeds to point out why it is a bad idea to do surgery and only if I was not confident in that concept would he go ahead and take the risk of surgery- now I could see how this could have gone down very differently if I were to say really do you think we should do that well what if you are wrong... and led them to believe that I was not deciding but leaving it up to them... well then a provider would have to be doubly sure of their dx and if he was wrong then I trusted him to decide -- it is all his fault, so he would be careful to avoid that judgment even if it is a bad idea to do the surgery.
with all that being said educate yourself about the ins and outs of DM and GD read alternative as well as straight med advice-
there are things that can help determine fetal well being like non-stress tests and kick counts...
 

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I've posted about this before, but I think it is sad women are risked out for GDM. I had the privilege (note sarcasm here) of experiencing GDM with my last pregnancy. I know some midwives don't believe the condition even exists or should be treated, but after having such a clear case of it myself, I beg to differ.

however, I found a great endo who started me on insulin. we had lots of discussions about the risks of homebirth, insulin, etc. and he really felt that homebirth wasn't not a problem if the GDM was well managed during the pregnancy. He also felt (and I agree) that insulin injections are better than using pills because the pills cross the placenta and are not well studied on pregnant women. But insulin is a hormone and can control the GDM very well. Of course, changing diet and exercise are essential. He felt that many of the problems caused during the labor and delivery stem from the fact that women are not allowed to eat/drink during the labor and are often put on an insulin drip. His advice to me was to stop insulin injections when I felt I was in labor and eat lots of simple carbs/easy to digest food throughout labor. And don't even bother testing the baby at birth, just nurse it right away! Of course if baby shows signs of hypoglycemia or won't nurse, then that would be the time for further action.

All of this is just my opinion and his, but I would not hestitate to take on a GDM woman for a homebirth. That's one of the disadvantages that birth center midwives have, is the protocols. And hospitals. My own doc told me that the only reason they did so much testing on GDM babies was because it is protocol and if something happens they will be held liable. Not because they feel that all GDM women and babies need that much screening.

Good luck!
 

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well, I don't agree with the GDM diagnosis and I definitely take issue with standard "treatments" improving "outcome" (large baby).

I'm sorry you're losing your birth center birth. The information you have been given is against the most current research and some of it, as has been pointed out, is actually totally incorrect.
 

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No, well-controlled diabetes, gestational or otherwise, is NOT a reason to induce early! I'm not going to get into the topic of whether or not a diabetic woman should be induced "post-dates", but inducing prior to due date is definitely not necessary assuming that your blood sugar has been well-controlled throughout the pregnancy. You start to see more negative outcomes with women whose blood sugar was not well-controlled for whatever reason -- that's when you see the large babies with poor lung development that your OB was talking about. (Although, whiskey tango foxtrot? How is inducing at 39 weeks going to lead to a baby with better-developed lungs than a baby that comes at 40 weeks? Failure to compute.)

As pps have mentioned, you can of course refuse to consent to anything. However, if you are interested in maintaining a halfway-decent relationship with your OB, then before going in with guns blazing, my recommendation would be to say, "I don't see any medical indications that induction at 39 weeks is justified in my case. My blood glucose control has been excellent." If you're not totally opposed to it, suggest that they do non-stress tests (NSTs) close to your due date to confirm that the baby is healthy and doing well. A lot of times, I think OBs will relax and back off a little bit with the induction talk if you're willing to put up with more monitoring in late-term pregnancy. Or you can simply say, "No, I'm not coming in for an induction at 39 weeks," of course, but I'm not your midwife or your OB so I'm unqualified to tell you if that's a smart idea in your particular case or not. All I can say is that standard induction at 39 weeks for no other reason than that the mother has diabetes is an outdated protocol and is totally unnecessary.

I have a high-risk perinatologist as my OB. I have never met anyone who is more knowledgeable about the topic of diabetes in pregnancy. And with my 2nd pregnancy, when I was not only diabetes prior to pregnancy, but was on insulin, and was a VBAC on top of that, he didn't even breathe a word about induction until my 39-week appointment, and that was only to say, "If you're still not looking favorable by next week at this time, we might need to discuss options." (I went into labor on my own at 39.5 weeks, so the issue became moot.)

Good luck to you whatever happens!
 

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I had GD when I was pg with DD and was told the opposite of what you are being told. From what I have read and was told by my OB, GD babies can run a higher risk of the lungs not being developed enough and she would never induce me before 40 weeks. I went into labor at 40.5 weeks, and DD's lungs were fine and she was 9lbs 2oz, which I might add is not big when compared with all the other babies in my family who were ALL 8.5 lbs and up. Yes, DD was the biggest so far, but only by a few ounces. And those great ultrasounds that estimate weight? Well I had over 10 in the last 2 months of my PG, and they were still wrong about DD's size. The day before I went into labor the u/s said 8 lbs. I doubt she gained that much in 1 day, and I have heard a lot of stories where the us said xx lbs and the baby was less weight, by a lot.

I think your OB is misguided and frankly, taking a baby too early for no other reason than possible size, could lead to a lot of problems that you don't need or want. You need to let that baby cook as long as possible to ensure the lungs ARE mature.

Just my 2 cents. Good luck!

Liz
 
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