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Discussion Starter · #1 ·
Hey there, I need some advice with any information you guys can give me related to VBACing. The complicating factor is that my SIL is diabetic (type 1). With her son (who is now 4) she was induced at 39 weeks with cervadil and pitocin, had an epidural, got to 10cm and he didn't descend fully after pushing for 1.5 hours for whatever reason... they decided to do the c/s. He was a very big baby though, at 9.5 lbs, but from the way she's built (tall, classic hourglass figure, etc.) I would think she could easily deliver a decent sized baby with the right support. After her ob performed the u/s, she mentioned that my SIL has an adaquate pelvis for an average child and I want to help her believe that pushing in a more ideal position she can birth an even larger child...

The main concern of mine is the induction. She would like to go as natural as possible this time, but she's worried about having to be induced at 39 weeks again if she hasn't gone into labour by that time. I know it's not a good idea to induce for a "big baby" but given the fact that her son was already 9.5lbs at 39 weeks?

Also, does anyone have any statistics regarding diabetic mothers (especially type 1) and the dangers of going to term and beyond for the baby (I've read there's increased risk of calcification of the placenta among other things, but I want to know exactly what sort of risk).

She's not worried about the VBAC part of it... and since I'm training for my VBAC in May I already have tons of info on that. It's the diabetes we need some help with...

Thanks for anything you can give me!
 

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Unfortunately, I believe that a lot of the research governing management protocols for diabetic pregnant women is outdated and comes from a time when glucose management during pregnancy was not nearly as good, on average, as it is today. However, I did turn up this journal abstract, which may be of some help. (The full article, as far as I can tell, isn't available online, or at least not for free, but you can probably score a copy at a medical library or through Medscape).

Quote:
J Matern Fetal Neonatal Med. 2002; 12(6):438-41 (ISSN: 1476-7058)

Sacks DA; Sacks A
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Kaiser Foundation Hospital, Bellflower, California 90706, USA.

Reasons for inducing labor at term in pregnancies complicated by diabetes include the avoidance of fetal demise and the prevention of excessive fetal growth and its concomitant conditions, shoulder dystocia and Cesarean delivery. Objectively evaluating the risks and benefits of labor induction is potentially confounded by the status of the cervix at the time of initiation of induction, early determination of an arrest disorder and physician bias toward Cesarean delivery for women who have diabetes. In non-diabetic women, incorporating estimates of fetal weight in deciding the route of delivery has not diminished the incidence of shoulder dystocia, and may have increased the incidence of Cesarean deliveries. Currently available evidence suggests that, while induction of labor for women who have diabetes may not carry much maternal or fetal risk, the benefit of this procedure is unclear.
 

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Quote:

Originally Posted by mum2James&Bean View Post
It's the diabetes we need some help with...

Thanks for anything you can give me!
California has a program called "Sweet Success". Goggling it should get you lots of info! Hope that helps and good luck to both of you!
 

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Discussion Starter · #4 ·
Hmmm... so I guess by the lack of interest in this thread that maybe no one has an opinion on this huh? That really sucks
I guess you guys probably don't deal with a lot of high risk patients, so I can understand not having a lot of info on this. Gonna bump anyway just in case someone sees this who didn't notice earlier!

Thanks Jan & Feminist~mama!
 

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Got your PM

I don't have a lot of good info on Type 1 diabetics. You might try ~pi - she has posted quite a bit about her pregnancy and birth as a type 1 and has done a lot of research.
Type 1 does carry more risk, but as JanB mentions, many studies were done before tight glucose control as is used now and it is hard to know how to interpret them now.
 
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