High-Risk Pregnancy

GD and birth experience

Okay, so I'm not the type to have a "birth plan" or anything, but I was really hoping to be able to have a natural delivery. No induction, no c-section, and no drugs.

A few months ago, my diabetes educator mentioned that I wouldn't be able to go past my due date without intervention because of the aging placenta. At the time it freaked me out, and I think I convinced myself that it wouldn't come to that.

Today I saw my OB and brought this up. He's great about answering my questions but he always waits for me to initiate the asking so this was the first mention of delivery with him. He definitely said I'd be looking at 39 weeks, induction or c-section, depending on how baby is measuring and positioned.

So unless I go into labor on my own before then, there's no way I'll get the birth experience I was hoping for. And I know that's still a possibility, but I know FTMs often go past their due dates. I'm trying to prepare myself for these very real possibilities, but I really hate it.

So I go to my sister for support. She's had 3 c-sections, tried for VBAC twice with no success. She's still very much against intervention, so she tried to convince me to fight it. I'm not fighting it. I know nobody can force me to go to the hospital at 39 weeks, but this is the health of my baby! Whatever organization might not recommend delivery at 39 weeks, but I'm a high risk case, and I trust my doctors.

What makes it worse is that BF is scheduled for back surgery next week, when I'll be 31w4d. He has a 6 week recovery period with serious restrictions, and that's cutting it close. If his recovery goes well, we should be okay, but I don't want him to overdo it so soon after surgery if I have to recover from a c-section. My mom should be able to help out as needed, but I want to keep her involvement at a minimum for a number of reasons. She's a very brittle type 1 diabetic and she's been having a lot of serious highs and lows lately. I just don't feel like I can completely trust her with my baby.

Anyways, I guess I'm just looking for some support, that everything will all be okay, and maybe some tips to help me come to terms with
my fate. I know it's not the end of the world, and the only important thing is the health of my baby, but it's still scary.
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Re: GD and birth experience

  • First, it's completely possible that you might still go into labor on your own-- I had my membranes stripped at my 39 week appointment, and it didn't seem to do much at the time, but I went into labor on my way in to be induced 24 hours later.  So don't rule that out, but don't count on it either.

    The thing you can focus on is that your doctor, your hospital and your LND nurses all have the same goal you do--a healthy baby and a healthy mom.  If they're kind people (and really, most health care practitioners I meet are), they'll also care about your happiness and try to take that into account, but it'll be secondary to your health.  Ask a lot of questions, ask about relative risks, and just make sure you understand WHY recommendations are being made.

    When I was diagnosed with GD, I changed my birth plan to "Whenever possible, tell me what you are about to do (or what you recommend we do), and WHY so that I have a chance to process that.  My first and primary desire is a healthy baby and I will do whatever I need to accomplish that, so if you give me an order with no explanation, I will assume it is an emergency and comply."  I trusted my nurses, so writing that out and committing to it helped me let go of my expectations.

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  • Its possible you may go into labor on your own - I went before 39 weeks (with charted pregnancies, so my EDD was accurate) both times. I did end up with Pitocin both times due to length of time that my membranes had been leaking.

    That said, doing a c-section at 39 weeks is not always for the baby's benefit, it's a medical malpractice suggestion to avoid risks that can ultimately lead to a lawsuit (I write medical malpractice insurance). If you're comfortable with your EDD and that being the gauge that's absolutely fine... but I would ask before committing to surgery that you do a NST/BPP once or twice during those final two weeks to see the actual health of your pregnancy and not a textbook guestimate.

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  • I'll be doing NSTs twice a week at that point.

    This pregnancy was unplanned, and while I was tracking my cycle on a calendar, I'm very irregular and I wasn't temping or anything to find the actual date of ovulation. I'm not 100% sold on my EDD. First dating ultrasound put it at 10/26, which matches up with one possible conception date. LMP date is 10/17, which the doctors are going by, but that matches up with another possible conception date +/- 1 day. Later ultrasounds put the due date closer to the 17th, even though baby was measuring in the 24th percentile at 24 weeks (based on the 17th as my EDD). I was initially trying to fight it, but we can't prove which one is correct, and so I'm comfortable with the earlier date. And my diabetes educator has been informing me about hormonal changes that can affect blood sugar and what weeks they occur, and I'm right on track with everything she's told me to expect.

    I'm hoping it all works out, and I'm trying not to freak out. Last night when I posted this, I was really freaking out and couldn't sleep. I told my doctor that I really want to avoid surgery, especially since BF will be recovering from surgery and won't be much help. So I'm hoping that next time we talk about it, we can work out a plan, maybe let me go to 40 weeks as long as everything still looks good.
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  • My doc is allowing me to go to 41 weeks pendimg babys health. I am attempting vbac and want to go all natural. Induction isnt an option for me. Maybe see if they will do a gentle indiction, foley bulb and half pitocin. It may reduce your need for an epidural

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  • I asked my obgyn about delivery possibilities at my appointment Monday, and she said that as long as:

    1) baby stays on track growth wise and isn't getting HUGE from the GD
    2) my sugars are still controlled by diet and exercise
    3) insulin/other GD meds are not being used
    4) everything else about the pregnancy is going fine (fluid levels, baby's HR, etc etc etc)

    that she has no problems letting me go until Baby decides to get here.  In general, they don't let anyone go longer than 2 weeks past their EDD because the placenta starts to not function as well/provides less nutrients to baby.  I haven't heard anything about placenta degeneration in regards to GD and needing to be induced at or before 39 weeks...my docs said that getting baby out by 39 weeks is the "standard of care" for treating GD but that is a GUIDELINE formed mainly to account for GD making most babies a bit hefty and thus making natural birth more difficult, not a hard and fast proven medical fact. There can be variation among different people.  If everything is going fine with your pregnancy for you and baby there's no reason why you can't push back a bit and tell your doc you want to do it all au natural and wait for the LO to get here on its own schedule.  

    But seeing as how I'm not an MD, this is all just my 2 cents :)
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  • Are you diet controlled? I am controlling very well with diet and I am due today. No sign of babe yet. The OB co-managing me with my midwife, has said he sees no issue allowing me to go until 41 weeks. I will have an NST today to make sure everything still looks good. I know ultrasounds can be off based on baby's weight, but at 36 weeks I had one and baby measured at 6.6. Fluid levels were fine and my numbers are still great. I would seriously not want to be induced that soon if everything looks good!!

     

  • I asked my obgyn about delivery possibilities at my appointment Monday, and she said that as long as:

    1) baby stays on track growth wise and isn't getting HUGE from the GD
    2) my sugars are still controlled by diet and exercise
    3) insulin/other GD meds are not being used
    4) everything else about the pregnancy is going fine (fluid levels, baby's HR, etc etc etc)

    that she has no problems letting me go until Baby decides to get here.  In general, they don't let anyone go longer than 2 weeks past their EDD because the placenta starts to not function as well/provides less nutrients to baby.  I haven't heard anything about placenta degeneration in regards to GD and needing to be induced at or before 39 weeks...my docs said that getting baby out by 39 weeks is the "standard of care" for treating GD but that is a GUIDELINE formed mainly to account for GD making most babies a bit hefty and thus making natural birth more difficult, not a hard and fast proven medical fact. There can be variation among different people.  If everything is going fine with your pregnancy for you and baby there's no reason why you can't push back a bit and tell your doc you want to do it all au natural and wait for the LO to get here on its own schedule.  

    But seeing as how I'm not an MD, this is all just my 2 cents :)

    I am right on track with the 4 things you listed for delivery possibilities and due today! Would you consider going until 42 weeks or do you think its risky? I am crossing my fingers that LO comes by next week but having a hard time thinking about going to 42 weeks even if things look okay. Just wondered what your plan is!

     

  • I am on a low dose of insulin (14 NPH) at bedtime, and diet controlled the rest of the day. My OB did mention that things were different for insulin-dependent moms as far as the aging placenta and also mentioned a higher risk of still birth. 

    I go to the perinatal office for sugar checks every 2-3 weeks, and I know I'll start NSTs pretty soon. At my next appointment, I'm going to discuss this with the nurse. I haven't actually seen a doctor there except for my first appointment and my a/s. 

    My OB said that we'd start monitoring fluid level and baby's size, but he seemed pretty set on the 39 week mark. 

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  • I am Type 2 Diabetic and on Insulin since 8 weeks.  The AMA standard for diabetics is to deliver at 39 weeks.  I will be induced or a planned c-section no later than 39 weeks.  However, they are monitoring me heavily the last trimester.  I am on weekly appointments (with NST) until 34 weeks and then 2x a week for NST and BPP.  Plus I see an MFM again at 36 weeks.

    Your doctor advising induction or c-section at 39 weeks seems to be the standard of care for most medicine controlled diabetics.  I would ask for more information regarding their outline of care for the remainder of your pregnancy.  My dr gave me the outline of what they do and the additional appointment information early on so I knew what to expect.

    And I know it stinks to not have your "ideal" birth plan, but we need to be flexible for our health and baby's health.
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