3rd Trimester

Induce or not?

I read the other post about BP below, and maybe I can get some more opinions about my situation and whether you think it would compel you to agree with induction.  

The doctors got worried I had pre-e at 25 weeks because I had elevated protein.  That went down and the doctor said it was probably just a bladder infection.  I've had marginally high bp the whole pregnancy (although it was never high before that), which is usually about 130/84 in the office but more like 117/75 at home.  

They next said I had g.d., although the results were marginal and I probably wouldn't have been diagnosed in some practices.  Since then, I monitor my blood sugar at home and it is never even slightly elevated beyond what is average for a non g.d patient and I can't get it to elevate even if I drink soda and orange juice and eat white rice.  They say fine, but you're probably still just controlling it with diet and better to say you have g.d. than that you don't. The baby measures in the 74th percentile, my weight gain is slightly below average, and there is no other reason to suspect g.d.

The high risk OB wants to induce at 39 weeks, and says better that than to risk having a stillborn.  I certainly don't want to put my baby at risk, but I'm not convinced my blood pressure is high enough or my g.d. real enough to merit induction.  It seems they're over-careful, and although that's great when it means extra watchful monitoring, when those results aren't compelling, why not assume induction is not necessary?  On the flip side, is induction so bad?  It's my first pregnancy, so I don't know if it's worth a battle. 

Re: Induce or not?

  • Why are you seeing a high risk OB?  Can we get a little background please?
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  • I went to the high risk person when they diagnosed pre-e.  She said, no, you absolutely do not have pre-e, but we'll induce anyway at 39 weeks b/c of your marginally high bp.  After that, I didn't see her, but now I will because they think I have g.d.

     I am 34 and had pretty terrible morning sickness for the first 2 trimesters, but overall they always have said things were fine and it was a completely uncomplicated pregnancy until the scary 25 week appt where they found the elevated protein.

  • So they want to induce because they think you have pre-e or gd, but cant prove it?  That all sounds fishy to me.  I would want to talk to a different ob and get a second opinion. 
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  • I had to be induced around 39weeks with DD1 due to hypertension.  I went with what my doctor thought was in the best interest of myself and my baby.  I personally followed their medical expertise.  but i agree if they haven't had this stance the whole time and you want peace of mind, get a second opinion. GL.
  • image cowgirltu:
    So they want to induce because they think you have pre-e or gd, but cant prove it?  That all sounds fishy to me.  I would want to talk to a different ob and get a second opinion. 
    Yeah, I don't think I can really say a clear yes or no on this.  It seems like you don't have enough info to make a good choice on this.  Either get clarification from the OB, or get a second opinion from a different doctor. 
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  • I would ask them to show you the medical literature supporting induction for someone with your BPs/sugars. While I would certainly want to defer to their expertise if it was evidence based, I would want some reassurance that they had a solid reason for their recommendations.
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  • image cowgirltu:
    So they want to induce because they think you have pre-e or gd, but cant prove it?  That all sounds fishy to me.  I would want to talk to a different ob and get a second opinion. 

    It's more like they're just like, "if you fail the 3 hr g.d. test based on our criteria, you have g.d. and we induce g.d. patients" and "if you have marginally high bp, it's always safer to induce."  I guess it makes sense to have rules, but it just seems like it would be better to try to consider more data and make a case by case judgement, and it seems like they don't really do that.  Unfortunately, they are widely regarded as the best OB office in town, so I'm not sure if there is a place to get another opinion. 

  • So, have you not taken the 3 hour glucose tolerance test yet?
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  • Yes, I took the 3 hour test.  The hospital sent me the results and said I passed.  Then the OB office called and said I failed because their criteria are lower.  It was definitely borderline and not great, but I thought they should test me again or decide what to diagnose/how to respond based on by daily blood sugar monitoring, but they seem to say, if you fail according to our criteria, you have it no matter what happens the rest of the pregnancy.
  • Is your BP always that elevated when you see your OB?  Have you ever had readings where the top number was 140+ and/or the bottom number is 90+?  You don't have to have pre-e for BP to be a concern during pregnancy.  PIH(pregnancy induced hypertension) can be bad enough on its own.  I think you need more information before making a decision regarding this.

    With regards to the GD, you kind of have to go with what your office categorizes as GD.  I know some offices say under 140 is good, while others say under 130. You can't really make one doctor's office use the standards of another.

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  • My bp at the OB office is always around 130/80, and it has never been over 140 or over 90, except at the first appt where it was 159/80, but I was nervous, and when she took it again, it was back to the 130/80 range.  What information about this should I look for?  

    I know they have their rules about diagnosing g.d., but when results are borderline I think they should look at your blood sugars, baby's growth, and perhaps a few more office measures before deciding if you have g.d. that merits changing the way they treat your labor. 

  • I probably would go with what your doctor recommends.  Since you saw your regular OB and the high risk OB and it sounds like they both agree on the induction of 39 weeks, I would count the fact that you saw 2 doctors on this as your "2nd opinion".  You are right though that it sounds like they recommend this for everyone with BP on the higher side and not on a case by case basis.  I would just ask them to explain more about why this is their recommendation. 
  • I was induced with my first baby right at 40 weeks and ended up having to have a c-section after 14 hours due to failure to progress. As it turns out the baby was turned and would not drop or engage, my OB said that I probably wouldn't have been able to deliver him. That said I wonder if I had not been induced if I would have been able to have a vaginally delivery. That said it it came down to a question of the baby's health, I would say to err on the side of caution. I had a good c-section experience, but then I have nothing to compare it to.

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  • Well ACOG doesn't recommend induction for GD at all. And my BPs are exactly like yours. In the office I'm high b/c I'm stressed but at home I'm perfectly ok. Hypertension can also be completely separate from pre-e. I've had this discussion with my high risk OB. She monitors my BP and checks it again at the end of the appointment and it's always on its way back down. As long as it doesn't get ridiculously high and/or I don't have protein she knows she's gonna have to present some cold hard facts and evidence based research to convince me to induce. Especially since I'm now doing weekly NST so unless those become "bad"...

    ETA: ACOG doesn't recommend if their reasoning is for big baby. Haven't done the research on GD alone. But I don't see why they'd just indue for GD especially if you and baby are fine. 


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  • image sthomas1222:

    Well ACOG doesn't recommend induction for GD at all. And my BPs are exactly like yours. In the office I'm high b/c I'm stressed but at home I'm perfectly ok. Hypertension can also be completely separate from pre-e. I've had this discussion with my high risk OB. She monitors my BP and checks it again at the end of the appointment and it's always on its way back down. As long as it doesn't get ridiculously high and/or I don't have protein she knows she's gonna have to present some cold hard facts and evidence based research to convince me to induce. Especially since I'm now doing weekly NST so unless those become "bad"...

    ETA: ACOG doesn't recommend if their reasoning is for big baby. Haven't done the research on GD alone. But I don't see why they'd just indue for GD especially if you and baby are fine. 

    From my understanding, inducing for GD is not really about having a big baby, but more about GD causing the placenta to break down faster than normal.

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  • Sit down with your medical team and ask them to explain your case to you.

    It sounds like you now have two doctors, discussing two diagnosis and recommending possible induction. You can come online and ask opinions, but the truth is that we don't have the whole picture that your physicians do...and every patient is different (so even if someone's BP is "just like yours" it doesn't mean anything).

    Doctors don't know that you don't understand what is happening unless you say so. It sounds like you have many questions outside of induction (you are still questioning your GD diagnosis) that need to be explained first. Your health care provider's job is to explain to you things in a way that you understand and can follow. Just saying something is "their protocol" means nothing....why and what evidence prompted this protocol to be enacted? 

    It can be hard during an appointment for patients to sort through their thoughts (I know that sometimes I forget to ask things once the doctor is actually in the room), so I recommend that you bring a notebook to your appointment with your questions and concerns written on them. Also bring your DH or someone else with you who can help ask for further clarification as well.  

    I hope that you are able to sit down with your OB and get a better understanding of what is going on. 

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  • Yeah, I do have a list, but I do need more clarification.  I was very happy early in the pregnancy with how they treated me, but now it seems like questioning does not get the response I want.  Maybe part of the problem is that they rotate you through doctors and everyone seems to have a different level of concern about these issues.  I had rib pain, and one doctor said it was just a muscle and not to worry and the next sent me for a gallbladder scan, put me on two prescriptions, and sent me to a specialist.  I once went and told the desk as well as the nurse I had had an ultrasound the last week so I was sure I wasn't supposed to have one again.  They were all just like, no, you are.  Then the ultrasound tech was like, what, last week? when I said we'd gotten a better view of her face the last week.  Then when I finally saw the doctor and said I didn't know if I should have had one, she was like, it was fine...  When the nurse called and said they were diagnosing me with g.d., I said that I already had a pretty specific diet due to morning sickness and non-pregnancy gastro issues and wanted to talk to the doctor about the diagnosis, and she said, no, just talk to the dietitian, who will work with your "lifestyle" (which was irritating, since it's not like I choose to be allergic to fat or sick every day).  Then when I did talk to my doctor, she said I did not have to meet with the dietitian because my blood sugar numbers were fine.  When I try to get more specific about reasons for things, they're just like, we just want the best outcomes for your baby.  I don't think they usually take the time to look at all the data, and although I'm used to that in some situations, it is not so satisfying in this case.
  • I was a scheduled CS at 39 weeks, since my brother was big, and my mom's OB said the only reason babies get big is because of GD.  My mom NEVER had a high blood sugar reading, but her OB still diagnosed her as GD.  (Wouldn't you know it, my due date was right around Thanksgiving.)  

    I'd say no, unless they can give you a more compelling reason.  

  • Have you heard of the term white coat hypertension? Many people have an elevated BP reading while at a doctor's office because of stress or anxiety around the appointment.

    From your lower readings at home you might have it. Talk to your doc about it.

    I have it and always take some time to relax before getting my BP checked. Easy to do with the longer midwife appts. Maybe not as easy to do at shorter and more stressful OB appts.

  • I have blood pressure issues and my doctors office isnt letting me go past 37 weeks. They would have induced me on Monday if I hadn't refused and asked for a second opinion.(have a appt with a specialist on Friday) Mind you my blood pressures have been 140s/90s consistently but ever ultrasound check they have done on the baby has come back normal. She hasn't been affected by the high blood pressure. I told them that I want to make it to atleast 35 weeks before they induce which is next friday. So they put me on strict bed rest and hourly bp monitoring at home. I would definitely request a second opinion if you feel like they are just trying to induce to induce..
  • I feel like this is a decision better made by you and your medical team, not you and a message board full of strangers.
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