May 2013 Moms

Induction at 37 weeks.

I saw my new OB team today. (Had to change since we moved to California.) They said they will be inducing me at 37 weeks because I'm diabetic. I asked if they would consider my current health, etc., and then decide. They said nope, if you're diabetic, we induce at 37 weeks.

It's a military hospital, so it's all about policy.

I am going to fight this like the dickens. Unless I actually need it of course! But my A1C is PERFECT. Like, better than most non-diabetics. So if my baby isn't growing too fast at the end, and my placenta is healthy, I don't want to be induced for no reason other than a check in the box saying I'm diabetic. I'm working diligently and successfully to keep my diabetes under strict control, and I think that should be considered. If the baby's not too big, I think the benefits of avoiding early induction outweigh the risks.

Anyone else being told they'll be induced early no matter what?

I am scared to make the leap to what military insurance calls 'Standard', which is more like regular insurance and you pay copays to see civilians. But I think I'm going to to start calling around and seeing if I can find a civilian OB with a different attitude towards diabetic pregnancies. 

**ETA. He also made some really ignorant comments about diabetes, which makes me think he pre-judges, and doesn't actually think about the patient as an individual. :/ That does not make me happy at all. 

 

Re: Induction at 37 weeks.

  • Holy cow!  My best friend is Type I, with a pump, great control and has had two babies.  She was not induced with either, just monitored very closely and more frequent baby size checks toward the end.  She ended up delivery voth 2-3 weeks early, but was not induced at all.  Granted this is a single situation, but she is a physician and did lots of research on diabetic pregnancies and said that induction is NOT standard practice.  GL trying to resolve your insurance/doc situation.  
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  • image hogrefea:
    Holy cow!  My best friend is Type I, with a pump, great control and has had two babies.  She was not induced with either, just monitored very closely and more frequent baby size checks toward the end.  She ended up delivery voth 2-3 weeks early, but was not induced at all.  Granted this is a single situation, but she is a physician and did lots of research on diabetic pregnancies and said that induction is NOT standard practice.  GL trying to resolve your insurance/doc situation.  

    Do you think she might have some resources she could share? I'd like to educate myself as much as possible so I can really stand my ground with knowledge and confidence. I'm on a pump, too, and my numbers have never been better. My endo says I should have zero complications due to diabetes if I maintain this level throughout. The OB just doesn't seem to care how well controlled I am.

    My sister is a Type 1 as well, and all 3 of hers were scheduled inductions because of size, but she went into labor on her own beforehand with all three.

  • YGPM!  :-)  
    image kmcd23:

    image hogrefea:
    Holy cow!  My best friend is Type I, with a pump, great control and has had two babies.  She was not induced with either, just monitored very closely and more frequent baby size checks toward the end.  She ended up delivery voth 2-3 weeks early, but was not induced at all.  Granted this is a single situation, but she is a physician and did lots of research on diabetic pregnancies and said that induction is NOT standard practice.  GL trying to resolve your insurance/doc situation.  

    Do you think she might have some resources she could share? I'd like to educate myself as much as possible so I can really stand my ground with knowledge and confidence. I'm on a pump, too, and my numbers have never been better. My endo says I should have zero complications due to diabetes if I maintain this level throughout. The OB just doesn't seem to care how well controlled I am.

    My sister is a Type 1 as well, and all 3 of hers were scheduled inductions because of size, but she went into labor on her own beforehand with all three.

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  • image hogrefea:
    YGPM!  :-)  
    image kmcd23:

    image hogrefea:
    Holy cow!  My best friend is Type I, with a pump, great control and has had two babies.  She was not induced with either, just monitored very closely and more frequent baby size checks toward the end.  She ended up delivery voth 2-3 weeks early, but was not induced at all.  Granted this is a single situation, but she is a physician and did lots of research on diabetic pregnancies and said that induction is NOT standard practice.  GL trying to resolve your insurance/doc situation.  

    Do you think she might have some resources she could share? I'd like to educate myself as much as possible so I can really stand my ground with knowledge and confidence. I'm on a pump, too, and my numbers have never been better. My endo says I should have zero complications due to diabetes if I maintain this level throughout. The OB just doesn't seem to care how well controlled I am.

    My sister is a Type 1 as well, and all 3 of hers were scheduled inductions because of size, but she went into labor on her own beforehand with all three.

    Thank you! :) 

  • image LexiLupin:

    I have heard some great things about Standard, I would at least check out the area resources first. But I would probably double check with Tricare before doing much research and getting my hopes up in case they're jerkfaces about switching so late, no clue how that works.


     

    That's a good idea - I can call them too. I also need to learn about the copays. I'm not sure how it will affect my insulin pump supplies, etc. Thanks! 

  • I had gestational diabetes and even developed high blood pressure at the end (not pre-e though) and was always told 39 weeks would be the earliest.  37 seems really early unless there's an absolute need to get the baby out. 
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  • At the hospital in Hawaii, I saw a rotating team of OB's, and I would ask the same questions over and over to make sure I got consistent answers. I'm not sure if this hospital will work the same way. I'm definitely going to keep addressing it. I'm hoping the next doctor is a different one, and see if they answer differently.

    They can't MAKE me, right? I just want to make the best choice at the right time based on my and baby's actual state of health, not an overreaching policy.  

  • image LexiLupin:
    image kmcd23:

    At the hospital in Hawaii, I saw a rotating team of OB's, and I would ask the same questions over and over to make sure I got consistent answers. I'm not sure if this hospital will work the same way. I'm definitely going to keep addressing it. I'm hoping the next doctor is a different one, and see if they answer differently.

    They can't MAKE me, right? I just want to make the best choice at the right time based on my and baby's actual state of health, not an overreaching policy.  

    Ah. Did you discuss this issue with the OBs in Hawaii? It seems odd that it would only just now be coming up if it is, in fact, a strictly standard policy across the board for military hospitals. And if it isn't, I feel like you should be able to get around it provided everything still looks good at 37+w.

    They can't make you show up for an induction of course, but I don't know if Tricare will continue to cover your care if you go against advice and all that.

    If you haven't been over there yet, there might be someone with comparable experience on the Military Families board.

    Every time I asked questions about the 2nd half of pregnancy in Hawaii, they would tell me to wait and ask after our PCS since they knew I was moving, and switching from an Army hospital to a Navy hospital.

    I'm going to go XP over on that board. Thanks! 

  • I will also be induced at 37 weeks, due to a classic "top to bottom" cut on my uterus from my last c-section which puts me at high risk of uterine rupture.  My son was 9 lbs. 12 oz (22") and the OB wanted to give herself enough room to get him out without potentially damaging my other organs.  Since I thought my DS was my last child, I didn't really care back then how the uterus incision was made.

    Fast forward 12 years, and I now have a surprise pregnancy!  Everyone I've seen has said I need a repeat c-section because of the incision, so a VBAC is out of the question.  I did have my DD vaginally prior to my son.

    The OB will be doing an amnio on the day I am 37 weeks to insure LOs lungs are mature, and will then do the c-section.  They also did this before they took my son at 38 weeks.  (No, I didn't have diabetes, or gestational diabetes either).  I know that is standard practice if you are taking a baby that far in advance.  37 weeks is technically considered full-term, and that is why they won't stop a naturally occuring labor at that point.  However, inducing you if you are planning a vaginal delivery has a higher chance of causing you to need a c-section.

    I agree with PP that you should try to get more opinions....I'm just telling you my situation so you know you are not alone!  Multiple doctors have told me that with the classic incision, both LO and I could be at risk if my uterus ruptures, and if this baby is anywhere near the size of DS it will put a lot of strain on that scar.

    At the end of the day, a healthy LO and mom are the top priority so I would do whatever the majority of doctors you can ask would recommend.

     Good luck!  

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    AMA: 43 DH: 49 DD: 07/09/98 - 15 years
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  • I think you're smart to look around for another doctor.  Also, they can't actually do anything w/o you OKing it.  The big issue would be whether your insurance would still cover it if you go against "doctor's orders".  Could you call them and ask?
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  • I wont go past 37 weeks but im having twins.
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  • My sister has diabetes (on a pump, etc.).  They were actually worried when they thought she was going to have the baby early (at about 36 weeks).  They were really worried about the babies lung development at that point.  She ended up having the baby at 37 weeks...on her own.  There was no size issue at all...my niece was only 6 lbs. 

    I think you are so smart to question this "policy."  My sister was going to a high-risk doctor who really knew what he was doing.  Is that an option for you?  It's good you found this out so early so that you can really educate yourself and figure out what your best game plan is.  Good Luck!

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  • I am very surprised that an OB would have this attitude.  I think that you should definitely seek a second opinion.  I understand taking a baby because early because they would thrive better outside than inside, but purposefully yanking a child out just because of diabetes can lead to issues.  37 weeks is only a few days from being considered premature.  And, while 37 weekers normally do not have too many issues they can spend some time in the NICU catching up.  That creates unnecessary stress on the baby and mother, along with accruing unnecessary financial burden.  Ask for another doctor.   
  • I'm also Tricare and have done standard in the past.  We switched back to Prime because we have pretty decent care in our area and we were sick of unforeseen copays.  I would think at this point there is still a lot of time to plead your case, and again my prior experience has been that you see a different provider most times you go in.  If not, you can always request to schedule with someone else at the clinic and see what their policy is.  I believe the ACOG now considers "full term" 39 weeks, (they say 37-39 weeks is "early term"), so you could always use that to your advantage.  I am having twins and was told 38 weeks is the latest they will let me go (at a Naval hospital).
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  • image surpriseaddition:
     37 weeks is technically considered full-term, and that is why they won't stop a naturally occuring labor at that point.  However, inducing you if you are planning a vaginal delivery has a higher chance of causing you to need a c-section.

    They're trying to change this though with new research from 37 weeks to 39 weeks.  There has been a lot of new research lately that shows it's more like 39 weeks until full term rather than 37 and they would call 37-39 weeks early term or something like that.

    OP I would definitely try getting another opinion.  If you truly have a medical need to deliver early that is one thing but simply having it happen because of hospital policy is not okay IMO. 

      
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  • I saw your post on MF and wanted to jump in here to make sure you saw it.

    Call the hospital and ask to speak with the patient advocate. Plead your case and tell them you were not satisified with the way the doctor treated you.  Also find out if its actually a policy throughout the hospital or if it can be done on a case by case basis. Are there any other OBs that you will rotate through?

    You can also call Tricare and tell them you are unhappy with the quality of care on post and request a referral off post. It may not always work but it is worth a try and then if not consider switching to standard.

    GL and I HTH! If you have more questions I pop over onto MF but I'm on June 2013 mostly.

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    CJ 05/29/2013

  • I am in the Military and i was talking to a girl i work with the other day and she had a story very simular to yours. She was at a military hospital and she was 36 weeks when they said her blood BP was  high and they were going to induce her the following day, needless to say she had told them that she had just ate a big meal right before she took the BP test and she thought that was why her BP was high. Long story short she told them she didnt want to be induced just because they had one test that said her BP was high and is otherwise healthy. they even went as far as to send in a Capt in to intimidate her into letting them induce her. She still refused to let them induce her, two weeks later she had a healthy little boy w/o being induced.

     

     

  • image LexiLupin:

    I have heard some great things about Standard, I would at least check out the area resources first. But I would probably double check with Tricare before doing much research and getting my hopes up in case they're jerkfaces about switching so late, no clue how that works.


    Military OBs nearly killed my dear SIL during/after her last pregnancy (she now has a permanent blood clot running from her calf to just inches under her heart) because they used checked boxes instead of their brains. She switched to Standard and got much better appropriate care. She is now in a surprise pregnancy with doctors under Standard and is doing so much better. Her plan of care moving forward is so much better and goes through 6 months post-partum, instead of just 6 weeks.

    Do your research, including contacting the practices that you would want to use under Standard, but don't let fear of the unknown stop you from switching if you think you'll get better care.

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