GD/Labor induction: Anti-induction argument sources to bring to midwife?

dollypardon

Hey guys!

I'm a recent lurker on the high-risk board and participate mainly on the Dec 13 board.

I was diagnosed w/ mild GD that I've controlled with diet but am getting intense pressure from my midwife's (new) OB practice to induce before or my my due date. I know this is a common thing to bring up around here, but I was just dropping in to say that I found this summary that states that the WHO does NOT recommend induction for GD alone:

https://www.guideline.gov/content.aspx?id=39385

I was wondering: Does anyone else have links to scholarly articles that might be helpful to bring along to my next appointment? I'm not looking for political rants or blogs...more along the lines of articles in medical journals or government publications that are easy enough for a non-medical-professional to understand.

Thanks!

stephl3055

This article is a little lengthy, but I think it has some good information. 

https://evidencebasedbirth.com/does-gestational-diabetes-always-mean-a-big-baby-and-induction/

For what it's worth, I had GD and was induced at 40w5d, with LO being born at 40w6d.  LO was 8 pounds, 4 ounces and measured almost to the day in size everytime I had an u/s or my fundal height was measured.  My OB only mentioned once that LO seemed 'big' but even he guessed she would be about 7 pounds, 14 ounces a week before she was born.  I was diet controlled as well. 

earychener

I know you're looking for scholarly articles, but as a healthcare professional I will tell you they will be hard to find.  Even the source you cited says that the recommendation is "very-low quality evidence, weak recommendation".  That is actually the weakest recommendation they give (very-low, low, moderate, high). That means that even though they say if GD is the only complication they don't recommend induction before 41 weeks, it is a very weak recommendation.  Most OBGYN's won't follow guidelines based on very-low quality evidence.  Especially when GD (even when controlled) has shown to have complications with the placenta after term, and that in each individual's care you have to weigh benefits vs. risks.  At 38 and 39 weeks, risks are very low for inducing, so that is why most OB's practice that way.  Until the WHO has better evidence and a stronger recommendation, I don't think you'll find many OB's who will let you go past your due date with GD.  I'm controlled as well, and my OB is inducing me at 39 if I haven't had her before then, and I am perfectly fine with that, based on current research and evidence-based practice.  Good luck! Hope you find what you're looking for!

ETA:  sorry! I'm also from Dec '13.  I wanted to add, my OB was fine with letting me go to 40 weeks if I was diet controlled, but I had to start Metformin a few weeks ago.  Also, she would NOT induce me at 39 weeks if my cervix wasn't favorable for induction (she did not want to increase my chances of C-section).  She is a very conservative OB, in my opinion, and her C-section rate is very low.  She would, however induce with unfavorable conditions if medically necessary.  Just wanted to add this so you could get a sense that my OB is not just induction-happy. 

memo9

Just wanted to give some support: I was scheduled to be induced at 40w4d and I went into labor on that very day and birthed an 8lb 9oz baby with no complications.  I'm so, so glad that my OB didn't push for an earlier induction.  I was also diet controlled.