XP - GD/possible c-section or induction — The Bump
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XP - GD/possible c-section or induction

I'm due January 2nd. I got put on insulin a couple weeks ago. My OB stated that since I am on insulin, it changes things. I have to have a bpp/nst every Wednesday and the first bpp results were great, except baby is measuring large.

They said baby is 5-12. Greater than 90th percentile? Dr. said she knows these can be way off, but if baby continues to measure large, she would advise a scheduled c-section if measurements say she's over 9 pounds because of risk of shoulder dystocia. She also said that I can't go over 39 weeks. So, I guess I'd be induced? I'm so upset about this. I don't want a traumatic birth experience, but I didn't want there to be this much medical intervention.

My whole family has over-9-pounders. There is no history of gestational diabetes with any of the women I'm speaking of. My mother, my husband's mother, my sister-in-law, my cousins...

Does anyone have GD delivery experiences to share? Is there no way I can wait 'til after 39 weeks to deliver? I've heard induction before baby is ready to come out usually fails and ends with surgery. And I just plain old don't want a c-section.

P.S. Should I bother bringing up the fact that I ovulated late? She didn't seem to care when I first saw her, but now it's a matter of days. I was keeping track of my cycles and I got a positive reading for an LH surge 22 days into my cycle.

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Re: XP - GD/possible c-section or induction

  • Chicsub had GD with her second baby, and had a successful vaginal birth. She posts here sometimes, but is also on the VBAC board, too. I think hers was diet-controlled, but I always thought that if your GD is controlled, vaginal birth is okay? I don't know a lot about GD protocol, though...

    C-section isn't recommended for suspected macrosomia (only if the baby is suspected of being more than 11 pounds). Would you be willing to talk to a different doctor, or even switch? You have a right to refuse the c-section if you want. hth and good luck!

    DS1 - Feb 2008

    DS2 - Oct 2010 (my VBAC baby!)

  • I had GD but was not on insulin.  My water broke 3.5 weeks early. I went through a complete induction and pushed for 2.5 hours.  My son was not coming down enough and was face up so my doctor suggested a c-section and since I was exhausted, I agreed.  I don't see why you couldn't try for a vaginal birth unless your doctor thinks you baby is just too big for that. I think the most important thing is making sure your baby is delivered safely.  I'm sure your doctor has your best interest in mind.

    Also, I had a growth ultrasound 5 days before he was born and they said he was over 7.5 lbs.  So I went into the delivery thinking he was going to be big.  He was a good size for being early(6 lbs 11 oz) but not even close to what the ultrasound said.  There is a lot of room for error on those.  Good luck with your delivery!!

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  • There is a difference when it comes to GD and insulin is one of them.  Usually you see a lot of docs talking induction/big baby for ALL GD patients regardless of how it is managed, which is one of my biggest pet peeves after going through GD and learning more about it. 

    Anyways, there are more risks when you are on insulin and that has to do with your placenta breaking down faster for one.  The other factor is that if the baby's size is being affected by GD and not just genetics, the risk of shoulder dystocia is higher b/c of the distribution of weight in the shoulders and abdomen.  My DD was measuring ahead at one point, but it was her noggin that was 4 weeks ahead and skewed the overall measurements.  When she was born her head was 45th percentile, so obviously that was off anyways.  My midwife did say that late growth u/s are less accurate, so that's a tough position for both you and the doc.  FWIW, my DD was 8 lb. 11 oz., but was proportionate, so they don't attribute her size to GD (probably similar to the bigger babies in your family).

    It's hard b/c there isn't too much info out there on GD or even TypeI/II diabetes in pregnancy out there so many doctors/midwives just base their treatment on old data.

    Here is a site that I referenced a lot and found it to be more thorough than anything else I had found.  I researched it a lot b/c I was going for a VBAC and knew that GD would be yet another hurdle.

     http://www.plus-size-pregnancy.org/gd/gdinsulin.htm#Timing of Delivery

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  • Also keep in mind that another factor that your OB might be considering is how long you struggled to keep your blood sugars under control prior to going on insulin.

    Like PP said, there are other factors beyond just the size of the baby. Whatever decision you make, good luck to you and baby.

     

     

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  • I had GD and took insulin. I ended with a c-section delivery, but only bc I have had a c-section before and they cannot induce vaginally if you've had a c-section before.

     

    The magic cut off date was 38 weeks. At 38 weeks, I had a semi planned c-section. Really, had I gone in labor before 38 weeks, we would have tried a vaginal.

     

    What I find people fail to tell you is that not all babies from GD mothers are big. Mine was smaller than average. At 38.5 weeks, she was 6.7 pounds. I was always measuring a few weeks behind and their weight estimations were bang on at birth. This is believed to be caused by decreased blood flow secondary to GD. I was also on that ridiculous diet and only gained ~17 pounds during the pregnancy.

     

    Near the end, I was losing weight and the insulin management was getting really complicated. It kept increasing and I really struggled with maintaining therapeutic blood sugar levels, despite the diet and weight loss. My insulin intake almost tripled what it was in the beginning, by 38 weeks.

     

    They did not induce me due to the size of my baby but bc of the insulin management that was getting too difficult to stay on top of.

     

    Nothing wrong with questioning the doctor and getting a second opinion, though. 

    Mer Bleu Geneva

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  • I had GD with both my babies and both were c/s.

    My 1st was diet controlled and I still had to do weekly nst's.  He measured at 8.5 lbs.  I went into labor on my own at 38 wks, 6 days.  After being in active labor for 18 hrs and never progressing past 6 cm, his head got stuck in my cervix and I started to swell up.  It was clear he wasn't going to come out so I had a c/s.  He was 9 lbs, 8 oz.

    With my 2nd I wanted to attempt a VBAC; however I had GD again and this time I had to be put on insulin injections.  They were estimating her to be around 9 lbs.  I ultimately decided for a RCS because I was scared that if she was too big I wouldn't be able to deliver her and she would get stuck (just like DS) and I didn't want to go through that again.  She was 8 lbs, 3 oz. 

    The moral to the story:  Everyone is different and every pregnancy is different.  It could go either way and there is no way to know for sure.  I probably could have VBAC'd my DD because she was smaller than they predicted but I didn't know.  I will say I had a much more pleasant birthing experiance with my scheduled RCS than I did with my 1st.  Ultimately I am happy with the decision I made and it was still a very positive experience.  I am of the opinion that when it comes to having a baby you should err on the side of caution. 

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