GD ladies - Induction question

Sarafuss · May 2011

Has your OB discussed your options?

I haven't talked with my OB about this yet but I'm afraid he will want to induce. Is there a certain protocol your doctor usually follows for GD patients? Just curious! TIA!

heie0008 · May 2011

My OB wants to induce at 39 weeks, I know some people have mentioned that their OBs induce earlier at around 38 weeks.

flows912 · May 2011

If I was diet controlled, my OB was going to let me go until 41 weeks before inducing. Since I'm on insulin, they won't let me pass 40 weeks.

Sondra614 · May 2011

I may have misunderstood my OB, but I thought she mentioned that the meds used for induction are not safe for GD patients, so we scheduled a repeat c-section for 39W1D. However, she gave me the all clear to try for a VBAC if I go into labor on my own before that date. So, as for the induction vs. c-section part, I'm not entirely clear, but she definitely said that GD patients are rarely allowed to go beyond 39 weeks with frequent monitoring to avoid potentially dangerous complications, but some doctors prefer to go even earlier.

Sarafuss · May 2011

Sondra614:
I may have misunderstood my OB, but I thought she mentioned that the meds used for induction are not safe for GD patients, so we scheduled a repeat c-section for 39W1D. However, she gave me the all clear to try for a VBAC if I go into labor on my own before that date. So, as for the induction vs. c-section part, I'm not entirely clear, but she definitely said that GD patients are rarely allowed to go beyond 39 weeks with frequent monitoring to avoid potentially dangerous complications, but some doctors prefer to go even earlier.

Thanks for the info! I'm interested to see what my OB says next week. Did your OB say what the complications might be? Is it just because of the size of the baby? Or something else? I'm not sure how my LO is measuring (I'll have a growth u/s at 36 weeks) but if he's measuring okay I would like to avoid induction/c-section if I can.

memali26 · May 2011

Sondra614:
I may have misunderstood my OB, but I thought she mentioned that the meds used for induction are not safe for GD patients,

GD patients are induced all the time. I'm not sure why the drugs used would be any less safe for a GD induction than any other induction. Could she have said/meant that induction isn't safe for someone who might VBAC, like you said you might? I have heard that before, but never that it's unsafe for GD.

memali26 · May 2011

Sarafuss:

Did your OB say what the complications might be? Is it just because of the size of the baby? Or something else?

Complications from GD can include a larger than average baby (though if you are well controlled, your baby shouldn't get huge); early break down of the placenta, causing the baby to not get vital nutrients; blood sugar issues in baby at birth; and very, very rarely, fetal demise if the pregnancy continues too long once the placenta begins to break down. For those reasons most drs don't like to let GD moms go past due date.

My OB with my first pregnancy induced diet controlled patients at 40 weeks, if they hadn't delivered on their own before that, and insulin controlled patients at 39 weeks. I was insulin controlled, induced at 38w6d. DD was born at 39w2 days, 6 lbs 11 oz and perfectly healthy.

My current OB would prefer to let me go into labor naturally if I'm diet controlled. He said he'd probably strip my membranes around 38 weeks to attempt to get things going. Now that I am on insulin, he wants to wait and see how things go. If I can stay on the very low dose I am currently on, he may let me go as late as 40 weeks before inducing; if we have to increase my insulin (which I am almost 100% we will as I am only 21 weeks) then we'll re-evaluate and probably induce at 39 weeks.

Neither of my OB's would jump right to c-section based on size of the baby unless there were other factors that would lead them to believe I couldn't deliver vaginally.

Mrs.N.H. · May 2011

memali26:
Sarafuss:

Did your OB say what the complications might be? Is it just because of the size of the baby? Or something else?

Complications from GD can include a larger than average baby (though if you are well controlled, your baby shouldn't get huge); early break down of the placenta, causing the baby to not get vital nutrients; blood sugar issues in baby at birth; and very, very rarely, fetal demise if the pregnancy continues too long once the placenta begins to break down. For those reasons most drs don't like to let GD moms go past due date.

My OB induces diet controlled patients at 40 weeks, if they hadn't delivered on their own before that, and insulin controlled patients at 39 weeks.

This!

I'm on Glyburide (1/2 pill at bedtime) and I will be induced at 39 weeks.

tawillers · May 2011

Because I'm a vbac hopeful I will not be induced. My doctor has agreed to let me get to my due date, but doesn't want me to go past it. If LO doesn't come by then, I'll have an RCS.

ermaderma · May 2011

I haven't talked with my OB yet, but I did ask the physician assistant at my last appointment. They will start talking inductions in my 39th week if i am favorable. They won't let me go more than a few days past my due date. Also, they have a cut-off for C-sections. If baby is measuring 9lbs. 12 oz or more, they will automatically schedule me for a c-section. I am hoping to at least make it to my due date.

She did not say if there was different protocol if I am diet controlled vs. taking meds. I plan on discussing it with the doctor at my next visit on June 1.

pixiegirl131415 · May 2011

My doc won't let me go past my due date for sure, but whether I am induced early or not will depend on how I and the baby are doing. They've started BPP and Non-Stress tests every week from here on out, since I was put on glyburide. I may still end up on insulin. They're going to monitor size and the placenta very, very closely. There is still too much unknown at this point to say yes or no to an early induction.

5de5 · May 2011

My OB advised against inducing for me because of the meds and where I was as far as diluation/effacement etc. The policy at the hospital was that once the induction started I wouldn't be able to eat which could cause sugar trouble and my OB felt it would be more likely that then the baby would start having issues and I'd need an emergency c/s. Maybe that's what the PP's ob meant by the induction meds not being safe?
I had a schedule c/s due in part to this reason. If I had been diet controlled I would have been allowed to go to 41 weeks, but was only allowed to 40 if on medication

pixiegirl131415 · May 2011

5de5:

My OB advised against inducing for me because of the meds and where I was as far as diluation/effacement etc. The policy at the hospital was that once the induction started I wouldn't be able to eat which could cause sugar trouble and my OB felt it would be more likely that then the baby would start having issues and I'd need an emergency c/s. Maybe that's what the PP's ob meant by the induction meds not being safe?
I had a schedule c/s due in part to this reason. If I had been diet controlled I would have been allowed to go to 41 weeks, but was only allowed to 40 if on medication

At my hospital, they can compensate for this with an IV, though they do allow you to eat some also, not just ice chips.

memali26 · May 2011

5de5:
My OB advised against inducing for me because of the meds and where I was as far as diluation/effacement etc. The policy at the hospital was that once the induction started I wouldn't be able to eat which could cause sugar trouble and my OB felt it would be more likely that then the baby would start having issues and I'd need an emergency c/s. Maybe that's what the PP's ob meant by the induction meds not being safe?
I had a schedule c/s due in part to this reason. If I had been diet controlled I would have been allowed to go to 41 weeks, but was only allowed to 40 if on medication

With my induction, I wasn't allowed to eat as long as the meds were in place. I needed two rounds of cervidil before pitocin did anything, so before they placed the second round they turned off the pit and let me have dinner. Once the cervidil was in place and/or pit running, they had me on both a glucose drip and an insulin drip and checked my blood sugar every 1-2 hours to adjust them as needed. I'm delivering at a different hospital this time, but I'm going to request this two drips again because it worked out really well last time and my BS stayed stable for the most part.

Cali1012 · May 2011

I am currently diet controlled and working with CNMs at a birth center. Pending NSTs (which I start next week), they said I could go to my due date, and possibly to 40w3d, but not longer than that, otherwise I will be induced or have a scheduled c-section, depending upon my cervix/baby's position at that point.

Sarafuss · May 2011

Thanks for all of the info ladies! I'm interested to see what my OB's position is on this.

ohfour · May 2011

All I know is when I got the diagnosis, my OB said "you can't go past your due date". I go for a growth u/s in 2 weeks. If baby is measuring normal, then we start NSTs at 36weeks, if measuring big or very small, we start right away. I don't see how she can say I can't go past my due date without any monitoring of the baby yet. My GD is diet and exercise controlled right now. It's not even worth arguing about right now because I will not agree to induction unless there is a medical reason for it. She already has my due date 9 days early, because I was charting and know when I conceived and she's going by LMP since I didn't have an early ultrasound. Anyway, I will absolutely refuse anything before 40 weeks, for sure, unless there's a problem with me or the baby. My friend just had a scheduled 39 week c-section and her LO has been in the NICU for 2 weeks, was 4lbs 4oz, no sucking reflex, low blood sugar, etc. They are now saying they thing she wasn't that far along because baby was not mature. Things like this scare me.

Sondra614 · May 2011

Like I said -I may have misunderstood what my doctor said, but my impression was that induction was not an option because of potential reaction to the drugs. -She did tell me that size is a concern for GD, but that u/s monitoring makes it relatively easy to determine if the baby is too big to deliver vaginally. If baby is not exceedingly huge, she is pro vbac as long as labor occurs naturaly. However, she said that I (I thought she was referring to GD patients in general, but maybe not) cannot be induced and I thought her reason had to do with the drugs. The reason could be specific to me though, and I'm just the ass who assumed too much My doctor was out of town when DD was born via c/s (very long story!) after my GD ultrasound indicated that my amniotic fluid levels were slightly low at 37 weeks. The hospital where the c/s was performed never notified my doctor, and there are lots of gaps in my records (no stress tests performed, no second opinions, and no reason listed other than "fluid levels slightly lower than expected) She did mention that it was very odd that my fluid levels were low, since one concern with GD is that fluid levels can be too high, so maybe that has something to do with it.

I'll defintely ask for clarification when I see her next week, since the GD/induction meds concern doesn't seem to be the general rule from what many of you have said.

Anyway, to OP: it's scary to think about the possibility of having to be induced or undergo a c-section, but whether you go naturally or require medical intervention, you'll get through it. I think many of us plan our ideal birth scenario, and feel like failures if it doesn't turn out to be the way we'd imagined. Definitely be pro-active in your care and ask questions (I wish I would have stood up for myself and asked more questions when DD was born, but I was a scared first-time mom and just did what I was told), but try not to stress out about the what-ifs or take it personally if things just don't happen the way you've always pictured.

I have no experience with induction, but my worst fear was having to have a c/s (the only other operation I've had in my life was having my wisdom teeth removed, and I was completely knocked out for that, lol!). Despite the lack of information about what was happening and why, the actual procedure and recovery were a walk in the park compared to what I had imagined they would be. I did not feel a thing during, and had very little pain (just some tenderness at the incision site) after the operation. DD was perfectly healthy, besides a very mild case of jaundice and at the end of the day, it didn't matter how she got there -just that she was there

Wow, sorry for the long post!

memali26 · May 2011

Sondra614:
Like I said -I may have misunderstood what my doctor said, but my impression was that induction was not an option because of potential reaction to the drugs. -She did tell me that size is a concern for GD, but that u/s monitoring makes it relatively easy to determine if the baby is too big to deliver vaginally. If baby is not exceedingly huge, she is pro vbac as long as labor occurs naturaly. However, she said that I (I thought she was referring to GD patients in general, but maybe not) cannot be induced and I thought her reason had to do with the drugs. The reason could be specific to me though, and I'm just the ass who assumed too much My doctor was out of town when DD was born via c/s (very long story!) after my GD ultrasound indicated that my amniotic fluid levels were slightly low at 37 weeks. The hospital where the c/s was performed never notified my doctor, and there are lots of gaps in my records (no stress tests performed, no second opinions, and no reason listed other than "fluid levels slightly lower than expected) She did mention that it was very odd that my fluid levels were low, since one concern with GD is that fluid levels can be too high, so maybe that has something to do with it.

I'll defintely ask for clarification when I see her next week, since the GD/induction meds concern doesn't seem to be the general rule from what many of you have said.

I hope my post didn't sound rude or like I thought you were crazy or anything! I was just really surprised to hear that a dr might feel induction wasn't safe for GD moms since so many GD moms are induced, myself included. That's why I asked if maybe it was due to you being a vbac hopeful (good luck, BTW!!). Let us know what your dr says, I'm curious. And going to see if there's anything left on google about GD inductions I didn't read before my first induction, LOL.

Sondra614 · May 2011

Your post wasn't rude at all -I'm glad you said something! I don't know anybody else IRL who's had GD, and have only recently started spending a lot of time reading on the boards, so I didn't know induction was common and was just going based on my experience. Now I'm armed with another question for when I go in on Thurs. morning and will report back

I'm definitely trying to be more pro-active this time around so that I don't feel as helpless when the time comes, but there are so many details and so many doctors do things differently that it's hard to stay on top of every little thing!

o2bme · May 2011

I was had diet controlled GD and my dr induced me at 39w 6d. She does not like her GD patients to go past the due date. Now if I was on insulin then she would have induced earlier. My baby was 8 pounds 7 ounces so he was an average baby. Don't let people scare you with the huge baby thing. Even with GD you can have average size babies.

memali26 · May 2011

Sondra614:
Your post wasn't rude at all -I'm glad you said something! I don't know anybody else IRL who's had GD, and have only recently started spending a lot of time reading on the boards, so I didn't know induction was common and was just going based on my experience. Now I'm armed with another question for when I go in on Thurs. morning and will report back I'm definitely trying to be more pro-active this time around so that I don't feel as helpless when the time comes, but there are so many details and so many doctors do things differently that it's hard to stay on top of every little thing!

Okay, good, it's just so hard to read tone on the boards so I wanted to be sure I hadn't offended you And I completely agree that there is so much to stay on top of - it can be so overwhelming! As much as the GD sucks, it's really taught me to be the advocate in my care. My dr's are probably sick of me coming at them with so many questions after all my research :P

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