I am almost 31 weeks pregnant, and it's going well so far. The baby was about 3 lbs according to the last ultrasound check 6 days ago. My OB talked about the delivery process and mentioned that she would schedule the induction (just in case) on the 38th week. Isn't it too early for a diabetic who doesn't have any complications or issues with pregnancy so far?! I am very concerned about the whole situation, since I don't think my OB had dealt with too many women with type 1 diabetes (mostly gestational diabetes), which makes me a bit nervous.
I went to my endo today and shared my concerns with her. She (being type 1 herself and having two healthy kids) said that there is no reason for me to have induction if there are no issues (baby size or anything else) closer to the due date, and that induction at 38 weeks could be just too early. She said that I need to push back and be able to stand my ground.
Another concern I have is 'who will be controlling my blood sugar levels during the labor'? If it's just a nurse, would she know enough about diabetes in general? Sometimes I get the feeling that nurses at the OB office have no idea what type 1 diabetes is. At one of the appointments one nurse even asked me to do the glucose test by giving me a bottle with sugar water... and even after I told her that I have type 1 diabetes, she was not too concerned...
Unfortunately, I can't just go to a different doctor, since this is the provider covered by my insurance.
Did you have any similar experience with your OB? Do you have any advise on how to deal with such a situation and when to say 'no' to certain procedures?
Is this really the only OB covered by your insurance? Even if you go to the next town or something? I'd be pretty concerned too, especially about them wanting to give me a glucose tolerance test! (Um, no, crazy nurse, I'm not going to tolerate that very well...)
After careful monitoring of my baby throughout the pregnancy, especially her size these last 6 weeks or so, my OB is letting me go to my due date but not beyond. So I have an induction scheduled for next Thursday, but we're both hoping I'll go into labor on my own before then. Very early in the pregnancy, I asked him if he routinely scheduled T1 diabetics at 38 weeks, and he looked at me funny and said, "it isn't 1970."
I am 34 weeks now. When I first went in to see my OB and later the perinatologist the both said that they would prefer an induction before the due date.
My diabetes and thyroid have been tightly controlled. Right now the baby is breech and my OB is suggesting a C-section at 38.5 weeks if needed. If the baby flips he will look at an induction at a similar time frame, however, he said that conditions had to be favorable. If I was not thinning and effaced then he would let me go into my 39th week and induce closer to 39.5 weeks. He is pretty flexible, just does not want me going past my due date.
I will be running the plan past the Peri on thursday and see what he thinks.
My endo has privileges at the hospital I am delivering at and she said often they will allow patients to wear their pump and self monitor their sugars. We will be discussing this in greater depth this coming monday.
Oh, P.S. all I've been told so far re managing my BGs during L&D is that I *do* get to wear my pump, and just to turn the basal down to 50%. They said they'd tell me more soon... not that there's much time left! (That induction next Thursday is the day before my EDD.)
They get a little blasé sometimes. I occasionally want to shake my OB and say, "yeah, YOU'VE done this 20 bazillion times, but *I* haven't!!!
Initially, my doctor didn't want me to go past 38 weeks, either. Because I had some ovarian cysts, it was a planned c-section from the beginning. However, my A1c was under 5.3 for the majority of my pregnancy, and if it wouldn't have been for slightly elevated blood pressure at my 38 week appointment, I probably would have pushed for a full 40 weeks. So, I had a scheduled c-section at 39 weeks exactly. IF you're healthy, I would push for as long is healthy for both you and your baby.
In terms of managing my diabetes during delivery, I had proven throughout my pregnancy that I was in tight control, so I pretty much insisted on managing my blood sugars during the c-section. It's such a short procedure, and my husband was there to test me every 10 minutes or so, and there was IV glucose at the ready in case I needed it. My biggest concern was being put in IV insulin because I KNEW my standards for control would be different than the hospital's, and I really, really wanted to be in charge of eating what and when I wanted, rather than some nurse telling me what to do. Frankly, this was my biggest fear prior to delivery.
The doctors and nurses were all great about me being in control. All I had to do was test frequently and write down my readings so that the nurses could chart them and my doc could help recommend postpartum dosing given the fact that I was breastfeeding.
Pretty much, stand for what you want and make them justify WHY their way is better, and whether it is a firm policy or simply "procedure"...
My doctor said he wouldn't let me go past my due date, but I ended up having to be induced at 37 weeks... I'd just talk to your OB about why you are uncomfortable with the early induction. Do you have a sense already of how your OB reacts to saying "no"? I know mine was part of a practice that was very aware of communicating what they thought was best in a way where you could still have a choice unless there was an emergency...
I do know that I was also concerned regarding someone else taking care of my blood sugars, but the nurses had a strict format for dosing out insulin once I was on an insulin drip and my blood sugars were fantastic. Plus, the nurses at the OB office were not at all like the labor/delivery nurses who are dealing with birthing babies 24/7 and not the office life...
Thanks a lot ladies for for sharing your experience! I seriously started to consider managing my own BS levels during labor (with my husband's help). I'm just not sure how capable I will be during the process when trying to concentrate on giving birth. I definitely don't want the nurses to overdose me with insulin. I don't wear pump simply for the reason that it did not work for me after trying it for six months before I got pregnant. It completely messed up my numbers at that time, so I came back to multiple shots and have no regrets. I do wear Dexcom which has been really helpful, and I am planning to use it during the labor as well.
Now I am gathering information and support from my endo to be ready to say "no" to unreasonable suggestions from my OB. I will be asking for the reasoning she has behind her decisions. I am just getting really scared about induction and possible c-section. Really hope to be able to avoid it.
I also wonder how accurate due dates usually are... :)
I am sure I can find another OB in another hospital, but don't think it would be a good idea at the moment. I would have to check other doctors, who may turn out to be the same. I have only two months left, and I would rather try to avoid stress as much as possible and concentrate on keeping my BS levels normal.
I like the comment your doctor made. It made me laugh :) I hope you will go into labor on your own before next Thursday. Good luck!
Oh I can so relate to having pressure from my OB and Peri to deliver early! Despite having extraordinary control throughout the entire pregnancy, my docs wanted me to be induced at 38-39 weeks. My peri actually said "If you were my daughter, I would want you to be holding your baby by 39 weeks." Okay... Ultimately, after combing medical journals and agonizing over the timing of things, my husband and I decided that we felt comfortable waiting until 40 weeks or possibly later before induction. There was just frustratingly little evidence that pregnancies in well-controlled diabetes stand a significantly greater risk of complications after 39 weeks. Ultimately I had to stand my ground and be clear with my doctors what we wanted to do and not do. They couldn't force me to do anything I didn't feel comfortable doing. Fortunately I went into spontaneous labor at 39 weeks exactly and delivered a perfectly healthy son by vaginal delivery.
Regarding managing blood sugars during delivery, I decided that I did not feel comfortable having random hospital staff controlling things. I worked with my husband to establish game plans for various scenarios (For example, "If dexcom and finger stick say that I'm 80 and dropping, pour 1/2 glass of lemonade" etc...) and also worked with him to practice testing my blood sugar and using both my cgm and pump. This ended up working out great. Between myself and my husband, we were able to keep my sugars comfortably in the 100-120 range throughout. My highest number hit right before pushing, and I think it was 154. In the end I trusted myself and my hubby more than unknown nurses. It was a good call. Best of luck to you!! Trust yourself and stick to your guns!
Hi Ana, I'm glad that you posted this topic. I've been agonizing over being induced early, too. My OB wanted to induce me at 38 weeks, but my Peri is recommending 39 weeks now because of my good control. As long as there are no problems with me or the baby, I plan on fighting for 40 weeks. It's very stressful, though, feeling like there is no one on my side.
My old OB for my last pregnancy was willing to let me go to 40+ weeks without being induced, so it seems like my current docs just have a different opinion. And it makes me worried that they'll be more likely to do a C-section, too. Like Lauren said, I also have not found any medical journals that have done any studies on well controlled diabetics...so their opion doesn't really seem to have a medical basis.
For my last pregnancy, my OB encouraged me to wear my pump and it turned out perfectly. I should have done a temp basal at a ~30% lower rate, though because I did end up having to eat something due to my BS dropping. This time, I definitely will fight to wear my pump because I don't think the nurses would be able to do as good a job as me (and my husband as my backup).
They are planning to induce me between the 36th and 38th week because they have had issues with diabetic mommas going longer and their placenta was breaking down, causing big issues and stillbirths.
Sometimes I also feel that there is really no one to support me except my husband. I do have a great endocrinologist though who is very supportive, and every time I have an appointment with her, it's very encouraging. I also talk with my previous OB [I moved away and no longer visit her, but can always give her a call :)] and she said that diabetes itself is not considered a complication, and there is no reason to use any medical procedures if everything is going well. She also mentioned that it's very important to let your body do what it needs to do if there is no harm to the mother or baby of course. During my last OB visit I expressed my concern again about the induction at 38th week, and my doctor seemed to be more understanding and is willing to wait and cooperate as long as everything stays within the norm. It was a huge relief. I am just very scared of any unnecessary procedures since they may lead to further procedures and even a C-section (which can be avoided). My husband and I are now thinking about getting a doula who has experience with diabetic mothers.
Also, I heard from many women that wearing a pump during labor is very helpful (as LAK mentioned as well), and I think, no one should discourage or prevent wearing a pump during labor.
It sounds like, between your husband, your endo, and your former OB, you actually have a pretty good support system! I am definitely of the mindset that, if it ain't broke, don't fix it! Unless your doctors see some reason to intervene (low fluid levels, pre-eclampsia, evidence of placenta breakdown, etc...) then there is no reason to do anything. Your body will, in all likelihood, do exactly what it was designed to do. Also, for what it's worth, we had a doula, and she was fantastic!! A huge support and advocate. Oh, and wearing a pump during labor/delivery is a no-brainer (unless of course you don't want to wear it, which is totally fine too.) If you want to wear it, then do! No one knows your diabetes like you do, and you are really the best person to manage those blood sugars at that critical time.It was very easy to wear. I stressed about how exactly I would wear it in the hospital (in an arm band? In some kind of pocket?) Turns out I ended up just staying connected and setting it next to me on the hospital bed. No problem at all.
Sarah-- my doctors had the same concern, but they agreed to closer monitoring and keeping the little one inside as long as possible. The non-stress tests and the ultrasounds will show if the baby is in stress. I was going every other day, then every day in the last week and we were able to complete week 38.
That said, I was SOOO focused on making it to week 40 because I thought of that as "success" (and because my mother had her babies in week 42!). When we had our c-section one day after completing week 38, our little guy was completely ready to come out! He had meconium in the amniotic fluid, no vernix left on his skin, and seemed ready for the big world!
My OB allowed me to self monitor and I typed up a plan in case of c-section where I wasn't able to self monitor on what to do. We knew ahead of time there might be a chance of a crash c-section so he let me decide what I wanted to do. My daughter was born at 36 weeks due to water breaking early. She was 4.5 lbs. My Ob didn't even bother to schedule a c-section he was willing to let me go until she was ready to come out. He didn't feel there was no need to do an early induction or a c-section since I was under tight control already. He even allowed me to tell him what I wanted on hand iv wise concerning diabetes and told me that my diabetes care was totally in my hands.
Your little guy is sooooo adorable by the way. If I wasn’t at work in uniform I’d totally play with him and pinch his adorable cheeks. He’s such a flirt! Lol
I go for another anatomy scan and the fetal echocardiogram tomorrow morning… That may determine how closely I’m watched and how soon it all starts.
I had my little girl in July of 2010, and I was told by my obgyn that they were going to induce me right at the 38 week mark. I too wanted to wait and hoped that I would deliver naturally as I really didn't want to be induced. The reason they wanted to do it at 38 weeks is because they say a diabetics placenta can dry up. However, I don;t wuite get that if you are in stable condition, I had nothing wrong with me, no high blood pressure, no high sugars, no low sugars, in fact pregnancy only made my diabetes better and I'm not sure if it's because I was extra cautious or what???? I did not feel like a diabetic when I was pregnant, and i really wanted to be treated like a woman without a condition! The had had my induction date set for July 30th and I went to get checked out on the 26th just to see if I had dialated. The OB had ensured me that I would not be delivering anytime soon and that I would be getting induced on the 30th....well boy was she wrong! My water ended up breaking 12 hours later, but unfortunately the way I was positioned to help relieve the labour pains, I was causing stress on my little girl and was told I should have a c-section. I was ok with it because I was in pain and at that point I just wanted to get her out! During the c-section, I kept my insulin pump on and monitored it myself...they never even checked my sugars the entire 4 days I was there which I thought was kind of weird but at the same time I liked it that way! In the end, I had a little girl who was born at 37 1/2 weeks! She nursed and took the bottle immediately which was a bonus for me, and she is now a healthy almost 2 year old!
I say go with your gut because it's always right and don't do anything you don't want to do!!! You could even try natural ways of going into labour so you dont end up getting induced.
Good luck and please make sure to let me know how everything goes...if you have any other questions, please ask :)
I'm 31 1/2 weeks and the baby is measuring about 5lbs now so we are keeping an eye on it. My BG's are great and my A 1C is 5.5 so we shall see.... Do you see a high risk OB? Mine is wonderful and very helpful!
You will have to ask the hospital you are birthing at about who will be controlling your BG's.They will keep an eye on it of course but sometimes they will let you keep your pump on and other times you have to be put on an insulin drip. You can always check your own BG's though.
It's your body and your bbay and you can say no to anything you don't feel comfortable with.Ask lots of questions and write a birth plan.
Congrats by the way!!!
Thank you for sharing your experience. It's very helpful to know other peoples' stories. It's strange though that they never even checked your blood sugars. Was it something you talked about with your doctor before?
Thank you Angela! I'm not sure if my OB is considered a high risk OB or not, but she does act like one :) My endo is the most helpful person. She said she would look into the hospital protocol and let me know about what their strategy for controlling BS is, and then will help me with birth plan as well.
I am not on the pump. I just did not like it. I used Omnipod for 6 months when I was thinking about trying to get pregnant, but it just did not work out, which pushed my trying to conceive further. I got back to my injections, brought my A1C down again, and felt much better about not using a pump.
So here we are :)
Got my A1C checked this week, and it's 5.1. The lowest I've ever had! During the last ultrasound, they said that my baby is measuring just according to a textbook (neither smaller or bigger), which is a good thing, I believe :)
Congratulations to you to! Please keep us posted how everything goes.
