How hands-on is/was your Endo during labor?

Diabetes and Pregnancy Trying to Get Pregnant
#1

First, a little back-story.

I love my Endo. Not in a creepy way, but in that in the 20+ years of living with D I have finally found a doctor I feel I can be open and honest with and who sees me as a person and not just a bunch of bg numbers. (Plus a ton of other reasons, but I don’t want to gush too much!) She’s been such a huge support during my entire pregnancy, encouraging, correcting, but not nagging and not always pointing to worst-case scenarios. She’s not all rainbows and glitter all the time, but we’ve got a great relationship going. And I’ve been doing really well with my management. Especially considering this is a suprise pregnancy and I my a1c was above 7 when I first found out.

But, she’s not asociated with the hospital I’ll be giving birth at, or with my MFM clinic.
This is a choice I made when I first found out I was pregnant and I made it for two reasons. First, if I stayed with her hospital/group I’d be transferred to their MFM and not allowed to work directly with her until after giving birth (their policy). Second, the hospital she’s with is downtown Chicago - great for appts during work, not so much for driving from the northern suburb I live in while in labor.
So I actively made the decision knowing she wouldn’t be able to join me at the hospital when time comes.

But I also really like the MFM group I chose. There is a rotation of about 7 Drs and they and their staff have all been wonderful and supportive as well. They’ve let me work with my Endo on the diabetes side and don’t try and over-ride her. I’ve been lucky with this and excited about the upcoming birth of my son because of all of this.

Until yesterday.

The hospital has a policy that I meet their Endo at least once before birth so she’s familiar with me and my needs once the time comes for baby to enter this world. Ok, Great!
We set up a meeting that I believe is supposed to be me getting to know her and vice-versa, we’ll talk about what the labor options are, where I’m at with my management, etc. I’m not told to bring anything specific to the appt and go in optimistic.
It was horrible.
She had the nurse take my pump, meter and cgm from me to download numbers before I was even in an exam room. Then she couldn’t download and asked me to write-out my bgs for her. Ok, fine.
Then the appt finally starts (an hour late!) and she’s all about the bg numbers, the old-fashioned questions (you’re only wearing flip-flops because of swollen feet, right? . . uh, right. . . .) and I totally felt like a little kid being quizzed. Nothing was mentioned about me personally, nothing was asked about how my actual pregnancy is going - and she has access to all the charts! - in fact she asked about family history and stuff that is in my chart. Basic first-time patient stuff. Ok, I get she probably needs a lot of this, but once we got through that, she starts needling me about individual bgs on the 7 or so days I had a chance to write out. And making me feel bad for the few highs with no mention of the three days of great numbers. Plus this is all the testing side and nothing from my cgm. Of course my tests show more of the extremes, besides meals/snacks that’s when I test! My cgm shows how my over-all trends are in great range for long stretches . . . .Sorry, I’m venting a little.
After this she finally gets around to anything pregnancy-related by giving me all the worst-case scenarios. Even the ones from bad management in the first trimester. I’m 34 weeks! Even if I had horrible control then (which I didn’t) what good does stressing me out about it now do? Better yet, when she got to the chances of complications to the baby now and during/after labor, she kept telling me he could be “fat”. Not “big” like everyone else says. But FAT. And she said it a few times. Even going into risks of him being Fat when he’s 6,7,8 years old. (BTW, so far he’s measured right on for his age. No issure from the OB side of him being big AT ALL!) She did say this is more likely with extreme highs, which I have had NONE, but she felt the need to use this scare tactic, why?

At long last, she wrapped up by TELLING me she was going to manage my insulin with my pump during labor. Which I’m totally fine with. Even better if my husband and I are able to do it ourselves and I can labor at home for a bit (fingers crossed!). But then she doesn’t feel my basal rates are correct (based on . . . ???) and wants me to do basal rate testing to check them. Ok, it’s always good to make sure things are on track, but really? You want a 34 week pregnant lady to go without food for 12 hours? And why does she get to decide if my basals are right or not? I’ve been working with my endo on this for months. They may need adjusting, but why does she get to make that decision?
ARGHHH!!!
(My husband was with me and later said he wanted to punch her a few times during the appt. Gotta love him.)

Ok, venting part over, now for the question.
How much hands-on time does the Endo have during actual labor? I’m starting to stress about the thought of having her in the room the whole time. Until now, I’ve been pretty comfortable with the general idea of labor. Even being in a hospital surrounded by staff and machines, etc. Now, I’m just freaking a little that there will be a person I actively do not want there.
Any advice?

(PS - I do realize that everyone has their own style of diabetes management and some may very much like what I’ve said about the MFM Endo. I appreciate this and to each their own. She does not have the style that I choose to follow and this is a very sensitive time for me to have to deal with it.)

#2

My ob let me handle everything myself. My a1c was good enough he felt like that an endo couldn’t get better control than what I had. So I told them what I wanted in the labor and delivery on hand and I told them how to handle blood sugar issues that arose. For the most part, he let me do what I wanted to do. They did monitor my daughter after she was born but because my blood sugar levels stayed steady during her delivery, she didn’t have any problems.

#3

Yikes! I haven’t gotten that far yet, but this definitely gives me some questions to ask my OB and endo at my next appointments. My endo is located at another hospital from where I’ll deliver (and in a completely different organization), so I don’t think they’ll be able to be there at all for labor/delivery. But I didn’t even think they’d need to be - I’m still new to all this, I guess.

#4

Wow…I so can relate to this. I actually chuckled while reading this…only because I’ve had similar problems with my Endo and past Endo’s.

I’m only 29 weeks, and so far my Endo assures me that I and hubby will be managing the diabetes with the cgm/pump/meter. We shall see. I would love to hear the true side of course.

#5

Wow, I am so sorry that you had this experience! That Endo sounds impossible and I am so happy that your husband was there and was so supportive!

My Endo had nothing to do with my labor (it wasn’t even brought up for an endo to be there) and my ob was comfortable with my husband and I handling my BG levels throughout labor. My pump was connected for most of the time and either disconnected or suspended (I really can’t remember!) for the active labor, which was unfortunately in my case, prolonged.

Best of luck to you! I know it is hard, but put all your focus on you and your baby. Try not to let her negative energy affect your delivery!!!

#6

Thank you all for your responses. And for getting through my long post!
I think I need to have a conversation with the OBs. Maybe I can retain most of the control of my diabetes during labor. They did just say it was a new policy that I had to meet with her. . .
Deep breaths!

#7

My ob was the same way. My a1c was in the 5’s me entire pregnancy, he said that an endo couldn’t get any tighter control than i already had so he wrote on my chart when i was admitted due to water breaking early, that I was to make all diabetic decisions, I could eat what I wanted and if I requested something due to diabetes they were to give it to me without checking with the ob on call. I kept my cgms on during labor and monitored my own sugar through that and he asked me what to have on hand iv wise.

#8

Ugh. How frustrating!!

I have a great working relationship with my endo as well (and could go on and on about how great she is) and she is also at a different hospital, but my OB-GYN totally trusted my endo and me to manage my blood sugars throughout the pregnancy. She always just asked if everything was OK. My OB-GYN specializes in working with diabetics – so she could have given more advice, but didn’t see the need since all was OK.

My endo does not come during labor, but told me in advance how and when to adjust my basals. Since I had a c-section, I do not know what it would be like for natural labor, but before and after the c-section, my OB-GYN and the nurses just asked what my numbers were. I made all decisions related to insulin doses and managing the pump.

Perhaps you could agree to have the endo “on call” in case you need her advice (which I doubt you will!). I did call my endo’s cell phone at 10pm the night before the c-section to ask whether or not I should correct a 140 mg/dl blood sugar level. :slight_smile:

#9

Yes, I haven’t heard of an endo being in the room and I doubt that any endo could make better decisions than you.

#10

I’m only 21 weeks right now but I think my endo/ob relationship is similar to Kirsten’s my ob trusts my endo (who is amazing) to handle all the diabetes stuff. I don’t think he will be there for the labour but I don’t know how it will be handled. I would hate to have to deal with a different endo during labour-she doesn’t know anything about you or your diabetes. I think asking if she could just be on call sounds like a great idea. I wouldn’t hesitate to complain about her too. Endos work so closely with people-bedside manner is extremely important!

#11

I don’t have any advice or suggestions, because I’m just now pregnant with my first, but I’d be So Angry too. I’ve fired doctors for less. Call me picky, but a STRANGER with a medical degree does NOT get to have such authority over my life, especially on the first date. The problem with most specialists I’ve worked with in the last almost thirty years is that their egos are so friggin delicate. They don’t like being questioned, taking suggestions, etc. She must be totally out of her mind to suggest basal testing at this point. At 16 weeks, I don’t think I could do it now. I’d be darn near crazy from hunger and nausea.

I was worried at my 16 week appointment that I was going to catch a little flak about a random 282 after a pod occlusion. However, my A1c is 5.3 and he’s extremely happy with that. I would have been DEMORALIZED to walk out of there feeling guilty about a couple of unavoidable random highs…we all take are control very seriously, and very personally.

If I would have been in your shoes, I would have made the exact same decisions. Here’s hoping for a quick, complication-free and easily-managed delivery where you don’t have to worry about her.

And let us know how it goes after you talk to your OB about the experience. Perhaps they’d be willing to write orders like some of the other ladies on the board have had for self-management throughout delivery.

#12

My endo was not present during my c/s, but she did give my surgical nurse instructions over the phone about my pump that morning and then she would call my hospital room or stop by once a day and see how I was doing and help me make changes to my basal rate. I was charged a small amount from her office for the in-person visits. That was the extent of her involvement. She essentially was just there as a resource for me to check in with about my decisions, but the only people present at delivery were the anesthesiologist and my OB and her assisting surgeon and staff.

#13

My endo also was with a different hospital that my MFM group. So, my endo didnt have anything to do with my labor whatsoever. I did relinquish power to the nursing staff to do an IV drip during labor. It was a tough decision for me because I have had so many bad experiences with wrong insulins and such during previous hospital stays, but when in active labor there is so much pain and other things to worry about (like how to possibly squeeze in 30 mins of sleep between all of the nurses and doctors coming in and out of the room) that I had the nurses do the drip and finger sticks so I could focus on other things and try to rest. I made sure that I asked and confirmed every IV drip being administered before it was in my blood stream, but in the end, my BG stayed between 70 and 140 through the entire 21 hours of labor. I was lucky that I had very nice nurses for the most part.

#14

I didnt eat thru labor either- aside from ice chips, but I had an IV of 1 unit per hour of Humalog. I was in labor for 21 hours and my BG was always in range. My daughter was born with low BG and they took her for a few hours to they could monitor her and feed her a few times to get her BG up to where it needed to be.