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?
the old idea is that persons with diabetes should deliver at 38 weeks to minimise complications. However, for a person with well controlled diabetes and with no issues with the baby (and ongoing appropriate monitoring) then there should be no need to be induced.
My Obe told me that she preferred women with diabetes to deliver around 38 weeks. I made it clear that I wanted to wait for labor to start by itself naturally.
My Obe was noticeably anxious as I went past 38 weeks with my daughter (now 6 weeks old), but we agreed not to consider induction unless I went past my due date (40 weeks). In any case I went into labor myself at about 39 1/2 weeks.
It would have got awkward if I had gone beyond 40 weeks though.... thankfully I didn't.
Do stand your ground. From what I've read 38 weeks can be too early for some babies... ideally you go into labor by yourself... and if all looks great I'd say closer to the due date may be an option.
It was agreed that I would manage my own diabetes if I had a natural delivery (that had been the plan), but that the hospital would manage it if I had a CS.
At the hospital and in labor they gave me pitocin to try to encourange the labor to progress. They tried to give it to me in dextrose (sugar) solution. I caught that and made them check with my endo and the IV was changed instead to saline.
I ended up with CS when the labor failured to progress (turned out baby was wrapped up in the umbilical cord - like a seatbelt stopping her from dropping).... they put me on IV insulin during the surgery and were monitoring blood sugar every 15 minutes or so. I was swinging all over the place (considering they were also giving me dextrose to counter the insulin).... anyway, once I was in the recovery room after surgery I started monitoring myself again (I had refused all offers of sedation)... would have passed out from a low if I hadn't tested my own sugar and told them to do something FAST (they'd overdosed insulin during the surgery)...
Anyway, all turned out fine. I was back to monitoring my own bs after surgery... and things stabilised pretty quickly once there was no more placenta, after I recovered from the insulin overdose (they had me on dextrose all night!). Anyway, I have gone from over 100 units a day just before delivery to only about 20 units a day now (helped by breastfeeding I'm sure).
Just make your plans and do monitor your own levels regardless of what the hospital does.
You know your body and your diabetes.
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 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!
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... :)
IF you know exactly when you got pregnant then I guess it could be pretty 'accurate'. But real length of human pregnancy is 38 - 42 weeks. So there's a wide range. They say the early u/s give a pretty accurate due date, plus or minus 2 weeks.
In my experience you can still manage your own blood sugar even in labor.
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!
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).