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Anybody wanna help me research?? Going over EDD with diabetes/insulin.


Forum: September 2013 Playroom

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  #1  
April 20th, 2013, 10:58 AM
TaraJo29's Avatar Mega Super Mommy
Join Date: Dec 2009
Posts: 1,741
Here is what I want to know. My OB said there are "risks" of going over my due date when I am diabetic so early in this pregnancy and on insulin already so early (before 20 weeks).

Apparently developing true gestational diabetes before 20-24 weeks is very unusual so since we realized I was diabetic at 11 weeks the endocrynologist thinks I might be pre-gestationally diabetic, or at least insulin resistant to some extent.

I do have the option of trying a VBAC... IF the larger medical center which is about 1 hr away will consider me a good candidate. My OB said they may not because risk for rupture increases since I've had many births (8 pregnancies, 5 births, 4 were vaginal, 1 was c-section). So my OB is going to set me up with a consultation with them to discuss whether they would agree to me doing a VBAC there or not. IF they do, my OB and I both agree that the only way I want to attempt a VBAC is if I go into labor naturally and am not induced. HOWEVER, the problem is that my OB insists I should NOT go over my due date, so then the only way I can do a VBAC is IF the medical center agrees, and IF I go into labor on my own ON or before my due date. Otherwise, I will probably have a c-section scheduled for the next day. I did go into labor twice on or before my due date, so it's possible that will happen this time, but I'm not counting on it. I asked about just giving me a little more time, and is it *really* a big deal if I went one week over my due date?? She said yes it is, because "risks" increase, especially because I am on insulin so early. I should have asked what risks but I didn't.

So what I want to know is WHAT risks... besides "big baby." She acted like there were more risks than that which she didn't necessarily want to scare me about. I think the risk of my having a very big baby (especially one bigger than my 4th! Who was 9 lbs 11 oz and had a huge head) is unlikely because my blood sugar is so tightly controlled.

I have read on other forums people saying there is a connection between placental breakdown with mothers who are on insulin earlier than in mothers who aren't. But I haven't found any "official" articles yet. I will be having a LOT of NST tests and a LOT of ultrasounds and I wonder if it has to do with checking placental function?? I have ZERO desire to have a c-section (other than I want my baby to get out safe and sound), but if I found out that risk of stillbirth goes up by 50% or something once I'd go past my due date, then I would say "I'm in!" But if I do an elective c-section I just want to feel good about it and not be second-guessing it, ya know?

So I don't necessarily think my OB is wrong that I shouldn't go over my EDD, but I would like to be fully convinced, ya know?? I will definitely ask next time to go ahead and tell me the risks, but in the meantime, I would like to find out what the risks of going over my due date are in my situation.

Sorry about the novel. Sometimes I can't be concise for the life of me.
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  #2  
April 20th, 2013, 11:43 AM
ValyntineG's Avatar Based on a True Story
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It looks to me like the risks are all either due to or associated with "big baby." The scary technical term they'll use is "fetal macrosomia"... but it means the same thing.

Most of what I'm reading cites difficult birth and recommended C-section. However, keep in mind that America is fairly notorious for having unnecessarily high C-section rates. Doctors like to avoid anything that might be considered a more difficult vaginal birth. For liability issues and other reasons.

That said, it's ultimately your call. If it were me, I would refuse an induction before 40 weeks (regardless of preconceived fetal weight... ultrasound weight is often wrong by several pounds) and agree to a section in an emergency scenario, but that's it. And that's just me. You may decide something totally different. In any case, I can't find any major risks that aren't associated with the size of the baby.
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  #3  
April 20th, 2013, 12:04 PM
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Did they do an A1C test on you before they started you on insulin this pregnancy? It is a blood test that tells the doctor if you had it,I believe for a three month period before.
I have always tested negative on this one. But for some reason I become very diabetic during pregnancy. Usually for me my babies come very early and I go into labor on my own. But I believe the risks they talk about is increased risk for early placental failure,increased risk for stillbirth. You also are at risk for permanently damaging your pancreas if you continue to eat lots of sugary foods and don't take the correct amount of insulin.
For me they monitor me weekly starting at 30 weeks, bi-weekly stress tests, ultrasounds every 4 weeks starting at 26 weeks to monitor babies growth and placental health.
There are many things you can do to assist your body in readying itself for going into labor, nipple stimulation is one of the easiest ways but there are many other things to you can research online. I think your doctor is right about you needing to deliver a little early and certainly not late,too many risks involved so maybe helping to stimulate your body along after you turn 38 weeks might help especially if you really want a VBAC. I have never needed to help my body along bc my h2O broke with 3 and I was 5+ centimeters dilated before getting to the hospital with the other 3. That said I have had a few friends try some of these techniques and they swear they really do work to help your body self stimulate into labor. Another disclaimer here is this can be very controversial and there are many opinions on the subject,only you know what is right for you and your baby I also know they waited until they were 38 weeks or farther along to try any of these techniques. My favorite doctor an older gentleman in my practice who delivered two of my six babies always tells me when I inevitably worry about going into labor early - that an average range for full term babies is 37-42weeks,anytime during that time is considered a full term baby. He always tell me your body is very obviously on the short side of this duration! It is weird for me my worst delivery was my first when I went 11 days overdue. I had a sick newborn and me also,plus the longest hardest recovery. But they didnt test or treat you for diabetes back in those days,but i know i defintely had it!For me going early has always been a good thing. And thankfully they have all come home with me after delivery
Also my practice tells me every pregnancy that they would induce me at 38 weeks if I don't go into labor on my own because of the risks. When is your due date? Have you been able to keep your guards low with the insulin? Do they have you on the dial a dose pens? Long acting and/ or short insulin? I am on both long and short with he dial a dose pens. Since we homeschool my kids have learned a lot about sugar and the body watching me give myself shots. And none of them are fearful of shots anymore,which is the one good side story to having to do this every pregnancy. I know you have a lot to think about having to consider Caesarian and VBAC's. I am always fearful I'll end up with a c-sec every time bc statiscally their is a much greater chance in we moms of many. So I spend the last few weeks doing tummy exercises and squats to keep my babies head down and praying a lot!
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  #4  
April 20th, 2013, 12:04 PM
Member
Join Date: Feb 2013
Posts: 34
Did they do an A1C test on you before they started you on insulin this pregnancy? It is a blood test that tells the doctor if you had it,I believe for a three month period before.
I have always tested negative on this one. But for some reason I become very diabetic during pregnancy. Usually for me my babies come very early and I go into labor on my own. But I believe the risks they talk about is increased risk for early placental failure,increased risk for stillbirth. You also are at risk for permanently damaging your pancreas if you continue to eat lots of sugary foods and don't take the correct amount of insulin.
For me they monitor me weekly starting at 30 weeks, bi-weekly stress tests, ultrasounds every 4 weeks starting at 26 weeks to monitor babies growth and placental health.
There are many things you can do to assist your body in readying itself for going into labor, nipple stimulation is one of the easiest ways but there are many other things to you can research online. I think your doctor is right about you needing to deliver a little early and certainly not late,too many risks involved so maybe helping to stimulate your body along after you turn 38 weeks might help especially if you really want a VBAC. I have never needed to help my body along bc my h2O broke with 3 and I was 5+ centimeters dilated before getting to the hospital with the other 3. That said I have had a few friends try some of these techniques and they swear they really do work to help your body self stimulate into labor. Another disclaimer here is this can be very controversial and there are many opinions on the subject,only you know what is right for you and your baby I also know they waited until they were 38 weeks or farther along to try any of these techniques. My favorite doctor an older gentleman in my practice who delivered two of my six babies always tells me when I inevitably worry about going into labor early - that an average range for full term babies is 37-42weeks,anytime during that time is considered a full term baby. He always tell me your body is very obviously on the short side of this duration! It is weird for me my worst delivery was my first when I went 11 days overdue. I had a sick newborn and me also,plus the longest hardest recovery. But they didnt test or treat you for diabetes back in those days,but i know i defintely had it!For me going early has always been a good thing. And thankfully they have all come home with me after delivery
Also my practice tells me every pregnancy that they would induce me at 38 weeks if I don't go into labor on my own because of the risks. When is your due date? Have you been able to keep your guards low with the insulin? Do they have you on the dial a dose pens? Long acting and/ or short insulin? I am on both long and short with he dial a dose pens. Since we homeschool my kids have learned a lot about sugar and the body watching me give myself shots. And none of them are fearful of shots anymore,which is the one good side story to having to do this every pregnancy. I know you have a lot to think about having to consider Caesarian and VBAC's. I am always fearful I'll end up with a c-sec every time bc statiscally their is a much greater chance in we moms of many. So I spend the last few weeks doing tummy exercises and squats to keep my babies head down and praying a lot!

I am sorry for the double post, this stinking IPad has done this the last few times,it's driving me batty,maybe I'm better off posting things from the laptop instead:-/
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  #5  
April 20th, 2013, 12:32 PM
mirdeemrlvs's Avatar Mega Super Mommy
Join Date: Feb 2012
Posts: 1,464
My second daughter was 9 lbs 2 oz. She was about 5 days late, I had my membranes stripped and I labored naturally. Got to the hospital at 8 cm. She was born 30 min later.. her head popped right out, but they said her head was "stuck" one of the gentlemen in the room rushed over and rammed on my stomach and out she came. There was a fear of her having shoulder dystosia, or not ever recovering use of one of her arms. She is 7 and just fine, but apparently that is one of the risks because they have large shoulders (babies from GD moms)... so, my third dd, they induced at 39 weeks, she was only 7 lbs 13 oz. I hated being induced! This time I am really watching my diet and hoping to pass the test.
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  #6  
April 20th, 2013, 04:55 PM
H_Hplus1's Avatar Supermom to 6
Join Date: Mar 2011
Location: Georgia
Posts: 1,063
I really don't like to put in opinions because mine are one sided due to experience and not research. As a former NICU nurse, I have seen a lot of babies come to the unit due to GD and going over a due date. Shoulder Dystocia was a big deal and I have witnessed grave consequences because of it. That said some women deliver just fine. I have had 3 large babies myself(9,9,91/2) and my DD delivered a 10 1/2 pound baby last June with no complications. We didn't have GD issues which from what your saying is concerning. Cudos to you for starting to look up and study the topic now while you have time. I will keep my eye out for information and can contact my long time friend who is a travel nurse for the NICU if you'd like. Just let me know. She's worked all over America for over 20 years.
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