Too quick to Induce...... Questions?

I was at 39 weeks exactly yesterday. At appt last night still wasn't dilated
although I was 70% effaced. Due to my gestational diabetes (which is totally
under control btw- baby's fine as am I....weekly Biophysical profiles, growth
sonos, and fetal non stress tests....baby is perfect size) my doctor is saying
that he will induce me no later than three days after my due date due to the
high risk factor of the pregnancy (exclusively from diabetes). This seems
pretty standard for diabetic moms based on the conversations I've been having.

How do induced contractions differ, if at all, from naturally occuring ones?

What is the rate of vaginal vs. caesarian delivery with an induction?

Does anyone have any experience with this?

Of course there is the possibility that I can go into labor naturally in the
next week. He did not rule that out. He's just setting up the hospital
timetable in case, as I would be staying over the night before and given a
suppository (forgot name) and the next day put on pitocin (sp? too lazy to look
it up...) he said he'd let me labor as long as necessary to aim for a vaginal
delivery but if my cervix didn't dilate I'd need a c-sect.

Does this possible induction seem excessive or is it pretty much standard for
diabetic moms?

thanks,
lisa

Zucca4 wrote:

I was at 39 weeks exactly yesterday. At appt last night still wasn't dilated
although I was 70% effaced. Due to my gestational diabetes (which is totally
under control btw- baby's fine as am I....weekly Biophysical profiles, growth
sonos, and fetal non stress tests....baby is perfect size) my doctor is saying
that he will induce me no later than three days after my due date due to the
high risk factor of the pregnancy (exclusively from diabetes). This seems
pretty standard for diabetic moms based on the conversations I've been having.


There is *very* *very* little evidence to support inducing
women with controlled gestational diabetes. There's a world of
difference between women with true diabetes who happen to be
pregnant and women with gestational diabetes.


How do induced contractions differ, if at all, from naturally occuring ones?


There's a lot of variation in how women experience
contractions, but most women who report having had spontaneous
and induced labors suggest that the induced contrations were
more difficult.


What is the rate of vaginal vs. caesarian delivery with an induction?


It depends very much on how ready you are to go into
labor anyway, the position and presentation of your baby, and
how you cope with the interventions. Your risk of a c-section
is significantly higher if your Bishop's score (a measure of
cervical readiness) is low.


Of course there is the possibility that I can go into labor naturally in the
next week. He did not rule that out. He's just setting up the hospital
timetable in case, as I would be staying over the night before and given a
suppository (forgot name) and the next day put on pitocin (sp? too lazy to look
it up...) he said he'd let me labor as long as necessary to aim for a vaginal
delivery but if my cervix didn't dilate I'd need a c-sect.

Does this possible induction seem excessive or is it pretty much standard for
diabetic moms?


It's excessive and not warranted by the research,
especially with well controlled GD and no other indications
of problems, and it could increase your odds of a difficult,
instrumental, or surgical birth. I wouldn't allow it,
personally, unless they could show me test results indicating
a problem (with suspected large baby not being a problem).
If you want to read more, check out Henci Goer's books
_The Thinking Woman's Guide to a Better Birth_ and _Obstetric
Myths versus Research Realities_. You can get another view
of the literature in Enkins, et al.'s _A Guide to Effective
Care in Pregnancy and Childbirth_.

Best wishes,
Ericka

Ericka,

Thank you so much for taking the time to respond. You answers are always so
well researched and crafted- I value your suggestions.

The weight of the baby at 38 weeks was 7 pounds 6 oz. I was told that was
normal and in the 75th percentile- however it could also be a pound in either
direction as the results are not "exact". I go for another growth sono this
Tuesday, my 40th week.
Hopefully the baby will still be in an acceptable weight range. My own weight
gain has been a mere 12 pounds and I have really taken excellent care of myself
this pregnancy.

My question is this: if the accuracy is not 100% what are the chances of the
baby being a pound OVER or UNDER what I'm being told. Which is more common?

I feel odd about being induced three days after my due date when everything is
going well. However if the baby COULD HAVE been 8.5 pounds two weeks ago and is
now hypothectically almost 10 pounds (I know babies usually only gain 1/3 lb
per week after the 38th week, or so I've been told...but worse case scenario
here) I'd be a little nervous letting it go any longer.

What would you think the maximum weight should be before an induction would be
warranted?

Thanks Ericka,
Lisa

Zucca4 wrote:

Ericka,

Thank you so much for taking the time to respond. You answers are always so
well researched and crafted- I value your suggestions.

The weight of the baby at 38 weeks was 7 pounds 6 oz. I was told that was
normal and in the 75th percentile- however it could also be a pound in either
direction as the results are not "exact". I go for another growth sono this
Tuesday, my 40th week.
Hopefully the baby will still be in an acceptable weight range. My own weight
gain has been a mere 12 pounds and I have really taken excellent care of myself
this pregnancy.


Really, you cannot go by u/s estimation of weight. It
could be off by a pound or more in either direction, and
that's a *LOT* of weight in a little baby! A pound in either
direction is probably enough to cover most of the spectrum
for birthweights. You might want to err on the side of
being conservative if there was some dire consequence to
the baby being on the large side, but frankly, there isn't.
The worst that happens is that you have a hard time getting
the baby out vaginally. This is unlikely, particularly if
you retain your ability to move around during labor and
assume different positions while pushing. The downside is
that if you have an u/s suggesting that the baby is larger,
your risks for a c-section go up independing of the truth
of the matter. A study that compared a group where baby
was estimated to be big with a group of babies that were
the *exact* same size, but where there was no u/s size
estimate, found that there were more c-sections in the
group where the doctors believed the baby was big. Because
they believed the baby was big, they made decisions using
that information that made a c-section more likely.


My question is this: if the accuracy is not 100% what are the chances of the
baby being a pound OVER or UNDER what I'm being told. Which is more common?


There really isn't a "more common." If you look at
the research on u/s size estimates, most of them consider
the estimate "accurate" if it's within 10 percent--which is
quite a large margin for "accurate" if you ask me! And
then on top of that, most of the studies (IIRC, since it's
been several months since I looked) found that the u/s
were "accurate" (using their definition) only around 75 percent
or less of the time. The bottom line is that it's *really*
easy for them to be way off.


I feel odd about being induced three days after my due date when everything is
going well. However if the baby COULD HAVE been 8.5 pounds two weeks ago and is
now hypothectically almost 10 pounds (I know babies usually only gain 1/3 lb
per week after the 38th week, or so I've been told...but worse case scenario
here) I'd be a little nervous letting it go any longer.

What would you think the maximum weight should be before an induction would be
warranted?


Research hasn't found that there *IS* a max weight.
Research suggests you're best off forgetting about size
estimates and attempting the vaginal birth. If you have
good, knowledgable support for the birth and if you retain
your mobility so that you can work with your body, odds
are very good that you will deliver your baby vaginally
with no problems. In the unlikely event that you *can't*
deliver the baby, you can have a c-section then. It's
a shame to have to go into a c-section after laboring,
but then at least you know that the c-section is really
needed. While emergent c-sections are slightly more risky
than elective ones, a c-section for failure to progress
isn't a dire emergency and can be done carefully and
under epidural anesthesia, so that shouldn't be a problem.
Honestly, I'd probably refuse future sizing u/s and
induction and just let nature take its course. If you
go significantly postdates, you can start doing tests
to assess fetal wellbeing to make sure that baby and
placenta are doing well, but I wouldn't induce purely
for suspected large baby.

Best wishes,
Ericka

The weight of the baby at 38 weeks was 7 pounds 6 oz. I was told that was
normal and in the 75th percentile- however it could also be a pound in either
direction as the results are not "exact".

Phooey. It could be more than that. My twins were estimated at 8 pounds and
8.75 pounds at 37.5 weeks. They were born over two weeks later, the one who was
supposed to be 8.75 pounds plus two weeks' growth was actually just under
eight. The one who was supposed to be 8 pounds plus two weeks' growth was 8
pounds 11. They didn't even get it right on which one was bigger.

--Helen

As I understand it with diabetics the reason to induce is because of big
babies. Recently over on the uk pregnancy group, all the big babies that
have been induced have ended up with a section, mainly because the
induction has led to an epidural and then ineffective pushing. I'm glad
Ericka has been able to give you more information.

On 21 Nov 2003 21:53:11 GMT, (Zucca4) wrote:

I was at 39 weeks exactly yesterday. At appt last night still wasn't dilated
although I was 70% effaced. Due to my gestational diabetes (which is totally
under control btw- baby's fine as am I....

May I ask you more about your gestational diabetes?
I was diagnosed with diabetes in my 9th pregancy week ( I am 14 full
weeks today) and they can't tell weather it is gestational or regular
typ 2 diabetes.
It sounds absolutely great that both you and the baby are fine. All I
hear about at the moment is diabetic mums with macrosomatic babies and
deformations.

My questions a

How far along were your gestational diabetes discovered?

How high have your BG levels been?

Did you have to take insuline injections?



/Erika

The first ten years of your life you try to be just like your parents.
Then for then years you try to be as little as your parents as possible.
Then you gradually change in to them.

"Zucca4" wrote in message
...
The weight of the baby at 38 weeks was 7 pounds 6 oz. I was told that was
normal and in the 75th percentile- however it could also be a pound in
either
direction as the results are not "exact".

FWIW, the u/s estimate of my third baby's weight was 7lb.3oz. at 37 weeks
(ultrasound was done, ironically, due to IUGR concerns because my fundal
height didn't change for several weeks). They didn't tell me what percentile
that was, but if 7lb.6oz. is 75th percentile at 38 weeks, I'd think he must
have been over the 80th. He was born 3w2d later at a very average 7lb.15oz.

IOW, I think you have *nothing* to worry about!
--
Be well, Barbara
(Julian [6], Aurora [4], and Vernon's [20mo] mom)

This week's special at the English Language Butcher Shop:
"Rejuvinate your skin." -- Hydroderm ad

Daddy: You're up with the chickens this morning.
Aurora: No, I'm up with my dolls!

All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman

I was discovered to have GD at about 27 or 28 weeks...whenever the routine test
is given. I actually forget. Sometimes I wonder if it should have been given
earlier as my father had been diagnosed with Type II diabetes this past June
and my paternal grandmother was a diabetic as well. There were women in my
group who were screened for it very early on as their parents had it. My Dad
wasn't diagnosed when I initially got pregnant so I guess no red flags were
raised. Also my urine samples had all been fine.

My blood sugar levels have been excellent throughout thanks to 2 daily insulin
shots- 6 units 10 minutes before b/fast and 24 units upon bedtime (initially
started at 12 units and within weeks got up to 24 as I got a cold and it spiked
my sugar levels and my body seemed to "adapt" to the higer dosage....)
Compared to some of the other GD moms in my group who were taking 100 plus
units at a time, tis was a pretty low dosage. Of course I've had to watch my
diet extremely carefully...it hasn't been too bad though and I've continued
with all of my gourmet meals, but in smaller portions and with lots of
walking....

My morning counts are always under 90 now and after meals are generally under
140. I'm most sensitive in the mornings, so most of the carby things I eat are
reserved for late afternoon snacks and dinner followed by a long walk when I'm
not too busy. Initially I was very over-zealous and pulled almost all carbs
away from my menus- this of course put me in mild ketosis a few times and
scared me.....my blood sugars were nice and low though...Achieving a good
balance can be difficult, but you'll figure it out.

Your nutritionist will give you a framework of how many carbs should be allowed
at each meal and you can play around until you figure out how you'd like to use
them.
For example, through trial and error I've discovered I absolutley can't
tolerate rice (even more fibrous brown) but can eat large portions of pasta
without spikes. You will see what your sensitivities are.

My shots,btw, are no big deal. Small, fine needles administered to my hips,
thighs, and sides of my belly. No pain at all. And I've long since gotten over
the finger-prick thing which really made me NUTS initially.

Good Luck to You. I have felt absolutley great throughout- perfect really- and
I wish the same for you


Feel Free to ask any questions
Lisa

Erika wrote:


May I ask you more about your gestational diabetes?
I was diagnosed with diabetes in my 9th pregancy week ( I am 14 full
weeks today) and they can't tell weather it is gestational or regular
typ 2 diabetes.
It sounds absolutely great that both you and the baby are fine. All I
hear about at the moment is diabetic mums with macrosomatic babies and
deformations.


To be honest, with a diagnosis that early, it is
very likely that you either have true diabetes or you
are pre-diabetic normallly. Gestational diabetes usually
doesn't show up until later.
That said, what were your numbers? Were you
barely out of normal range with conservative thresholds?
Or did you blow the limits right out of the water?
Unfortunately, there is a world of difference
between true diabetes and gestational diabetes in terms
of the potential effects on the baby. In gestational
diabetes, blood sugars are generally only out of line
in the third trimester, and the risks are typically
just large babies and maybe neonatal hypoglycemia
(which might be more management related than anything
else). When blood sugars are seriously out of control
in the first trimester, that's when you run the risk
of deformations. The good news is that you were
diagnosed early in the pregnancy so that you could
start getting your blood sugars under control. With
true diabetes (unlike with GD) outcomes have improved
dramatically with good treatment.
In terms of insulin, there has been virtually
no research that shows that insulin is really effective
for gestational diabetes. It does tend to make the
babies a little smaller, but doesn't reduce mortality
or morbidity (including things like likelihood of
c-section or shoulder dystocia which are generally
thought to be related to the size of the baby). Some
researchers feel that the use of insulin for GD is
irresponsible. On the other hand, insulin is clearly
an important therapy with true diabetes when diet and
exercise aren't controlling blood sugars. So in your
case where there's a good chance that this isn't just
GD, I would keep an open mind about insulin if you
can't get your blood sugars under control without it.

Good luck,
Ericka