Counting down and preparing for birth

I’m still pregnant. This coming Sunday is my due date and the baby still seems to be holding tight. I’m having inconsistent contractions, which are definitely uncomfortable but also very welcome because I know the more work my body does now to prepare, the shorter my active labor will be.

My gestational diabetes is still very well-controlled with diet, which is awesome and very fortunate. I had an ultrasound to estimate size a week ago and then the baby measured about 7 lb. 2 oz., which is much less than the 7 lb. 10 oz. Jake weighed in at birth, and the 8 lb. 4 oz. that Lane came in at. The ultrasound tech said that chances were good the baby would weigh less than 8 lbs. at my due date, which is welcome news. Of course those ultrasound estimates can be pretty far off, but given I received good news, and I know I don’t have a ginormous belly, I’m going to assume the estimate is at least somewhat reliable.

One thing that’s come up is my OB/midwives’ general policy of inducing labor for moms with gestational diabetes. I had an in-depth discussion with one of the midwives about it, and they as a practice are pretty adamant about inducing if I haven’t delivered by my due date, because, she said, there is an increased risk of stillbirth in diabetic pregnancies. The reason for this is that the placenta gets worn out a little faster because of the issues with diabetes, and can’t sometimes handle the stress of late pregnancy and labor. She told me all about her recent review of the available literature, blah blah blah. I told her I was very uncomfortable with a standard policy of induction being applied to me (as a well-managed gestational diabetic patient) without specific evidence that MY pregnancy and THIS baby was somehow at risk. But, I was still a week and a half before my due date for that conversation, and we agreed there was time for things to happen on their own before a decision needed to be made.

There are lots of reasons I want to avoid an induction. Labor induction leads to a greater incidence of c-section, which I would very much like to avoid because a vaginal delivery, I believe, is more healthy for both the mother and the baby. Labors that are induced can be much more painful and I desire a drug-free vaginal birth. I know I have handled my last two labors fairly well, but if the contractions were much more intense, I’m not sure I’d have the stamina. And, if my contractions are much more intense in an induced labor, I feel like that’s more stress that the baby and the placenta has to endure, and isn’t that part and parcel to the logic of why they want to induce in the first place? It seems somewhat like a flawed logic — your placenta might be deteriorating and might not handle the stress as well, so we are going to give you drugs that might create a more stressful situation than a spontaneous labor. That, to me, just doesn’t hold up well, especially in the absence of any evidence (like through an ultrasound or non-stress testing) that there’s any added risk in my specific medical case.

Well, I am a researcher. I decided to see if my desire to avoid an induction was grounded in science and could be backed by the opinions of people who have had peer-reviewed research published in major medical journals. Or, was I just being stubborn and fixated on an ideal that really wasn’t ideal given the gestational diabetes, even if it seemed my case was mild and well-managed?

My goodness, I LOVE THE INTERNET.

What I learned is that gestational diabetes is divided into two classes: A1 and A2. A1 is me: glucose intolerance that is well-managed through dietary control. A2 are the more unfortunate women who need greater medical intervention to control their glucose levels — insulin injections, other diabetic medications, etc. and even with these sometimes their glucose levels are not well-controlled. It is believed that many of the A2 cohort are previously undiagnosed or borderline type 2 diabetics. My suspicion was that evidence of an increased risk of infant mortality (ie. stillbirth) was much greater for the uncontrolled or harder-to-manage A2 diabetics and that that risk was much reduced for women with A1 gestational diabetes. What I found, in reviewing a couple different studies and one metastudy is that my theory holds some water. Risks of stillbirth for the A2 diabetics are much greater than for those women with A1 gestational diabetes. For the A1 diabetics, the risk does seem to be slightly higher when compared to non-diabetic pregnancies, but having my condition be well-managed with diet only makes me much more confident that it is not a medical imperative that I be induced on my due date if I have not spontaneously gone into labor.

(I certainly don’t mean this as evidence for anyone else… I’m just thinking out loud here. This is for my own state of mind only! If you are finding yourself in a similar predicament, please do your own research and talk to your own care provider. I am NOT giving medical advice!!)

With my other two babies, I delivered the first (my daughter) at 3 days past my due date, and my son at 3 days before my due date. Length of gestation is very consistent for most women, so I am confident in my body’s intention to go into active labor sometime between right now and three days past my due date. Knowing there is some research that illustrates a very, very small risk (statistically speaking) of stillbirth, which isn’t too different for me than other pregnant moms without the label of “gestational diabetes”, I think I can confidently put off a scheduled induction. I won’t refuse it entirely, but I will compromise. If I haven’t gone into labor by four days after my due date, I will agree to an induction. Chances are pretty good that it will never get that far anyway. And if I don’t go into labor on my own, then chances are also pretty good that it will take very, very little “induction” to get labor rolling for me and the baby.

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One response to “Counting down and preparing for birth

  1. I had to be an over-informed consumer of OB-GYN services, for entirely different reasons (having to do with medication use during pregnancy and my choice to go for six months of functional versus eight-ish months of misery – kind of the opposite end of the spectrum from you, but a similar end-result, and had I known what was waiting for me I would happily have picked up drinking during that last trimester, as a replacement…).

    It bites, because it really doesn’t fly that the medical community, whether it’s one practitioner or a whole group practice, tries to apply a one-size-fits-all approach to individuals, and then relies on those same individuals to plead their own cases to change the rules. Too much responsibility on the patient, methinks… most of them out there aren’t as smart and well-read as us, don’t you know. 😉

    I’m so glad you were able to have a healthy, happy birth. Just so glad. The mere concept of the alternative terrifies me for weeks leading up to the delivery of any babies I know of, lately…

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