QuestionHi there,
I am pregnant with my third child and an IDDM patient. I have very well controlled blood sugars, and have had two very sucessful spontanious births with no complications other than some low blood sugar readings in my babies that was easily corrected with breastfeeding.
Both of my children were born naturally at 38 weeks, the second with the gentle help of caulophyllum (homeo) for inducing labour. Each time there has been speak of induction, but becasue I delivered before my due date I did not have to entertain those conversations.
With this third pregnancy, I am about 5 days from my due date and am facing an induction on sunday (my due date) at the request of my OB. They wanted to induce at 39 weeks but let me go to 40 weeks.
My question surrounds the issue of when I should agree to induce this pregnancy, what specific indicators can we look for to make it medically indicated to induce this pregnancy, and what exactly are the complications that make induction the protocol as it seems as though diabetes = induction regardless of individual circumstances. I don't feel good about it, but that doesnt' mean that it shouldn't happen and I know that.
Please advise, thanks!
Ashlely
AnswerAshley,
You are correct that most doctors think diabetes = induction, or worse, automatic c-section. Unfortunately, this belief is based on a false sense of control rather than research-based evidence that induction improves outcomes for the mother or baby when the diabetes is well-controlled.
The main risk in a diabetic pregnancy is uncontrolled blood sugars for you and/or the baby, as well as an increased risk of placental calcification and/or stillbirth at term. Doctors feel that by inducing, they can better control your labor and prevent complications. In reality, induction introduces the possibility for a whole host of complications that wouldn't otherwise exist, including increased risk of fetal distress and c-section without improving the outcomes to you or your baby.
Now, factors to look for include evidence of fetal distress and/or placental calcification near term. This can be determined by use of a Biophysical Profile, which is a non-stress test and ultrasound that looks at several factors to determine the baby's well-being as well as your own.
If the results show no concerns, then you should be able to safely wait until labor begins or 42 weeks, whichever comes first. Unfortunately, in some regions, doctors prefer to use 40 weeks as the cut-off rather than 42 weeks. Again, doctors fear placental deterioration but the research shows that risks in a typical pregnancy don't increase until after 42 weeks. It can be much harder to determine when the risks increase in a diabetic pregnancy because blood sugar levels can vary and may also be complicated depending on which medications are being taken.
Due to these reasons, many doctors will want to intervene when no other risk factors are present. Without knowing your complete history, my best advice is to discuss exactly what reasons your doctor has for wanting to induce and then discuss your options. Remember, he cannot do anything without your consent and he is also obligated to give you a full explanation of the risks and benefits to both induction and waiting for spontaneous labor before recommending a course of action. Be sure you get both sides of the story so you can be comfortable that you've made the best decision in your circumstances.
Best,
Catherine
