# Statistics behind the hospital induction policies



## Babysaurus (Feb 27, 2012)

Hi, 
I am now 24 weeks and am starting to think about the birth side of things a lot more. Please don't assume I am someone who'd put either myself or my baby under unneccessary risk, but I am starting to question some of the policies I have been told about so far. Hence, I want to start reading up on things so I can get a better idea.
I have been repeatedly told that I 'have to be induced' at 38 weeks. I heard via this site this is due to the placenta starting to fail but when I mentioned this to the obs he said the main reason is due to the size of the baby in diabetics, and bigger babies have a higher risk of dying during childbirth. I am a Type 1, my last HBA1C was 5.3 (and previous to that was 6.1, 6.3 and 6.0) and the baby, so far, is measuring in the middle, to small, of the growth scales they give. Given this info, and the fact that the placenta failing didn't seem to be viewed as a likely scenario, an early induction which may result in all sorts of nasties such as forceps or c-sec seems a bit over the top. 
Does anyone have any links I can have a look at to learn a bit more about the real risks of going over 38 weeks so I can get a proper picture of why they have the rules they have? 
I am wondering if these polices are another 'catch all' to include Type 2's, gestational diabetics and Type 1's who have really struggled and / or had problems. 
Thank you! 
Bx


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## PhoebeC (Feb 27, 2012)

All i know is my hospital said they always induced diabetics at 37 weeks think they said due to the size and the placenta 
I didn't make it that far but had a 36 hour labour and forceps in the end 
Will be interesting to know the answer x


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## Babysaurus (Feb 27, 2012)

Hi Phoebe, 
Mine have said similar but I asked if the size was normal, is it mainly due to the placenta and the obs didn't seem too fussed about this (I can't remember the exact way it was put) and gave the impression this wasn't an especially likely thing. Which makes me curious as to why you'd be induced, and all that entails and can entail, if the baby's size is no different to what is considered 'normal.' Seems a bit over the top really when it's viewed like that doesn't it? 

I am not just being awkward for the sake of it with them, but I do think finding out why certain polices are in place can sometimes reveal that actually it is not that relevant to yourself at that particular time. I am also very wary of going through an induction for, what turns out to be, a minisucle risk but is 'recommended' for all diabetics 'just in case.' 
Gawd, I am coming across as a real nit picker now aren't I?! I am not normally, honest!


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## Babysaurus (Feb 27, 2012)

And as I know two people who have had massive problems since having forceps deliveries, I am not able to switch off and go into this with my eyes shut!


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## PhoebeC (Feb 27, 2012)

Its understandable to worry and wonder totally natural 

I was a forceps birth and so was my daughter and we are both fine (even out the odds for you) 

I needed them id have never done it without them i had pre-clampsia and was swollen everywhere Saying that its okay for me to say this now she's here and fine

The more natural a birth can be the better If id got ti 36 weeks id have done everything to get her out without induction they arnt fun at all x


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## beckyp (Feb 27, 2012)

I'm afraid I don't know statistics and can only share the information I found through asking people when I was pregnant last year.  I had the same queries.

As I understand it, many hospitals like to induce diabetics earlier than 40 weeks due to the possibility that your baby will be larger than they'd like but more and more are trying to do this as late in pregnancy as possible now.  If you are well controlled during pregnancy this should be less of an issue. 

The chances of the placenta failing are low and my consultant couldn't stress this enough to me.  The signs of the placenta failing in pregnancy are when you insulin requirements start to decrease instead of increase and this should be pointed out to your team if it occurs.  It did with me but they still stressed that my placenta was healthy at birth.

I always felt that inducing at 38 weeks was a big risk.  Unless there is something wrong with you or the baby then I don't think it should happen as the baby isn't always ready to enter the world and the chances of csection are increased.  I was induced at 38 weeks (but was booked for 39 weeks) as I had high blood pressure (through the roof!) and 3+ protein and my insulin requirements had dropped by 50% (since the beginning of pregnancy).  I went to the hospital on Tuesday, had a 6 hour pessary on Wednesday morning which failed, had another on Wednesday night with a stretch and sweep which failed, had my waters broken on Wednesday which failed and was then put on a drip on Wednesday night.  By Thursday morning the doctor examined me and said that my contractions weren't strong enough and I needed an emergency c-section.  

Inductions clearly work for some women (as proven on this website with lots of healthy babies!) but they don't work for all.  From reading fellow type 1's birth stories on this website it always appeared to me that more ended in csections.  

Basically, without any more waffle from me (and unproven theories!), I guess what I'm trying to say is that the better controlled you are (you obviously are judging by your HBA1C's), there is less risk that your baby will be too big.  My hospital had a guide on how big is 'too big'. If your baby is 'too big' a csection would be advised.  All hospitals do things differently though.  My advice (for what it's worth!) is BAKE THAT BUN FOR AS LONG AS POSSIBLE!  They will be monitoring you weekly at the end of your pregnancy (from about 34-35 weeks) so will be able to judge how things are going.  

I hope the rest of your pregnancy goes well.


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## Babysaurus (Feb 28, 2012)

Becky thank you ever so much for your answer. 
I am in full agreement that 'cooking' that baby for as long as possible is a good thing, and it is good to hear that your consultant also seemed to think the placenta failing is not a major issue for induction. The one I spoke to didn't seem to think it was too high a risk either, and also, although he didn't elaborate too much, seemed to think it would be gradual rather than sudden thing. He was far more concerned with the whopper baby scenario, despite not evidence to imply that was on the cards. 
I am obviously going to have to enquire more and more, but as things so far with this pregnancy seem fine (I realise that may change, although not if I can help it!) now I also think all the talk I have heard so far of how I 'have' to be induced at 38 weeks at the latest seems a bit over the top. 
As this is my first baby (and possibly my last!) I very much doubt that he or she will be ready to come out on the dot of 38 weeks, and have a horrid suspicion that it may end in either instruments or c-sec due to this. While this would be part and parcel of the whole having a baby thing if I was carrying a 10lb or over baby, or had another health problem which would make early delivery important, I am not sure it makes sense if there actually aren't any other issues but it simply fits with hospital policy for 'all diabetics.' 
As I have said before, I would not want to put either of us at any risk but I also feel as if fitting it with a one size fits all policy won't do us any favours either. 
I may change my mind closer to the time, and I realise things could change as things progress, but I am still going to be questioning things to the maximum first (for my peace of mind if nothing else!) 
Thanks again!


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## Medusa (Feb 28, 2012)

Hi, I have had two babies, the first the induction took a long time but i had a perfectly normal delivery no forceps or anything like that, he was 8lb7, the second one i was taken in to be induced but luckily i was already dialated, my control was better second time around but the baby was just shy of ten pounds! I think they like to play it safe but the chances are they wont induce you bang on 38 anyway due to volume of births that take place, i think maybe it would be worth you getting a second proffesional opinion which you are entitled to as although i can share my experience i am not knowledgeable in every aspect of the inductions stats etc


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## AlisonF (Feb 28, 2012)

I have no experience of this, but I would be asking exactly the same questions as you Babysaurus if I was in your place. 

In the back of my mind, I was sure I'd read that induction at 38 weeks was starting to be considered less necessary, if size, placenta etc were all fine and close monitoring continued. But a quick scoot round the internet didn't come up with that, so I'm starting to think I heard it at a conference or dreamt it. 

The NICE guidelines for diabetes and pregnancy http://www.nice.org.uk/nicemedia/pdf/CG063Guidance.pdf say: 

1.4.1
Timing and mode of birth
1.4.1.1
Pregnant women with diabetes who have a normally grown fetus should be offered elective birth through induction of labour, or by elective caesarean section if indicated, after 38 completed weeks.

I think the key words there are "should be offered", ie you don't have to accept. But we're still lacking any real evidence for you to make an informed decision with I'm afraid. If it were me, I'd be spending a few hours on the internet, trying to find the latest research, and possibly asking for a second opinion. I'd be interested if you do manage to find the latest evidence being used to make the induction recommendation/anything that contradicts it.


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## RuthieG (Feb 28, 2012)

*Induction?*

Hi Babysaurus

I am a few weeks behind you (nearly 18) so haven't had a big conversation yet about the birth with my consultant but from what we have discussed thsi si what thy have said at my hospital (St Mary's Manchester):

- Usually they will induce at 37-38 weeks and i got the impression this was due to the size of the baby, although I would need to ask for the full reasons and policy
- My last HBA1Cs are nearly identical to yours and during my last chat with the consultants Obs he said something like 'the way you are going you will be begging us to induce you at 40 wks'. I said that I was under the impression that they always induced at 38 weeks but the consultant said no, not if it isn't necessary - this pleased me no end
- The consultant was really keen to stress that they like to do it as absolutrely naturally as possible and as much like non-diabetics do as possible. 

I am there tonight so might ask if I get chance and if not I will ask in two weeks at the 20 wk scan appointment. then at least we can have a view of what different teams/hospitals say. I defintely think you are right to ask questions and to understand the reasons behind every decision being made - then you can put your two-penneth in!

I enjoy reading your posts as you are a few weeks ahead and your bloods etc are almost identical to mine!


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## Babysaurus (Feb 28, 2012)

Thank you everybody for your replies. I was thinking about this a lot last night when I was trying to go to sleep and its getting me quite wound up (not badly so, but I am now desperate to have a proper discussion about it with someone at the hospital.) 

To me, at the moment at least, it looks as if the induction at 38 weeks business is a blanket policy to cover everyone, including those who have ignored any medical advice, have developed gestational diabetes but not treated it properly and so on. When I asked, briefly as it was when I was only about 14 weeks at the time, why they induce it was a brief answer basically along the lines of it being the safest option. I suppose now I need to ask them _why_ it is supposedly more safe. 

I am starting to see it like this: inductions are mainly done due to the size of the baby. They are gruelling to say the least and almost always require an epidural so the one being induced can cope with the pain. (I have to say, something that makes an injection and tubing inserted into the spinal cord look like the preferable option isn't a nice thought!) Due to how epidurals work, they can more often than not then lead into a cascade of other interventions such as the hideous forceps / ventouse or c-sec (c-secs seem to happen a lot in diabetics, do you reckon this is due to inducing early?) Obviously these methods can lead to problems of their own in terms of recovery, for both the mother and the baby. 

The baby is meant to be in there for 40 weeks (interestingly, in France the gestational period is considered 42 weeks, not 40) for a reason surely? I have also read that the suck reflex is better in babies born 40+ weeks (not looked into this yet, will keep you posted) which makes breastfeeding in particular, but I imagine bottle feeding too, easier would it not?

Another thought I have had re the 'big baby' scenario is how big is 'big' meant to be? I ask as many women have babies of 9lb or more and they are not pumped full of drugs to get them out early are they? If my baby was looking big-ish, as was the woman next to me, why does it make sense for me to have my baby asap but not for her to? Also, the estimated sizes given are notoriously inaccurate (I realise this can work both ways!) so its not like it's set in stone anyway! 

Ruthie the obs I have spoken to, admittedly not in huge detail as yet, seemed a lot less flexible that the one(s) you have dealt with so far. Please keep me posted as to how you got on today. 

Right, I shall get Googling and see what I can come up with! Thanks again for your replies x


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## allana (Feb 28, 2012)

Hi,

I have a 19 month old little girl and I'm 17 weeks pregnant. When I had Amelia I was induced again they told me it was due to the size of the baby. When she was born she was only 5llb 10 oz. I agree with other people on here, if you have good control your baby shouldn't be huge. I have my next appoint at 21 weeks so I am also going to ask more questions, as it would be much nicer to go in to labour naturally.

Please do let me know what answers you get ladies

Allana xx


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## Babysaurus (Feb 28, 2012)

Allana, your story is exactly the kind of story that bothers me about this whole induction policy business! This all sounds very much like a case of 'one size fits all' doesn't it? 
I am compiling my list of questions and getting my research sorted all ready for the apt tomorrow (not sure if it's jsut with the endocrinologist or the obs as well but hopefully it is the obs.) 

I can't believe this doesn't all get questioned more often!


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## allana (Feb 28, 2012)

Tbh I'm angry that I didn't question more 1st time round! But as you know managing pregnancy and diabetes is a full time job lol.  I think they want to minimise risks so treat everyone the same. Please do let me know what answers you get as it wil also help me get answers. I hope you do get to see the obs tmrw Hun.

Good luck! 

Allana


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## Medusa (Feb 28, 2012)

i do remember though being thankful of induction at 38 weeks the last few weeks are very long.... ask anyone who goes to 42 lol


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## Twitchy (Feb 28, 2012)

I suspect instead of a 'one size fits all' policy this has historically been more of a 'this is safest for most' approach...The diab specislist Obst who delivered my babies in '07 & '10 had decades of experience & a wary 'lets get a live baby out of this pregnancy' approach - from the first time we met him he told me i had a 70% probability of it being a c section. Unfortunately i'd already been suckered into the whole 'must do this natural nct earth-mother style or i'm a total failure' psyche so i wasn't best impressed! I can only speak from my experiences but baby 1 was born by 'semi elective emergency c section' at 34w 5d due to severe Pre eclampsia, which is associated with t1. He weighed 5lb 12oz which was bang on the 50% percentile. I'd been achieving HbA1cs of around 5.6 - 6.5% by obsessive control, but the docs still thought baby was surprisingly well sized given thx degree of PET, they think the PET cancelled out thd big diabetic baby factor.  Baby 2 was born at 35w4 d, again semi elective emergency c section, this time due to failing placenta (sudden, severe inexplicable hypos). Having been warned to watch out for these hypos i self presented at hospital. The 'normal' docs were talking about leaving me til my planned date, or maybe inducing if the hypos continued...they were happy because bizarrely i was only crashing at lunch times (but then mega hypo!!). I knew my doc was back in thd next day, & when the ward doc looked at my notes & started talking about  maybe bringing things forward to the end of the week i asked for the specialist...he took one look & declared baby was to be born today!! And she was, hugly macrosomic (sumo style!), by emergency c section & needing forceps to 'unwedge' her! She was 7lb 13oz, which is apparently normal for full term babies, but this was only 35w4d. My control had been described as 'excellent' through this pregnancy too. She was beetroot red - the placenta failing had meant she'd been generating lots of extra red blood cells apparently, & her initial apgar score was thru the roof because she was now getting more oxygen! The comment was 'tomorrow would have been pushing it.'  

I don't know why i only seemed able to do 'half baked babies'. Maybe it's being a very 'old' diabetic, after many years on the pants 2 jabs a day routine...dunno.   I'm not telling my experience to scare anyone, just to put across why docs can be cautious. At the end of the day, if i'd demanded to try for a vbac, i honestly don't believe baby would have survived, & for me the important thing was baby surviving. First time round i was too ill to care about how baby arrived, 2nd time round i trusted that one experienced, cynical, caring doc. (thank God!!!

Re feeding,  baby 1 struggled, kinda got there in the end with top ups but a combo of my diabetic control, his jaundice (assocd with br feeding) & collective exhaustion meant it was far from easy. Baby 2 was a hungry little monkey, latched on within hrs of being born & fed far better. There is an association between gestational 'age' at birth & feeding success, but again my personal take is 'pushing it' might not be worth it if there is evidence (hypos etc) that it's necessaryto get baby out. 

Hope that makes sense & doesnt sound like im trying to worry anyone, just sharing what happened to me, like i said i might have just been unlucky, it might be how long id  already been diabetic, but if i were to have another baby with this dodgy body of mine id rather have a live, slightly early c section birth baby who maybe needed formula than gamble it all & lose, as it were. Right, am off to hide now before the hit teams of the nct & la leche league hunt me down & beat me with (organic) sticks lol...


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## RuthieG (Feb 28, 2012)

*Appt today*

Hi Babysaurus

I only saw the diabetes doc today so no news but I am seeing Obs next time (two weeks today) at 20 weeks. I will keep you posted and also see what he answer are to your questions (hopefully tomorrow)

Ruthie


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## Babysaurus (Feb 28, 2012)

Twitchy, thank you ever so much for your post. 

It is helpful and thought provoking to hear another side to things as I was, well still am to an extent, of the train of thought that it's all precautionary and for every single diabetic regardless of their individual circumstances. Your post has given me another viewpoint to the induction side of things to mull over (it has especially sunk in that you too are / were very well controlled.) 

I think I am getting enough questions, and sometimes knowing the answer regardless (always helpful so you can work out how straight they are being!), together to start enquiring more. The way I see it, if I went in and asked for an elective c-sec they'd more than likely refuse on the grounds that it was an unneccessary medical procedure. I feel a similar way about an induction if there are not solid grounds for it, that too would be an unneccessary procedure. Hence, I need to get asking more and more about what's behind the policies and also weigh up the real risks. 

It seems as if it is not just me who is questioning all this so I will, of course, keep you all posted!


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## Babysaurus (Feb 28, 2012)

Ruthie, I was wondering how you'd got on! I see my diabetic doc tomorrow and sometimes these apts also include the obs so, if I get chance, I will do some enquiries and keep you posted. I also have a midwife apt at 9am so will see what her views are on things too, although I will not expect too much as, good as they are with some things, the midwives are not specialists with diabetics and all that can entail.


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## Smit (Feb 28, 2012)

I hate to say but good control does not always lead to a smaller baby. See my post from last week. 5 weeks ago I was measuring too small and the consultant said he was happy to leave me until 40 weeks as I have really good control. Then last week at my scan I was measuring 2 and a half weeks ahead and now they are saying if things continue I will be induced at 38 weeks if not earlier. 

I agree with you babysaurous, research everything and ask lots of questions. Thats what I have being doing since I found out I was pregnants but remember things can all change as you are well awhere with my situation. Good luck and keep us posted on what you find out/consultants say. I'm dreading my next appointment. Bloods all back in range but sure baby is growing rapidly. Doesn't help my hubby is 6ft 6!


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## Babysaurus (Feb 28, 2012)

Smit, you should have married a dwarf! I have also been 'helpfully' told by my sister-in-law that all the babies in my husbands family have been 8lb's and upwards ('a healthy size' she said - OUCH!) If mine is similar to his or her cousins does that mean I have to be whisked in and induced?! 

More seriously, I am keeping an open mind and am also aware that things can change but asking and enquiring is never a bad thing in my view, so I'll be back asap with the answers! J


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## Ellie Jones (Feb 28, 2012)

The 38 week induction isn't a figure pulled out of a hat, it is based on sound data collected which is an on-going procedure of periodically reviewing data collect with every new delivery.

Data and pure experience means that they know around this 38 week mark is the best time to deliver a diabetic baby for best chances of survival both inside and outside the womb..

Each mum will be treated as an individual, as they get nearer to the 38 week mark monitoring increases so that the consultant can look at mum's results, bp etc, check scan's and the presentation of the baby to decided the best time for delivery.

I wasn't diabetic when I had my oldest and she decided to arrive at just under 37 weeks.  So I actually 'cooked' a little bit longer being induced both between 38-39 weeks....


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## rachelha (Feb 29, 2012)

I was going to be induced at 39 weeks as all was going well, but I had bad swelling of my legs, hands so was induced at 38.2 weeks.  They dont do growth scans in my region so we had no idea that Nathan was large, 9lb 11oz.  I was induced, pushed for a while, had forceps and then a section as Nathan was just not moving down the birth canal.  I managed to breast feed him despite a difficult start as it took a while for my milk to come in some was topped up on formula to begin with.  
I am with Twitchy on this one, I would rather have an earlier healthy baby than risk problems by hanging on another few days.  A good friend of mine (not diabetic) recently had a very difficult labour with a big baby who is now permanently brain damaged.  I don't mean to scaremonger but if there is a next time I will be insisting on baby coming out at 38 weeks.


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## Babysaurus (Feb 29, 2012)

Ellie, I am perfectly aware that they have not pulled 38 weeks out of a hat. And as I have, despite my blood results, been told I have to see a dietician 'to learn about healthy eating' a nurse 'to make sure I am testing my blood glucose' amongst other examples I can safely say that, actually, I don't feel as if I have been treated like anything other than 'a diabetic patient.' 

Rachel, another thought provoking viewpoint from the 'other side', as it were. Am quite shocked they don't do growth scans in your region, I thought it would be standard practice everywhere. I was told today that while these can indeed be inaccurate, this can also mean a pound over and not just a pound under which was a very good point. 

I saw the midwife this morning. It was a really good appointment. I mentioned my concerns re induction and asked what she thought. In short, she said it is often done for very good reason but my hospital does tend to book diabetics in for 38 weeks regardless. She was more than happy, growth scans and everything else allowing of course, to back me with going to 39 weeks as she says the chances of the induction being sucessful are far higher then. Also, looking at my scans and bloods so far, she said it all looks good so far but obviously it is still very early days. 

I did stress to her that I was not going to simply refuse things willy nilly, but I did think it was important to be able to weigh up the pros and cons effectively. She agreed with this and said that this is really the best approach to avoid 'being processed as a diabetic and not a mummy to be.' 

Have the diabetic ante natal this afternoon, and this includes an obs apt. Will see what they say and report back.


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## Monkey (Feb 29, 2012)

Bit late to this, but I don't think its a bad tihng that you're questioning the pollicies - I'm all for being as aware of possible of what decisions are being made and why!

I did opt for induction at 38weeks, so slightly biased I suppose. It wasn't a bad experience (I know that sounds odd considering the next bit!), 20hrs overall including dilating to 10cm, pushing for 2hrs and going to theatre for an emcs. But, for a first labour, I don't think that's a bad length!

One thing you might need to consider is what you would want in terms of extra monitoring if you decide to go past 38 weeks - would you request 2 or 3 times weekly scanning to check placental health/fluid levels? Would your hospital automatically offer that?

It's all really interesting - let us know how things progress, because I'm certainly keen to hear.


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## newbs (Feb 29, 2012)

Just to reiterate that tight control does not necessarily mean you will have a small baby - I had very tight control with my first pregnancy (HbA1c 5.3%) and similar control with my second (5.7% I think) and both my babies were 8lb 3oz at birth and both born at 38 weeks, the first naturally and second induced (ending in emergency c-section).

I was told both times that I would be induced early because of baby's size and because of the placenta problems and didn't really question it tbh.  With the first pregnancy I had pre-eclampsia so am thankful I went into labour naturally early anyway and the labour was quick and relatively easy.  However, if I had my time over I probably wouldn't have chosen to be induced with my second pregnancy as the induction went wrong from the start and my little girl was very distressed and it ended with her being born with me under general anaesthetic as they had to save her life.  I do feel that this was partly because she was being induced when she wasn't ready to be born yet.

Good on you for questioning what you have been told, I am interested to know how things work out for you.


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## HappyHelen (Feb 29, 2012)

Hello!

Sorry i am also coming to this conversation very late. I think you should definitely question why an induction is necessary as nothing should be prescribed blanket fashion.

My experience was that I was induced at 38w and 4 days. To be honest I didn't question this but by 38 weeks I was soooo uncomfortable I was glad to be giving birth. I was told that any baby born after 38 weeks is not classed as premature and i was also told that the feeding issue you mentioned should generally not be an issue if the baby is not premature - I have no idea if this is correct. However Callum didn't have any problems feeding. 

Anyway, I tried naturally but my cervix would not dilate despite 3 attempts (induction was not a nice experience). After a day and a half of contractions and no dilation, I agreed with the doctors to give up on the natural approach and had the c-section the next day which had always been booked "just in case".

My experience of the c-section was that it was fairly uncomfortable for the first week but I was never in any real pain. The worst part was not being able to do much baby wise once the baby was here and also not being able to drive for 6 weeks.

From my experience, a c-section really wasnt too bad but I know that experiences vary greatly. What I'm trying to say is that don't be too scared of a c-section if it is required. I'm glad I tried naturally but didn't feel a failure because that didn't work as ultimately Callum arrived safely.

As others have said I would be really interested to hear what your doctors say and if you feel strongly enough, you should push for what you want. 

H x


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## Babysaurus (Feb 29, 2012)

Hi everyone, 
Right - I am about to have some very late dinner (I had to sleep for two hours when I got in from the hospital so am now running very late) but will quickly fill you all in. 

The obs appt was initially supposed to be quite brief, the focus was more on the diabetic doc (just going through the motions to be honest now I am pretty clued up with the pump and can alter things myself) but I asked things all the same, and it turned into a bit of a marathon! 

In short, the first obs (sorry for not writing the full word - I can never spell it!) said they induce at 38 weeks at the absolute latest 'as that is policy.' When I started to ask about the why's and wherefore's he didn't really have much other info other than 'its best for you and the baby.' But why? I kept asking so he eventually got someone else. The second bloke said they do it as a matter of course mainly due to size. I asked what would happen if size was not an issue and he said its never really come up before and 'most diabetics come in at 38 weeks if they have not before. 
I explained that I was not planning on refusing anything as such, but I did want to know how relevant what I was being told was to me. I also explained that I didn't want to go through an induction with all the possible connotations if there was not a solid reason behind but it was in fact just 'what they did'. I also explained that I realised that size can go up regardless of control but also pointed out that, at 25 weeks and with my bloods the way they are at the moment, we had no sign that this was definitely on the cards and wouldn't we be better playing it by ear? 

So, in short, this is currently the plan. I was told also that the vast majority of diabetic patients they have (mainly Type 2's and Gestational Diabetics) have quite poor control and they are fortunate, and it is very unusual, to have someone in with an HBA1C of 7% as it is often in the 8's or 9's (I then felt quite smug when I saw him look in my notes for my HBA1C record!) Due to this they want to get the babies out asap to avoid further problems and this is why they say they 'only let you go to 38 weeks.' 

As my circumstances a different to 'the masses' (sorry to sound arrogant but think many of you are prob in the same boat sometimes, I think us Type 1's often are) we can see how things develop but 'if things progress ideally' it will be 40 weeks instead, which also stands a far higher chance of the induction being effective (and may also mean I stand a chance of going into labour myself, although I realise this chance is still slim!) 

Lastly, the midwife I spoke to earlier today mentioned water as pain relief. I didn't think this was an option due to induction / monitoring etc and she said that it may well be, at least for part of the time. (The main thing she was concerned about was how waterproof the pump was.) She also was keen to emphasise that just as I am diabetic doesn't mean I have no other option but to go down the massively medical route - there was room for compromise.


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## Monkey (Mar 1, 2012)

That sounds positive, babysaurus. FWIW, I really felt my labour was as unmedicalised as possible, given the circumstances - yes, I was induced, and yes, I had syntocinon, but didn't have an epidural with it (which I know lots of hospitals will urge you to do) and had a fab mw who was as hands off as possible. It's all about you knowing what things you are able to control, and accepting that there are some things that aren't going to be 'normal', however much you'd like them to.

Jus to pick up on something you said earlier about suck reflex - I think there's very little difference in the development of the sucking reflex in babies born at 38 and 40 weeks. Certainly before 37 weeks (the point where you're considered premature) there can be some underdevelopment, but generally by 38 and beyond there's much less cause for concern.

And control - my hba1c was in the low 6s for the majority of pregnancy (I think a 7 towards the start) and C was born at 38+2, weighing 10lb 11oz. My diabetes consultant was absolutely astonished - I'd measured big, but no-one predicted that!


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## Natalie123 (Mar 1, 2012)

Good for you for questioning! I have to admit that I would do exactly the same, and the way that diabetic births seem to be so medical just puts me off of getting pregnant even though I want kids.


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## rachelha (Mar 1, 2012)

Good on you for sticking to your guns and getting answers, very interesting.  Great to know try are listening to what you would like to happen.  Keep us updated on how it all goes.


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## sugarfreerach (Mar 6, 2012)

My consultant was actually against early induction saying she would monitor me very closely and play it by ear.  I ended up being induced at 36 weeks anyway due to a failing placenta even though my hba1c hadn't gone above 6.2% for the whole pregnancy. He was also born 7lbs9, which i was upset about at the scans as I was under the impression that my sugars being so well controlled would've stopped this. (Big for a 4 week perm baby)


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## beckyp (Mar 7, 2012)

I just wanted to check in and see how you got on with your appointment....good on you for sticking to your guns.  

At my hospital my ob was the only one that dealt with diabetes - be in type 1, type 2 or gestational - and I always felt that she put us all in the same boat without a lot of knowledge of how hard it is to keep it under control - she would circle the odd double figure and treat you like a school girl.  She had the bedside manner of a wasp and I suspect she used to get really frustrated with women not caring about the effects of bad control so always seemed surprised when my husband or I would ask a reasonable question - a lot of which you covered in your appointment.  There were times that we watched women come out in tears from their appointment from where she had obviously given them a b*ll*cking about their control. 

Having said that, I wouldn't have changed her for the world.  When I said that something wasn't right at 38 weeks, I was induced the following day.  I'm just grateful that I read Twitchy's post about her placenta failing because the hospital staff (diabetic or general pregnancy) never mentioned the signs.  From that point on I always wanted to be one step ahead in the knowledge of what could go wrong and then I could ask the right questions without being fobbed off - something I suspect happens to a lot of people.  I get the impression that you are not easily fobbed off!!!

Also, as a lot of people have said, your perfect readings don't always produce a smaller baby.  My HBA1C never went above 6.9% during pregnancy (that was the highest reading at the end) and E was born at 9lb5oz.  The DSN told me afterwards that it helps but a lot has to do with the way food is stored and used by the baby so there is nothing you can do about it!  My description isn't all that accurate - I'll try and remember word for word what she said. 

I look forward to reading how your pregnancy progresses.  I hope it runs as smoothly as it has been.

If it helps, I'm 5 weeks now and have been told that it is policy in NZ to induce no later than 38 weeks so i will be having the same conversations with this ob as I did in Essex last year!


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## Babysaurus (Mar 7, 2012)

Keyboard Is Buggered - Mig Be As I Jus Wiped I. Will Wrie Wen I An!


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## Babysaurus (Mar 7, 2012)

Keyboard is behaving again! I had wiped it so some of the keys didn't work. 

Becky, I am wondering if the obs tend to get irritated and frustrated as so many, according to my DSN, women (esp of the Type 2 and GD kind) don't take a lot of notice but are always more than ready to lay the blame on the HCP's if something goes wrong? I was told that the majority in the ante-natal I go to are Type 2's and GD's and they seem to be a lot more blase about control etc. I guess as Type 1's have a very different outlook (or can do anyway.) 

9lb 5oz sounds eye wateringly big, but not ridiculously so for these days. It does make you wonder how big they'd be if you weren't diabetic. I didn't realise that it was to do with how the food was stored too, but that may explain why some of us with good HBA1C's have had larger babies. Bugger!


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## Twitchy (Mar 7, 2012)

Babysaurus said:


> Keyboard is behaving again! I had wiped it so some of the keys didn't work.
> 
> Becky, I am wondering if the obs tend to get irritated and frustrated as so many, according to my DSN, women (esp of the Type 2 and GD kind) don't take a lot of notice but are always more than ready to lay the blame on the HCP's if something goes wrong? I was told that the majority in the ante-natal I go to are Type 2's and GD's and they seem to be a lot more blase about control etc. I guess as Type 1's have a very different outlook (or can do anyway.)
> !


I think you may be on to something there - when i found out i was preg 2nd time i was due to start on a pump & the dsn refused to go ahead - her comment was that they would not give me a pump because "if something goes wrong you'll sue"!!!!  ...So i just had to stick to trying to combat DP with nightly 3 am checks & umpteen tests / tweaks a day! Nice attitude to care, eh?


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## Babysaurus (Mar 7, 2012)

Twitchy, I'm shocked! Dear me!


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