I'm currently 8 months pregnant (due 3/22). I'm type 1 diabetic and have had several minor complications with this pregnancy. My unborn son has single umblilical artery (apparently there are supposed to be two arteries), I have an excessive amount of amniotic fluid (not enough to be drained but enough to cause ALOT of pressure for me) and this little boy is measuring a tad bit on the big size, due to my diabetes. I was having a lot of extreme low blood sugars (fasting bs sometimes 47) so my OB (upon consulting my endocronologis) suggested cutting back on my insulin (he would rather I be a little high, like 160s than to be THAT low).
I am already having a scheduled c section (this will be my 2nd csec). My 1st csec was an emergency one due to the health of myself and baby.
So my question is this. My doc has indicated that he'd like to do an amnio on 2/25 to determine if this baby's lungs, other vital organs are fully developed enough to deliver him early. My concern is that upon doing the amnio there are so many risks that can cause pre-term labor. I'm concerned that one month early could be a little too dangerous. I'm all for the amnio (I had one with my 1st born also) so I know what to expect. But upon having the 1st amnio, my doc determined to deliver my son that day and it was 3 weeks ahead of schedule. My son was only 5lb 10 oz when born and I think we could have waited a week or two more easily.
So now I'm wondering if I should just simply tell my OB that I'd prefer to wait until AT LEAST March, and closer to the actual due date. I see no need to rush him more than necessary, even if he's big, I'm having a c section anyway.
My OB is the same one that delivered my 1st born and while I trust him, I know alot about pregnancy is just a mystery and all doctors do what THEY are comfortable with, not necessarily what's required.
Any ideas or suggestions??
Thanks again to all of you offering both personal and professional opinions! The professional opinions were awesome and helped me devise some great questions for my OB regarding some of the concerns I was having and I didn't feel quite so overwhelmed going in today. Had our appointment to discuss the options with the OB. He agreed based on all info thus far that, while he will continue to monitor this situation closely (NSTs twice a week, several additional US and lots of follow up appointements) he has agreed that we can wait a little longer.....Barring any additional complication or needs, I have the amnio now scheduled for March 9th and, if lung development is good, the c section is sceduled for March 11th. Of course, my doc is still being very cautious and will change plans if necessary (which I'm completely fine with) but so far, I'm confident that this will work out just fine for myself and my baby.
I can't thank you all enough for your words of encouragement! You are all the best!!
Any c-section is considered elective if it's not a true emergency, ie, the life of the mother or baby is at immediate risk.
The best treatment for neonatal hypoglycemia is breastfeeding.
If I had all these risk factors, I would be seeing the most qualified specialist I could find, not an OB who seems to be in over his head, and would be delivering at the best hospital with a NICU.
the problem with diabetes in pregnancy is that there is a risk of stillbirth. This may be why your doctor wants to deliver early. The fact that your insulin requirements are decreasing may also be a sign that the pregnancy needs to come to an end earlier as well--the placenta is no longer secreting the same amount of hormones. Ask your doctor why he wants to deliver early. They don't want to do anything to harm the baby but if he wants to deliver early, he probably has a good reason/concern.
D. - Your doctor has reasons for wanting the amnio - you have polyhydramnios, diabetes which is apparently not well controlled with wide fluctuations in blood sugars, a large baby which is the result of the blood sugars and there is a single artery - which in and of itself can be of concern in terms of blood flow, nutrients and oxygen getting to your fetus through the cord. All of these conditions represent some amount of risk to your unborn child and at 36 + weeks gestation, which you would be on 2/25, the risks of prematurity, while present, are very low. Apparently, your doctor is engaging in a risk/benefit analysis here and thinks that the risks of keeping the baby in are potentially higher than delivering a little bit early. He is hedging his bet by getting the gold standard of evidence - an amnio - to determine fetal lung maturity. Your doctor is practicing smart medicine by thinking ahead about your potential complications. If you don't agree with his management plan, you have every right to question it - but your decision should be based on medical evidence and by weighing the risks presented by your health conditions against the early delivery - you should ask your doctor for morbidity and mortality statistics for 36 week gestation babies in terms of understanding what kinds of problems can happen when babies are delivered at that point, or do some online research. I agree with the poster who suggested getting a second opinion - I would recommend a maternal fetal medicine specialist who could fill you in on everything you need to know. By the way, this cesarean would not really be considered "elective" here because there are a number of indications for the delivery - i.e. your diabetic condition, large baby, etc. so 39 weeks is not the magic number here.
Don't go ahead with it until you've had a heart to heart with your doctor. It might be the best thing, but be sure! Let him know where you're coming from and why you'd like to wait longer, and see if he can convince you to change your mind. If you feel like he's being unreasonable about going early then you can refuse to have it done. You are not under arrest, you have the last say about what's best for your body, even if its wrong. But obviously the safety of you and your baby is your top concern and if its bad to wait, then you'd go ahead with it.
I had gestational diabetes and everyone freaked out about wanting to deliver me early. I wanted a natural child birth, so the idea of an induction or c-section was scary! I was (in my doctor husband's words) the most compliant diabetic he'd ever seen, because I wanted my baby to not get so huge we'd have to deliver early or do a c-section. Ultrastounds showed an average sized baby, but they still wanted to induce me. In fact the morning of my visit to schedule the induction was when my water broke (2 weeks early) and she came on her own, and I was able to have a natural child birth. And my baby was 6lb 11oz. So much for everyone's fears right? The frustrating thing was that the Maternal Fetal Medicine doc was giving me the opposite advise, since the baby was small he didn't see the need for an induction and told me to just protest. I'm thankful that it didn't get to that point, but I understand a little of what you're going through. I was gearing up in my mind about the conversation I wanted to have with the doctors about when and how the induction would take place, and I was bringing my hubby along for support.
Best wishes! Having your baby is a blessing, and 35 weeks is early, but not dangerously early. If that's the best thing then don't freak out about it and go with the flow. If not, stand up for yourself!
Hi D. ~
I'm an OB nurse, and I have to agree with both Laura & Sasha. Yes, there are risks having an amnio, however, because of all your issues, there are risks to the baby by staying inside. At 36 weeks, the baby is still considered pre-term, but with the amnio your doctor would know whether his lungs are ready or not. Girls mature faster than boys, so he may not be ready at that point. Stress can mature a baby's lungs faster than usual (such as the polyhydramnios and diabetes). The size of the baby has nothing to do with whether or not his lungs are mature (my own grandson was 36+ weeks gestation, weighed 9 lbs and needed to be placed on a ventillator for 5 days due to prematurity). This is somewhat considered a "elective" cesarean, as far as you could opt for a VBAC (not really recommended since the baby is big), but it's really a necessary one. I assume that your doctor has consulted with a perinatologist, but if not, don't feel bad asking to see one. It is your right to make sure that you receive the best care possible. I would visit the hospital and find out what support they have for your son if you do deliver early and he needs help. Do they have a NICU? or do they transfer babies to a larger hospital when they need more support? Don't be surprised if your son needs an IV after birth ~ your sugar passes through the placenta to the baby, but your insulin does not. Therefore, he creates his own insulin to deal with the increased sugars. After delivery the sugar supply is suddenly cut off, but he still has increased amounts of insulin in his system, so they often crash and need an Dextrose IV so that they can wean the sugar away a little more slow.
Good luck!
D.
My docs told me that at 34 weeks the baby was old enough to suck and breathe.. so they would not try to stop labor after that point..
If the dr wants to do the amnio.. and the results come back that thelungs are mature.. he will want to get that baby delivered.
diabletic moms are at high risk of still births.. so they like to deliver a bit early.. as soon as the baby is ready they want to get the baby out so it is safer for him.
talk to your dr.. but your baby will probalby be safer on the outside.. and your sugar will be easeir to control too.
Follow your gut I would wait till the 2nd week of march.
Honestly, even if you trust your doctor, I would get a second opinion. The general recommendation is that an elective cesarean should not be performed before 39 weeks of gestation. If there are serious concerns to your health or the babies health that make an earlier delivery necessary they should be weighed very carefully. Even babies born between 32 and 36 weeks of pregnancy, though they may have no initial problems, are at higher risk for respiratory issues and learning disabilities later in life.
If it was me, I would hang on as long as possible.
