C section - 37 wks or wait longer?

[Mel98]

Hi all

I really need some advice. This is my second pregnancy - my sugars have not been well controlled throughout as my insulin resistance has been ridiculously high (to put it into perspective I’m taking 30 units of insulin for a single piece of toast in the morning and a similar amount for breakfast and lunch. My basal insulin is over 80u a day!!!!) As a consequence Baby’s AC measurements are off the scale and my obstetrician is recommending me to have baby out at 36/37 weeks. My only contention is that unlike my last pregnancy this one has been much smoother for me healthwise - I have no BP, blood tests and urine tests are all fine. I just have real concerns about having a baby early term - my son was born at 36/37 by emergency c section and basically couldn’t breathe when they took him out. He was on oxygen for 2 days and was fine thereafter but he is now 2 years of age and has a lot of developmental delays (autism) I always think it’s because he wasn’t given longer to cook inside and he just wasn’t ready to come out I obviously followed the doctors advice at that time as there were other factors - high BP and suspected preeclampsia - but this pregnancy is worlds apart in terms of my overall health but as per the cautious obstetric team a big baby resulting from poorly controlled diabetes is at risk of placental malfunction and still birth. I have been looking into the brain development of babies born at 37/38 compared with 39/40 and apparently those last 2 weeks are crucial (not just for lung development and weight gain but actual development and size of the baby’s brain) I really would like to hold out until 38+6 (or 38 weeks minimum) as a result but wanted some advice from other members - would you follow medical advice or go with your gut feeling?

 

[Juicyj]

Hi @Mel98 This is a really tough one.. I had mine at 37 weeks and she was 9lbs 7ozs, she has been really healthy and only developmental issues we have faced is that she has slight dyslexia but partner was severely dyslexic so never attributed this to being born at 37 weeks, I was diagnosed with gestational and put onto insulin at 23 weeks, I had pretty good control but I literally went with the flow of the doctors advise as i didn't know otherwise. As a mother we want the absolute best for our kids and our intuition is our strongest voice - I would go back to your doctors and talk this through with them, it is important that whatever decision you make you feel supported with, unfortunately Dr Google is the worst one to turn to when faced with a challenging decision.

 

[Diakat]

Talk to your team again and tell them why you are worried. Get them to explain the risks of hanging on in plain language.

My daughter came at 36 weeks, is 7 now, healrhy so far and one of the top achievers in her class so the last few weeks seem to have mattered less for her.

Talk it over with your partner as well.

 

[ickihun]

Hi all

I really need some advice. This is my second pregnancy - my sugars have not been well controlled throughout as my insulin resistance has been ridiculously high (to put it into perspective I’m taking 30 units of insulin for a single piece of toast in the morning and a similar amount for breakfast and lunch. My basal insulin is over 80u a day!!!!) As a consequence Baby’s AC measurements are off the scale and my obstetrician is recommending me to have baby out at 36/37 weeks. My only contention is that unlike my last pregnancy this one has been much smoother for me healthwise - I have no BP, blood tests and urine tests are all fine. I just have real concerns about having a baby early term - my son was born at 36/37 by emergency c section and basically couldn’t breathe when they took him out. He was on oxygen for 2 days and was fine thereafter but he is now 2 years of age and has a lot of developmental delays (autism) I always think it’s because he wasn’t given longer to cook inside and he just wasn’t ready to come out I obviously followed the doctors advice at that time as there were other factors - high BP and suspected preeclampsia - but this pregnancy is worlds apart in terms of my overall health but as per the cautious obstetric team a big baby resulting from poorly controlled diabetes is at risk of placental malfunction and still birth. I have been looking into the brain development of babies born at 37/38 compared with 39/40 and apparently those last 2 weeks are crucial (not just for lung development and weight gain but actual development and size of the baby’s brain) I really would like to hold out until 38+6 (or 38 weeks minimum) as a result but wanted some advice from other members - would you follow medical advice or go with your gut feeling?

Can I ask were you using metformin throughout this pregnancy, like I did for my 4yr old?
I also ask because your novarapid units are far less than what I was taken and used metformin which does normally reduce some of the amount needed.
My 4yr old is also behind in his development, being assessed soon.
Remember high bgs cause larger babies not how much insulin or metformin used to manage bgs.

 

[ickihun]

In my experience 5yrs ago I just wanted my baby out due to some frightening no movements in our last trimester due to increasing insulin too much via maternity DN advice. I went back following week to tell them he stopped moving so I reduced my insulin down a little as I felt too much too soon. I didn't phone an ambulance as baby started moving again with the lesser insulin, at that time. I watched his movements like a hawk and mainly slept when I did which is often normal.
My advice if you ever have any concerns call the dn at hospital and they can advise as they should have toons of experience. However, I felt on my occasion, mine was wrong to make me increase sooo much. I'm highly insulin resistant which can be very challenging for these not IR experience dns. We are all different.
You know your body and baby better and they should know insulin capabilities better than us.
Some DNS in maternity don't have much experience with large mums getting pregnant and needing sooo much insulin and just how easily that can be used up or not.

 

[ickihun]

If your instincts think something, your normally right. Mummy and foetus are a tuned more than we think.
Go with your instincts. You may not get a choice, in some cases thou. If consultant advises c-section at a stage....go with it.

Please let me know how you get on. ☺

I great time awaiting your arrival, I bet your getting excited?

 

[Tilly_S]

Hello , my second baby is now 8 months old , I had similar issues but with low sugars as in docs wanted him out ASAP incase of placenta failure ... anyways I ended up having him at 35 weeks and I wish I had him in longer just 3 weeks longer would of made a huge difference he was rushed straight from me after birth I didn’t have the golden hour and he spent a week in special care due to breathing problems ....My first was born at 38 weeks he weighed 7 lb 3oz and I was told he was huge ! Turns out he was just short ! So my advice would be too keep baby in as long as possible and consider 38 weeks for c sec xxx it has made me feel so guilty personally I beat myself up every day for being induced at 35 weeks but it is down to you and what your gut ells you x

 

[Mel98]

Thanks for the replies ladies. It's nice to know that you had babies at 36/37 weeks and they have turned out to be bright little things. I'm just paranoid after seeing what is happening with my son and thinking could it have been this or that

Can I ask were you using metformin throughout this pregnancy, like I did for my 4yr old?
I also ask because your novarapid units are far less than what I was taken and used metformin which does normally reduce some of the amount needed.
My 4yr old is also behind in his development, being assessed soon.
Remember high bgs cause larger babies not how much insulin or metformin used to manage bgs.

Hi ickihun - is your child a boy or girl? I hear boys are usually slower than girls in general but none of the boys I have met my son's age look to be behind their female counterparts at all. In fact they show up how far behind my son actually is

Yes i was asked to take one dose of metformin in the morning to cover my post-breakfast spike but i've been a bit naughty and tried to maintain control via insulin only as once again i took every possible medication under the sun when pregnant last time - all the prenatals with folic acid plus high strength folic acid for diabetics, blood pressure medication, antibiotics for infections and metformin. I've tried to maintain less interference with this pregnancy where i could. I think if i knew what caused my son's problems I would be following all the medical advice I could get but i'm so hesitant this time.

 

[Mel98]

Hello , my second baby is now 8 months old , I had similar issues but with low sugars as in docs wanted him out ASAP incase of placenta failure ... anyways I ended up having him at 35 weeks and I wish I had him in longer just 3 weeks longer would of made a huge difference he was rushed straight from me after birth I didn’t have the golden hour and he spent a week in special care due to breathing problems ....My first was born at 38 weeks he weighed 7 lb 3oz and I was told he was huge ! Turns out he was just short ! So my advice would be too keep baby in as long as possible and consider 38 weeks for c sec xxx it has made me feel so guilty personally I beat myself up every day for being induced at 35 weeks but it is down to you and what your gut ells you x

Yes my gut is telling me to let this one stay in as long as possible but how do i live with myself equally if something did go wrong and I ignored medical advice The team have said if i don't go for 36/37 weeks that i will simply need to be monitored daily but even that is not a guarantee as placenta could be working fine one minute and fail the next. It's such a personal nightmare choice. And i totally understand that 'golden hour' absence. The same with my son. He was in my belly one minute, out the next and I had to sleep alone without him for 2 nights - kept feeling my stomach as if he was still inside me since my hormones and brain couldnt compute that he was apart from my body. It was the loneliest and strangest period. From what i understand even if this one has no breathing issues (which it likely will as c section deliveries before 39 weeks don't push out fluids in their lungs), the baby will likely have low blood sugars and need special care as my BGs have been running high all through. When i say high my HBA1C has been 7% all pregnancy. I'm so conflicted about everything

 

[ickihun]

Thanks for the replies ladies. It's nice to know that you had babies at 36/37 weeks and they have turned out to be bright little things. I'm just paranoid after seeing what is happening with my son and thinking could it have been this or that



Hi ickihun - is your child a boy or girl? I hear boys are usually slower than girls in general but none of the boys I have met my son's age look to be behind their female counterparts at all. In fact they show up how far behind my son actually is

Yes i was asked to take one dose of metformin in the morning to cover my post-breakfast spike but i've been a bit naughty and tried to maintain control via insulin only as once again i took every possible medication under the sun when pregnant last time - all the prenatals with folic acid plus high strength folic acid for diabetics, blood pressure medication, antibiotics for infections and metformin. I've tried to maintain less interference with this pregnancy where i could. I think if i knew what caused my son's problems I would be following all the medical advice I could get but i'm so hesitant this time.

My 10yr old was insulin no metformin and 37wk induced. He's very intelligent. Maths was his strong point but he doesn't like his maths teacher so its showing. She stresses them out and shouts at them.

However my bgs were better in his pregnancy because I was younger. I feel I received a lot more support too as I'd had failed IVF and a decade of medical intervention to conceive, unsuccessfully.

4yr old's pregnancy also had not perfect bgs, on and off. I'm guessing like yours but genetics plays a huger part than diabetes control with some conditions or characteristic in we human beings.
I feel I cannot worry about every eventuality, in case it might happen. I know some things happen, to everyone. I'm more anxious making sure I'm not court out when it happens rather that if it happens. Which I am working on, with support.

I often get confused about the chances of something bad happening. Very very rarely does a person have unfortunate luck, on going. Life never stays the same.
This pregnancy will definitely not be the same as your last. May be very similar but not identical.
I'd encourage you to perfect your bgs in preparation of the birth. No matter how much insulin that is but only strictly supervised. Treat hypos effectively, if they occur.
What have you been told to reduce high bgs?

 

[ickihun]

Yes my gut is telling me to let this one stay in as long as possible but how do i live with myself equally if something did go wrong and I ignored medical advice The team have said if i don't go for 36/37 weeks that i will simply need to be monitored daily but even that is not a guarantee as placenta could be working fine one minute and fail the next. It's such a personal nightmare choice. And i totally understand that 'golden hour' absence. The same with my son. He was in my belly one minute, out the next and I had to sleep alone without him for 2 nights - kept feeling my stomach as if he was still inside me since my hormones and brain couldnt compute that he was apart from my body. It was the loneliest and strangest period. From what i understand even if this one has no breathing issues (which it likely will as c section deliveries before 39 weeks don't push out fluids in their lungs), the baby will likely have low blood sugars and need special care as my BGs have been running high all through. When i say high my HBA1C has been 7% all pregnancy. I'm so conflicted about everything

Weigh up pros and cons.
Write them down and look at them and give them their medical importance.. For you (mentally) and your baby.
It is a personal choice but medical risk has to come first.

If later c-section, is only downside aging or abnormal placenta?
In your case you have bad diabetes control too so not good for baby.(constant risk of still birth) Can you not perfect this more?
Can we (forum members) not help you with that?

Myself I'd always take advice from consultants. They know the whole story and the risks currently with the NHS and that hospital care.

PS. What I find very interesting is your blood pressure is good even thou having high bgs. Or is that because you're on tablets to control it? Or are you less stressed on higher bgs? Are you comfort eating?

Excellet bgs are brilliant for baby and healthy pregnancies.
How often are you over 7.5mmol/l on your meter? Before food and 2hrs after.

 

[ickihun]

Yes my gut is telling me to let this one stay in as long as possible but how do i live with myself equally if something did go wrong and I ignored medical advice The team have said if i don't go for 36/37 weeks that i will simply need to be monitored daily but even that is not a guarantee as placenta could be working fine one minute and fail the next. It's such a personal nightmare choice. And i totally understand that 'golden hour' absence. The same with my son. He was in my belly one minute, out the next and I had to sleep alone without him for 2 nights - kept feeling my stomach as if he was still inside me since my hormones and brain couldnt compute that he was apart from my body. It was the loneliest and strangest period. From what i understand even if this one has no breathing issues (which it likely will as c section deliveries before 39 weeks don't push out fluids in their lungs), the baby will likely have low blood sugars and need special care as my BGs have been running high all through. When i say high my HBA1C has been 7% all pregnancy. I'm so conflicted about everything

Is it a typing error 7%?

 

[Mel98]

In your case you have bad diabetes control too so not good for baby.(constant risk of still birth) Can you not perfect this more?
Can we (forum members) not help you with that?

I see the diabetes team each week with my readings and it seems no matter what they advise i just can't seem to get the sugars down after breakfast. The rest of the day seems reasonable although still not on target.

They advised me to inject 30 mins before breakfast last Thursday - i tried today to give it 1 hour before breakfast and i am still not in range. I woke up with a fasting reading of 4.4, took 38units 1 hour before breakfast. I tested myself before eating my 2 weetabix and I was 5.4 (so i'm still higher than when i woke up). Then 1 hour after actually eating, i'm 9mmol. I should be 7.5 or lower

I've tried eating less carbs, still the same issue. I just think its a combination of dawn phenomenon, cortisol and placental hormones working against me no matter what i do in the early hours. Since increasing my bolus amount and taking it at night and in the morning my fasting readings are always spot on. My post breakfast meal however is still never right. Sometimes i would go to 15 and 16s. I also find it hard to wait 15 mins before eating when waking up, let alone waiting 30mins as i'm still suffering morning sickness and if i dont eat carbs immediately I vomit bile

Myself I'd always take advice from consultants. They know the whole story and the risks currently with the NHS and that hospital care.

Yes i would normally agree but my consultant seems to err on the side of caution regardless. She won't even take a well controlled pregnancy beyond 37 weeks. I asked if she had encountered any still births and she said 'no because we never go beyond 37'. So it doesnt really address my concerns. She just recommends early delivery and no stats at the hospital to suggest going beyond that is actually detrimental.

PS. What I find very interesting is your blood pressure is good even thou having high bgs. Or is that because you're on tablets to control it? Or are you less stressed on higher bgs? Are you comfort eating?

yes its strange that my BP is normal. It's actually lower than it has ever been which is weird but i think it's because i'm more active in this pregnancy than last. I take my son for daily walks, take him to nursery by foot, take the stairs to work etc. I think it's had a positive effect and my erratic sugars don't seem to be affecting it.

[/QUOTE]How often are you over 7.5mmol/l on your meter? Before food and 2hrs after.[/QUOTE]

Yesterday

Waking - 5.2
1hr after breakfast - 9.2
2hrs after breakfast - 6.2
1 hr after lunch - 6.1
2 hrs after lunch - Hypo
Before dinner - 5.2
1hr before dinner - didn't test
2hrs after dinner - 6.6


Also has anyone had steriod shots before delivery? They are asking me to come in on Monday and Tuesday overnight for 2 shots. I'm not only worried about how high my sugars will go as a result of this as they are already not great but also that this might trigger another issue with autism in the child as i've read that too much cortisol for the baby is linked to behavioral issues like ADHD and autism. I'm probably genetically likely to have an autistic child and an environmental trigger like a steriod shot might be all it takes But if i don't take them, the baby might have breathing issues on delivery. I just can't make up my mind on anything and i'm considering not turning up on Monday as well

 

[ickihun]

Weetabix has to be changed to something less carbs maybe but if you do take less novarapid FIRST or you will get a hypo. Half your 38units and eat a 2 egged omelette with peppers or mushrooms but not sweetcorn and definitely no bread or anything made from wheat/grain. Onion too if you like or snippets of thin ham or tiny bits of bacon. Fill yourself up for your baby and your needs. Breakfast is your best opportunity to start your BG day well.
Your next hurdle is lunch then dinner. Once again if you need more insulin to cover a healthy diet, it's normal in pregnancy. Eat a banana before any hypo can get close or any fruit. However if in hypo territory treat with glucose as normal. Use your fruit to keep hypos at bay.

 

[ickihun]

Drink a half glass of full-fat milk on rising to stop bile or have you been given gaviscon, if not ask from GP in these late stages of pregnancy. Gaviscon will prevent reflux in pregnancy.

 

[ickihun]

I bet if you get excellent bgs your consultant will listen to your wanting longer for your baby hun.
Give it a go.
I'll help you and you can at least have a good argument for a longer pregnancy. Currently no one would sanction it.

 

[joanne75]

Hi have you asked to swap insulin to fiasp?? Works a lot quicker then novorapid should prevent post meal spikes.

I was pregnant 2yrs ago was on less insulin then u for meals but still nearly triple what I was taking it’s such a battle isn’t it. I had a lot of amnotic fluid kept going up and down and they didn’t know why I was in 1 night for steroid injections, bs didn’t go above 7 so not too bad, I was induced at 37wks due to the fluid, induction didn’t work and they wanted him out so had a c section, my son was whisked away and was in NICU I didn’t see the colour of his eyes or hold him until he was 12 days old he was born with Sepsis (not wanting to scare you) and fairly rare, however sometimes it’s right to go with what the doctors say hope all goes well xx

 

[ickihun]

I see the diabetes team each week with my readings and it seems no matter what they advise i just can't seem to get the sugars down after breakfast. The rest of the day seems reasonable although still not on target.

They advised me to inject 30 mins before breakfast last Thursday - i tried today to give it 1 hour before breakfast and i am still not in range. I woke up with a fasting reading of 4.4, took 38units 1 hour before breakfast. I tested myself before eating my 2 weetabix and I was 5.4 (so i'm still higher than when i woke up). Then 1 hour after actually eating, i'm 9mmol. I should be 7.5 or lower

I've tried eating less carbs, still the same issue. I just think its a combination of dawn phenomenon, cortisol and placental hormones working against me no matter what i do in the early hours. Since increasing my bolus amount and taking it at night and in the morning my fasting readings are always spot on. My post breakfast meal however is still never right. Sometimes i would go to 15 and 16s. I also find it hard to wait 15 mins before eating when waking up, let alone waiting 30mins as i'm still suffering morning sickness and if i dont eat carbs immediately I vomit bile



Yes i would normally agree but my consultant seems to err on the side of caution regardless. She won't even take a well controlled pregnancy beyond 37 weeks. I asked if she had encountered any still births and she said 'no because we never go beyond 37'. So it doesnt really address my concerns. She just recommends early delivery and no stats at the hospital to suggest going beyond that is actually detrimental.




yes its strange that my BP is normal. It's actually lower than it has ever been which is weird but i think it's because i'm more active in this pregnancy than last. I take my son for daily walks, take him to nursery by foot, take the stairs to work etc. I think it's had a positive effect and my erratic sugars don't seem to be affecting it.

How often are you over 7.5mmol/l on your meter? Before food and 2hrs after.[/QUOTE]

Yesterday

Waking - 5.2
1hr after breakfast - 9.2
2hrs after breakfast - 6.2
1 hr after lunch - 6.1
2 hrs after lunch - Hypo
Before dinner - 5.2
1hr before dinner - didn't test
2hrs after dinner - 6.6


Also has anyone had steriod shots before delivery? They are asking me to come in on Monday and Tuesday overnight for 2 shots. I'm not only worried about how high my sugars will go as a result of this as they are already not great but also that this might trigger another issue with autism in the child as i've read that too much cortisol for the baby is linked to behavioral issues like ADHD and autism. I'm probably genetically likely to have an autistic child and an environmental trigger like a steriod shot might be all it takes But if i don't take them, the baby might have breathing issues on delivery. I just can't make up my mind on anything and i'm considering not turning up on Monday as well [/QUOTE]

Your yesterday results are perfect.

Are you not just worrying too much?

 

[ealingr]

Steroids aren't just helpful for baby's breathing - they have other benefits, too. If your medical team is recommending them, I'm sure they believe the benefits outweigh any risks.

I had real challenges with morning/post-breakfast BGs when pregnant, too. One tactic which helped me was setting an alarm to take insulin before my regular "getting up" alarm. For example, if I was planning to get up and have breakfast at 7.30 then I would set an alarm for 6.30 to take my breakfast insulin (and rest/try to go back to sleep until 7.30).