Question about inductions

[@4lgd]

Hi, I am in the very early stages of pregnancy, but have already been told I'll be induced before my due date. Kind off annoyed about this and just wanted to know a bit more about why it appears that induction is the automatic option for diabetics? Surely if everything else is going okay I won't necessarily need to induced? Don't get me wrong, if it was in mine and the babies best interest I wouldn't hesitate, just annoyed that it appears to be an automatic thing and nothing to do with the individual. Any info on inductions and why its needed in T1s would be gratefully appreciated.

 

[azure]

@@4lgd I hate induction too, but I understand the thinking behind it so I put up with it. But it's a pain (literally!)

The placenta of people with diabetes ages faster than non-diabetics, and it can fail in the last stages of pregnancy. It tends to be around two weeks older than it should be. That's why induction is scheduled for week 37 or 38. It's a precaution

Edited to add that there's no way to check whether the placenta is deteriorating so even if all all appears to be ok it's not worth the risk.

 

[jade88]

Hi 4lgd to add to what Azure said I was told diabetics are at higher risk of still birth or other complications so once baby is full term (37 weeks) there is no reason to leave baby and longer they do higher the risk becomes! Also diabetics tend to have bigger babies (hence growth scans) but even they are only an estimate (totally underestimated size of my baby at 36 week scan - he was 9lbs can you imagine how big he could have got!?) I didn't mind bring induced as I was so excited to meet him and was nice to know when he was coming! Also get to miss out on last couple of weeks which seem to be the most uncomfortable! Good luck with your pregnancy! xxx

 

[@4lgd]

Thanks for the replies guys. I knew the placenta deteriorated quicker, but didn't know that this could not be monitored. In that context then an induction does seem wise. I wonder why the risk of placenta deterioration and increased risk of still birth? I'd very much like to see the research behind these (and many other) statements. I wonder if it is based on older research from when the tools available to control diabetes were a bit more crude.

jade88, that's a good point about missing the most uncomfortable last few weeks, there has to be some advantage to being diabetic. Also I shouldn't be complaining about a potential early arrival, I am due in December, the further away from christmas day the better!!

 

[heavenly]

Have a look at the NICE guidance. This will give you further information and links to research in the area.

 

[tigger]

Also be aware that different hospitals have different views on the end date. Mine is 38+6 but most others seem to be 38+0. It also depends on your control as that can affect the size of the baby and prevention of shoulder dystocia. However you'll find a number of ladies on here with amazing control and hba1cs who had other things go wrong nearer the time which necessitated earlier deliveries.

 

[Diakat]

I was induced, not too bad pain wide, but my placenta totally disintegrated once baby was out so ended up in theatre to get that out. Just goes to show how dodgy they can be. They are trying to keep you both safe. Huge hug and enjoy your baby when it arrived. X

 

[carlylou2688]

I was allowed to go full term as baby measured fine on all scans and not too big. I was induced at exactly 40 weeks. My baby was born weighing 8lb 9oz. It all depends on hospital policy, how your diabetes has been, if you have any other problems and how your baby is looking on the scans. Congratulations on your pregnancy

 

[sammy704]

I just recently found out about induction too (and was annoyed). I was told by one doc that they want to do before 39 weeks and another today that it's "a matter of opinion." There is higher risk, but for those with higher control and good scans (I go 2x a week for biophysical profiles via ultrasound), that going to 40 weeks should not be an issue. Although, he said he would not go beyond that before inducing.

 

[Loulou52]

Guidelines ag my hospital are to induce at 38 weeks. I went to 39 with my first but docs were not happy with this. Induced at exactly 38 weeks with this one. Neither of my boys were especially big at birth: 6lbs 10ozs and 7lbs 10ozs but it was the possible placenta failure that worried my docs- this is incredibly serious. I would have loved to to keep them in longer but I worried too. I had no other complications either. It was a relief to hold them in my arms despite the length and intensity of the inductions. Good luck with everything.

 

[kitty55]

Thanks for the replies guys. I knew the placenta deteriorated quicker, but didn't know that this could not be monitored. In that context then an induction does seem wise. I wonder why the risk of placenta deterioration and increased risk of still birth? I'd very much like to see the research behind these (and many other) statements. I wonder if it is based on older research from when the tools available to control diabetes were a bit more crude.

@4lgd - I'd just like to throw some advice in - now I am a first timer so there might be others more experienced than me in having babies, BUT I experienced exactly the same as you did and got told that I'd be induced between 37 and 38 weeks and initially there seemed to be no conversation about why exactly that was. I am aware of the possibility that the placenta could deteriorate earlier than in normal ladies but this is not a given and I have spent weeks doing research online to find exactly the facts and figures about all the risks of stillbirths being more common and placenta deterioration. And guess what I found!? Nothing apart from 10 year old stuff that was put together when medical devices to control diabetes where nowhere near as advanced as they are nowadays. My hba1c was in non-diabetic levels through my whole pregnancy and my growth scans showed baby was on 50th percentile all the way and literally everything is going as well as it can so I spoke to my obstetrician and was very grateful to hear that she supported me fully in my decision to not be induced but rather be monitored. I have always said that if there is any actual medical reason for baby to come out earlier I am the last one to refuse induction but if there is not then I didnt see the point. If your docs say there is an increased risk just ask them for the data and figures of it - my obs actually confirmed that the research was old and I wouldn't be able to find anything new.
Little story on the side: My obs is on holiday next week and hubby and I decided to have an induction on Thursday due to a variety of reasons (obs away this week, baby better out than in generally after 40 weeks - we did research it, I had two sweeps and my obs was convinced it would pop out after one pessary as my body is in fact getting ready for birth). To cut a long story short - I had a 24hr pessary put in on 1pm Thursday which gave me contractions overnight and even worse on Friday morning (to the point I thought I wouldnt survive) so I had painkillers and a bath at 11am and all went away. My obs came at 1pm to take the pessary out and said at the time I should go for a walk to see if the contractions came back. I went for a long walk and at 5pm when she came back to see me before going home she suggested another 6hr pessary, breaking my waters on Sat morning and possibly putting me on a drip. I had a very quick chat with hubby (did that before already as I knew that was an option) and decided I rather avoid a chain reaction of medical intervention as that was what I never wanted in first place and went home fully supported by my obs. I am going in every day now for CTGs and scans every other day and I am sure baby will come in the next few days on their own. I have never been so happy about a decision I have made before.
Good luck to you! And feel free to get in touch. Hopefully I won't get slaughtered here as I know what the general opinion is but this is my story and I am obviously watching BGs and movements etc with eagle eyes as I am 40+1 today. xx

 

[azure]

You won't be "slaughtered" @kitty55 Every woman - diabetic or not - has to make their own decisions in pregnancy and prior and during delivery, and their own decisions about what risks they can bear

Regarding the pessary, it seems to,work great for some women, fine for others (as in it's a good start to induction) and not really work much at all for other women. It did hardly anything for me, but having my waters broken was the real game changer as far as induction went. That's not always possible as obviously they have to be accessed ok, but for both my second and third deliveries, that really helped.

It's also worth remembering that babies and Mother Nature have a mind of their own : D

 

[LittleGreyCat]

Thanks for the replies guys. I knew the placenta deteriorated quicker, but didn't know that this could not be monitored. In that context then an induction does seem wise. I wonder why the risk of placenta deterioration and increased risk of still birth? I'd very much like to see the research behind these (and many other) statements. I wonder if it is based on older research from when the tools available to control diabetes were a bit more crude.

<snip>

I can't say too much or give any names or links because this is research yet to be published.

However I am aware of a study where the BG monitoring is very advanced and there are apparently still enhanced risks in going to full term if you are diabetic however good your control is.

The other thing not mentioned directly so far; I understand one of the risks to the developing baby is that its pancreas tries to take over the load for both mother and child which results in it having to work harder than normal, and also is one explanation for high birth weight. Simply, as I understand it the baby is taking glucose out of the shared blood stream and depositing it as fat, plus possibly getting more nutrients than normal and growing faster.

Our first child was induced for medical reasons not related to diabetes (apparently the awkward little so-and-so was fighting with her mother whilst still in the womb).

Resulting high blood pressure discovered at the pre-natal check up in the hospital resulted in "We will admit you now. No, you can't walk to the ward you must sit in this wheel chair.".

Shortly followed by "The best place for your baby is in the cot next to you!".

She came out jaundiced and weighing 6 lbs 2 oz but it still going strong 30+ years later.

 

[azure]

I don't know what study you're referring to, but yes, I was told that the placental deterioration risk was unrelated to HbA1C too. My HbA1C was excellent (28 ie 4.7) but I went for induction for that reason.

 

[LittleGreyCat]

I don't know what study you're referring to, but yes, I was told that the placental deterioration risk was unrelated to HbA1C too. My HbA1C was excellent (28 ie 4.7) but I went for induction for that reason.

As I said, I can't quote the details of the study as it is yet to be published.
I am just mentioning it because the suggestion was raised that all the studies relating to risks during pregnancy were "old".
Hopefully something will be published fairly soon. I have no knowledge of any specific publication date.

 

[azure]

As I said, I can't quote the details of the study as it is yet to be published.
I am just mentioning it because the suggestion was raised that all the studies relating to risks during pregnancy were "old".
Hopefully something will be published fairly soon. I have no knowledge of any specific publication date.

No problem

When I looked I found one study that took place in Denmark. I think it was published a couple of years or so ago. Although it wasn't just about diabetes - it also included other at risk women - it showed that a good induction policy reduced the number of stillbirths.

As with all studies, that only shows the overall picture not one woman's specific personal risk. Even if a risk was low as 1 in 1000, it's no consolation if you're unfortunate enough to be that woman. That was the way I looked at it. Induction is a nuisance but I put up with it because I didn't want to look back and wish I'd made a different decision...