Type 2 means induced labour and monitoring?

Munkki

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527
Type of diabetes
Type 2
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Diet only
Hi all,

I don't know whether I am right here, so if not, please let me know and I will move the post to the type 2 forum.

I was diagnosed with type 2 in Summer 2015, with healthy HbA1c readings since Autumn that year, due to LCHF/keto, exercise and IF. I surprisingly got pregnant (stopped IF), 18 weeks today :happy:.

It was quite a marathon with all the appointment with midwives, doctors, etc., and after not caring for a long time (no retina photos, I had to ask for HbA1c tests etc), suddenly my diabetes appears to be a very serious issue. I am still having perfect control, measuring 7 times a day! The pregnancy is progressing nicely. Nevertheless, the doctor said, we will probably need to induce at 37-38 weeks anyways, because a higher risk of stillbirth, and connect me to a monitor :bigtears:

Is this really necessary? I know they need my consent and cannot handcuff me to a bed, but I want to make informed decisions. How do I know this is necessary and not just a box-ticking exercise?
 

Resurgam

Expert
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9,849
Type of diabetes
Type 2 (in remission!)
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Diet only
Having had two babies weighing over 9lb - if they want to induce you a little early as the babies are large, I'd say that was a pretty good idea, as I feel lucky that there were no problems - I remember the midwife swearing when she saw the width of the shoulders appearing before her.
If you are still avoiding high carb foods then it might become obvious that the fears are unwarranted, but closer to the time you will probably be closely monitored and you should have the opportunity to discus things such as the baby's presumed weight and development.
My daughter in law is a high risk mother and is expected to give birth by induction in the middle of next month, about three weeks early - but the baby is rapidly approaching 7lb now....
 

HSSS

Expert
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7,465
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Type 2
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Can’t comment on your circumstances but I had 2 9lbs and a 10lber. And I heard comments about the last ones shoulders too. He however was the easiest birth overall. That said he was a few days early and the other two 2 weeks late. I wasn’t diagnosed a the time but I believe by today’s standards I might have been and it certainly was the start of the path for me. I understand as the pregnancy progresses control might get harder so it might be a case of waiting and seeing how things go.

In your shoes I’d be asking for explanations of why they advise what they do and how it applies to you not just in general. If your numbers remain ideal and scans don’t show any concern re size I’d need more convincing than if these facts didn’t remain true.
 

Munkki

Well-Known Member
Messages
527
Type of diabetes
Type 2
Treatment type
Diet only
Thank you so much for sharing your experience. They generally said that they want to induce early, because of higher risk of stillbirth. The size of the baby can be measured, more or less exactly, but if it is growing normally, I will not be convinced of an early induction. So far, my control has been good, for example, today I remained in the 4s and 5s (4.8 after lunch), so there is some hope.

Also, they want to keep me on a monitor, maybe one that is not portable, to test my blood sugar. I mean, why should it suddenly be too high or low during labour? Has this happened to anyone here? Also, why are point measurements not sufficient, given that I can take them myself?!
 

lucylocket61

Expert
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6,435
Type of diabetes
Type 2
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Is there a reason you are unhappy about having the early induction?

I had gestational diabetes with my 9lb son. I previously had a stillbirth, with no diagnosis of diabetes, but was probably pre-diabetic.
 

Munkki

Well-Known Member
Messages
527
Type of diabetes
Type 2
Treatment type
Diet only
Is there a reason you are unhappy about having the early induction?

I had gestational diabetes with my 9lb son. I previously had a stillbirth, with no diagnosis of diabetes, but was probably pre-diabetic.

I am so sorry to learn about the stillbirth. I want everything to go as naturally as possible, but I see how two more weeks of gestation are peanuts compared to the baby actually passing away.

Generally, I feel like I am put into a general category of people with diabetes, including those with no control at all. I feel there is too much interference and I don't trust doctors since my diabetes diagnosis - I would not be where I am today if I listened to medical professionals, suggesting carbs and medication.
 

NicoleC1971

BANNED
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3,451
Type of diabetes
Type 1
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Pump
Thank you so much for sharing your experience. They generally said that they want to induce early, because of higher risk of stillbirth. The size of the baby can be measured, more or less exactly, but if it is growing normally, I will not be convinced of an early induction. So far, my control has been good, for example, today I remained in the 4s and 5s (4.8 after lunch), so there is some hope.

Also, they want to keep me on a monitor, maybe one that is not portable, to test my blood sugar. I mean, why should it suddenly be too high or low during labour? Has this happened to anyone here? Also, why are point measurements not sufficient, given that I can take them myself?!
Sounds as if they are treating you as high risk and in some ways it is good to have all that extra monitoring but it can make your pregnancy rather medicalised. Bear in mind that they won't be seeing too many women like you who have got their sugars under control and improved their fertility it would seem via low carb high fat so won't have a lot of clinical experience of it but just the opposite where women and babies run into problems giving birth to large babies due to uncontrolled blood sugars I assume.
I also felt pretty healthy but things can and do go wrong in the later stages due to insulin resistance caused by pregnancy hormones so all I can suggest is the impossible of relaxing when not at appointments whilst keeping an open mind as your pregnancy progresses. It is good that you will have more checks and more scans to check baby's growth and will allow you to make an informed decision about the birth as it gets nearer.
I think the lives of 2 of my 3 kids were saved by all the extra attention I got (type 1 with pre eclampsia first time and 3rd time baby's heart just stopped beating during a routine check).
Congratulations and I hope you enjoy your little bump over the coming months - its a lovely time IMO!
 
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kikiwg

Newbie
Messages
4
Type of diabetes
Type 2
Treatment type
Insulin
Hi all,

I don't know whether I am right here, so if not, please let me know and I will move the post to the type 2 forum.

I was diagnosed with type 2 in Summer 2015, with healthy HbA1c readings since Autumn that year, due to LCHF/keto, exercise and IF. I surprisingly got pregnant (stopped IF), 18 weeks today :happy:.

It was quite a marathon with all the appointment with midwives, doctors, etc., and after not caring for a long time (no retina photos, I had to ask for HbA1c tests etc), suddenly my diabetes appears to be a very serious issue. I am still having perfect control, measuring 7 times a day! The pregnancy is progressing nicely. Nevertheless, the doctor said, we will probably need to induce at 37-38 weeks anyways, because a higher risk of stillbirth, and connect me to a monitor :bigtears:

Is this really necessary? I know they need my consent and cannot handcuff me to a bed, but I want to make informed decisions. How do I know this is necessary and not just a box-ticking exercise?
HI CONGRATULATIONS
if you want the evidence base for your suggested care look at NICE guidelines for pre existing Diabetes and pregnancy the references at the end will give u the research that supports the care
 

dje55

Active Member
Messages
26
Type of diabetes
Type 1
Hi there,

Congrats on your pregnancy.

Unfortunately the rate of stillbirth at term for women with diabetes remains higher than the general population. This does not seem to be reliant on blood sugar control. The placenta forms and develops differently for women with diabetes, again despite good blood sugar control.

These are the reasons why you have been offered induction a couple of weeks earlier. Not because you have been lumped together with those whose control is less than optimal. The guidelines are available on NICE website, they are called NG3.

Hope this helps. It's always your choice, and you're right, they can't force you to have an induction. Monitoring in labour is recommended because of the placenta changes too. I have had two induced labours with monitoring and normal deliveries. Was not tethered to the bed for either!

Speak to your diabetic specialist midwife or consultant midwife at your hospital to explore all the options.
 

Munkki

Well-Known Member
Messages
527
Type of diabetes
Type 2
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Diet only
HI CONGRATULATIONS
if you want the evidence base for your suggested care look at NICE guidelines for pre existing Diabetes and pregnancy the references at the end will give u the research that supports the care

This is a great suggestion, thank you.
 

Munkki

Well-Known Member
Messages
527
Type of diabetes
Type 2
Treatment type
Diet only
Hi there,
Unfortunately the rate of stillbirth at term for women with diabetes remains higher than the general population. This does not seem to be reliant on blood sugar control. The placenta forms and develops differently for women with diabetes, again despite good blood sugar control.

Thank you, this is the first explanation that makes sense to me! I am reading some books at the moment, including The Positive Birth Book, and am looking up the academic references cited in the NICE guidelines this morning (next week from work, if I don't have access from home). As you suggest, I am scared of being tethered to the bed, fearing a hell of a birth. I trust the Diabetic Nurse more than the doctor, but will discuss options with both - and inform myself as much as I can beforehand.
 

Munkki

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Messages
527
Type of diabetes
Type 2
Treatment type
Diet only
Phew, that was a difficult read. The good news is that the NICE guidelines recommend monitoring the blood glucose levels of the mother once every hour during labour and birth, not continuously.

Stillbirth is more complex, and cannot be predicted with tests, as it seems. However, there is a lack of controlled studies and academic references. There was literally just a paragraph about it, nothing mentioning the placenta. @dje55 have I missed anything?
 

Munkki

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Messages
527
Type of diabetes
Type 2
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Diet only
(Same as in another thread, if you are wondering :angelic:...)

Hi, I want to update on this conversation, now that my daughter is actually born... So, I declined the early induction, which was offered for week 37 or 38, but showed up for a lot of monitoring. I was hoping for a natural, spontaneous birth, but, in the end, went for two sweeps around my due date and then for an induction at 40 weeks + 5 days. My daughter was born at exactly 41 weeks. She has been very healthy and far from stillbirth, as far as I can tell. I stayed in the hospital for more monitoring after birth, which was good, as I got lots of breastfeeding support. My baby has been thriving from the start, and is hitting all milestones early. I have also breastfed her without major problems. I am glad, I declined the early induction, so glad! In hindsight, it seems ludicrous to me to have forced her out of my tummy up to four weeks earlier. As it was difficult enough to get her out just after the due date, weeks earlier would have been just more painful, I suppose.
 
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Munkki

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527
Type of diabetes
Type 2
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Diet only
To add, I had a very good and understanding obstetrician, who sent me the journal paper showing the risks of stillbirth for women with diabetes ('Factors associated with stillbirth in women with diabetes', Diabetologia(2019) 62:1938–1947https://doi.org/10.1007/s00125-019-4943-9)

As expected, the sample consisted of women with much higher blood glucose levels and BMIs and just was not including women with diabetes type 2 that is controlled to healthy levels.
 
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GDM06

Active Member
Messages
33
Type of diabetes
Type 2
Treatment type
Non-insulin injectable medication (incretin mimetics)
I was now type II DM, but had gestational diabetes in both my pregnancies with good glycaemic control although was on insulin.
I had induction at 39+6 with my first 16yrs ago- the guideline was 38 weeks at the time. I wasn't comfortable going post-date but wanted to go closer to term as much as possible so as to reduce the chance of failed induction. I had a vaginal birth. My consultant was okay with the same as long as I was not over 40 weeks.
My second 10yrs ago was planned for 39+ weeks as well but had to be induced at 37+ due to low liquor volume. I had a vaginal delivery.
I work in healthcare so I am aware of the risk of IUD, but the risk is higher post-date in diabetes so was comfortable with my decision not to have an induction at 37-38 weeks.
You could consider requesting sweeps from 37 weeks onwards to see if may help move things along, but I will discuss with your consultant if you are not very comfortable with induction at 37-38 weeks.
 
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Munkki

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Messages
527
Type of diabetes
Type 2
Treatment type
Diet only
Thank you GDM06. It's good to learn about your experience. I am now pregnant with my second and, at this moment, comfortable with going past my due date. Also because this time, my due date was set a week earlier than previously calculated.

I went for two sweeps in my first pregnancy, but I guess when the baby isn't ready the baby isn't ready. My obstetrician is more relaxed this time around, which helps.
 
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PrincessDolly

Member
Messages
5
Type of diabetes
Type 2
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Tablets (oral)
Thank you GDM06. It's good to learn about your experience. I am now pregnant with my second and, at this moment, comfortable with going past my due date. Also because this time, my due date was set a week earlier than previously calculated.

I went for two sweeps in my first pregnancy, but I guess when the baby isn't ready the baby isn't ready. My obstetrician is more relaxed this time around, which helps.
Hello I had gestational diabetes that was undiagnosed 21 years ago - my baby was just under 12 lbs full term (induced) and I am very grateful she and I survived the birth which was vaginal - but she got very stuck and the birth was extremely traumatic and caused lasting damage to my body that included surgical repairs a year later and issues that continue till today. I am now type 2. Being induced isn’t great, but the extra monitoring is really really good. I knew my baby was very large, and I had sugar in my urine at every visit but nothing was ever done-wish I had had the confidence then to push for more monitoring and scans and for a section but it was during a period where the big push was towards “normal birth” & I was much younger. There isn’t much discussion about childbirth injuries but they are real and long lasting disabilities can result. I do hope you get the birth you want - be confident.