Argument with OB

Yesterday I had an appointment with my OB to discuss my baby's growth and a plan for delivery. She was very impressed with my diabetes control and said that they never see anyone as good as me (HbA1c is 36 and it's very rare that I'm ever above 9 or below 4 - thanks to the insulin pump I got just before pregnancy!) She said baby's growth was good and with each scan his measurements have stayed on the same growth line. Baby is on the bigger size but he has been from the very beginning (me and my brother were both biggish babies).

The appointment started off well until I mentioned that if I don't go into labour naturally then I would like a c-section. I gave her the following reasons:
1. My Grandmother and my Mother both had difficult births. My oldest uncle required forceps which resulted in his death at 4 days old. All of my Grandma's subsequent pregnancies were born via c-section. My mum also required forceps with my brother and she had a 4th degree tear.
2. I have very narrow hips so I fear that I'll have the same fate as my Grandma and Mum.
3. Baby has a large head - BPD = 98th percentile, HC = 97th percentile, adding to the fear that he won't fit...
4, I have read about the high rate of emergency c-sections with inductions.
5. I've heard horror stories from friends that have been induced (all ended in emergency c-sections).
Basically, with my size, family history, size of baby's head, induction stats etc I'm convinced that if I'm induced it will end in an emergency c-section. I would much prefer a much more relaxed me, hubby and more importantly unstressed baby and have an elective c-section.

The OB gave a big rant on why I was making a very bad decision but in the end agreed to let me have an elective c-section BUT she said that if I get a c-section between 37 and 38 weeks that I will require steroids since baby's lungs are 2 weeks behind since I'm diabetic (won't need steroids if I birth naturally). I said that I would like to wait until 39 weeks then so that I won't require the steroids. She has basically refused to let me wait until 39 weeks. Even after I told her that my physician and two OB's I have seen previous to her said 39 weeks was fine. One even said she preferred to wait until 39 weeks to deliver! She is adamant he must be delivered before 38 weeks. This sounds like absolute BS to me and I see no reason (provided baby is fine) why I can't wait until 39 weeks! I just hope I don't see her for my next appointment...

Sorry for the huge rant. When were you induced/have an elective c-section? Anyone wait until 39 weeks?

azure said:

Could you get a second opinion if you're not happy? Is there any kind of hip assessment you could have to help predict if you'd have problems delivering naturally? I know some ladies do have hips that cause problems and there was a lady here who, I believe, had a section for that reason.

I was induced at 37 weeks. I didn't want a section, but I could have chosen one if I wanted one. My obstetrician said they wouldn't want to do a section until 39 weeks as a section didn't get the lungs working like a normal delivery did (excuse my non-technical explanation).

Were you given any reason why she was saying that re timing?

In the UK, generally induction happens in the 37th or 38th week. I understand this is because there's a greater risk of placental failure in Type 1 diabetes (not sure about the other types).

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Thanks for the suggestion, at my next appointment I'll ask if there is a hip assessment they can do

She gave the placenta failure reason for the timing but when I asked why diabetics have a greater risk I didn't really get a clear answer. I guess I was hoping that if my blood sugars are kept within range that the risk would be no greater than everyone else. I guess not. Do you happen to know why we are at grater risk?

I've seen 2 previous OB's. The first one said she likes to wait until 39 weeks and the second said between 38-39 weeks. They also gave the reason of placenta failure for not going to term but for some reason they believe it's safe to wait until 39 weeks. The OB I saw yesterday did happen to be from the UK (I'm in NZ) so maybe that's why her recommendation on timing was different to the others. It's been hard to get a clear answer with everyone's differing opinions and it would be so much easier if I saw the same OB each time.

azure said:

I'm no medic so I can only tell you what my consultant told me: all placentas age and will eventually fail if pregnancies went on for weeks overdue. That's why doctors don't let women go over about 42 weeks. In diabetes, the placenta can age faster and be more vulnerable to failing before the due date. To avoid the risks associated with that, induction is usually recommended prior to the due date.

I'd assumed poor control would make that failure more likely, but it seems it can happen despite good control. My HbA1C was 27, yet I chose to be induced early as there were subtle changes that worried me. There's no test that can diagnose placental failure so if there's a potential concern, it's likely the baby will be delivered early.

Regarding the section - my consultant said it's a balancing act. 39 weeks is best for lungs, but then the risk of placental failure is greater so it may be safer to have steroids and a section a little earlier. I asked my consultant how they decide and she said they weigh everything up on an individual basis.

It's a really hard call as obviously it'd be lovely to wait and go into labour naturally, but then there are the worries about the placenta.

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Wow 27! Good work! I don't think I could ever get a result that good as I'm likely to have a small snack when I'm approaching 4

I'm just hoping that I go into labour naturally so that I don't have to make the decision. Baby dropped a week ago and I'v been having menstrual like cramps for about the same amount of time so I'm hoping that something will happen within the next few weeks.

1Sarah1 said:

Hi for both my pregnancies the plan was to deliver 38-39 weeks. Unfortunately I got pre eclampsia first time and was induced and ended up with emergency section at 35w. Second time with twins I opted for section but ended up delivering at 35w.

Natural labour is much better for babies lungs as the fluids get squashed out -they may need special care as a result -some sort of support for their lungs.

Please don't think sections are easy-I'm 3months post section after twins and still not fully recovered.

I would defo see if you can get a another opinion-obviously you and your OB need to discuss the risk factors and decide the best action.

Good luck and well done on hba1c

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I would love it if I had a natural labour as I know it's best for baby and myself. I just have a very strong feeling that if I'm induced it will end in a stressed baby and an emergency section and I would much prefer a planned c-section over an emergency one.

tigger said:

My hospital policy is 38+6 for type 1 either induction or cs. Other hospitals hsve earlier cut off dates. Your hospital should have a policy. I went for induction with my 1st which was unpleasant and ended in emcs. My next were twins who came at 33+4 via vbac and could both breathe by themselves despite the fact they're not meant to until 34 weeks. I heard comments about well developed placenta, diabetic mother while lying there so i'm not sure where this thing about lungs not developing comes from. I'm currently at the end of pg and have a cut off date which is my cut out date. I've told them if the baby comes of its own accord i'll try vbsc again and if not an elcs. They can't induce me again thankfully as a result of the cs. My recovery from vbac was much better than emcs. Saying which they spent a long time assuring me when i was pg with the twins that elcs is very different and a much easier recovery. ...until nhs policy changed when I was 20 wks and they started to push me towards vbac very heavily. .....

At the end of the day it is a gamble on everyone's part with a lot at stake. Do you have appts with both endos and obs? I suggest you wait til you have one of those and request consultants for both and discuss dates and methods. You have a much higher chance of avoiding a cs if it starts naturally but it can happen even then.

They were only prepared to start the discussion with me at 32 weeks this time so don't worry if it's not sorted earlier on.

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Thanks for your reply You helped me make up my mind that if I don't go into labour naturally then provided me and baby are fine, I want to wait until 39 weeks and have an elective c-section. I see both the endo and ob every 2 weeks (I'm almost 35 weeks now). Ironically, when I told the endo I wanted a c-section if I don't go into labour naturally, she told me I'm best to wait until 39 weeks so that I won't need steroids. Only 5 mins later was I told by the ob that she wouldn't allow me to go to 39 weeks... It seems my hospital doesn't have a policy and that each individual doctor has their own. I think as long as I don't see the same ob as last time (I just see whoever is there on the day) then waiting until 39 weeks and getting an elective c shouldn't be a problem. If I do see her again, I will be putting my foot down.