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Induction/Birth

Discussion in 'Pregnancy' started by BethTwydall, Oct 9, 2019.

  1. BethTwydall

    BethTwydall Type 1 · Active Member

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    Hi Everyone

    I'm hoping this post doesn't turn into a rant but just needing some advice from other diabetic mums/mums to be!
    Bit of background, diabetic for nearly 20 years, control has been good for the past 7/8 years, hba1c around 45-50 and steady.
    I'm a massage therapist specialising in pregnancy and teach pregnancy yoga. My mum was a doula for many years. I'm also currently studying Maternity Care at University. I am very well informed about birth, its a natural process that the female body is made to do. I am however also very that the NHS has guidelines that it uses for diabetic/'high-risk' pregnancies.
    I attended a pre-conception appointment today, the appointment went well, as in the consultant said there is no reason why I can't go ahead with a pregnancy. He also said that my control puts me in the same place as the general population. The obstetrician however straight away said that I will have to be induced at 37 weeks. I thought to myself this isn't the time to start a battle and just simply said that I know I have choices. She said no, this is the NICE guidelines on which they follow. Not to mention there was 8 other people in the room for my appointment, but that's another issue!
    In my own research I can see that the NICE guidelines have been created from very old research carried out when diabetic women probably weren't as well controlled as we can be now. I think we can all agree that technology has changed massively even in the past 5 years and control can be that much tighter. Also diabetic women don't all fit into a one size fits all model.

    So my question is, did you refuse your induction? Did you get to make choices around your birth? Were you informed about your choices and given clear evidence based information? Was the evidence up-to-date?

    I'm not even pregnant yet and I'm already feeling anxious about the forceful 'care' from the NHS. I'm going to do some more research and speak again to the diabetic consultant who was very positive and see what he says about this.

    I understand that they induce as diabetics can have bigger babies, but only if they are not well controlled. As I'm aware, there is no evidence that diabetic women birth any differently from non-diabetic women, if their blood sugars are controlled, so why the need to induce?

    Interested to have a discussion about this.

    Thanks!

    Beth
     
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  2. Abbybarford

    Abbybarford · Member

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    My glucose levels were very controlled during pregnancy and my little girl was born 7lbs 2oz. If I had gone full term she would have been alot bigger. However the reason for being induced early is because the last two weeks of the pregnancy the placenta can start to deteriorate which means that baby is at risk so it's in the babys best interest to be induced early.

    I found being induced made the contractions far worse, and if I had a choice i would not have chosen it. But unfortunately it's too much of a risk to go full term
     
  3. BethTwydall

    BethTwydall Type 1 · Active Member

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    Hi Abby

    Thanks for your reply. I'm just wondering if you know of any evidence of placenta deteriorating after 37 weeks? Did you get the info from a midwife etc? It would be really great to have a read.
    I was under the impression health professionals want to induce due to increase risk of stillbirth (0.05% to 0.1%), I haven't heard about placenta deterioration.
     
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  4. Abbybarford

    Abbybarford · Member

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    The midwives and health professionals do discuss this all during appointments after growth scans. Theres many things that can occur if the placenta does deteriorate such as stillbirth, however it is a risk throughout the entire pregnancy not just the last couple weeks.

    I suppose it depends on the pregnancy, if you have no problems and baby is growing at a steady rate they may not need to induce but they might monitor you for the last two weeks, to check the placenta is still working. I wouldn't stress yourself out, but personally I would have wanted to go Into labour naturally, there was never an option mentioned to me
     
  5. BethTwydall

    BethTwydall Type 1 · Active Member

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    Thanks again for your reply :) It's just difficult for me as I'm learning at my university course all about how every woman has a choice, it's their bodies etc but in reality when it comes down to it many women aren't offered a choice, and I feel like this even from pre-conception! I know diabetic bodies are more complicated but things have changed so much recently. But you are right, I will not stress, try and have as healthy pregnancy as possible and think more about induction when the time comes. x
     
  6. HSSS

    HSSS Type 2 · Well-Known Member

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    @wiflib I understand is a recently retired midwife with a woman centred approach. Hope she doesn’t mind being tagged in as she may have something to add
     
  7. Antje77

    Antje77 LADA · Moderator
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    Hello @BethTwydall ,
    I don't have children and don't expect I will have, and I don't know much about pregnancy and birth either so I don't have any information for you.
    I like your question and your attidude a lot though :)
    Just yesterday I saw my GP for an inflammation in my hand. We're trying to find the cause and I mentioned T1 and she reacted right away with a 'yes that makes you more prone to infections.' I said: 'Oh, I thought that having high bg made you more prone to infections. I don't really have that. I meant to say that having one auto immune condition gives you a higher chance of others, so maybe we should look into that possibility as well.'
    She agreed right away (she's a very nice GP).

    I think wanting to know exactly on what grounds you're supposed to be induced is a good thing. If they make sense you'll probably happily agree and if they don't in your particular situation you'll know why you don't agree.

    @wiflib may know some relevant literature for you.

    Good luck!
     
  8. Diakat

    Diakat Type 1 · Moderator
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    I don’t know of any written evidence but in my case I was induced at 36 weeks as my placenta was failing - ended up with it essentially falling to bits and extra procedures to remove. Baby was healthy though.
     
  9. kitty55

    kitty55 Type 1 · Well-Known Member

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    I am happy to report that for my pregnancy in 2015 I did the exact same research as you and came to the exact same results too. I luckily had the full support of my obstetrician at the time when I said I am not going to get induced but rather wait for the baby to make a move - my diabetic team was horrified as they had never anyone going any longer than 37/38 weeks. I however made an informed choice and waited until my baby made the move at 40+2 days and I went into natural labour. I did come to an agreement with my obs that I'd come in every day for a CTG as soon as I hit 40 weeks so on the morning I started labour I had a CGT and also a scan and went to the labour ward that afternoon.
    I always said if there is any reason whatsoever due to which I can't just wait and the baby has to come out I will happily get induced but thankfully it wasn't necessary.
    I have been 48hrs in labour at the time and ended up with an emergency section due to the baby sitting in a slightly awkward position and his pH levels being off at some point. This didn't have anything to do with me being type 1 though obviously. I stayed the whole time on my pump/libre combi and avoided a sliding scale too.
    It will be your baby, your body and your choice!!!! Good luck and if you have any questions shout. No one can force you to be induced!!! xx
     
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  10. BethTwydall

    BethTwydall Type 1 · Active Member

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    Amazing! Thank you so much for your reply ❤️
     
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  11. michelle88

    michelle88 LADA · Well-Known Member

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    I gave birth to my 2nd son last September 24 at 38+5 weeks, having gone into labour naturally. My doctor wanted to have me induced at 38 weeks at the latest, but I refused, saying that my blood sugar levels had been in range over 90% of the time, and my HbA1c was consistently around 5.7% (mostly thanks to the Libre). I wasn't induced with my first son either, and he was born at 39+6 weeks! My doctor said it didn't matter if my levels were perfect, because as a diabetic the risk of the placenta failing was higher and he didn't want to risk a stillbirth (imagine how encouraging that sounded to me). But I held my ground, explaining that I was scared of induction and the stronger contractions because of it. He said he couldn't force me so he accepted my decision. I'm glad I didn't give in to him! My son was born with an Apgar of 10.
    Funnily enough, my diabetic team were not in favour of me having an induction either. I can't blame my doctor though, apparently today's guidelines seem to dictate that all pregnant diabetics should be induced at 37/38 weeks.
    As kitty55 said, no one can force you to be induced. The decision will ultimately be up to you!
     
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  12. Reemap

    Reemap · Well-Known Member

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    Hi There .. I delivered baby in April 2019.. I was on insulin the entire pregnancy.. diabetes got detected in second month of my pregnancy.. I was induced pain at 38th week because my baby was not getting enough blood supply and he was small for his gaestational age . He weighed 2.5kgs at birth but looked very tiny. I was advised to eat lot of protein for him to gain weight where they can induced me pain.
     
  13. Emj185

    Emj185 Type 1 · Member

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    What is a CTG? I don’t particularly want an induction if my baby is at no risk, I’d rather let him arrive on his own in his own time.
    My research has turned up the same info as yours and OP but feels like a bit of a battle with my medical team!
    I’m wondering if I volunteer for this CTG as well it might smooth the waters a bit?
     
  14. kitty55

    kitty55 Type 1 · Well-Known Member

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    Sorry, only just ready your reply. The CTG is that strap thing around your belly and I totally didn't mind going in every day just for the CTG. I was extremely lucky that my obs was that supportive of my idea to let the baby make a move in his own time. My diabetes team however had never ever had any diabetic before who hadn't been induced according to them. So they were nervous and got more nervous every day from 38 week onwards where they haven't had any news about me going into labour on my own LOL
     
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  15. Munkki

    Munkki Type 2 · Well-Known Member

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    This thread reflects my experience at the moment, 18 weeks pregnant with pre-existing type 2 diabetes and the doctor wanting to induce at 37 or 38 weeks. I have started a thread on this in Gestational Diabetes, but still haven't found evidence of placentas not working properly independently of blood sugar control.
     
  16. michelle88

    michelle88 LADA · Well-Known Member

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    I can only speak from my experience, having given birth last September at 38+4 weeks. I was not induced, although that was what my doctor wanted for me because "that's the standard procedure for diabetics". My baby was not overweight and there was nothing wrong with the placenta, so I decided to wait until my son wanted to come out, and I'm glad I did. I've never heard of the placenta not working properly independently of bg control.
     
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  17. dje55

    dje55 Type 1 · Member

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    There are some interesting articles on the placenta and diabetes if you use Google scholar.

    Head to Google scholar and search for articles on diabetes and placenta.

    Hope this helps.
     
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  18. CL85

    CL85 · Member

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    Hi everyone,
    I am nearly 32 weeks pregnant and my obstetrician has informed me I will be induced early due to being type 1. No information, no thorough discussion. Very much the typical one size fits all approach. I do not feel like I have been asked to give informed consent. She has very poor interpersonal and patient centred skills, and every interaction I have had with her I have left disappointed. So, I have done a lot of my own reading and research to inform my judgement and decision before agreeing to it either way. I may also request a second opinion. I appreciate induction reduces the chance of still birth in type 1 mothers but when you look at the stats, like Beth mentioned above, it is actually a very small percentage chance anyway. Some research also suggests that this risk is mitigated further with good control and healthy BMI. When considering the entire potential process of induction (none of which she has discussed with me) i.e. risks, complications and overall potential trauma of inducements (if it isn’t straight forward and the whole process is required), risk of the drip interfering with oxytocin and therefore bonding and breast feeding behaviour, more intervention, forceps, extra pain etc etc, I am weighing up if it’s worth it to offset what appears to be quite small risk. Inducement could mean being in hospital several days too, something which is a risk in itself in the current climate. I am fit, healthy, have very good control A1C currently and consistently 39-42 throughput pregnancy, and no further comorbidities. First growth scan was normal on all levels. I am struggling to see the benefit of putting myself through induction for the sake of it, just because of protocol. I would prefer the at least try the process of a natural birth and for baby to come when he is ready, even if it does end up with some form of intervention, at least it’s intervention when required, rather than intervention ‘in case.’ It is great to hear about experiences on here and very reassuring that people have declined advice and tried for a natural birth. I am due to speak to my obstetrician this week and I am dreading it, she doesn’t make me comfortable at the best of times but I am planning on discussing how I would prefer to try and avoid an induction. Can anyone offer any tips or any useful questions I should ask to ensure I get the support I need if I opt for natural? I am not sure what to expect if I don’t go ahead with their recommendation and I don’t expect her to be the most supportive so want to feel prepared. Any advice appreciated! Thank you!
     
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  19. Munkki

    Munkki Type 2 · Well-Known Member

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    Hi, welcome here and apologies for the late response. I am 32 weeks pregnant now and had a conversation about a conversation about induction today. The obstetrician sounded like the induction will be performed and I replied with "You are offering it" and then "I haven't yet decided whether It agree with it." She reacted very well. It is true, though, they are offering the induction according to the NICE guidelines and you have the right to decline. I am more confident now that I have mentioned this today, but like you I am nervous about the actual first conversation about the induction. I have read some literature, including "Am I allowed" by AIMS. Are you worried that they will stop caring for you completely? I am often scared of setting boundaries, but more often than I expect, I see that people react well. I also have the impression that they do what they have to do (follow NICE guidelines) and, if you decline for the best reasons, that should be fine. How are you feeling about things now? Have you already had the conversation?
     
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  20. MiriamL-W

    MiriamL-W · Member

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    Hi Beth,

    My son was born in 2017 and I have been T1D for 26 years. I felt like I was fighting the doctors from day one just as you seem to be. I honestly think that’s because T1D scares them, they only know horror stories and it’s such a complicated condition that they can’t hope to fully grasp it - let’s face it we struggle with in every day. So they try to keep things in their control and sod what you want. That is not right. You will be a mother who’s body and rights are just as valuable as any others. Keep bringing the evidence to them along with your amazing control and make sure they justify why they want to do whatever it is they say they want to do, ‘cause we want to’ is not a reason. If you are healthy and well, there is no reason you can’t do it anyway you like.

    It sounds like you are seriously well informed and have great support around you. You are going to be great. Although I think you will scare the sh*t out if them

    Sadly there is very little research out there and it’s not that up to date. Feels as if its worked out through hear say.

    I stuck to my guns and although had lots of complications (not diabetes related) had a healthy baby with a good weight 7.8 managed my own sugars through labour with the help of my husband and did things on my terms. It is hard but it’s your baby and your body. Stay strong, you totally got this.
     
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