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Type 2 means induced labour and monitoring?

Discussion in 'Gestational Diabetes' started by Munkki, Feb 25, 2020.

  1. Munkki

    Munkki Type 2 · Well-Known Member

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    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?
     
  2. Resurgam

    Resurgam Type 2 (in remission!) · Expert

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    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....
     
  3. HSSS

    HSSS Type 2 · Well-Known Member

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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.
     
  4. Munkki

    Munkki Type 2 · Well-Known Member

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    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?!
     
  5. lucylocket61

    lucylocket61 Type 2 · Well-Known Member

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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.
     
    • Hug Hug x 2
  6. Munkki

    Munkki Type 2 · Well-Known Member

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    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.
     
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  7. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    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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  8. kikiwg

    kikiwg Type 2 · Newbie

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    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
     
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  9. dje55

    dje55 Type 1 · Member

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    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.
     
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  10. Munkki

    Munkki Type 2 · Well-Known Member

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    This is a great suggestion, thank you.
     
  11. Munkki

    Munkki Type 2 · Well-Known Member

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    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.
     
  12. Munkki

    Munkki Type 2 · Well-Known Member

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    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?
     
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