I am 37 weeks today, with my first baby. I was just diagnosed GD a week and a half ago. I passed the three-hour GTT test with flying colors at 30 weeks, and then at 34 weeks had an ultrasound where they were estimating my baby to be approximately 7 lbs 3 oz already. So they wanted me to test my blood sugars 4 times a day for a week - fasting and then 1 hr after each meal. Some of these were high - nearly all of the fasting ones were high - so they went ahead and diagnosed me GD and gave me Glyburide to have at night, which has brought all of my fasting blood sugars back down. The rest of them I am handling well with diet and exercise, except for a few small spikes here and there. Baby has passed every non-stress test and biophysical they have given him (twice a week for the past three weeks). I have stopped gaining weight - in fact, I lost two pounds. Also, my amniotic fluid decreased from 22-23 cm to 15 cm, which they seem to like better as well. So far, so good, right? I'm not into intervention, but I buy keeping my blood sugars in line as better for baby and for me.

Now, of course, they want to induce me. They've tried everything - telling me that shoulder dystocia kills babies, telling me they won't "let" me go past 40 weeks, and probably not past 39, and even telling me that women with GD have a higher rate of "spontaneous fetal death" in the uterus. They're clearly trying to scare the crap out of me. But if baby has passed every test, and my blood sugars are all under control, I just don't see why we would want to induce. Why not just wait?

I have another growth scan on Monday, and I'm wondering how it will turn out. The reason why I am posting here is because people keep saying "besides the risk of a big baby," and I'm fairly certain I'm going to have a big baby. Even with as inaccurate as ultrasounds are, there's not much wiggle room for an approximately 7 lb 3 oz baby at 34 weeks to not be pretty big at 39 or 40. Sometimes I want to stand my ground, and sometimes I get tired and I just want to give in. I got a second and third opinion from other OBs - even one whose a good friend of my mom's - and they agree with inducing diabetics between 39-40 weeks. I feel stuck. I can say no, but I'd hate for him to have shoulder dystocia because I was stubborn.

Please read over the rest of this thread and follow the links to sources that are relevant to your situation. I think you will find that the thread  and links will respond to your concerns about gestational diabetes and help you stand your ground. However, if something isn't addressed to your satisfaction, please get back to me on it. 

-- Henci

thank you so much for your reply. i did read the rest of the thread before i posted - i think i just wasn't sure about how much the "big baby" aspect affects this. now they want me to do an elective c-section because the growth scan showed him to be "estimated" at about 11 lbs, or 5,000 grams. His head was estimated to be 35 cm and his belly 41 cm. i am 37 1/2 weeks. now i'm not even concerned about induction any more - my issue is whether to have a c-section or whether to try to get him out vaginally first. i'm really torn about it. any thoughts you have would be great, although i apologize if there is another thread on this topic that i have missed. either way, i really appreciate your time! my doula speaks very highly of you. :)

Posted By on 17 Aug 2009 02:41 PM

thank you so much for your reply. i did read the rest of the thread before i posted - i think i just wasn't sure about how much the "big baby" aspect affects this. now they want me to do an elective c-section because the growth scan showed him to be "estimated" at about 11 lbs, or 5,000 grams. His head was estimated to be 35 cm and his belly 41 cm. i am 37 1/2 weeks. now i'm not even concerned about induction any more - my issue is whether to have a c-section or whether to try to get him out vaginally first. i'm really torn about it. any thoughts you have would be great, although i apologize if there is another thread on this topic that i have missed. either way, i really appreciate your time! my doula speaks very highly of you. :)

• Hire an experienced doula whose references you have checked. (Looks like you've already got that one covered.) She can give you ideas on how to help labor progress, encourage you when others would discourage you, and help you talk through your options so that you make decisions based on reason rather than fear.
• Starting labor on your own is your best option for a complication-free experience.
• If you have no medical problems, stay home until you are in active labor, that is, contractions for at least a couple of hours that are no more than 5 min apart (count from the beginning of one contraction to the beginning of the next), a minute long, and strong enough that you cannot walk or talk during one.
• Do not allow yourself to be admitted to the hospital until you are at least 3-4 cm dilated. If it is during the day, get checked at your care provider's office. At night, explain that you want to know what is happening, but you will go home if you are still in early labor. You may wish to hang out for an hour or two and get checked again if you think things are going hot and heavy. 
• Ask for the nurse who is most comfortable working with couples who want natural childbirth.
• Tell nursing staff that you are hoping for an unmedicated birth. Please do not suggest an epidural, but you welcome any ideas they have for making your comfortable. If you change your mind, they will be the first to know.
• Unless there is an emergency--and you will know when that is the case--if medical intervention is suggested, ask questions and then ask for time alone to consider whether you will agree.
• Refuse any intervention based on exceeding an arbitrary time limit for making progress. 
• Stay mobile in labor. Insist on intermittent listening rather than continuous electronic fetal monitoring, refuse an IV, and avoid, or at least delay, an epidural.
•  Avoiding an epidural means you will need other ways of coping with labor pain. A good set of childbirth education classes and your doula should prove useful there. 
• Develop a system so that your spouse and doula can distinguish between "I don't think I can do this" from "I want an epidural."
  • code word: some word that you would not ordinarily use. Until you use it, you can bitch, moan, complain, curse or do whatever you need to say or do to cope.
  • preset time period: If you say you want an epidural, your team has some prearranged period of time (say, 30 min or 5 contractions) to try to make you more comfortable. If, at the end of that time, you haven't changed your mind, you get an epidural.
• Push in an upright position. Give birth on hands and knees as the safest and best means of avoiding or resolving shoulder dystocia.
• Nonconfrontational strategies for resolving conflict include:
  • Make statements no one can disagree with: "I know we all want what is best for this baby, which is why I want to do X. "
  •  If an intervention is suggested, don't respond. Look at the person and wait. Silence makes people uncomfortable and they will fill it by making a different suggestion. Wait for one you like and then agree. Then they think it was their idea. This was told to me by a doula who got it from her father who was in sales. She has seen it work.
  • Don't be drawn into an argument. Just politely repeat your position in slightly different words. "We have decided that we don't want to have membranes ruptured now." "I hear what you are saying, but we have decided to wait." 
• Spend time in the bathroom. It makes you unavailble. If you want to clear the room of medical people, start necking with your husband. Necking is good for the labor too.

Here is a set of videos jointly produced by Lamaze International and Injoy Videos that should prove helpful.

Please keep us posted on how things work out.

-- Henci

In addition to Henci's excellent list above, here is resource from Lamaze and InJoy that you can use if you determine that induction is your best bet. Tips for keeping your birth as healthy and safe as possible when induction is necessary.

Hi! I am 35 weeks pregnant with Gestational Diabetes. I am controlling with diet but my fasting blood sugar (Overnight) is sometimes just a little high, maybe by one or two points. My midwife told me if I cant control it at night she wants to put me on insulin at night. I really hesitate bc I am taking three different meds right now. I have my prenatal, an oral antibiotic (I will explain), and albuteral.  First my asthma has never been bad but in the last few weeks with the baby pushing on my diaphram on top of having a mild case of asthma, has made it worse. I have to take at least 3-4 puffs every 4-5 hours to keep it under control. (under advisement of the ER doc I saw)  The oral antibiotic is a preventative measure, as at the end of my first trimester I had a UTI, kidney infection, and kidney stone (all at the same time!).  I am also GroupB Strep positive. As you can see this pregnancy, my first, has not been the easiest.  I have lost 3 pounds since the begining of my pregnancy and the baby is measuring right on target.  My first question is it really necessary to take insulin if my blood sugars are relatively under control? And second my midwife has mentioned that she may want to induce me at around 39 weeks.  I wanted to go natrually, but when I asked about going over my due date she said that would never happen, they dont allow GD patients to go overdue.  I am not willing to induce before November 12, and I am due November 15, if the baby is not that big anyway.  I dont want to make a big fuss, but I have been scared and pulled to my wits end.  I am getting a little angry that I am not being listened to about my body and my baby. Am I being hypersensitive?  Thank you so much for your time and input.

Patti Reposa

Henci,

I want to comment on one argument that you have made in several replies with regard to labor induction for GD patients at 39 weeks. Your argument is that if the patient has good blood sugar control, then she does not differ from other normal pregnant women. It follows that her treatment should not differ from others as well. This argument is not necessarily water-tight. A GD patient with good sugar control may appear to be the same as normal pregnant women in terms of blood sugar level, but she has the underlying etiology, which can produce problems even when sugar level is under control. Stillbirth, for example, is not limited to women whose sugar level is too high; it does happen with greater probability in GD patients with good glycogin control. Similarly, a woman with good sugar control can show other symptoms of GD (e.g., I am 39-weeks with diet-controlled GD, but I have polyhydroamnio - too much fluid, a symptom of GD). Unless one assumes that sugar level is the only damage to a pregnancy, and denies other possible effects caused by the underlying etiology, one simply cannot treat GD women the same way as other normal pregnancies. Ultimately it is the science that will resolve these questions. Taking an extremely strong stance on this may lead to dangerous recommendations to your GD patients.

-Vanessa

Posted By on 10 Oct 2009 09:44 AM

Hi! I am 35 weeks pregnant with Gestational Diabetes. I am controlling with diet but my fasting blood sugar (Overnight) is sometimes just a little high, maybe by one or two points. My midwife told me if I cant control it at night she wants to put me on insulin at night. I really hesitate bc I am taking three different meds right now. I have my prenatal, an oral antibiotic (I will explain), and albuteral.  First my asthma has never been bad but in the last few weeks with the baby pushing on my diaphram on top of having a mild case of asthma, has made it worse. I have to take at least 3-4 puffs every 4-5 hours to keep it under control. (under advisement of the ER doc I saw)  The oral antibiotic is a preventative measure, as at the end of my first trimester I had a UTI, kidney infection, and kidney stone (all at the same time!).  I am also GroupB Strep positive. As you can see this pregnancy, my first, has not been the easiest.  I have lost 3 pounds since the begining of my pregnancy and the baby is measuring right on target.  My first question is it really necessary to take insulin if my blood sugars are relatively under control? And second my midwife has mentioned that she may want to induce me at around 39 weeks.  I wanted to go natrually, but when I asked about going over my due date she said that would never happen, they dont allow GD patients to go overdue.  I am not willing to induce before November 12, and I am due November 15, if the baby is not that big anyway.  I dont want to make a big fuss, but I have been scared and pulled to my wits end.  I am getting a little angry that I am not being listened to about my body and my baby. Am I being hypersensitive?  Thank you so much for your time and input.

Patti Reposa

No, you are not being hypersensitive. You have the right to make informed decisions about what happens to you and that includes informed refusal as well as informed consent. In order to do that, you need to know the benefits and harms of all your options, not what you will be "allowed" to do or not.

Clearly, your pregnancy is more complicated than simply having blood sugars that are on the high side after eating. If I were you, I would want to get all the specialists involved in my care (asthma, diabetes, pregnancy) in one room (or one conference call) and come up with a plan based on evaluating those benefits and harms according to my individual case. I would also want to discuss how that plan might change under various scenarios. In addition, I would also want to know if there were any interactions among my medications that might be affecting my blood sugars, asthma control, and vulnerability to infection, and whether adjusting them might be helpful. I hope you are under the care of specialists because neither your midwife, her back up obstetrician, nor an ER physician have the specialized training and knowledge to best advise you on the treatment of diabetes or asthma, not to mention the nuances of dealing with asthma in pregnancy. The reason I recommend getting them all together is that specialists are usually limited to their own bodies of knowledge and may miss or not take into account something not in their field.

Here is an page from the Childbirth Connection website on informed consent/refusal. I would add that you are looking for information: How often does that happen? What might that lead to? What action would we take if it did happen? Can you show me the sources that support that? Red flags would be scare tactics--anecdotes intended to frighten you into doing something--threats, or assurance that there are no adverse effects to medical interventions such as induction. Every medical intervention has potential harms as well as benefits.

As a general principle, unless there is a good reason to do otherwise, your best option for a safe, healthy birth is to let the process unfold in its own time with supportive rather than interventive care. The issue here is whether there is a good reason to do otherwise, and that is a question that cannot be answered simplistically.

-- Henci

Posted By on 12 Oct 2009 02:59 PM

Henci,

I want to comment on one argument that you have made in several replies with regard to labor induction for GD patients at 39 weeks. Your argument is that if the patient has good blood sugar control, then she does not differ from other normal pregnant women. It follows that her treatment should not differ from others as well. This argument is not necessarily water-tight. A GD patient with good sugar control may appear to be the same as normal pregnant women in terms of blood sugar level, but she has the underlying etiology, which can produce problems even when sugar level is under control. Stillbirth, for example, is not limited to women whose sugar level is too high; it does happen with greater probability in GD patients with good glycogin control. Similarly, a woman with good sugar control can show other symptoms of GD (e.g., I am 39-weeks with diet-controlled GD, but I have polyhydroamnio - too much fluid, a symptom of GD). Unless one assumes that sugar level is the only damage to a pregnancy, and denies other possible effects caused by the underlying etiology, one simply cannot treat GD women the same way as other normal pregnancies. Ultimately it is the science that will resolve these questions. Taking an extremely strong stance on this may lead to dangerous recommendations to your GD patients.

-Vanessa

The only strong stance I take is that women should make informed choices based on accurate, unbiased information on the potential benefits and harms of all their options, including doing nothing. This, unfortunately, is hard to come by with conventional medical management.

-- Henci    

Just wanted to add that my daughter is 21 years old. Healthy from day one. Weighed 90 lbs prior to pregnancy and had no risk factors at all. She failed the one hour glucose (277) and went immediately to endo who put her on insulin. In a million years I would not have believed there was even a possibility she'd fail that test.  Don't just assume that it doesn't happen to active, healthy women.

It is extremely unusual for a young, low-weight woman to have such extremely high sugar values. I think she must be one of the "needles in the haystack," the woman who has true, undiagnosed diabetes. I have also said that the screening would be a good thing if all it did was identify those rare "needles" and alert women with what would be be termed "carbohydrate intolerance of pregnancy" that they need to be especially careful to eat a healthy diet and engage in regular moderate exercise. The problem is that typical management and care provider attitude that the pregnancy and birth are a disaster waiting to happen is likely to do more harm than the sugar intolerance. 

I'm glad your daughter was identified and is getting appropriate care.  

-- Henci

I just have to say that I am so happy I have stumbled into this forum, and especially this thread of posts.  I am 27 years old, pregnant (25 weeks) with my 2nd child. I had GD with my first, and have been early diagnosed with my 2nd. 

I went into this pregnancy thinking automatic C-section--and if not C-section at the very least induction. I have since decided to educate myself tremendously--the first time I was pregnant I was only 19--and very healthy--jogged frequently, ate decently, and not a large size either.  However, I have gained weight (or more so not lost weight since my son was born 8 years ago).  I am thankful that I have been able to control my blood sugar levels with little medicinal help and diet--I am not gathering up the courage to tell my DR that unless the ultrasound (which of course I've "had to have" done every month) is showing a uber-large baby, that I am against induction, as well as, most interventions. 

Thanks to educating myself, the scariest part of that is that I now have to tell my mom who is flying from MD that she may not be here when our little Logan is introduced to the world!

I am glad you found my Forum helpful. I would add that the research does not support inducing labor for a baby who is predicted to be big. Inducing increases the cesarean rate without decreasing the chance of shoulder dystocia (the head is born, but the shoulders hang up behind the pubic bone). That being said, the fact that you have had a prior vaginal birth means that inducing labor does not increase your cesarean risk provided you a cervix that has gotten ready for labor on its own (Bishop score more than 6).

While I'm at it, here are some ways of minimizing the chance of shoulder dystocia and of avoiding a cesarean or instrumental vaginal delivery.

• Have patience. Labors with bigger babies can take longer. So long as you and the baby are tolerating labor, there is no need to intervene.
• Avoid an epidural. It interferes with your ability to push effectively. There are many effective ways to minimize and cope with the pain of labor. 
• Give birth side-lying or on hands and knees. These positions reduce the likelihood of shoulder dystocia compared with the usual position of lying on your back.

These Lamaze videos cover the principles of a safe, healthy birth.

~ Henci

I realize I am coming into this discussion really late...however, I am curious if there is a difference in risks between a gestational diabetic and one who is a true type 2 diabetic? Here's my story.I had gestational diabetes with my second baby (insulin dependant), but about 6 months after having her, was diagnosed a type 2 diabetic. My mother has type 1, and was hospitalized the last few weeks of her pregnancy with me. Basically My endocrinologist thinks it is possible I may have been diabetic before I ever got pregnant. (I was borderline by 3 points with my first child maintained with diet...yet I was 130 lbs 5'2" when I became preg with him and actually did not gain more than 15 lbs the entire pregnancy...)

I am now pregnant with baby number 3. I was on 3 types of medication before and during this pregnancy (including Metformin) and placed back on insulin at around 10 weeks gestation. I have had a lot of issues during this pregnancy. I was born with a mitral valve prolapse that naturally gets worse with pregnancy but this time I was put on partial bed rest due to chronic hypo-tension (or LOW bp). I began contracting around 27 weeks non-stop and have-on 3 occasions-been given meds to stop/slow labor. I was induced at 39 weeks with my second baby mainly because I had polyhydraminos and she turned breech at 38 weeks. They did the ECV and then decided to induce. This time they want to induce again at 39 weeks because I am a type 2 diabetic. I am on a lot more insulin this time around. As of today (@34 1/2 weeks) I am taking 208 un of insulin per day. 3 times what I took with my second baby. This will most likely increase even more. But, I really do not want to be induced, however she is measuring at 5 lbs 13 oz since 2 days ago....and she is also in a breech position. What are my options? I feel lost because they seem like they would rather me get induced at 39 weeks with now an added possibility of a c-section. Do I have any say? I honestly do NOT want to have another ECV either because there are so many risks with that as well. BTW, My son (my first) was born on his own-no meds at all @ 37w&6d weighing 7lbs 6 oz and 19 in. perfectly healthy. My second (dd) was induced at 39w0d weighing 7lbs 0oz 18 in. (they estimated her being 9lbs 2 oz!!!! boy, were they wrong!). Can I step in and give MY opinion? or will it matter? I am beginning to wonder if they just want this baby out at 39 weeks because they are tired of my issues??? I feel as if asking too many questions gets me a lot of eye rolls and shrugs. they never give me straight answers anymore. they act like since this is my 3rd time (despite my age and my health issues) that I should KNOW the deal. Sorry ifI sound like I'm venting but it's frustrating. Not to mention all the NSTs and AFIs etc....I'm gtting just as sick of them as they are of me! But I want what is BEST for my baby. I'm not so sure what that is any more.

Of course your opinion matters! You have the right to make informed decisions about your care, which you cannot do without your care providers giving you accurate, objective, complete information. Many childbirth educators suggest the BRAIN acronym to their students to help them with this:

Benefits
Risks
Alternatives, including doing nothing
Instinct/intuition
No/not now

Here, too, is a page on the Childbirth Connection website with general information on informed decision-making. I would add to beware of attempts to manipulate your decision such as scare tactics ("You can do that if you don't care what happens to your baby"), anger ("And what medical school did you go to?), or patronizing you ("I see you've been playing around on the internet"). If your care providers are unwilling or unable to provide you with the information you need, then I think that the best thing you can do for yourself and your baby is find care providers who will.

I don't have research-based data on the effects of type 2 diabetes on pregnancy, but I can tell you that external cephalic version is safe and effective when done carefully and that there is no need to induce after one because few babies turn back, and for those that do, the procedure can be repeated. You do have some options, however, that don't involve manipulating your belly: the Webster technique and moxibustion. For that matter, vaginal breech birth is a perfectly viable option for most women provided their care provider knows what he or she is doing.

As for inducing labor, if you decide that would be best, I can tell you that absent a medical reason to induce sooner, it is recommended to wait until 39 completed weeks (the beginning of the week that ends with your due date) to minimize the chance of respiratory problems. Although this is less of an issue in women with prior vaginal births, waiting for cervical ripeness (Bishop score 6 or more) minimizes the chance of a cesarean for lack of progress. I would refuse misoprostol (A.K.A. Cytotec, "miso") because other agents work equally well and don't have its reputation for causing serious problems. I would also recommend refusing membrane rupture. That way, if the induction doesn't "take," you can stop the induction and go home. Once membranes are ruptured you are committed to delivery one way or another. Also, once you are in progressive labor, the oxytocin (Pitocin or "Pit") drip can be turned off to see what happens, leaving just the plain IV fluid. In many women, especially women with prior vaginal births, labor will continue on its own. If it doesn't, no biggie, the Pit can be turned back on.

~ Henci

Hi Henci!  I was wondering if you know anything about gestational diabetes and a small baby?  I was diagnosed with GD at 28 weeks and managed with diet alone for about 2 weeks, but instantly lost 3 pounds.  My numbers continued to rise even though I was living on salad and less than 15 carbs a meal, so they put me on insulin and I'm now taking it morning and night.  I average about 30 carbs per meal now and the insulin continues to be adjusted as needed and overall my blood sugars are always higher than 120 1 hour after meals.  They range from 120 to 200 depending on what I eat, which 130/140 being average.  I do experience blood sugar lows about once a day even though I try to eat extra protien.  To make matters worse, I suffer from panic disorder and my anxiety over giving myself shots is so severe that I am completely unable to do it.  Luckily my sweetheart of a husband gives me my shots for me, but the timing is not consistent as it depends on his work schedule which changes daily.  I've also noticed that as the insulin has increased, my blood sugar lows have increased and that has also added to my anxiety as I'm constantly worried that I will faint when no one is around and go into some freaky coma and die.

As for weight... I've only put on 1 pound total in my 3rd trimester for a total of 15 overall (I'm 37 weeks).  I started my pregnany 20 pounds overweight, but nowhere near obese.  As of last week at my 36 week exam, I still only measured 33wks pregnant (3 weeks in a row) so the Dr. ordered an ultrasound.  The ultrasound does show that the baby is measuring between 1 and 2 weeks small depending on which measurement you look at.   Based on measurements, he came in at the 14th percentile and an estimated weight of 5lbs, 7oz.  At the 20 week scan, he was exactly 50th percentile and I know my due date is either accurate or up to 4 days later than where it should be based on LMP and conception dates (we were trying, so everything was calculated). 

At this point we are not worried about the baby being too big, but actually whether or not he's thriving as well as he should.  My husband and I are not big people, so it makes sense that our baby would not be big, but I'm concerned that with the extreme diet that I am on coupled with the anxiety, baby may not be getting what he needs to grow. 

Do you happen to know of any circumstances where gestational diabetes can have a reverse effect?  I'm just trying to wrap my head around what may be going on with me.  Although excited that I don't have a lot of weight to lose after the baby comes, it bothers me that the baby is measuring small now.  I'm curious to know if this may be considered normal since most mothers with GD have bigger babies and my blood sugars aren't controlled as good as they could be.  I do see the Dr. tomorrow and will find out what he thinks is best course of action.  Any insight that you have would also be appreciated.  Thanks for your time!

I just read the research, and I am not a clinician, so I cannot advise you personally. However, from what you write, it is clear that something unusual is going on. Type 1 diabetes runs in my family, and my brother is an endocrinologist, which means I am aware that managing insulin can be tricky, and, yes, insulin can cause low blood sugar and small-for-gestational-age babies as can calorie-limited diets, although what makes it even odder is that you aren't experiencing low blood sugar and you aren't limiting calories. If you haven't involved a specialist in insulin-dependent diabetes, I would request a consult with one. You may also want to consult a maternal-fetal medicine specialist if you are just seeing an ordinary obstetrician. Make sure your doctors know about you being prone to anxiety attacks. This could well be part of the problem. One thing I do know is that part of the anxiety response is to flood the body with glucose so that muscles are primed for fight or flight.

You will probably be needing to make some decisions soon about tests and treatments such as whether to induce labor. The acronym BRAIN can help:

B enefits
R isks
A lternatives (and the benefits and risks of those, including doing nothing)
I ntuition or instinct (after taking in the information, what do you feel about the baby's condition and what is right to do?)
N o or not now ("How urgent is it that I decide now?" can help with this.)

You and your husband will need complete, objective information on which to make any decisions both now and during labor. A touchstone during the information gathering process is to ask yourself, "Am I getting feelings or information?" Getting feelings is a huge red flag. Unfortunately, some caregivers will attempt to scare or bully women into doing what they think she ought to do, which means they will almost certainly be giving you incomplete, no, or even misinformation as well. If that happens, it would be best to find someone else to consult, or, if that is not possible, at least to take it into account, and barring an emergency situation, refuse to allow yourselves to be stampeded into a decision.

~ Henci

Hello Henci. I have been following this thread for awhile now but waiting to add my question until the time was finally at hand... Sooo I will try to keep this basic and not over complicated..  I was diagnosed with GD at about 12 weeks into my pregnancy thanks to having glucose in my urine. I had an A1C score of 5.9% with the cut off at 5.7%. I was under managed care from my OB, and the Sweet Success program and their perinatologists. I had frequent ultrasounds and went to all my appts. I was first put on Glyburide which worked for my fasting #'s but I wasn't on a schedule as far as my meals so the Perinates put me on insulin and metformin. I gained a ton of weight and it did nothing for my fasting numbers and I wasn't happy, the Metformin made me very ill. Luckily I lost my job couldn't afford the insulin anymore so they put me back on Glyburide and my numbers have been great my A1C is  even down to a 5.7%. Ok all that being said...  I have had very frequent ultrasounds and they seem to agree with me that the baby is younger than what my  EDD says by about a week or so and it has been so consistently my whole pregnancy.  She is in no danger of being a large baby she is measuring at 6 lbs at 38 weeks no larger chest or shoulders and all seems well enough with her. The placenta looks great too. She has normal growth rates much to my Drs surprise. ( I don't know why I have been well monitored my whole pregnancy instead of dealing with GD at a later date when the damage is usually already been done) So my OB wants to induce at 39 weeks! Next week he wants to induce, not because the baby is big or too small or not thriving. Simply because there is a threat the placenta can fail. My logic tells me if the placenta was going out 1.) it would show on u/s as calcification or the baby would stop growing normally and or 2.) I would start failing my NST tests that I do twice a month.. Last week at my 38 week appt he ambushed me and started with the scare tactics of how it is better for the baby out than in etc etc and scheduled me an induction date for next week even tho I am not dilated or effaced. I guess I am just seeking reassurance I am not over reacting when I go to my next appt because I am going to cancel my induction. I just really feel there should actually be something going wrong to warrant it not the threat something could go wrong...... I just feel like if my body isn't ready and or baby isn't ready as a first time mom and overweight the odds of me going from a natural unmedicated birth to interventions epidurals and c-sections is very high. What do you think?

If you have read this thread, you will know that I have written that logically, there should be no reason an otherwise healthy woman under good control should be at greater risk for a stillbirth. I have not been following the gdm research closely of late, but I have an early study that showed that other factors such as hypertension that were associated with gestational diabetes explained the excess in stillbirths, which makes sense. I also have abundant evidence that inducing labor in first-time moms roughly doubles the likelihood that labor will end in c/sec surgery and that inducing before 39 completed weeks, that is, before the beginning of the week that ends with your due date, puts your baby at excess risk of serious breathing problems, greater difficulty breastfeeding, etc. There are no guarantees in life, but I think you are on solid ground to follow where your own analysis of the situation has led you. Cancelling the induction is likely to make your care providers unhappy and worried, and they have already attempted to use scare tactics on you. That being so, you will want to make sure that decisions now and in labor are based on accurate, objective, complete information on the potential harms and benefits of all your options, including doing nothing.

While I am at it, you should also know that routine NSTs have not been shown to improve outcomes even in high-risk pregnancies. On the downside, they are not harmless. Like all fetal surveillance tests--amniotic fluid volume, modified biophysical profile--they have very high false-positive rates (the test says there is a problem but there isn't), which leads to unnecessary inductions and c/sections because, of course, once a test says the baby is in trouble, no one in their right mind is going to ignore it.

~ Henci