June 27, 2006 04:37 PM
(in response to Archived User)
I’m so pleased you found my articles on GD helpful!
Let’s apply what was in them to analyze your situation.
Starting with the facts of your individual case, you have had 4
previous births, which I presume were all vaginal, you are eating a
healthy diet, and other than some degree of what should properly be
called “carbohydrate intolerance,” you are healthy. Now
with that background in mind, let’s look logically at the
problems your ob has threatened will occur if you don’t agree
to an early induction.
Starting with birth weight, the size of the baby has far stronger
relationship to maternal weight before pregnancy than to the
mother’s blood sugar levels, so if you are a high-weight
woman, that is the primary issue determining birth weight. If that
is true in your case, it was probably true for one or more of your
previous pregnancies. Having had four previous babies vaginally, it
is highly unlikely that you won’t be able to birth this one.
And in point of fact, even untreated gestational diabetics only
have odds of 20% to 30% of having a baby in the top 10% of birth
weight instead of the background 10% odds.
Moreover, fetal weight estimates are highly inaccurate. You might
as well flip a coin as go by the ultrasound results if you are
trying to predict which babies will weigh more than 8 lb 13 oz
(4000 grams), the usual definition for “macrosomia” or
big-bodied babies. On the other hand, the ob’s belief that
the baby will be too big is a more important factor than the
baby’s weight. There are a couple of studies that show that
the c/sec rate is much higher in cases where the ob thought the
baby weighed over 4000 grams than when the baby was actually in
this weight range, but the doctor didn’t suspect it.
If your ob is saying that inducing will prevent shoulder dystocia
(the head is born, but the shoulders hang up behind the pubic
bone), you should know that studies do not find that inducing labor
decreases shoulder dystocia or birth injuries, but it increases the
c/sec rate. What will help is birthing in a hands & knees
position (Bruner JP et al. All-fours maneuver for reducing shoulder
dystocia during labor. J Reprod Med 1998;43(5):439-43).
Moving on to the “aging placenta” claim, in years gone
by, it was policy to induce women with pre-pregnant
insulin-dependent diabetes early because there was a higher risk of
losing the baby at the end of the pregnancy. However, with much
better insulin regimens to control blood sugar, even these women
are going to term nowadays. Running higher than normal sugar levels
in late pregnancy hardly puts you in the same category with a
poorly controlled, long-term, insulin-dependent diabetics. In any
case, you are controlling your sugar. If your blood sugars are
normal, then there is no basis for thinking this pregnancy will be
any different than your previous pregnancies.
Looking at the other side of the ledger, there are serious
potential harms to inducing at 38 weeks. Some studies suggest that
even women with prior vaginal births are at higher risk for
cesarean surgery if they are induced with an unripe cervix and that
cervical ripening agents do not help. And even more concerning,
babies induced early are at greater risk of ending up in intensive
care with respiratory problems. Were I you, I would be particularly
worried about this risk since you say your other labors were
induced because your baby was supposedly overdue. It sounds more to
me like your babies just need to “bake” a little longer
before they are “done,” which means that inducing this
baby at 38 wks would pose a greater risk for you than for a woman
whose pregnancies tend to run 39 wks.
Agreeing to have fetal surveillance tests is an option, but it has
hazards too. In a healthy woman, which you are, a
“positive” result, a result that indicates the baby
isn’t doing well, is much more likely to be a false positive
than a true one. But once there is concern about the baby, no one
will (or should) be willing to ignore it. Because of this, you will
want to decide carefully whether to get on this train because once
you do, you won’t be able to get off.
In the end, no option can guarantee a good outcome. The best you
can do for yourself and your baby is to make informed decisions
based on knowledge of the pros and cons of all your options,
including doing nothing. It is difficult to achieve that goal when
your ob gives you a one-sided picture and one that is not
reflective of what the research says at that.
By: Henci Goer