I'm glad to hear that your obstetrician is open minded because you are right about the research. Inducing labor for predicted big baby does not reduce the incidence of shoulder dystocia, birth injuries, or cesarean surgeries. That conclusion doesn't change when the mother has diabetes. Here is what I would recommend to minimize the chance of having problems at the birth:
- Avoid epidural analgesia: It will interfere with your ability to push effectively and to get into the most effective pushing positions. Early epidurals in particular increase the chance of having a persistent occiput posterior baby (facing your belly instead of your back), and malposition plays a stronger role in cesareans for lack of progress than the baby's size.
- Plan on getting on all fours for the birth or for turning onto
hands-and-knees (the Gaskin maneuver) should the shoulders hang up:
All fours is the most effective thing to do to get a baby safely
born without injuring the baby or the mother. Here is a reference
you and your ob might want to read:
Bruner JP, Drummond SB, Meenan AL, et al. All-fours maneuver for reducing shoulder dystocia during labor. J Reprod Med 1998;43(5):439-43.
Discuss this with your obstetrician ahead of time because she may never have had a patient give birth in this position, and you will want to plan for this possibility together.
Put the baby to breast as soon after the birth as the baby is ready and willing: Your baby is more likely to have low blood sugar after the birth than the average baby.
The nice thing about these recommendations is that unlike medical interventions like induction, these have no potential harms, only potential benefits.
You are fortunate in that you already know you can birth a big baby. That knowledge will be a good thing to bolster your confidence as you go into labor with what is likely to be another big baby.
BTW, if your sugars are under control now, don't be too concerned that your A1C values haven't come down. The A1C actually gives a broad picture of what your blood sugars have been like over the previous weeks, not what they are currently. In other words, they lag behind where you are now.
Thank you so much! That info definitely boosts my confidence in my decision to not induce. Thankfully, my midwife will be present at the birth. She and my doctor know I want to deliver on all 4's.
I ended up receiving an epidural and pitocin my last delivery because of a long labor. I intend not to accept these interventions this time. It does give me confidence to know that I pushed out a 9lb 1oz boy laying on my back numb from the waiste down. If I can do that, I feel I can birth any size baby without the epidural and in an open pelvic position.'
Thank you again!