Hi there! I hope you will get a chance to answer my post. I am a great admirer, and I have your two famous books, but they mostly address healthy low-risk women, which I am not exactly. I'm wondering if you have had better luck with the research than I have had, because I am facing major stress from my medical team. I'm sorry if this is a little rambling; I'm still so upset.
Tonight I narrowly avoided induction after my doc tried to scare the living daylights out of me. I would love to switch to a birth center or midwife but I am risked out by the fact that I've had T1 diabetes since 1993, so I am forced to deal with high-risk doctors in a hospital, or go it alone. Too scared to go it alone! I have no complications and my blood sugars are pretty decent, although as a T1 there is always a bit more of a rollercoaster. I wasn't planning to get pregnant as soon as I did so my first A1c was 7.0%, but since then I have consistently been under 6.0%. Last A1c was 5.7% and I don't have a lot of lows. I am currently in my 38th week, and I am not dialated whatsoever as of today. I am sure that if we tried induction it would fail. I am trying to go about this in as natural a way as possible.
I am not at all afraid of macrosomia. I have had ultrasounds for growth every three weeks and we are always in the 25th percentile, so even the doctors can't scare me with the idea. (My husband is a little dude and I'm not huge either but I have nice babybirthing hips.) I have biophysical profiles every week, plus two non-stress tests a week, which I detest, since my little girl doesn't like to move and nearly fails them unless I dose her with caffeine before I go into the tests.
I have had enormous amounts of testing done, and amnio too. There are very few things that could actually be wrong with this girl at this point. I have had a zillion ultrasounds and I'm sure there are no major congenital malformations. There are some minor things u/s doesn't pick up. I am mostly worried about her having hypoglycemia after the birth, and I'm worried about shoulder dystocia, of course. Aside from that I think we are fine as long as we are left to cook as long as necessary. I quizzed my doc about all-fours (I read Ina May) and of course he has never heard of the Gaskin maneuver and said we would never do it -- I have prepped my husband and my doula that we are pushing on all-fours and that is that. They will flip me no matter what the doc says.
But I have these docs breathing down my neck about "unexplained stillbirths." They keep telling me I can't go to term because diabetics have these unexplained stillbirths, but they can't tell me what my risks are, and it's as though they believe induction is risk-free, which we know is not at all true! The best I could find in the research is that about 3.9% of all diabetics, controlled and not well-controlled, have stillbirths. They did not break them out into groups at all. I don't think that is a good enough reason to induce, since this baby is kicking fiercely every night and always passes her BPPs with flying colors.
Today this doc was telling me I ought to induce and I said I wasn't going to do it, so then he insisted right then and there on an NST, which he said we failed due to late decelerations. He said he was very concerned about the wellbeing of the baby, despite our perfect BPP YESTERDAY and being scheduled for an NST tomorrow. Then he told me to go straight to the hospital for another (do not pass Go, do not collect $200), which we passed just fine (after a double espresso).
MY point, which this doc will not listen to, is that if he thinks there is fetal distress now then he will certainly guarantee more of it with Pitocin against an unripe cervix. It's a cesarian waiting to happen. I am trying to find support for my position, maybe to add up my risks that I would incur with induction and probable c-section so I can compare them to my 4% chance of stillbirth (obviously a stillbirth is something more final than a uterine scar or breastfeeding problems so it's sort of apples to oranges but at least if I had NUMBERS then I could make an educated case for myself, they way one does when comparing risks of amnio vs. risks of down syndrome et al).
In my opinion, these "unexplained stillbirths" are not really unexplained. Usually the reason is chorioamnionitis (in T2s), ketoacidosis, placental abruption, IUGR, or suboptimal blood sugar control (defined as HbA1c >7.5%, much higher than mine) or severe malformations. I don't see how induction is going to help any of these! Possibly with ketoacidosis but I don't plan on putting her through that in these last 2-3 weeks. If we were worried about severe malfomations then the damage would have already been done in the first trimester.
I have read these:
Audit on Stillbirths in Women With Pregestational Type 1 Diabetes, Diabetes Care, vol. 26, No.5
Differing Causes of Pregnancy Loss in Type 1 and Type 2 Diabetes, Diabetes Care, vol. 30, No. 10
Can you further me along at all? They almost didn't "let" me go home tonight. Should I think about maybe refusing all this testing, since it seems just to build a case for induction, as long as kick counting is good and blood sugars are good?
Thanks so much for any guidance or studies you can point me to,