Can I still refuse insulin without hurting my baby?
As I sit here in tears after a recent call from my doctor, I am
hoping someone out there has been through this same senario.
I have been diagnosed with GD and have been controlling it
excellently with diet. My midwife says as long as I continue to do
so, I will have no problem staying with her and having my natural,
non-medicated birth. However, I also have a low platelet issue,
which they did have to start me on prednisone with my last one (he
is now 2 yrs old) to bump it up for the birth. (That birth was
completely uncomplicated and natural all the way.)
A call from the doctor just now says they want to put me back on
prednisone (platelets are at 68,000) and I will need to go on
insulin because it will raise my blood sugars. I have fought so
hard to keep them from doing any kind of treatment (refused the
nonstress tests and BPP's as well), because I know from everything
I've read on this website that it only makes me more at risk for
Can I go ahead and take the prednisone and refuse the insulin
treatments? Once I start insulin, I lose my midwife and have to go
to an OB. There is no such thing as an enlightened OB around here
and I'm so afraid they will just want to induce or even worse have
Please if anyone can offer some words of advice I would sure
appreciate it. I wish with all my heart that I had found Henci's
articles before I had the stupid GD test....I would have refused
I would like to add that I am planning a hospital birth with a
Pregnant women experiencing complications should be able to get
the treatment they need without being forced to give up having
mother-friendly care. I can't think of a good reason why your
midwife would not be able to care for you during labor in a
hospital where, should it become necessary, there is the ready
ability to consult with or transfer care to a specialist and
immediate access to the hospital'sdiagnostic and
The best strategy I can think of is to try to get the
hospital to make an exception. Start with asking your MW what she
suggests. If you don't get anything useful from her, find out who
has the power to make an exception and schedule a meeting with that
person, you, and your partner. At the meeting, start with the old
salesman's trick of making a statement that can't be disagreed
with, for example, "I know we all have the goal of a healthy baby
and healthy mother. It stands to reason that goal can best be
achieved by care in which I get the treatment I need for the
complications I am experiencing but avoid treatments or
restrictions I don't need. I would like to combine the best of both
worlds by continuing my care with my midwife while having the peace
of mind of knowing that the doctors and hospital resources are
there if I need them. I understand that hospital policy makes that
a problem, but I am sure that by doing some brainstorming
together, you will be able to help us achieve that goal." Another
salesman's trick: if you get an answer you don't like, wait. Say
nothing. The silence will be uncomfortable and often leads to
the other person making another suggestion. Wait until you get one
you like and then agree. Now it's the other guy's idea. If you
start to cry, turn it to your advantage. That's the cue for your
partner to say, "You can see how important this is to her. Surely,
we can work something out." If neither idea works and you are stuck
with an ob whose judgment you can't trust, here are a couple of
- Hire a doula. Just having someone in your corner can help if
you are being leaned on.
- Barring an emergency, make an
informed decision when agreeing or refusing an intervention.
Induction, BTW, is never an emergency.
- Ask for a nurse who is comfortable with women who want natural
childbirth and to avoid intervention and who will help you make
decisions by explaining your options. Repeat at each shift
The good news is that this isn't your first baby, which makes it
harder for you to be bullied.
I hear what you are saying about the GD test, but if diet does
not control your blood sugar levels, I can't see that it makes
sense to refuse insulin and have them be out of
control. And I don't think refusing insulin would solve
the problem of them risking you out of midwifery care. Now they
would have a "noncompliant patient" on prednisone with high blood
sugars. Ditto for refusing prednisone. Then they would have a
"noncompliant patient" at risk for hemorrhage.
Anyone out there have any other suggestions?
Please let us know how things play out.
Thank you so much for your reply Henci!
It means a lot to me that you took the time to do so, I would
imagine you are a very busy person. :)
I spoke with my midwife this morning and she does not think that
my platelets are low enough to start on prednisone just yet. (They
are at 68,000). For the last pregnancy they bounced between
60,000-80,000 even when I started taking prednisone,
so she agrees with me that it is too early to jump right into
I have an appointment scheduled with the hematologist this
coming Thursday and will let him know what she said. He does not
know about the GD diagnosis, so I will be letting him know about as
well. He is usually pretty easy going, so I don't think he
will force the issue.
Again, thanks for your reply, and I will let you know how it
plays out. :)
I think it's a great idea to conference with your hematologist!
What you want is to come up with a treatment plan that best takes
care of your needs given your individual case after careful
consideration of the tradeoffs of your various options. The most
important thing you can do to optimize both physical and
psychological outcomes from this birth is to take charge of
what happens to you and insist on being a full partner in
decisions that get made about your care. I look forward to hearing
the next chapter in your story.
I have been in practice for 10 years as an OB/GYN and have
worked with midwives, doulas, etc. I have taken care of
thrombocytopenia (of which there are many causes) and certainly too
many women with gestational diabetes.
With regard to the diagnosis of thrombocytopenia, I think the
involvement of the hematologist is important. Ask about
causes and possible implications for the newborn. Some causes
can lead to a sharp decrease in the platelet count of your child
after the birth.
With regard to GDM, the majority of stillbirths that I have seen
were in women with DM in pregnancy who refused blood sugar
control. It is so simple to control and there are CLEAR goals
for starting medications. If you don't want to be on insulin,
ask about oral medications. I use these more than insulin in
the patient with mildly abnormal blood sugars. You did not
ask for this complication, it happens because of insulin resistance
caused by placental hormones. You have no control over their
effect, but controlling your blood sugars could save your babies
life! Just as you would take the time to put a
seatbelt on your child in a car, you should heed the advice to
check and control your blood sugars as needed.
If you don't like the OB who is involved in your care, get
another one! They need to be involved, but you have a
choice. Good Luck!
Dr. OB/GYN in WI
Thank you so much for both of your replies! I truly appreciate
Thought I would just update you on the latest. So instead of
sitting here in tears this time, I am so mad I could kick
Met with the nurse practitioner last week on my platelet count.
They have come up just a tad (63,000) and I am feeling really
really good for the first time during this whole pregnancy. I truly
believe that eliminating the foods that were causing inflammation
within my body and taking supportive supplements that the
naturopathic doctor recommended are helping. Anyway, she
recommended that I go ahead and start WinrHo or IVIG treatment. Not
knowing anything about these, I told her I wanted to research it
and talk with my midwife. She said that was fine, but they went
ahead and scheduled me for IVIG treatment. She assured me that this
treatment is completely safe.
Well, for starters, its untrue to say that it is completely
safe. It is a category C for pregnancy which means nobody really
knows if it's safe or not. Second, out of all the research I have
done (hours and hours), a platelet count above 50,000 is considered
safe for a vaginal delivery and also for a c-section (under general
anesthesia). Third, my midwife is still not concerned with my
platelet levels and having her on board with me helps a lot.
So I called them today to cancel the treatment that they
scheduled. I politely asked the nurse to let me know if canceling
it would and rescheduling it for later in the week would
cause a hardship because I didn't know what all was entailed in
getting it ready, OR if I should just call back when I decide to do
it and then they can get it ready. She proceeded to tell me "Well
now that you are scheduling your own treatments, why don't you just
call us? Is this what the doctor wants?"
Oh I can't even tell you how mad that made me. I bit my tongue
again and politely but firmly told her that my midwife backs me
100% and that it is ultimately up to me what I decide to do. And I
told her that I no longer wanted to deal with the nurse practioner
and was tired of being made to feel bad about my decisions. I have
an appointment with the actual hematologist tomorrow at 11am...
So, my question is this....as long as my platelets remain at or
above the safe 50,000 mark that is talked about in virtually every
medical journal out there....am I being irresponsible by fighting
these guys tooth and nail? Anyone have any experience with
Oh I'm just so tired of fighting for what I think is
BTW, my blood sugar continues to be great. I have had no problem
controlling it with diet. I continue to check it at least 4 times a
For starters, I would complain about the nurse practitioner's
behavior to her supervisor in addition to insisting that you be
assigned someone else. As for whether it is safe to refuse the
platelet meds if your platelet count remains above 50,000, if you
have a clinician whose expertise and judgment you trust--the
hematologist, maybe?--I would make a conference appointment, print
out copies of the articles you have found on the internet, and
bring them in for discussion. What you want is objective
information on the potential benefits and harms of refusing or
accepting treatment. If the expert you consult disagrees with what
your sources, he or she should back up the opinion with evidence
and discuss that evidence with you, explaining why it is more
valid. Consider it a red flag if the expert attempts to persuade
you by what my Aussie friends call "waving the shroud." If that
happens, find someone else. Don't give up the fight for what you
think is right! Don't give in to bullying! You have the right to
make decisions about your care and that of your child, and everyone
is best served by your doing so based on a careful weighing of the
pros and cons of your options. Please write again when you have
All Times America/New_York
Please note that this Forum is intended to help women make informed decisions about their care. The content is not a substitute for medical advice.