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    Questions? Ask Henci!


    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Archived User

    Hello Henci

     

    May I say how glad I am to have found hopefully a professional who might be able to advice me. I will tell you my back ground and hope that you can help the information I receive will help me personal but also I am hoping that I may be able to help other women and possibly challenge the NHS in particular the hospital where my care has been based. If anything I want to make them uncomfortable.

     

    I understand that you may not wish to answer my question on this basis so I wanted to be upfront about my intentions, I will not use your name unless you say it is ok.

     

    So here’s my back ground I’m a type 1 diabetic have been for 21 years and have relatively good control no medical problems link to diabetes, I am not over weight and attend the gym up to 3 time a weeks, also have a dog so walking is a must and also have a great garden which I love to dig – so I quite fit. I’m 35 turning 36 in October I’m 177cm tall and weigh 182 pounds.

     

    With my first child I was advice at 36 wks that I would be induced at 38wks with no real explanation, this being my first time I trusted the professional and went along with their guidance. My son’s growth was completely normal on the 50th C all the way though my pregnancy and although I would not say my blood sugars were perfect during they were within the advice limited set here in the UK. The induction was terrible I was not given any advice as to what it would be like and was left unattended for 4.5 hours and a total labour of 10 hours which ended in a emergency C section. My son foetal heart rate was dropping and his head was banging against my cervics, he was born healthy at 7bl 11oz on the 26.06.07 I tried to breast feed him but after 6 weeks gave up.

     

    My seconded pregnancy I was more armed with information and went for VBAC which my hospital seemed at first to support but as I went though pregnancy started to warn me of all sort of scary information. Towards the end of my pregnancy I was warned that my baby was big and that shoulder dystopia may occur (my scans all showed the 70 – 75 centil) however I felt better in this pregnancy than my first and had not gained as much weight and had kept fit, my HBA1c were very good too. After being scared half to death by the prospects of my baby getting stuck I almost gave up on a vaginal birth but my heart told me I could and I would never forgive myself if my baby was c section and turned out to be the same size as my first. So I did VBAC, with the information that I should consider having an epidural tap just in case they had to intervene. I was very closely monitored because of previous C section and was allowed to more around as much as I could with a drip in each hand and a strap on my tummy. I got to about 7 cm and the pain and being exhausted got the better of me so I had an epidural, I got fully dilated and to push but my request to have the epidural turned off was ignored and after an hour of pushing, I was advice to have a c section (they also came in early and offered me one?? Before pushing and telling me all the bad stuff again that could happen).

     

    By this point I was so scared and tried that I did as they said, however my baby was not in distress, she was born on 7.08.10 weighting 8lb 1oz she was born healthy and I am still breast feeding her.

     

    If you wish to comment on any of the above it would be welcome, as you may understand I am very traumatised by what has happened and there is far more I could tell you but don’t want to bore you with trivial information.

     

    My question are as follows

     

    Is there any true medical evidence into still birth of insulin diabetic mother past 38wks, and is this only reason other than larger babies (I note that in my medical notes they recommend 38/ 39 wks I am still at a loss as to why they were so determined to get me in when I wanted to wait)

     

    How much of a risk would I be taking if I decided to try for VBA2C if I am induced again?

    I would not want to try for baby number 3 until at least 2 years after the birth of my 2nd as this is a good age gap but also allows scare time to heal  

     

    Do 3rd babies tend to be bigger as a guide i.e. the first smallest, 2nd a bit more so on so forth.

     

    These may seem like simple question but I do not trust my hospital to get a honest answer and simple searching on the internet on forms etc has yet to produce any hard evidence.

     

    I thank you in advance for any help offered

     

    Sacha

    Henci Goer

    I can speak to the VBAC issue and to induction with a uterine scar or scar rupture, but I have never researched Type 1 diabetes and timing of delivery. If you want to surf the VBAC topic on the Forum, you will find the research on the risk of scar rupture after two cesareans (not different from one uterine scar) and likelihood of VBAC (similar to rate with one scar). You will also find the research showing that induction can, but does not necessarily, increase risk of the scar giving way. It does not increase risk if the cervix is ripe, that is, softened, effaced, and ready to labor. Also, using a physiologic oxytocin (Pitocin, Syntocinon) protocol, as opposed to an "active management" protocol, should reduce risk. (Dose increments and interval for physiologic induction come in the package.) Induction does, however, decrease likelihood of vaginal birth, so that has to be weighed in the mix, although I would think that it is probably less likely to do so in women who were induced with a ripe cervix and who have a patient care provider. A recent, large, multicenter U.S. study showed that VBAC women were likely to have cesareans for slow progress while still in early labor and especially likely to have cesareans before active labor when they were being induced. As for the concern about possible shoulder dystocia, the best way to prevent/resolve shoulder dystocia is to give birth on hands and knees or turn to hands and knees if the shoulders hang up behind the pubic bone. With today's modern epidurals, turning to hands and knees is not precluded, but you would probably need assistance. Finally, I wouldn't be terribly worried about whether your next baby might be bigger. Women frequently give birth vaginally to bigger babies than the one they supposedly couldn't birth the first time. Then, too, some factors are modifiable such as pushing in upright positions so that gravity can assist in bringing the baby down or at least not pushing on your back where your weight against the bed keeps your tailbone from flexing open.   

    ~ Henci    

    Archived User

    Thank you for your help I have read the VBAC treads. I have a meeting with the head Midwife at my hospital next Wednesday to go through my note at least to get an understanding of what happened. Wish me luck, it will be a meeting requiring a lot of tusiues and hugs from my fab Mum

    Henci Goer

    My advice is first of all, don't go it alone; take someone with you--your Mum? Second, because we tend to forget things when we are stressed, write down your questions in advance and take notes on the answers. Finally, ask yourself, "Am I getting feelings or information?" "Feelings" is the tipoff that the midwife is trying to scare you into doing what she wants instead of helping you make an informed decision. The Aussies call it "waving the shroud." Also, if she recommends an elective repeat cesarean, ask to see the evidence supporting that recommendation.

    Please write and let me know how it goes.

    ~ Henci 

    Archived User

    Thankyou Henci

    I have written my questions and they are well resurch, I will be taking both my Mother and husband as they both feel too that they have been "lied too" & "coherred" into decitions making and to doupt my abilites to labour and deliver normally. They will be my support for what will be a very hard day where the delivey of both my children is unvailed to me and I will push for the reasons and resurch behind it.   

    I am not pregnate yet with baby no 3 and wish some of this resuch had been done before the consecption of my first if I had know then what I know now, what would have been done to me, I would never have trusted them like I did. I and unfortunatly many others believe that they are the experts and therefore not to be questioned how wrong we are.

    If my Mum, when she believe that I was diabetic had not been so firm with the docter to test my bloods I may not be here today. He almost turned me out of his office saying it wasn't possible for someone so young to be diabetic, next thing he tested me and a ambilance is called to take me quick to hospital!!! Bless my Mum for trusting herself!! 

    I will post here what the results of my meeting are in the hope that it may help other women make an informed decison about what may happen to them if they agree to be induced for whatever reasons. It will always escape me why a perfectly health women, with a healthy pregnacy is offered induction/ c sections. The doubt put into womens mind about their own abiltiy to give birth is incredible when you are at your strongest but also your most vonrible.

    From where I stand Mother Nature has been doing a pretty good job at making sure women CAN do this, when docters think they can do a better job than her is when we are left with c section, baby distress, lack of breast feeding mothers etc. I am not saying they are not needed as they do have their beifits in a true emergency please save the baby and the mother but until that point leave well alone.

    Sorry for mini rant but the more I read about the state of health care in both the US & UK inregard to pregnacy and child birth the more angry I become at what is being done to women and their offspring.

    Henci Goer

    No apology needed. I feel the same way. More important than how either of us feels, the research solidly backs up that the overuse of tests, restrictions, and medical interventions is doing a great deal of harm, and the evidence is clear that the reasons for that overuse (belief system, economics, defensive medicine, maintaining power and prestige) have nothing to do with promoting the health and wellbeing of mothers and babies. 

    -- Henci

    Archived User

    Hi

    I have had my meeting so have some information to report. The Matron I met with was very approchable and likable but the meeting took place in the entrance to the delivery ward where I had my children so was very emotional for me and I relied on my Mum to ask the questions for me.

    The reasons given for induction at 38 weeks - is because of larger baby's I stressed that my baby's did not scan big so they gave the explination of the glougoes passing over to the baby which can result in still birth. I have a friend who is a diabetic nurse she said that the glougoes passing over happens through out pregnacey and if too much that is how you end up with larger babies/ birth defects/ still birth it doesn't suddely happen at 38 wks. So a unsatisfactory answer.

    I am now taking my resurch into this further and have spoken to another UK hospital where they don't induce pregnacey in health diabetics until 39/ 40 wks I am awating an email from the diabetic midwife to discuse further. 

    I have also emailed a Dr Melissa Westwood at Manchester univerity who is doing resurch into stopping gloucoes passing over to the fetoues to stop exsessive growth in mice, she has put me in contact with Maternal and Fetal Research Centre, Dr Alex Heazell, who specialises in stillbirth research - he will contact me shortly with more information.

    Everything else they told me in regard to my questions kinda stops being important if I find out that they didn't really need to induce me. The reason I was given for not getting my seconed out was failure to desend so she didn't even get into my pelives they insiste that this had nothing to do with being induced at 38 wks which again I find hard to believe. If she had been ready to have come out I would have gone into natraul labour by myself. They kept on saying that I was ready to go into labour because when they induced and I did but I kept saying it was not natural.

    As regard to the time scale of time to push I was given an hour apparently that is what they allow in VBAC they was nothing on recourd regarding my request to have the epidural turned off & in facted it was topped up, apparently they would have asked if they could do this. My husband or I can not remember being asked.

    I asked what they would recommened if I was to have another baby & they would want to c section me, as it would be less risk however when pushed they did say it would be my choice

    I will keep you posted as to what I find out but at the moment I am still of the opion that if you have a health pregnacey and the baby is doing well - DON'T be induced without good cause may be a 40 wks but no sooner! Do everything to get yourself there natraully.

    Thanks

    Sacha

    Henci Goer

    Please do keep us posted because it isn't true that having yet another cesarean is safer. The likelihood of some serious placental attachment problems increases with each cesarean as well as the likelihood of dense adhesions (internal scar tissue), which increase likelihood of chronic pain and of injury to organs or blood vessels should you ever need surgery again.

    If you plan a VBAC, here are some suggestions in addition to the others I wrote in an earlier post in this thread that can help you achieve a safe, healthy vaginal birth: 

    • Hire a doula, a woman trained and experienced in providing one-to-one labor support. That way you have someone in your corner. The website I linked you to has information, and there are some DONA doulas in the U.K. There may also be European doula groups. 
    • If you agree to an induction simply on the basis of not letting the pregnancy go beyond a certain length, refuse having the bag of waters broken. That way, if the induction doesn't "take," you can stop and go home.
    • If you and the baby are doing well, insist on continuing the labor. VBAC women often need extra time, not less.
    • Barring an emergency, if an intervention is recommended, find out its benefits versus harms, how likely they are, and the benefits versus harms of your alternatives, including doing nothing. Request time alone with your support team to consider before giving your consent or refusal.

    ~ Henci

    Archived User

    Hi

    Will definatly use a doula or independant MW next time and deffenatly go private, have already resurched this and spoken to both. They all support VBAC2/ 3/ 4 and will happly delivery a diabetic Mummy. The Independant MW had deliveryed a baby to a Type 1 diabetic mum at home!!! The Obcitrican I dealt with would have a fit, he was so against us going private when we asked he told us how much he was to hire a day (£1000) and would not be there all the time as would have to look after other women. Well I'm damed if I'm going to pay someone not to be there, the arrogance of the man was unbeliveable - like we couldn't possible afford him!! I can say we are very lucky as would could proberly afford him three or four times over but what right does he have to look down his nose at anyone!

    As to regarding "not having my water broken" I asked at my appointment why they did not wait until labour was esablished before doing this and they told me it was dangeroues?? Is this true? In many states of america they don't break the waters until labour is happening so why would they say this - do you have any ideas?? (May be American women are differant to English ones like they speek a bit different LOL - thats the only thing I can think we are all made the same arent we!!)

    I now have the telephone contact at a hospital in Southhampton UK of a diabetic Midwife where they don't look to induce a diabetic women until 39/ 40 awating spontance labour. That meaning if the baby is in trouble they will or c section other than that they wait!! I want to see what their take is on all this. I have also been reading the NICE guideline on diabetes in pregnancy and so far again I left at a loss as to why they did what they did and still do to other women. I attached the link so you can read through it seems that larger babies is the only reason so far. http://guidance.nice.org.uk/index.j...mp;o=40129

    Many thanks again and will keep you posted

    Sacha

    Henci Goer

    It looks like you have care lined up that is in line with your thinking, and I am very happy for you. As unpleasant as it may have been, the ob did you a favor by showing his true colors. What often happens here is a bait-and-switch -- the store advertises something on sale to lure customers in, but when they get there, it isn't available, and salespeople try to talk them into something else at a higher price. At first, the ob agrees to the VBAC, then, as the pregnancy advances, the ob becomes more and more negative about it and begins setting more and more hoops the woman must jump through to be "allowed" her VBAC. By the time the woman realizes she's got the wrong person -- if the ob doesn't succeed in scaring her into changing her mind -- she's so close to her due date that it is impossible to change care providers. (In this country, few doctors will accept a new patient late in pregnancy.)  

    As for refusing membrane rupture being "dangerous," there is no evidence that breaking the bag of waters increases likelihood of vaginal birth when used for induction, and, on the downside, unlike all other methods of cervical ripening and induction, it commits to delivery, opens a pathway for ascending infection, increases risk of umbilical cord prolapse (the umbilical cord coming down ahead of the baby, an obstetric emergency requiring cesarean section because the cord gets pinched between the baby's skull and the mother's pelvic bones), and, by draining the protective cushion of amniotic fluid, it allows the umbilical cord to be squeezed during contractions, which increases stress on the baby. I should add about this last item that babies generally tolerate this, but why add a stressor when there are no counterbalancing benefits? What if this baby just happens to be unable to compensate?

    ~ Henci 


    All Times America/New_York

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