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    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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    Feb 18
    2012

    Gestational Diabetes and other issues

    Archived User

    Hi,

     

    I failed my 3 hour OGTT. I've been eating a high protein, moderate fat, low carb diet and keeping my sugar levels well under the recommended maximums for fasting and after meals. I've read your articles on the significance of testing and treatment for GD, but still have questions.

    I'm 40 and will be having a VBA2C preferably with a midwife at home. I am working with one now for labor support, but have the option to stay at home. Unless something truly worrisome happens, I will be choosing to stay at home for the birth. Right now, I am 33 weeks and baby is measuring right on according to my midwife.

    A little background: I was induced at 41 weeks with my first baby. I had 1cm dilation, but about 80% effaced. Cytotec was used the first day and then pitocin the second. Things just pitered out. I never preogressed beyond 3 cm. My baby was 11.5 lbs. via c-section after some 30 hours. My Dr. didn't realize the size of the baby, so that wasn't a factor in the induction as much as my elevated blood pressure. I passed the GD earlier in this pregnancy. The baby's glucose levels were fine. There was no distress other than my sky rocketing BP. There was some meconium present when my membranes were ruptured, but baby was fine when checked after the birth.

    My next Dr. for my second pregnancy agreed to a VBAC, but after 41 weeks and very little going on, I scheduled a repeat c-section. My second baby was 10 lbs. My blood pressure was normal. No GD.

    I'm a patient at an instituition where it is their policy to allow VBAC, so if it comes to a hopital birth, I'm fine insisting on a VBAC. My worry is the conflicting information on GD. Add to that my age. My weight prior to pregnancy was 185. I've gained 20 lbs. I usually gain 20-25. My midwife hopes I go into labor earlier due to my past issues. I have so far refused any NST with Kaiser, which were offered 2x weekly as of last week. Should I be overly concerned about stillbirth issues going past 40 or 41 weeks with my age, GD, and my previous large babies? Ultra sound indicated that this baby is a girl. I am caucasin if that factors in.

    My midwife and I plan to do some natural induction techniques starting at 36 weeks. Any thoughts on that?

    Henci Goer

    I can tell you that in general terms, the risk of fetal demise in the population overall is about 1 in 1000 in both weeks 40 and 41 and then rises to 1.7 per 1000 in week 42 and beyond. What I can't tell you is how that number applies to your individual case. Having a previous cesarean increases risk somewhat (1 more fetal demise per 1000 in the second pregnancy compared with women with prior vaginal birth). I wouldn't worry overmuch about well-controlled GD. My reading of the research is that any association is because women with GD are more likely to have other risk factors such as hypertension or they have something more serious than mild excess glucose levels after eating. I don't know how your weight factors in because I haven't researched it, but here is my go-to website for anything related to high BMI women and reproductive health. As for "natural induction" techniques, I would be cautious. If it involves herbs, they are drugs too. Breast stimulation is effective at shortening pregnancy, and if you are otherwise healthy, appears safe. Here is a website with instructions.  Moxibustion, a Chinese medicine technique, should also be safe. It consists of using heat from a burning herb to stimulate certain acupressure points. (I was trying to find a site with instructions and wasn't coming up with one I liked.) Still, I'd wait for 39 completed weeks (the beginning of the week that ends with your due date) before trying anything.

    ~ Henci


    All Times America/New_York

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