I am 39 weeks and delivering with a midwife in a hospital. I have gestational diabetes and have been working very hard to keep my sugars in control with diet. I am being monitored by nurses for the diabetes and an induction has been scheduled for me four days after my due date based upon the increased risk of still born birth when the mom has gestational diabetes (and upon my midwife's vacation). But I'm worried we aren't giving this little girl enough time since this is my first and all the babies in our family come late. We've been through Bradley classes and have a pool for water birth. The hospital is very supportive of natural birth - the nurses will not offer an epidural if you let them know you'd like a natural birth. But I feel pressured about the induction date. I have an option to have it 9 days after my due date but they've said it puts the baby at incredible risk.

 

What I'd really love is to hear from people who've had experience with gestational diabetes and who are knowledgeable on the risks of going past due date.

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Hi! I can only share my experiences. I had gestational diabetes in both pregnancies and took insulin in both pregnancies.

 

In my first pregnancy, I was "allowed" to go to 40 weeks. I was induced at 39w5d and my induction failed to progress, so I had a c-section. I am pretty sure that had I not been induced, I would not have needed a c-section. My body was simply not ready to give birth.

 

When I knew I wanted to have another baby, I really researched the GD issue. Because I took insulin, I knew it was likely to reoccur. I was also concerned about the 40 weeks/induction thing. I found a doctor whose philosophy was to keep an eye on the baby and as long as the baby was okay, we would not induce. I had biweekly fetal well-being tests at the end of my pregnancy. (For the record, I believe he took extra precautions because I was GD w/insulin. That is likely not necessary in a pregnancy where the blood sugars are controlled by diet alone.) As it happened, I went into labor at 39 weeks and had my VBAC. But I was prepared to go to 42 weeks.

 

I had a perinatalogist who was advising me in both pregnancies. In both pregnancies, she recommended that I not go past 40 weeks. I really liked her and trusted her, but could not agree with her on this issue. Around the beginning of my 3rd trimester, I sat down and had a heart to heart with her. I told her that if she had any evidence I could read to help me make my decision, I would consider inducing around 40 weeks. She confessed that she did not have evidence, that it was more just "the way things were done." There were some studies that were done, but they were 40+ years ago and they were not done on gestational diabetics but Type I diabetics, who undeniably had some things going on that your average gestational diabetic would not. Plus, the level of monitoring and testing in late pregnancy was practically non-existent compared to what they have today. So, based on the fact that there was absolutely no compelling evidence that going past my due date would increase my risk of stillbirth, I became a lot more comfortable with the idea.

 

I will add, a lot of providers like to induce early because they are afraid of big babies. Whether they admit it or not. First, just because you have GD there's no guarantee your baby was big. Second, late pregnancy ultrasound for weight estimation is notoriously incorrect, so you would never want to induce based on that. My VBAC baby was "measured" to be 9 to 10 lbs a full week before she was born weighing 8 lbs, 11 oz.  Third, even if your baby is big, you can birth a big baby. So please do not consider inducing because of baby's size. The evidence does NOT support this practice. I'm putting this here just in case this comes up for you or somebody else.

If it were me I would get a second opinion. 

I didn't have gestational diabetes...but I do think providers often try to induce early in the case of diabetes. This was what they did for my cousin and she narrowly escaped a c-section. I'm against inducing because it significantly increases the risk of a c-section, according to the research. And I had a c-section - and let me tell you hon, you do NOT want a c-section. Granted my c-section was medically indicated after a 56 hour labor and the baby was truly, legitimately in distress (had a two day NICU stay as a result), but make no mistake: you don't want to do anything to increase your risk of c-section.

 

It would be great if your care providers can do what Blair's did, just keep an eye on the pregnancy and not induce unless there are results that come back that are non-reassuring. I do think care providers sometimes worry about having a too big baby with GD, but those ultrasounds are often way off. I had some bleeding late pregnancy and ended up in emerge, and the doc who did the ultrasound told me my baby was huge and looked at me disapprovingly. Well, let me tell you - my baby was born at 39 weeks and 4 days...at seven pounds even! Now, to my mind, how does a seven pound baby constitute a 'huge baby'?!? So I think those ultrasounds are sometimes off anyhow.

 

I wish you the best with the delivery. If you find that the induction date is something your healthcare provider won't flex on, what about doing a few rounds of labor induction acupuncture a couple days before you're scheduled for medical induction?  At least it works with your body to get you into labor, not against it like pitocin, etc. For some women it works right away, but generally people say to give it 48 hours for the acupuncture to work.

The risk is mainly the babies prolonged exposure to your high blood sugar. So, it is not how long you gestate as much as how much sugar is getting to the baby. If you can control your blood sugar by strict diet, it no more dangerous for a GD mom to go overdue than anyone else. However, if baby is getting pumped full of highly sugary blood,  the risks increase with your blood sugar levels.

Under normal circumstances, the best birth outcomes are when the baby delivers between 38 & 41 weeks. Before or after those times, risk gradually increases. You don't fall off a statistical cliff on your due date!

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