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gestational diabetes and vbac issues 
10th-Oct-2012 05:49 pm [gestational diabetes, size of the baby, vbac]
romaan
The drama continues.

Okay, so I've posted a million things but I'll do a quick recap --

Now 36w4d with my second child.



Took the first gestational diabetes test and failed with 138. Knew I'd never make it through the 3 hour because of nausea so I refused. I started testing my glucose at home. It was just fine. I stopped testing for a couple of weeks when my doctor didn't even mention my results on the one hour test or my refusal to take the three hour test. 

I went in a few weeks ago and asked to have a VBAC. My doctor insisted I couldn't do it and even went so far as to tell me that other doctors in the practice would refuse to do a VBAC for me. I was sort of stunned at this response. She said my previous baby had been so big and this one might be, too, and it was better to just schedule a c-section.

My first child was delivered via c-section after 36 hours of labor and four hours of pushing. I was told that her head was in the wrong position. At the time of her birth, the doctor on call told me we could still get her out vaginally but I was completely delirious and couldn't bear the idea of continuing. Long story short -- it was a really difficult birth but she was a healthy baby weighing 8 lbs 13 oz. I did NOT have gestational diabetes during that pregnancy. Her father was 8 lbs 11 oz at birth.

About two weeks ago, I went in for a check up and they said I was measuring big and wanted to do an ultrasound. The ultrasound showed a little bit of excessive amniotic fluid and had her estimated at weight over 6 lbs. I had to go for another ultrasound for an in-depth scan. The baby was estimated at 7 lbs 13 oz. They had me do a non-stress test (she was fine) and talk to the GD specialist. She gave me a meter and all the guidelines and I went home and started testing.


I started testing at home and all of my numbers were perfect -- in the high 80's after every meal except dinner which was about 130. The nurse said I could start testing every other day but I ran out of strips and had a lot of trouble getting new ones (state health insurance makes things complicated). I just got them refilled yesterday. My numbers were a bit high yesterday which was really unusual. I'm sick, though, and the pamphlet she gave me specifically says that sickness messes with your blood sugar, so I wasn't really surprised.

Today I had to go see my doctor for a routine visit. 

She said that the doctor at the hospital (where I had the level two scan, NST, and consult with the GD nurse) told her that I was having a huge baby. She said that I told her that I needed to have my meter checked because I didn't think it was reflecting accurate numbers -- I NEVER said that. I may have said I was taking Sudafed for allergies and thought THAT was effecting my numbers, but that was it.

My doctor said, "There's no way you can do a VBAC. She's too big. The other doctor said that unless you go early, there's no way; we're looking at an eleven pound baby here." 

I said, "I still want to try."

She said, "FOUR HOURS OF PUSHING."

I said, "Yeah, but people have big babies all the time, don't they?"

She gave me a look.

Then she was saying something about my numbers and how I have had " poorly controlled gestational diabetes." I'm sorry...what? How have I had poorly controlled diabetes? My post-meal numbers have been around 89. Out of 140. I'm sorry...I don't get it...in what world is that poorly controlled diabetes? I'm lost here. 

She talks really fast and sort of mumbles sometimes and my hearing is still effected by the cold I've had for almost three weeks, so I didn't really understand what she was saying -- something to the effect of its being uncontrolled being obvious because there was some extra amniotic fluid and she was so big.

Um, okay? I have had an 8 lb 13 oz baby already, so how is my having a big baby a surprise? I just...I don't get it. And with my numbers being PERFECT outside of yesterday and today (since I'm SICK), where else is this proof? I'm really confused.

So she gave me the VBAC consent form -- she's apparently resigned herself to the idea that she can't force me to do a c-section -- but I'm still upset. I know she's going to continue to try and bully me into a scheduled c-section and I'm now constantly second guessing my decision. 

I want my baby to come when she's ready to come. I'm not convinced that what happened with her sister is due to my inability to deliver a baby vaginally. From memory, it was malpositioning of her head. I'm on SNRIs and can't discontinue them without risking my mental health and well-being, so breastfeeding is important to me to keep her from having a severe withdrawal, and while I know I can do it even if I have a c-section, I feel like it'll be more difficult because my body won't have received the hormonal shifts it sets off with labor and it won't be prepared to start breastfeeding. With my first baby, I was pressured to do an induction and refused; I ended up with the c-section anyway but felt good that I'd at least tried -- I knew it was just meant to be that way. I don't want to wonder with this one. And if I go in for a scheduled c-section and she comes out at 9 lbs, I'll be PISSED. 

Has anyone seen any consistency with birth weight estimates when they've had several ultrasounds and estimations prior to delivery?

Ugh. Just really needed to vent. I'm worried and scared and concerned that I'm making a mistake with my decision but all I can think is -- what if she ISN'T that big? What if my memory is right and her sister was just positioned wrong? I don't want a surgery but I know that if I have a failed VBAC turned c-section, complications are increased.

I'm seriously torn and confused right now.
Comments 
10th-Oct-2012 09:58 pm (UTC)
I just wanted to tell you what you already know: ultrasound is a general guesstimate. I had very well-controlled diabetes (and even was on insulin) in my last pregnancy, and because of the GD, I was having weekly ultrasounds and NSTs. EVERY.FREAKING.ULTRASOUND TECH basically gasped and said "oh wow...your baby is going to be HUGE" and guessed him to be near 10 pounds. I did have more amniotic fluid than usual too, but nothing too alarming. When my son came out, he weighed 8 pounds, 9 ounces....only 6 ounces more than my first child in which I didn't have GD with. The big measurements were because his head was pretty large, his position was awkward, and also I think I've read that extra fluid can distort measurements as well. Don't let them bully you into something your heart isn't into. It's your body, your baby.
10th-Oct-2012 10:10 pm (UTC)
A tilted head can cause no end of grief. Lets put it this way, my midwives told me I had a pelvis you could "drive a truck through" because once dilated, I got my son out in 6 pushes with an epidural with a tilted head. however, the 30 hours PRIOR getting to 10cm were pure unadulerated hell.

They also told me its unlikely to happen again. It certainly SOUNDS like a tilted head. You can always get your medical records- chances are it might say that the baby's head was tilted.- mine did!!!!

http://www.spinningbabies.com/baby-positions/all-positions/asynclitism

Also, to encourage you. My labor, with a better positioned baby, was half the time, and she was a pound heavier and I pushed for about the same length of time!!

10th-Oct-2012 10:14 pm (UTC)
Have you been seeing a chiropractor this pregnancy to help baby get in optimal positioning?
10th-Oct-2012 10:18 pm (UTC)
Sorry, didn't mean to hit send yet. Anyway, I just VBACed a 9+pounder and I very much attribute that success to seeing a chiro regularly. Personally I think you are doing the right thing in standing your ground and at least attempting the VBAC but I think it will be hard without a supportive team.
10th-Oct-2012 10:16 pm (UTC)
You don't have GD and your doctor just seems like she wants to give you ANY reason to schedule a repeat c-section. Honestly, I would find a new doctor. If you cannot, stay away from the hospital until you are ready to push out the baby. I wouldn't trust a doctor like that at all.

My first child was 10lbs 7 oz and born vaginally. An 8lb baby sounds small to me. Stick with your gut on this - you know your body better than this doctor does. You can have a VBAC but it sounds like you will really have to fight for one.
10th-Oct-2012 10:28 pm (UTC)
This! My first was 8 lb 1 oz. My second was 10 lbs 15 oz. Both were born vaginally. The second was born sans meds in a waterbirth (and with a papercut of a tear). It can be done.
11th-Oct-2012 12:20 am (UTC)
This! My first was 9lbs 10oz, and I have GD this time (though it seems to be under control), and I was measuring two weeks ahead for quite awhile, and my OB is still behind me and my VBAC. I definitely don't think you're making any incorrect choices. I wish you had a more supportive doctor!
11th-Oct-2012 02:37 am (UTC)
+1
10th-Oct-2012 10:51 pm (UTC)
I'm not trying to persuade you either way, just give you some things you can think about and might help make up your mind :)

I did some poking about and found out the VBAC success rates in my state (western australia) and found out that it's about 40%, that means 60% of the women wind up with a c-section. And it's much MUCH higher in the public hospital system that appears to be the only place that genuinely supports VBAC - but we have a vastly different health system to yours so you're better to do local research :) This helped me to understand a little the risks of going public vs private and VBAC vs elective c-section. Well, not the risks, but the chance of success.

8lbs doesn't sound big to me - they consider an abnormally large baby that requires special intervention to be 4kg where I'm from. I had a 3.875kg one - well over 9lbs. I wound up with a c-section post attempted labour and was able to get my breastmilk to come through very effectively. Sadly we did not establish breastfeeding due to a tongue tie and some NICU issues - but I pumped instead for his first year.

Poorly positioned baby can be for so many reasons - it might be your anatomy but it's more likely to be just bad luck on the day - sometimes peoples bodies are just a bit oddly shaped but that's usually really obvious - scoliosis, strange bone formations, odd shaped utereus etc.

I asked about baby size here: http://pregnant.livejournal.com/17190812.html?nc=48#comments and I can't find it but somewhere there was a poll/post about how accurate ultrasounds were - and asked whether they were reasonably accurate vs the comments people often make about them not - and a lot (significantly in the majority but not a white wash overwhelm) said that basically the ultrasounds while not perfect were generally accurate - there was some light discussion that many don't post in posts such as this about it because there's a different attitude/belief in this community (and many others) that the u/s are inaccurate and that the OBs are trying to pull one over - but many (and it was more than 40) women responded that they got the big baby talk, and it was a big baby... It was surprising to see all these women come out of the woodwork who normally sit silent.

Personally I didn't get the big baby talk - we were so busy measuring my placenta that we didn't track the kiddo until about week 37 at which point it was 'hrm - this could become a bit of a problem - we'll watch with interest' - but I was in the high risk, most baby and mother friendly, most 'normal birth proactive' environment I've heard about for Australia... King Edward Memorial Hospital so they were amazingly supportive (and would basically expect a VBAC attempt this time around if I was there again).
10th-Oct-2012 10:55 pm (UTC)
I had GD managed with diet/exercise. I had weekly NSTs and BPPs, and a few extra growth ultrasounds. The last one I had at my doc's office estimated my baby at 8lbs, 10oz. I had one at the MFM ward the same week and they estimated 7lbs 12oz. She was born that week at 7lbs 8oz, so one machine was off by a pound, the other was closer.

I had a c-section after a few hours of pushing, because baby was positioned straight OP and I have a small pelvis, apparently. :|

Your doc sounds kind of jerky. I hope you get your VBAC!
10th-Oct-2012 11:36 pm (UTC)
I've been a type 1 diabetic for nearly 20 years now, and it can be difficult for me to control my blood sugars at times. With my son my numbers were better than pre-pregnancy but still not good for being pregnant. Around 7.5 months they did a scan and he measured around 7.5lbs already. They estimated him to be between 9 and 9.5lbs at birth. He was born at 9lbs 1oz. I had the NST's twice a week starting at 30 weeks and they showed some problems towards the end but nothing dire. I was induced at 38 weeks and after 16 hours of labor I just never dilated past 4cm, baby's heart rate kept dropping with contractions, etc. and I ended up with a semi-urgent c-section. My son spent 3 days in the NICU and 2 days in pediatrics because of blood sugar issues. My OB at the time said he wouldn't even consider a scheduled c-section until baby was estimated at over 10lbs. I'm now pregnant with #2 and have a different OB (different insurance) and she's very supportive of my decision to attempt a VBAC. I'm only 10 weeks so we haven't dived into the details of anything yet, but so far she's been really reassuring about the VBAC.

I feel like eventually I'll be put in the same situation as you. Even though my OB has been reassuring about it, at some point they'll do a scan to measure baby's size and I'm sure it'll come up big and I'll start questioning weather or not I can (or should) do it. My husband and I have decided we only want 2 kids though, so this is my last shot at a normal birth. I don't want to be left with any "what if's." Listen to your instincts and try not to question yourself too much. Go with what feels right.
11th-Oct-2012 12:24 am (UTC)
Even if your OB suggests you have an ultrasound to measure baby, you don't have to have one. My OB has been casually mentioning one for me for awhile now, and just asked at my 36w appointment if I was sure I didn't want to have one more. My first kiddo was 9lbs 0oz, so I'm just assuming her sister will be similarly sized. I know I don't want an ultrasound tech freaking me out with a "big baby" scare, so I'm just attempting a VBAC, and we'll see what happens!
10th-Oct-2012 11:38 pm (UTC)
Get a new ob!!!!!!!!!! I switched ob's at 36 weeks because my previous ob wouldn't let me attempt a vbac because my son was 8lbs8oz and this baby is "measuring big" at 6lbs 14oz at 36 weeks. Third trimester ultrasounds are notoriously inaccurate, so I wouldn't necessarily believe that. As for gd, maybe you have it, maybe you don't. To me it sounds like you're just fine.

Oh yeah, my son was posterior with a tilted head the first time around and just because it happened once, doesn't mean it will happen again. That is a load of crap your dr is giving you. Do you have an ICAN chapter near you? My local chapter was invaluable in helping me find an ob that will allow me to try.
11th-Oct-2012 12:28 am (UTC)
I'm living this nightmare right now. I failed the one-hour test by ONE point... and my midwife was insistent on a 3 hour. I said there was no way - I got violently ill on the 50g solution, I wasn't doing the 100g. She was opposed to me just testing my sugars - I did anyway and they're fine (fasting level is some days slightly above the preferred range, but nowhere near the GD range). She didn't like it. Sent me for a A1c - I told her they're notoriously inaccurate in pregnancy. She knew that, but her "peer review" group (including my psycho bitch midwife from last time who insisted my big baby was because of hidden sugar issues despite passing the tests) wanted me to get it done. Okay, did it... passed in the 3rd trimester range AND the regular range - not even close to the glucose intolerance, let alone the diabetes range. Then she decided it wasn't enough - I still needed the 3 hour. Nope, I fired her. I called the hospital based CNMs that she recommended, and they can't see me... unless I do the 3 hour test. When I said that wasn't a possibility, they set me up with appointments with the OBs, the High Risk OBs, and the Diabetes Care Team.

Hell to the NO! I talked with their intake lady on the phone - weekly ultrasounds starting at 32 weeks, twice weekly NSTs, mandatory induction by 38 weeks... *maybe* 39, and they can order a c-section if they think my baby's too big. Hello, my other three kids (no GD then): 9/3, 8/8, 9/12! I'd be cut for sure!

So I did the only thing I feel safe doing at this point - I went unassisted. I'm 33w3d now. I'm doing my own prenatal care, watching my waking sugars still (the postprandials were more than fine), and I have a few friends with medical backgrounds - one an L&D nurse - coming to help with the birth. Otherwise, I'm just doing the same thing I would have been doing at my prenatals with the midwife, and I won't hesitate to seek medical attention in pregnancy or labor IF I NEED IT. But a false diagnosis isn't going to be the cause of unnecessary surgery after 3 successful vaginal births.
11th-Oct-2012 02:24 am (UTC)
You are AWESOME!

I fired my midwives at 37 weeks when I was pregnant with my son for similar reasons - worries of a "too big" baby, lots of bullying to get ultrasounds and tests I refused to get, etc. I refused to get the GTT and they freaked the hell out. I consented to having my blood sugars tested two hours after a normal breakfast and the number was *fantastic*, yet the midwives still pressured me to get test after test ... until I fired them.

I have different midwives with this pregnancy but will not be bullied into ANY test this time and NO late term ultrasounds. I am so sick of care providers treating women like children who need to be scolded and told off for not obeying them.

Even though I have new midwives this time, I am also planning an UC for this birth. I don't like one of my midwives very much and don't want to risk having her at my homebirth, even though I am using them for my prenatal care. I also know how I react while in labour and I don't want *anyone* around me this time.

May I friend you? I'd really like to hear how your pregnancy and birth go!
11th-Oct-2012 02:44 am (UTC)
Sure - and I'm a "free trial" friender since I'm not at all public. If we're friends for awhile and you or I decide we're not the best match, no hard feelings =)
11th-Oct-2012 02:47 am (UTC)
OP - I meant to add, I've never had a size estimate ultrasound, but my SIL did. I don't remember their guess or his actual weight, but I do remember that their guess was exactly one pound bigger than what he ended up being.
11th-Oct-2012 03:07 am (UTC)
Because of my big baby last time (9lb 10oz girl), my OB had me test at 14w! Just by fasting overnight. I failed by maybe 3 points, and have been labeled as having GD my entire pregnancy (I'm nearly 37w), even though my tests have all been below where they want them, and the AC1 they sprung on me was fantastic! My OB keeps complimenting me on how well I'm controlling my numbers, and I'm honestly not doing a thing! It's ridiculous! Thankfully, she's fully supportive of my VBAC.

Good for you for taking the situation into your own hands! Sorry you had to deal with all this mess and stress!
11th-Oct-2012 09:27 pm (UTC)
Holy toledo! Kudos to you and best of luck!
11th-Oct-2012 12:48 am (UTC)
I didn't/don't have GD, but have big babies.
My first was guessed to be over 9 lbs, and even after she was born we all thought she was that big, but she was only 7lbs. 8oz. She had her head cocked to the side, it took 4 hours of pushing and then a vacuum assist to get her out. I was thisclose to a c-section for her.

My next they said would be 10 or 11 lbs. He was 8lbs.14oz. He had his head on straight and pushing was much, much faster.

The third was a week late, and guess to be around 10 or 11lbs, again. He was 9lbs. even.

If it were possible, I'd look into getting a new OB. It also does not sound like you have GD, just that you grow big babies.
11th-Oct-2012 01:18 am (UTC)
I dont have any experience with GD but with my 1st, I had an ultrasound at 36w and they said she'd be over 8lbs close to 9. She was born at 39w 7lbs 8oz.
11th-Oct-2012 02:16 am (UTC)
Echoing this: My baby was estimated to be at least 8 lbs. at my 36 week ultrasound and everyone freaked out and said I'd have to be induced. More than A MONTH later, he was born weighing *gasp!* less than 8 pounds.
11th-Oct-2012 02:04 am (UTC)
It sounds like your dr's are saying anything to get you to have a c-section. Mine did too. I was told my son was 10+lbs and my dr pushed for a c-section because of it. When I went into labor, all the nurses and drs kept telling me I was most likely going to end up with a c-section. C-section never happened and my son was born 7.7lbs.
11th-Oct-2012 02:12 am (UTC)

I don't see your doctors giving you any real reasons why you shouldn't try for a VBAC.
11th-Oct-2012 04:08 am (UTC)
Like others have mentioned, I would seek out a new doctor if you can.

A little story from my pregnancy.

I was never diagnosed with GD, instead with a glucose intolerance, but it was treated the exact same as GD. I failed the 1 hr (happens to lots of women) and the only part of the 3hr that I failed was the fasting number (I got a 5.4, they wanted a 5.3 or lower). When I had my meeting with the GD nurse at the hospital she lectured me on the importance of testing my overnight blood sugar within 15 minutes of waking up, because if I waited longer it would rise and I wouldn't get an accurate reading. Since my appoinement for the 3hr test was at 9am and I'd already been up for 2 hours you think they'd give a little bit of leeway on that number....But no, 0.1 above and I get a 'glucose intolerance' that is treated as GD.

I tested my sugars for a while after every meal and in the morning and never had a number out of place, other than my fasting would be a tad high (0.1 - 0.3 over) if I'd had a crappy night's sleep. I eventually stopped testing as it was only making me paranoid and scared to eat (ie. I'd get distracted by something at work and not finish my lunch, but if I ate later I was worried it would mess up my number so I just wouldn't eat). When I went back for another meeting with the GD nurse around 38 weeks (my first meeting was at 32 weeks) I hadn't gained a pound, and was still lectured that I should be taking my readings all the time, and that my baby was going to be huge, c-section possibility, baby having sugar problems etc etc. My midfvwives had been pressuring me to have a 36 week ultrasound done for a size guess, and while they scheduled me one, I phoned and cancelled it :)

At my BPP at 41w they measured my little girl to be 7 lbs 15 oz. She was born at 41w3d after a horrible induction (never again ><) and weighed 6 lbs 11 oz and 20.5" long. After all those scare tactics she was tiny! I remember asking my midwives if they were going to test her blood sugar (since everyone seemed to be so concerned about my GD). "Nah, she looks great!".

I know it's hard. We've been programmed our whole lives that doctors know best, go with what the doctor says, doctors orders. I would take a nice relaxing bath and go with what your gut tells you. Good luck <3
11th-Oct-2012 04:41 am (UTC)
Lots of good comments here. Some stories:

1) A friend of mine was labeled GD with borderline numbers and was induced at 39 weeks because "they couldn't let the baby get any bigger." Baby was estimated to be at least 9 lbs; she was barely 7. My friend was also due a week after Christmas, which would be the actual reason her ob pushed the induction, IMO. </p>

2) My friend at work had a section with her oldest due to an early epi and pushing on her back which wouldn't let the baby descend. She had a vbac planned until her midwives did a size u/s and told her the baby was "too big" for her to deliver vaginally because she was "too small." She scheduled a RCS, went into labor a week before it and showed up the hospital crowning, less than 2 hours from her first contraction. This GIANT baby that she HAD to be sectioned to have, that she could just NEVER push out cuz she was too small, according to u/s and her mw's? 6 lbs, 10 oz and born in less than 2 hours and 2 pushes. That woman would have undergone COMPLETELY UNNECESSARY SURGERY had her baby not taken charge. :)

3) Finally, my MIL has two sons. The oldest, my husband, was 10 lbs, 23.75 inches and frank breech (butt first). He was born vaginally and naturally. His brother was 12 lbs, also born naturally and vaginally. No GD, she just grows 'em big!

You are in charge here. No one can make you do anything you don't want to do. I know it's hard to buck the system, but take it from someone who didn't do it with her first pregnancy and regrets it everyday - its worth it.

11th-Oct-2012 06:39 pm (UTC)
i don't think you're making a mistake at all. some women just grow big babies. my mom had four kids and i was the smallest at 9lb 3oz - my sister was over eleven pounds! my mom is 5'2"..i really think you'll be fine. trust yourself, trust your baby, and don't let yourself be bullied.
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