04.01.11: Which Risks Will You Take?
Deborah is 36 weeks pregnant and has gestational diabetes. She’s been careful about diet and exercise and has maintained very stable blood sugar levels. Her doctor, however, is warning her she’ll probably need to be induced at 39 weeks and may need a c-section. He wants her to get an early epidural so she’ll be ready for surgery, “just in case.” Deborah’s warning bells are going off because that’s not the labor she had in mind. She’s hoping for a spontaneous and un-medicated labor and worries her doctor is setting her up for interventions she doesn’t want.
Gestational diabetes (GD) can have a big impact on mothers’ and babies’ health, but it doesn’t always have to be a big deal that requires all the tools in the medical toolbox. Often times, complications like GD can be managed carefully without making major diversions from the patient’s hoped-for birth plan.
Deborah’s doctor told her that GD babies have to be induced at 39 weeks because sometimes they “just don’t come” until they’re two or three weeks past their due date. Deborah, that doesn’t sound quite right to me. GD babies are at somewhat higher risk to come earlier than their due date, not later. If mom’s blood sugars aren’t well controlled, babies can get too much glucose through the placenta and grow too big. That can trigger premature labor, damage the placenta and bump up risks for delivering a baby whose lungs aren’t fully developed. Premature and super-sized babies tend to have more respiratory problems and a tough time stabilizing their own blood sugars too.
That doesn’t mean these problems are guaranteed to happen to you and your baby, Deborah. It means there’s a greater risk. Many GD babies are born healthy with normal weights and perfect birthdays and never have any problems at all. Here in America, doctors tend to practice risk-based OB care. They prevent bad outcomes (sometimes big, scary ones) by preventing as many risk factors as they can anticipate. That can work out great, but most interventions have risks of their own. And, just because there’s a greater risk for something to go wrong doesn’t mean it’s guaranteed to happen. It’s a risk. There are risks involved in every, single delivery. Every one.
While a 39-week induction is likely to turn out just fine, there are risks involved in jumpstarting labor. A lot happens in the last weeks and days leading up to spontaneous labor. All kinds of changes happen to moms’ and babies’ bodies that put the finishing touches on pregnancy and set the stage for labor. An induction at 39 weeks solely for the purpose of preventing a post-term baby seems like a bit of over-kill to me. Your due date is set for 40 weeks. That’s just an estimate. There’s meant to be wiggle room on either side of that date. As long as there are no other complications brewing why not wait and see whether you go into labor on your own? If you don’t or your baby shows signs he/she’s getting too big or isn’t thriving in the uterus, then you can do an induction. Your doctor can keep careful tabs on how baby’s doing with non-stress tests, kick counts and ultrasound.
As for that early just-in-case-you-need-a-c-section epidural; that’s probably not necessary. If trouble erupts during labor, the anesthetist can slide in a spinal or epidural pretty darn quickly and get you to the operating room on time. If it’s a major no-time-to-wait crisis (some c-sections are, but most aren’t), they’ll use general anesthesia. C-sections have their own set of risk factors.
The bigger question is: What should you do if you feel you’re being railroaded into interventions you don’t think you need? The answer: Communicate.
• Schedule an appointment with your doctor to talk about your concerns.
• Take your partner with you for support and backup.
• Tell your doctor what your hopes and goals are for labor.
• Be specific about your induction and epidural worries.
• Give your doctor a chance to explain his line of thinking.
• Listen carefully and ask all your questions.
Your doctor may have really good reasons for wanting an induction and early epidural that we haven’t covered here. It’s possible he hasn’t explained everything he’s worried about. It’s also possible he’s worried if he doesn’t plan for and prevent certain risk factors, then he’s not doing his job. He may not realize how different your vision for a perfect birth is from his. Give him a chance. He really does want the best outcome for you.
Then, once you have more information, make a choice:
a) Negotiate with your doctor for the labor you want,
b) Go with your doctor’s plans or
c) Find a new provider.
There are risks associated with each option, but that’s how it is with every labor and birth. There are always risks. Ultimately, Deborah, it’s up to you to decide which risks you’ll take.
This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.