Doctor wants to deliver at 38 weeks

It seems my gut feeling was right! I now have the results from a second opinion, and it seems my current doctor has misinformed me! After a detailed appointment and 3D scan with measurements, my baby is measuring completely normal weight from head, femur and abdominal measurements and my fluid levels are also completely normal, about 11, so nothing close to high! Also, with my diet controlled GD, my sugar levels put me in the category of a normal pregnancy. To top it off, I was advised that I am a very suitable VBAC candidate, with no cause to deliver at 38 weeks. I saw Dr. Raj at the AH. Am seeing my original doctor in the morning...will be interesting to hear what she says... AWESOME!!! That second opinion is always worth seeking, just as it's important to listen to your gut feeling. If your original doctor is resistant (without adequate justification), can you switch to Dr Raj? I'm so happy for you that the pressure is off. Continue taking such excellent care of yourself and very best wishes for the VBAC of your dreams. xxx

I have arranged an appointment for a second opinion. Thanks for all your replies X Excellent news and good luck. I know here in Oz, it isnt just standard procedure to induce due to GD- each case is looked at individually ( at least it should be) I had GD with my last baby and was insulin dependant.( # 4 was born 1 year ago) I wasnt going to be induced, but was going to need extra monitoring during labour and after, to check the sugar level of both Ds and I. My baby was actually on the smaller size, leading up to the end of pregnancy- which can also be the case for women with GD, as the sugars and affect the placentas ability to nourish the baby. In the end I WAS induced- but not because of GD. I live 40 mins from hospital and all my deliveries have been on the quick side- # 3 was less than 1.5 hrs from start to finish- and the drs didnt want me delivering on the side of the road. ( I was a high risk delivery due to GD and the fact I had a post partum hemorrhage after # 3)

After watching One born every minute last wk on UK tv (downloaded on itunes) you will want your baby out the sunroof!!!! I was in absolute tears, not sure if she had GD but she was a biggish girl and her baby was huge and got stuck. I had boarderline GD and induced at 38 wks due to high B/P but tbh I was delighted at that stage as I was fed up and v tired running after the family. In UK they don't do GTT unless absolute necessary, in previous pregnancies in UK I was never tested and only tested here as routine. They will also let you go over 14 days before induction which can be very traumatic esp if you have a big baby. There's no certificates at the end for any way you deliver - so best to do what is safest for mum & baby. Good Luck xxx

I say don't take the risk with your baby, all the issues you have with your pregnancy could be fatal to your baby. What is more important the health of your baby or the thought of a natural birth? I have had a c-section and a natural and I became a mom with both, no difference! Its the having a healthy and beautiful baby that counts, and I have been there and written the book, I am saying from experience and maturity. Either way good luck and health to you and your new one! I completely agree... My birthing plan went out the window & I was beating myself up that I had a C-Sect... BUT, my daughter is perfect & I would go through it all again without a doubt if there was any concern for my baby's health.... Get a 2nd opinion- it cannot hurt...

I think that is what we have all said. Talk to your doctor. I gave my experience and I had the backing of a very good midwife and not a lazy OB as mentioned by another poster in the UK who were both the voice of reason for me. Don't stress too much, all everyone wants is for you to have a healthy baby whether you have a vbac or a cs just ask the questions so you are comfortable with the decisions made. Write a list for your next appointment then you can go home and really be clear about your options. Again Good Luck!!

OP - with all due respect to other posters, you should be speaking to your doctor about this and getting all the pro's and cons of a normal delivery. It is good to express your fears here and hear of the experiences of other women, but you cannot compare your situation to anyone else's; and borderline GD is not comparable to diagnosed GD. Just because you hear of others that have been fine in similar situations does not mean you will be and that would be false reassuarance. An informed opinion is based on medical fact and not anecdotal evidence. There are so many variables that will determine whether it is medically advisable to have a CS including the GD, your age, reason for your previous CS, your size +pelvic girdle diameter, the polyhydramnious as well as the fetal weight and many other factors that make up the biophysical profile. Your doctor will be the only one in possesion of all these facts and has presumably made a decision based on these facts. Having looked after many macrosomic babies born to women with GD and attended their deliveries I can tell you that there are many complications. These range from just being large, hairy and sleepy to having dangerously abnormal blood sugars or many other complications due to injury during delivery, from shoulder dystocia to being stuck in the birth canal. That does not mean that you will have any of this complications nor can you assume you will be free of them. Your doctor should be able to tell you your risk having weighed up all the factors and taken their own experience of managing 100's of these pregnancies into consideration. My experience is that it is fairly normal if the risk is moderate to suggest a CS a 38 weeks in order to avoid them. In fact 38 weeks is the cut off for elective CS when they are performed due to any risk factors for all sorts of conditions in order to prevent an unplanned SVD. The only one who can give you all the information about your particular situation is your doctor who has all the facts. Speak to them and find out what your risks are and get a second opinion if necessary. ETA - of course I have seen many GD babies who have delivered normally and been fine. The point I am trying to get across is to make your decision based on knowing [b'>all [/b'>of the facts about GD deliveries after discusing your risk factors with your doctor, rather than relying on anecdotal evidence. <em>edited by Genie on 09/02/2012</em>

... Doctor can adbise better than EW!! You're so right. I also believe though that women can learn a lot from each other, including what are all of the variations on a 'normal' experience. By learning from other women, we go in to the Dr's office as fully informed as possible and have a better chance of - understanding what the Dr is talking about, - understanding whether the suggestions made by the Dr make sense for our own case - knowing what questions to ask so we can feel comfortable with decisions made. I like to go a bit women-power when talking birth and say that we need to reclaim our right to the birth that works for us. Anything on the spectrum from a drug-free V delivery through to a CS, it's up to every woman to understand her body and her medical advice and to be part of the decision making. Don't let the medical profession [u'>tell you[/u'> how you'll do it. ;)

Both of my sisters had GD and delivered at 38 weeks - one vaginally and one C section. Get a second opinion if you want but in regards to delivery time it sounds right to me. Obviously GD affects baby and I believe it is very normal to have ealry delivery. Doctor can adbise better than EW!! Again, I've had one GD pregnancy (delivered via SVD on my due date) and two borderline GD pregnancies...one induced VD at 39+5 (I think!) due to high BP and the other SVD at 39+6. GD alone, even GD plus suspected 'big' baby, is NOT an indication for CS. An OB should be making that decision, [u'>with[/u'> the patient, based on ALL factors to do with the pregnancy.

Hi with GD this is usual practice to deliver at 38 weeks. ... Sorry, but no it's not usual practice with GD. ;) "Usual practice" should be to assess every pregnancy individually and make the best decisions based on the evidence at the time. I think some lazy OB's have a 'usual practice' routine because it avoids them having to actually pay any attention to the patients (mum & baby) and guarantees they can get in their golf round or manicure. I've had one confirmed GD pregnancy and two borderline ones. With two gov't hospital deliveries, I've seen a LOT of OB's in two different countries and only one CS-happy OB said she prefers a CS at 38-39 weeks. She literally said, "I prefer..." with ZERO medical reasoning that she could explain to me. In fact she looked quite stunned when I politely asked why she recommends this for me. This was when I was about 20 weeks so needless to say, I never saw her again.

I say don't take the risk with your baby, all the issues you have with your pregnancy could be fatal to your baby. What is more important the health of your baby or the thought of a natural birth? I have had a c-section and a natural and I became a mom with both, no difference! Its the having a healthy and beautiful baby that counts, and I have been there and written the book, I am saying from experience and maturity. Either way good luck and health to you and your new one!

Hi with GD this is usual practice to deliver at 38 weeks. I was boarder line with my last pregnancy and due to measuring an average size my consultant allowed me to go to 39 weeks when I was induced. It's better to be safe than sorry. My midwife supported me against the diabetic team in the UK as all my readings were fine it was only after the GTT test I had a reading right on the upper limit but she did say a week isn't going to make a difference. Just talk to your doctor ask her to leave you as long as she feels you are fit and healthy. Good Luck!!

I've replied on your other thread too. :)

I have just copied and pasted what I put on the PB&T forum below... I think it probably comes down to the trust you have in your OB. Whilst I haven't had either of these issues, I have had friends that have had very bad cases of gestational diabetes, and have had to be delivered early by c-section (and at the 38 week mark - so this doesn't sound outside of usual protocol - but it is completely dependant on how 'bad' your case is, as to how far they will let your pregnancy progress). It is quite common for a baby with a mother suffering from gestational diabetes to be measuring 'large' - it is one of the issues associated with GD. I am only a week ahead of you, and DD was measuring 2.7kgs last week - which is quite a 'solid' weight, for this stage - normal, but a good weight. Another .3kgs may not sound like a lot, but you need to remember that until the 35/36 week mark, you baby isn't actually putting on much weight - this comes in the last few weeks of your pregnancy, so the fact you are already outside of 'normal' ranges could indicate your baby will put on a lot of weight in the next 5 weeks. From this point, 'normal' weight gain is approximately 250grams per week - so you would be looking at a 4.25kg baby - working on the assumption your baby is putting on a 'normal' weight, but with GD they tend to put on more. It also sounds like you have the added complication of excessive amniotic fluid - which can also cause problems for you, resulting in emergency c-sections being performed. I happened to look up the fluid information the other day because I was curious that the OB kept on saying mine was in normal range, so was wondering what would happen if it wasn't... From what I understand, if you have excess fluid there can be problems with the umbilical cord, or you can have problems with your placenta when your waters break - both are serious enough to warrent an emergency c-section, which is why they tend to book a c-section in advance prior to your waters actually breaking to avoid you have any serious health complications. Personally, on the face of it, it does sounds like your OB is weighing up both your complicating factors and giving advice to ensure your safety and the healthy delivery of your baby, but again, it depends on the faith you have in your Doctor. If you are really doubting her sincerity, you could either a) call her office and find out what the fluid measurement is, and do a quick online check of normal ranges - along with the weight measurement that you know; or b) go and get a second opinion just for your comfort, but you will probably want this to be with someone you can 'trust' in case there is conflicting information. I know it is extremely disappointing to have a plan of what you want to happen taken from you (I can imagine if I was told I couldn't have a natural birth this time after having one last time, I would asking a lot of questions), but ultimately, you just want to ensure that both you and your baby are safe. I hope that helps!

I would also get a second opinion. Just to be sure if this is really the best or only way to deliver the baby, especially as you seem reluctant to follow your Dr's advice. But if the second opinion is also the same I would follow your Dr's orders. I am very sceptic regarding the high c-section rate in the hospitals here and I doubt if all of them are really absolutely necessary, but what you described sounds solid to my layman's ears and in the end what matters is that you deliver a healthy baby in the safest way possible.

Both of my sisters had GD and delivered at 38 weeks - one vaginally and one C section. Get a second opinion if you want but in regards to delivery time it sounds right to me. Obviously GD affects baby and I believe it is very normal to have ealry delivery. Doctor can adbise better than EW!!

There is an utter fixation on weight gain for both Mother & baby during pregnancy here?! As you say it's very difficult to accurately estimate the size of a baby in utero & on this basis your Doctor may be unnecessarily recommending a c-section. Many women give birth to large babies in any event. If you are really determined to have a VBAC then you must change Doctor. Personally I would not be considering one unless my labour was allowed to commence naturally. Good luck. X Baby weight gain is an issue with gestational diabetes, its not normal rate of gain. OP has other issues related to the pregnancy and there's a reason she's been suggested what she has. OP - Please let us non-medical people not bias you, especially if it is away from the doctor's advice.

I had polyhydramnios(is it really called that?) during pregnancy. Baby was lying in transverse position and I was told that if my waters broke early then the cord would drop down, then the baby, cutting off the blood supply to baby. So they held on until baby passed 2 kg and did C-section. A large baby due to GD is not a healthy baby.

There is an utter fixation on weight gain for both Mother & baby during pregnancy here?! As you say it's very difficult to accurately estimate the size of a baby in utero & on this basis your Doctor may be unnecessarily recommending a c-section. Many women give birth to large babies in any event. If you are really determined to have a VBAC then you must change Doctor. Personally I would not be considering one unless my labour was allowed to commence naturally. Good luck. X

If you have polyhydramnios (increased fluid) there is more risk of a prolapsed umbilical cord if you have a spontanteous rupture of membranes, so your Doc is possibly trying to reduce the risk of this. He/she could try a controlled artifical rupture of membranes if your cervix is soft enough at 38weeks though.

Not a doctor but read tonnes of literature on the stuff and seems doctor has considered your situation well and its good judgement. If you feel unsure, then do get a second opinion, you don't have to change doctors, just get a 2nd opinion, good chances it will be the same and then you can feel assured. With gestational diabetes babies are usually bigger and given all other factors mentioned it does seem she's suggested the right course. PS - Hope baby makes an appearance sooner so you have a better chance at VBAC. You surely don't want to be delivering a 4++kilo baby VBAC and the risk of it in the end having to be a C section anyway. Congratulations in advance to the new addition X <em>edited by summerdream on 09/02/2012</em>

I know it's a hassle changing Drs so late, but there are some Drs who are willing to offer inductions to VBACers. Dr Raj at the American Hospital is very supportive of VBAC, so perhaps you could try and see her. Best of luck!

No idea what VBAC is but, as far as I know with 38 weeks the baby is ready and after that will only gain weight. Also, if you have had previus C section the chances you will have now a baby in a natural way is minimal. But of course I can be wrong, your baby is healthy at this moment, why you dont want let him come ?

If you are not happy, get a second opinion from a qualified obstetrician...... EWers don't really know your medical history so cannot give you the proper advise. Hope all goes well :)