May 29, 1999
Family Planning, Gestational Diabetes
Question from Dayton, Ohio, USA:
I am 27 years old and am now pregnant with my third child. I was 16 weeks when the doctor discovered that I have gestational diabetes. I failed my 1 hour fasting at 16 weeks and at 17 failed fasting and first two hours of my 3 hour. They have gave me a week to try and control it with a diet and actually I did well. If I couldn’t control it with diet they were going to put me on insulin.
My problem lies with the delivery of this child. With my first child, I was induced and labored for 7 hours when I dialated to 5 cm. I indured another 3 hours of labor before they decided that I would need a c-section. I delivered a healthy baby boy, 6 lb 14 oz. With my second child, they guessed her weight to be around 8 or 9 lbs so I chose c-section with her also, she was 6 lb 14oz also. With this child I must face the decision to go natural or c-section. Today my doctor informed me that if I tryed to go natural, that I would have to face the possibilty of my uterus rupturing. This is 1 out of 100 chance and in some cases causes death of the unborn child or mother and in some both. Then there is c-section, and if I didn’t have the diabetes I would say go ahead, but my doctor informed me today that the chances of me setting up infection is much greater now that I have diabetes, and that they actually expect it to happen. In these cases they would have a nurse come to my house and dress my incision as needed and that in some cases the infection is so bad that can lead to severe problems such as hysterectomy and in some death. Now I am left with this scary decision and I have no idea what I should do, or who I can talk to about it. I would love to hear from anyone else that may have suffered or is suffering the same problems.
Answer:
What your doctor told you is true, but is also the worse case scenario. A woman with a previous cesarean section who labors is at risk of uterine rupture. However, this can also occur in women who have never had a cesarean section. Therefore, I feel that it is reasonable to consider labor, if the baby is not too big. The risks of an elective cesarean section are infection, significant blood loss and potential injury to other abdominal organs such as the bowel or bladder. The risk of infection is increased with diabetes. However, the risk can be significantly reduced by good blood sugar control, if you are not in labor at the time of cesarean section, antibiotics at the time of surgery and good surgical technique. The liklihood that you will have a serious infection following surgery is low (less than 10%). This is usually treated in the hospital. Rarely do you have to have home care. If you labor and then end up with a cesarean section, your risk of a postoperative infection is about 15-25%.
OWJ
