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March 15, 2006

Pregnancy

Question from Galloway, New Jersey, USA:

I am 29 weeks pregnant with my second child. I have had type 1 for 32 years and have been using a pump for more than five years. My last a1c was 4.7. I am currently being seen by my endocrinologist, an obstetrician, and a perinatologist. I test my blood sugar eight to 12 times per day. All of my tests have indicated a normal, healthy pregnancy. With my first pregnancy, also healthy and normal, the perinatology team I saw insisted on an early induction, testing lung development beginning at 36 weeks. I was induced at 39 weeks and had a pretty awful experience, constant fetal monitoring, Cytotec, pitocin, and a foley to manually open my cervix. The result of this was a long, very painful labor (for which I needed pain medications) with contractions every one and a half minutes for 16 hours. My son was born face-up, with a forceps delivery, and extensive tearing. He was horribly bruised, and I feel, pretty traumatized. For this baby, I'd like to have a birth that is as natural and gentle as possible. If my pregnancy continues to be uncomplicated, my obstetrician said that she'll wait to induce at 40 weeks, but that I cannot go past my due date. I'd prefer to go into labor on my own to avoid induction and give us a better chance at a natural birth. Could you give me your opinion, please? I read on this site that a national organization for obstetricians and gynecologists does not recommend inductions for diabetics unless there are complications, but I was unable to find more information on this.

Answer:

The American College of Obstetricians and Gynecologists publishes practice bulletins that address specific problems. ACOG Practice Bulletin, Number 60, March 2005, “Pregestational Diabetes Mellitus,” discusses the timing of delivery. In a patient with well controlled diabetes, the ACOG states that the pregnancy can progress to the expected due date as long as the mother and baby are in good health. Management beyond the due date is not recommended. The concern is unexpected fetal death. This is more of a problem in uncontrolled diabetes. With close fetal surveillance the risk of death has been minimized almost to the point of a woman without diabetes. Nevertheless, going beyond the due date in diabetes is risky without much to be gained for the baby in terms of maturity.

OWJ