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November 9, 2005

Pregnancy

Question from Oklahoma City, Oklahoma, USA:

I am 23 years old and have had diabetes for 16 years. My husband and I recently discovered that I am pregnant. I realize that my pregnancy is classified as "high-risk" because of my diabetes, but I am in fairly good control. I had an A1c of 7.0 before conceiving, am healthy and REALLY do not want to have a cesarean unless there is a life-threatening situation. However, I am having trouble finding a doctor who will help me achieve this goal. The doctors just stress that "the baby might be too big" so, they want me to be prepared to have a cesearean done. Is there a resource to help me find doctors that might support natural birth for diabetics? And, what is your opinion of the need of a healthy diabetic to have a c-section in the first place? How can I get my OB/GYN to take my concerns seriously, or, how do I find one who shares my philosophy on this? I'm sorry if I am not asking a question appropriate for your forum. I just cannot ask one doctor about this. I have interviewed several doctors and have not been able to get them to tell me if there is another doctor out there who might be more supportive. I have an appointment scheduled with my endocrinologist, but it is not for almost another month, and I really need good care so I can have a healthy (and hopefully diabetes-free) baby.

Answer:

Just because you have diabetes does not mean that you have to have a cesarean section. True, your risk of delivering by cesarean is increased, but it is more likely that you will have a vaginal delivery. There may be reasons other than fetal size that would necessitate a cesarean section. Examples are breech presentation, severe fetal distress, or failure to progress in labor (this can occur with an average size baby). My impression is that the physicians that you have spoken to have expressed the opinion that your risk is increased, but have not stated that you must have a cesarean section. I think that they are being realistic.

OWJ