[MamaBabbitt]

I was diagnosed with GD in week 31 and it's been well controlled with diet and a steadily increasing does of Glyburide.
My due date is Aug. 28, three days away, and my doctor was really accomodating about letting me get to my due date because I was hoping for a natural childbirth. But now that the day is here, I'm getting a lot of pressure to begin cervix ripening and induction.
Anyone know how common it is to be allowed to go past your due date with GD -- or is that just unheard of?
And do cervix ripening and induction go hand in hand, or could I do the ripening without the pitocin and buy some more time to try to go into labor spontaneously.
I'm pretty adamant about natural birth, but I don't want to be dangerous or unsafe.

[sarahspins]

Is this your first baby?

Everything about what you just posted screams "NO, don't do it!!" to me... it doesn't sound like you're a good candidate for induction at all if they're wanting to do ripening first.

Have you had a lot of monitoring already? NST's and BPP's? If those are all looking great, I'd probably opt to wait it out a little bit longer, as long as the monitoring continues to look good.. especially since you're not on insulin.

You could potentially do the ripening without the AROM or pitocin... however, depending on what methods they use, that can still put you into labor, which still technically makes it an induction, and would carry similar risks of complication and ending in C/S.

That said, I walked into both of my inductions at 3cm and 80% effaced.. I was ready to go, I just needed a bit of a kick start. I had my water broken and got low doses of pitocin (so low in fact that it was turned off after just a couple of hours both times), and I had nice, short, easy labors (5 hours, then 4 hours). But not everyone does... especially if your body isn't already showing signs of beginning labor soon.

My last was a spontaneous labor (and wicked fast.. I walked into the hospital on my own at 9cm just about an hour after I woke up thinking "I might be in labor" and had him less than an hour after that - I had to WAIT for my OB to do a C/S first). I had no pain meds with him, they barely had a change to get an IV in me (after THREE tries.. ugh!).

I can't say honestly, after having done both, that I'd really want to choose one over the other.. for me they both had good and bad points. Having a crazy fast spontaneous labor is a little scary... that's one thing that I actually liked about my inductions, everything seemed so relaxed and casual - not like I was getting attacked by an 8 person trauma team! However, I felt about a gazillions times better after my last was born than I had after my inductions because I wasn't bloated with IV fluids. My milk came in MUCH faster too.

[butterflykisses]

I think the concern is that the babies with diabetic mothers can get too large to pass through the vaginal canal and/or get stuck which would end in an emergency C-section. It's a tough decision. Good luck! And congratulations!

[telizas]

FYI, I am a doula in the process of being certified and a mom of two, whose births did include the interventions you are considering. This is just my experience and should be taken as sisterly advice only.

If they do cervical ripening, be prepared to labor in bed. It may or may not kick-start labor and they will want to monitor you continuously. The ripening agents take 4 hours, and then they will administer it 2-3 times to see if it works. Most often it will NOT get labor started, and you will have to have pitocin, which WILL mean laboring in bed and being monitored.

If your baby isn't measuring big yet, I wouldn't do it. If you've had good u/s results thus far, there is NO reason to be induced. If the baby is already big (and by big, I mean over 10lbs), then I would say wait 3-4 days and try to kick start labor on your own and then figure out what to do. LOTS of women, with GD or not, have large babies. At this point it doesn't sound like your baby is so large that its being affected by your GD. I was already diabetic with my last pregnancy, and had a health 6lb baby - not all D babies are big, and some women with GD would make big babies even if they didn't have GD, so there's that to consider!

Have sex (lots of it!), walk, eat some spicy food, make HUGE plans that will be a PITA to break, and you'll go into labor on your own. You can try an enema as well, lots of women do a Fleet enema anyway and this can get things moving (no pun intended!).

Good luck! If you want to talk privately, feel free to private message me.

[sarahspins]

Yeah, my MIL who is *tiny* had a 9 1/2lb baby... no GD. My last was over 9lbs and I'm blaming it on DH's side of the family.. lol I don't think he was big because of D.. I had the best control with him out of all of my pregnancies. I expected he'd be bigger because he felt bigger, but not that much. He was the easiest delivery of my 3 though.. so "big" isn't always a bad thing. Fat is squishy My smallest baby actualy had the biggest head.

[butterflykisses]

I had a SIL who had a 11 lb baby with no diabetes, natural birth. He looked like a 3 mo old when he was born.

I had D with my second son. I carried him almost a full 3 weeks past his due date, because my doctor did not believe that I was that far along. He sent me to have an xray, lying on my stomach, as I understand it, to measure the skull which would tell him if he was ready? All I know is after this he decided that I needed to do a non stress test, I think it was called. This consisted of, ummm, stimulating the nipples. That causes the uterus to contract and they monitor the baby to see how he does. The nurses told me that this often stimulates labor...and it did. However, I did end up with a C-section, and a 8lb 8oz baby boy.

[MamaBabbitt]

Thank you for all the wonderful advice!
Yes, first baby. I've had NSTs every week for the past 5 weeks, and they're all fine. I'm monitoring movements myself, too, and that hasn't decreased.
I actually don't know the size of the baby because I haven't had an US since 31 weeks -- my OB feels they're sto often inaccurate, he didn't want to jump to early inductions or CS based on guesstimates. Which was nice to hear, since it's how I feel. But at 31 weeks they were predicting the baby to be about a week ahead, size wise.
What he wants to do is just ripening at this point with Cytotec, and on a very low-dose outpatient basis over the course of a few days. He says he's not trying to get labor started, he's just trying to get me ready should we need to induce.
He's pretty adamant that he'd prefer to induce me on my due date, but will wait if I want and I completely understand the safety implications. Oddly enough, a big baby isn't why he wants to induce. He wants to because he says that my placenta will degrade/shutdown/shrivel up, whatever, sooner because of the GD, and that my chances for stillbirth are increasing exponentially each day past 40 weeks that I go.
My inclination is maybe to let him do some VERY low dose ripening, but to put off pitocin for maybe a week. I'm NOT scared by a big baby, but I will admit he's scaring me with the stillbirth talk.

[sarahspins]

The risk of stillbirth really goes up only with insulin usage (and not because of the insulin, but because of the #'s that make you require it).. if your numbers have been really good I wouldn't worry about that so much.

HOWEVER, I would highly recommend that you at least get a biophysical profile done if you don't want to be induced on your due date.. it's a NST along with an ultrasound to check the pacenta and baby (and not just size)... it's good for peace of mind, if everything looks good, then you would be fine to wait a bit longer

If he's wanting to do the ripening outpatient, I'd probably be okay with it... what you don't want is to be stuck in the hospital with a cascade of interventions that starts because things aren't "moving fast enough". Thankfully I've never experienced that, but I know far too many people who have... and none of them even had GD (or pre-existing diabetes).

[telizas]

I'm going to be REALLY candid with you... the cervix ripening agents are prostaglandins. You know what also has them? Semen. Also, ALL placentas start to deteriorate after 40-41 weeks. Its not just because you have GD.

If I were you, I would try some good ol' sex and see if anything happens over the weekend. Then I might do some outpatient cervadil. JMO.

[Keezheekoni]

Stay *FAR FAR* away from Cytotec if you want to keep your natural birth plans. That stuff is unsafe, used off-label for induction, can cause hyperstimulation of the uterus, uterine rupture, fetal death and maternal death. Go read the manufacturer's website, they warn against Cytotec's use off-label. Doctors use it because it's cheaper than pit and works faster...

If your cervix isn't ready to open up, then no amount of ripening agents will move it along any faster. Which means, more interventions if the arbitrary "labor clock" is running slower in your labor than they want it to. If you want to avoid a section, *do not* let them break your water. You'll be lucky if they allow you to labor more than 12 hours after its rupture.

You should be okay going a week over term. The due date is just an estimate anyway... some people go to 43 weeks safely. Definitely since this is your first, you'd go over by a few days anyhow. That's typical.

Do know that babies tend to know when they need to be born. A lot of times babies will go overterm because mom isn't "ready" yet, like if you have cleaning to do, stuff to buy, stuff to build/put together, or mom and dad are arguing about whether baby is going to co-sleep or be in a crib, bottle or breastfeed, wear sposies or cloth diapers...on and on. (Okay, the last one was my dh's argument and mine - cloth TYVM). So if you do have any unfinished business, get that done in the next day or so, you might find yourself in labor that night!

[MamaBabbitt]

Keezheekoni, that's exactly what I'd heard about Cytotec, but when I questioned it, the OB got very defensive and told me to stop believing everything I read on the Internet. Actually, I read it in several natural birth books (my husband and I took Bradley method classes and were really trying for natural).

I told him I'd pay out of pocket just to get the Cervadil instead, and he said he'd do that, but he would NOT let me do Cervadil outpatient, and that protocol for use of that drug is to start pitocin the following morning, no exceptions. So basically, I can have the drug I want, but I will lose my choice on induction.

We've been having sex almost every night and nothing's happened yet. I've even broken out the breast pump to try to stimulate things. I walk a lot, I'm aiming for potholes. I'm out of ideas.

I just need to get myself calm about waiting for the baby to be born at the right time and stop being freaked out about going past my date. Which would be a lot easier if he'd stop being so agressive!

[Keezheekoni]

Tell your OB that you just want to be absolutely safe and you'd rather not risk the use of an off-label use of a drug. Easy. They can't give it to you if you don't consent.

They also can't induce you if you don't consent. Just don't show up for the scheduled induction. It happens all the time.

Again, if your cervix isn't ripe, it isn't time... Be careful too, because if you plan on breastfeeding and the baby isn't ready to be evicted, you could have weeks of bad latch and painful nursing, as well as slow weight gain. Then they'll push you to formula feed.

[sridder]

I had GD with my last 2 pregnancies. 2nd son was born on his due date and 3rd son was 10 days overdue so they brought me in and gave me pitocin to induce. He finally came 11 days late. Both healthy, happy babies. 2nd son was 8 pounds 5 oz. Third was 8 pounds 15 oz. Now those "babies" are almost 14 and 15.