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Gestational Diabetes Induction

Induction Of Labour

Induction Of Labour

In order for a baby to be born the cervix (neck of the uterus) has to shorten, soften and open and there needs to be contractions. In most pregnancies this process happens naturally between 38 - 42 weeks and is known as 'spontaneous labour'. Induction of labour is the process of starting labour artificially. Reasons for induction Prolonged pregnancy - where pregnancy continues after 41 weeks Pre labour rupture of membranes - where the waters surrounding the baby break and labour does not start within 24 hours and there is a risk of infection Medical reasons - where it is felt there is increased risk to the health of your baby or you should the pregnancy continue Does a diagnosis of gestational diabetes mean induction? For many ladies with gestational diabetes, we may fall into the 3rd reason stated above (Medical reasons). According to the current NICE guidelines induction (or elective caesarean section) should only be considered before 40+6 weeks for women with gestational diabetes if there are maternal or fetal complications. NICE (English & Welsh) guidelines: Timing and mode of birth 1.4.1Discuss the timing and mode of birth with pregnant women with diabetes during antenatal appointments, especially during the third trimester. [new 2015] 1.4.2 Advise pregnant women with type 1 or type 2 diabetes and no other complications to have an elective birth by induction of labour, or by elective caesarean section if indicated, between 37+0 weeks and 38+6 weeks of pregnancy. [new 2015] N/A for gestational diabetes 1.4.3 Consider elective birth before 37+0 weeks for women with type 1 or type 2 diabetes if there are metabolic or any other maternal or fetal complications. [new 2015] N/A for gestational diabetes 1.4.4 Advise women with gestational diabetes to give birth no later th Continue reading >>

Who Recommendation On Induction Of Labour In Women With Gestational Diabetes

Who Recommendation On Induction Of Labour In Women With Gestational Diabetes

Home > RHL Topics > Preconception, pregnancy, childbirth and postpartum care > Induction of labour > WHO recommendation on induction of labour in women with gestational diabetes WHO recommendation on induction of labour in women with gestational diabetes WHO recommendation on induction of labour in women with gestational diabetes If gestational diabetes is the only abnormality, induction of labourbefore 41 weeks of gestation is not recommended. (very low-quality evidence, weak recommendation) Participants in the WHO technical consultation acknowledged that labour induction may be necessary in some women with diabetes for example, those with placental insufficiency and uncontrolled diabetes. Induction of labour is defined as the process of artificially stimulating the uterus to start labour.(1) It is usually performed by administering oxytocin or prostaglandins to the pregnant woman or by manually rupturing the amniotic membranes. Over the past several decades, the incidence of labour induction for shortening the duration of pregnancy has continued to rise. In developed countries, the proportion of infants delivered at term following induction of labour can be as high as one in four deliveries. (2-4) Over the years, various professional societies have recommended the use of induction of labour in circumstances in which the risks of waiting for the onset of spontaneous labour are judged by clinicians to be greater than the risks associated with shortening the duration of pregnancy by induction. These circumstances generally include gestational age of 41 completed weeks or more prelabour rupture of amniotic membranes, hypertensive disorders, maternal medical complications, fetal death, fetal growth restriction, chorioamnionitis, multiple pregnancy, vaginal bleeding and ot Continue reading >>

Gestational Diabetes And Induction

Gestational Diabetes And Induction

Its less than a week ago that the midwife called to tell me I had gestational diabetes. I was shocked. I hadnt expected the test to come back positive. I suddenly remembered an article Id seen about gestational diabetes which had mentioned stillbirth. I mentally decided I wouldnt google anything incase it was scare mongering. After all you hear about gestational diabetes all the time, surely it couldnt be that risky. The midwife informed me that actually there were quite a few risks involved and that the consultant was likely to want to induce me before 38 weeks. I got off the phone upset. The next day I attended the diabetes clinic to be issued with my monitor and instructions from the dietician. I was assured that it wasnt actually due to my love of haribo and in fact pregnancy makes it harder for your body to create insulin, hence the increase in diabetes during pregnancy. The nurse wasnt so positive. I tried to take her words with a pinch of salt but Ill be honest I did start crying when she made it very clear that the biggest risk was stillbirth and the consultant would definitely want the baby out by 38 weeks. Ive got used to doing things alone (well without another adult present my four year old was there clambering on my knee as we spoke), but its moments like this when the loneliness hits. Its not just being alone for the actual appointment, many partners cant make all the antenatal appointments, but I knew I had noone to go home to discuss this with or just hug me.On the plus side my son has exceptional understanding of diabetes for a four year old! On the Saturday I decided Id try and get the baby out naturally. Only my mum wasnt around, my brothers who live nearby and were on backup to watch my eldest when I go into labour were away and my douala was on hol Continue reading >>

Gestational Diabetes And Induction Of Labour – What You Should Know

Gestational Diabetes And Induction Of Labour – What You Should Know

Gestational Diabetes and Induction Gestational diabetes (GD) was once a relatively rare condition, occurring in about 4% of pregnancies. In recent years, the rate of women developing GD has doubled, and experts believe the incidence of the disease will keep increasing. Most women with GD are told by their care providers they will need to be induced before their due date, destroying their hopes for a natural and intervention free birth. Having GD can have a big impact on mothers’ and babies’ health during pregnancy, but does it really need to change how we give birth? What Is Gestational Diabetes? Gestational diabetes is a condition that only occurs during pregnancy. Certain pregnancy hormones interfere with your body’s ability to use insulin. Insulin converts blood sugar into usable energy, and if this doesn’t happen, blood sugar levels rise. Insulin resistance can cause high blood glucose levels and can eventually lead to gestational diabetes. Some women will have symptoms of GD, while others will have none. Many women can manage the condition without treatment other than dietary and exercise changes. Around 20% of women will need insulin injections. So for many women, well managed diabetes means they can still have healthy babies and normal births. Induction Of Labour Many care providers routinely recommend that women with gestational diabetes be induced around 38-39 weeks. The most common reasons given for induction at this gestation are to prevent stillbirth, and to prevent babies growing too large for vaginal birth. However, the evidence related to induction for women with GD comes from the review of one trial, which looked at 200 women who had either GD, Type 1 or Type 2 diabetes. The World Health Organization states this evidence for induction before 41 w Continue reading >>

Gestational Diabetes Versus Unwanted Interventions

Gestational Diabetes Versus Unwanted Interventions

Deborah is 36 weeks pregnant and has gestational diabetes. She’s been careful about diet and exercise and has maintained very stable blood sugar levels. Her doctor, however, is warning her she’ll probably need to be induced at 39 weeks and may need a c-section. He wants her to get an early epidural so she’ll be ready for surgery, “just in case.” Deborah’s warning bells are going off because that’s not the labor she had in mind. She’s hoping for a spontaneous and un-medicated labor and worries her doctor is setting her up for interventions she doesn’t want. Gestational diabetes (GD) can have a big impact on mothers’ and babies’ health, but it doesn’t always have to be a big deal that requires all the tools in the medical toolbox. Often times, complications like GD can be managed carefully without making major diversions from the patient’s hoped-for birth plan. Deborah’s doctor told her that GD babies have to be induced at 39 weeks because sometimes they “just don’t come” until they’re two or three weeks past their due date. Deborah, that doesn’t sound quite right to me. GD babies are at somewhat higher risk to come earlier than their due date, not later. If mom’s blood sugars aren’t well controlled, babies can get too much glucose through the placenta and grow too big. That can trigger premature labor, damage the placenta and bump up risks for delivering a baby whose lungs aren’t fully developed. Premature and super-sized babies tend to have more respiratory problems and a tough time stabilizing their own blood sugars too. That doesn’t mean these problems are guaranteed to happen to you and your baby, Deborah. It means there’s a greater risk. Many GD babies are born healthy with normal weights and perfect birthdays and neve Continue reading >>

Gestational Diabetes And Giving Birth

Gestational Diabetes And Giving Birth

The latest guidance from NICE, published in 2015, has extended the time by which women with gestational diabetes should give birth to 40 weeks, 6 days – not much less than the general guidance for all pregnant women, which is 42 weeks. If you have not gone to birth at this point, induction of labour will be recommended. "When I was in the hospital, I felt I didn’t know what was going on. I would have liked more information about that part so I could have been better prepared." Gemma, mum of one The main reason for induction is to prevent stillbirth. For all women, the risk increases when their pregnancy goes past 42 weeks. However, one study has shown that women with gestational diabetes may be at risk earlier. So for this reason, the guidance in England and Wales states that if you have gestational diabetes, you should not go beyond 40 weeks, 6 days. An induction or caesarean may also be advised if your baby is very large (macrosomia) – as this may cause difficulties during the birth. On the other hand induction may also be recommended if the team detects poor growth in your baby. In Scotland, most women with diabetes in pregnancy are induced within 40 weeks. The guidance says that this decision should be determined on an individual basis. If you are taking diabetes medication or insulin, it recommends that you should be assessed at 38 weeks and delivered by 40 weeks. Choices you might need to make for labour and birth Most women with gestational diabetes have a healthy birth. But before you make your birth plan, you may need to take some things into account to make sure you and your baby are safe during and after the birth. If you have gestational diabetes, you will have less choice about where to deliver your baby. This is because you will need to deliver your Continue reading >>

Does Gestational Diabetes Always Mean A Big Baby And Induction?

Does Gestational Diabetes Always Mean A Big Baby And Induction?

July 3, 2012 by Rebecca Dekker, PhD, RN, APRN © Copyright Evidence Based Birth®. Please see disclaimer and terms of use. This question was submitted to me by one of my readers, Sarah. “I have a question about gestational diabetes. It seems like everyone I know who has had it has ended up being induced. Does gestational diabetes automatically mean induction? Does it automatically mean big babies? It seems like people get diagnosed and then give up on a natural childbirth and are treated as a sick person.” I talked to Dr. Shannon (a family medicine physician), and she echoed Sarah’s perceptions about gestational diabetes: “I would say that ‘routine care’ in the U.S. is to induce at 38 to 39 weeks for gestational diabetes (leaning towards 39 weeks nowadays) if the mom’s glucose is uncontrolled or if she is controlled on medication. However, women can technically be treated as ‘normal’ if their gestational diabetes is well controlled and baby’s growth looks normal on a 32 week scan. So people just might want to know they will get major push back from their provider if they refuse induction. It’s tough. Many OB’s cite the risk of stillbirth as a reason for induction, because the risk of stillbirth in women with regular diabetes is higher. However, there is no evidence that the risk of stillbirth goes up in gestational diabetes.” Evidence Based Birth® offers an online course on Big Babies and Gestational Diabetes (3 contact hours)! To learn more, click here! Dr. Shannon brings up several good points. First, she is talking about “routine care,” which is very different from “evidence-based care.” Routine care means that this is what everyone is doing—it’s routine, it’s standard. Evidence-based maternity care means offering care that is Continue reading >>

Planned Birth At Or Near Term For Pregnant Women With Gestational Diabetes And Their Infants

Planned Birth At Or Near Term For Pregnant Women With Gestational Diabetes And Their Infants

Planned birth at or near term for pregnant women with gestational diabetes and their infants The aim of this Cochrane review was to find out if planning an elective birth at or near the term of pregnancy, compared to waiting for labour to start spontaneously, has an impact on the health of women with gestational diabetes and the health of their babies. Planned early birth means either induction of labour or caesarean birth, and 'at or near term' means 37 to 40 weeks' gestation. To answer this question, we collected and analysed all relevant studies conducted up to August 2017. Women with gestational diabetes (glucose intolerance arising during pregnancy) and their babies are at increased risk of health complications (e.g. high blood pressure, bigger babies). Because of the complications sometimes associated with birthing a big baby, many clinicians have recommended that women with gestational diabetes have an elective birth (generally an induction of labour) at or near term (37 to 40 weeks' gestation) rather than waiting for labour to start spontaneously, or until 41 weeks' gestation if all is well. Induction has disadvantages of increasing the incidence of forceps or ventouse births, and women often find it difficult to cope with an induced labour. Caesarean section is a major operation which can lead to blood loss, infections and increased chance of problems with subsequent births. Early birth can increase the chance of breathing problems for babies. It is important to know which approach to birth has a better impact on the health outcomes of women with gestational diabetes and their babies. Our search identified one trial involving 425 women and their babies. In this trial , 214 women had an induction of their labour at term, the other 211 women waited for a spontan Continue reading >>

Gestational Diabetes But No Induction?

Gestational Diabetes But No Induction?

I was wondering if anyone has experience of having gestational diabetes but declining induction at 40 weeks? I was diagnosed with GD at 32 weeks. I have controlled it with diet. I had a difficult first birth after induction at 42 weeks, and am very unhappy about the idea of being induced at 40 weeks (which feels early for me). I have read all the NICE guidelines and understand the rationale for the policy. So dont need any replies focusing on that. I am just wanting to find anyone who as the experience of not being induced at 40 weeks - what happened? what led to your decision? Not the answer you want, so please don't flame me. Had 4 GD pregnancies. One went to 41 weeks, three induced at 38 weeks. I have 3 wonderful DC's. Induction not nice, but end results were better than stillborn dc at 41 weeks. Sorry. Go with medical advice. It is sound and it is based on very real concern for the outcome for the baby. Sorry to focus on that but it is a really important factor. I was induced bang on the dot of 40 weeks with DD4 after controlling GD with diet and it went slowly but smoothly. I had a pessary late in the evening of day one, then syntocinon about midday on day two, and DD4 was born in the wee small hours of day three. Altogether the experience took about 36 hours and I slept until about 2 am the morning she was born as well as sleeping the whole first night. I had been induced previously at 40+7 with DS, 40+7 with DD3. DD1 was a week late and DD2 was ten days late. With DS, I had a pessary the night before but had made no progress so they gave me syntocinon at 7 am and predicted the whole business would take 8 hours. They were off by only 6 minutes. With DD3, a pessary was all it took, and labour lasted about 9 hours start to finish. For a first induced birth, insist Continue reading >>

Gestational Diabetes Early Induction?

Gestational Diabetes Early Induction?

I have been reading about early inductions like 37-38 weeks for women who have GD, I am taking insulin in crazy amounts like 20+ before lunch and dinner but my OB seems not worried. He said that I could carry on till 40 weeks as the baby is measuring ok. My readings are still high like 8-10 after insulin. I am currently 34 weeks. Please share your GD stories, have you been told that you will/might be induced early? I am nervous as I don't want to know last minute that they need to induce me or have the baby too huge either!! I've dealt with gestational diabetes since the end of the first trimester. It's definitely a hard road to travel. Until recently I was controlled with diet and metformin but recently had to add insulin. Because of the increasing insulin needs I've been told we will look at a 37-38 week induction even though baby boy is measuring well at 32 weeks. I had GD my first pregnancy and was induce but I was a few days over due. I want a natural labor this time so I'm refusing inductions despite my GD but so far they haven't mentioned inducing at all to me. Mine is diet controlled though and I think that makes a huge difference. I'd trust your doctor though. If you induce early even if it's close there's always a chance your baby isn't ready and will need to be in the nicu so if he's saying you can go full term then I'd do it. A big baby is better than a sick one. fasting numbers have been the biggest issue. On last measure, our little girl was in the 76% of weight. As long as she doesn't exceed 90% and my NSTs are good, they will wait to induce me until I hit 39 weeks. The concern with GD is two fold. It effects the size of the baby as well as deteriorates the placenta earlier. That is why they sometimes err on the side of caution and deliver GD babies earl Continue reading >>

Induction Of Labour For Low Risk Gestational Diabetes

Induction Of Labour For Low Risk Gestational Diabetes

In obstetrics the decision to induce Gestational Diabetes is the honour of the Obstetrician. Is rather individualised. In my experience, a woman who has been diet treated is placed in Midwife-led care pathway and care is provided in the community. The final review is at TERM with the Obstetrician who will make the decision for induction. Otherwise this woman has the choice of choosing to deliver in the Birth Centre. The normal plan of care for our ladies with diet controlled gestational diabetes is to stop blood sugar testing around 36 weeks and treat the lady as normal - IOL at T+14 - the same as any other low risk lady. The normal plan of care for our ladies with diet controlled gestational diabetes is to stop blood sugar testing around 36 weeks and treat the lady as normal - IOL at T+14 - the same as any other low risk lady. The Obstetrician at my unit will induce all women with gestational diabetes before term ,if diet managed then as close to term as possible , however if needs Metformin or insulin then from 38 weeks as with the women with Type 1 and 2. Hi, In my units women with gestational diabetes are all reviewed by theobstetrician and those who are diet / metformin controlled then have shared care for the remainder of their pregnancy. As in Heather's unit, if blood glucose is well controlled by diet and growth is anticipated to be normal, IOL normally takes place at around 40 weeks. If on metformin IOL is generally between 39-40 weeks and if on insulin 38-39 weeks. It is interesting to see that in Sue's unit women who are diet controlled stop testing their BG at 36 weeks and they revert back to midwifery led care. Are there any figures from this unit to support this pattern of care because it would be a very useful tool to use if they are all good! We are cur Continue reading >>

Induction Of Labour In Women With Gestational Diabetes

Induction Of Labour In Women With Gestational Diabetes

Induction of labour in women with gestational diabetes Induction of labour in women with gestational diabetes Induction of labour (artificially initiated labour) is becoming more common worldwide. Up to 25% of women in developed countries undergo induction, while in developing countries these are generally rates are generally lower, but increasing. Induction of labour is not risk-free and many women find it to be uncomfortable. These guidelines were developed in order to promote evidence-based practice in inducing labour to improve maternal and newborn outcomes worldwide. The WHO recommendations for Induction of Labour (2011) contain recommendations on the timing and methods of induction and management of adverse events related to induction of labour. If gestational diabetes is the only abnormality, induction of labour before 41 weeks of gestations is not recommended. (Very-low-quality evidence. Weak recommendation.) Participants in the WHO technical consultation acknowledged that labour induction may be necessary in some women with diabetes for example, those with placental insufficiency and uncontrolled diabetes. Evidence base and GRADE tables for the WHO recommendations on induction of labour Evidence for this WHO recommendation was extracted from the Cochrane reviews below: Boulvain M, Stan CM, Irion O. Elective delivery in diabetic pregnant women. Cochrane Database Syst Rev2001, Issue 2. Art. No.: CD001997; DOI: 10.1002/14651858.CD001997. In pregnancies complicated by diabetes the major concerns during the third trimester are fetal distress and the potential for birth trauma associated with fetal macrosomia. The objective of this review was to assess the effect of a policy of elective delivery, as compared to expectant management, in term diabetic pregnant women, Continue reading >>

Induction Birth Stories

Induction Birth Stories

My gestational diabetes induction birth stories Here aremy gestational diabetes induction birth stories. With gestational diabetes, many ladies may be advised to have an induction of labour. Induction may be unknown and for many ladies, a scary and daunting, unnatural process. Many ladies hear lots of horror stories surrounding induction and so I felt it was time to share my induction birth stories. We explain induction, reasons for induction, national guidelines, lots of information around different methods of induction and links to research on our induction page . My induction birth stories - Jo, Author of Gestational Diabetes UK I only know gestational diabetes, I only know induction and so I can't say whether an induction is more painful etc as it is all I know. But I will share what my personal induction birth stories and experiences have been. Twogestational diabetespregnancies with early diagnosis, despite losing 5 stone in weight, I still got diagnosed with gestational diabetes at 11 weeks in my second pregnancy. I controlled my gestational diabetesboth times with fairly high amounts of insulin, around 200 units a day. I required more fast release insulin in my first pregnancy and more slow release in my second. In my first pregnancy I struggled more with post meal readings. I was testing at 2 hours post meals and followed poor dietary advice as advised by my dietician. In my second pregnancy I had researched gestational diabetes in depth, was learning lots about the condition, had set up the Facebook support group and was testing my levels at one hour post meals, plus additionally to test snacks and for spikes. My post meal levels were very well controlled following my own dietary advice, but I chased my fasting levels throughout, having to increase my night t Continue reading >>

Timing Of Delivery In Gestational Diabetes Mellitus: Need For Person-centered, Shared Decision-making

Timing Of Delivery In Gestational Diabetes Mellitus: Need For Person-centered, Shared Decision-making

Go to: Abstract Gestational diabetes mellitus (GDM) is a medical as well as obstetric challenge, which needs person-centered management. The timing of delivery of women with GDM is discussed by various obstetric professional bodies. We highlight pertinent medical, obstetric, and psychosocial factors which may influence the timing of delivery in women with GDM. This commentary proposes a person-centered approach to decide the delivery timing in GDM and supports shared decision-making based upon the individual’s biopsychosocial characteristics and environmental factors. Keywords: Antenatal corticosteroid therapy, Cephalopelvic disproportion, Diabetes, Fetomaternal distress, Labor, Macrosomia Go to: Introduction The prevalence of gestational diabetes mellitus (GDM) is rapidly increasing across the world and it is a common endocrine complication in obstetric practice today [1–3]. GDM, as a syndrome, is marked by controversy related to virtually every facet, ranging from its nomenclature, screening tools, and diagnosis to management strategies [4, 5]. Most debate on GDM management centers on medical issues, such as appropriateness of oral hypoglycemic agents. In this communication, we discuss the timing of delivery in GDM and emphasize the need for person-centered, shared decision-making in this regard. Compliance with Ethics Guidelines This article does not contain any new studies with human or animal subjects performed by any of the authors. Go to: Current Recommendations Expert recommendations suggest that women with uncomplicated GDM take their pregnancies to term, and deliver at 38 weeks gestation [6]. Such a decision is not as simple as it seems. These recommendations differ from earlier findings, which suggested earlier induction of labor [7], but are consonant wi Continue reading >>

Gestational Diabetes: Induction And After Birth

Gestational Diabetes: Induction And After Birth

Gestational Diabetes: Induction and After Birth Ive mentioned a few times that induction week is approaching and this pregnancy is almost over! A lot of people have asked me why Im being induced. It seems to be a big topic among moms and moms-to-be. Just like most other parenting topics. But, I dont mind. I look at it as every person is different as is every pregnancy and experience. So, I decided to write up this post to have it all in one spot and also give some insight to some new moms, or moms-to-be who may have been or may soon go through what I have with gestational diabetes and inductions. I am heading to the doctors tomorrow, and hopefully getting the date of my induction. I am looking forward to it and have made peace with the fact this is how it has to be. When we were discussing having one more baby, we talked home birth. I wanted a home water birth so badly, but I had a feeling from the moment I got those two lines that I was confident I would have GD again. My OB wanted me to take the test early at about 15 weeks, but I stalled. I took it at 19, got the results at 20 and started my diet right away. Why am I being induced?: This answer is pretty simple. I have gestational diabetes for the second time diagnosed, and a 3rd time in total. Typically, if you have gestational diabetes the doctors dont let you go many days past 38 weeks because of the what-ifs the risk of still-birth is more significant, as is having a bigger baby (this doesnt bother me) the risk of low blood sugar in baby is also there which I did have with Hanna, and Id like to avoid again this time, if possible. With Hanna, my placenta also decided to stop playing nice near the end and decided it would give us some issues with flow. I know there are more risks, feel free to look those up I real Continue reading >>

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