diabetestalk.net

Inducing Labor Gestational Diabetes

Gestational Diabetes: Does One Usually Get Induced?

Gestational Diabetes: Does One Usually Get Induced?

prolificwillybreederThu 05-May-11 08:10:03 Also marking place as won't be seen by consultant for a couple of weeks. Been left with so many questions! prolificwillybreeder, I was left with so many questions and was very confused after the diagnosis, I didn't know what to do really. ended up overreducing the carbons and had to stay in hospital to get the keytons washed out, so get as much information as you can. now I think I manage it more or less well, but there is usually such a chaos during the diabetes clinic in my hospital so I need to get prepared to my next meeting! jenga079 did you have high blood sugar or is it routine GTT, in which case you shouldn't really worry before Piffpaffpoff do you mind if I ask you how old you are? The reason I am so curious I was actually planning two babies but now I wonder if after each baby the risk of keeping the diabetes increases. I am 38 now Thought i could answer this question as i'm on number 5 but 4th diabetic pregnancy number 2 escaped it somehow.. In my hospital they generally say that if you are managing your diabetes with diet alone then you probably won't need to be induced. Obviously they will moniter the babies weight through scans every 4 weeks. If like me you are on insulin then they will moniter the babies weight and induce at either 38/39 weeks. Luckily for me i have had two induction dates set for two previous pregnancies and they both came the day earlier by themselves. I am currently 27 weeks and on corrective insulin so the likelyhood is that my induction date will be set for 38 weeks. Have a scan on monday to find out exactly how big he is already. GD normally diasppears after birth, but you are at more risk later in life if not kept in check. I had insulin controlled GD (gutted as I only weighed 9 and a hal 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 >>

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 >>

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 >>

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 >>

Being Induced At 39 Weeks Due To Gestational Diabetes ... Anyone Induced?

Being Induced At 39 Weeks Due To Gestational Diabetes ... Anyone Induced?

She's been averaging almost a lb a week so by Tuesday she would be at 9.5 lbs. I will be opting for epidural and pain meds so not too worried about the pain but he did mention c/s as a last resort if its unsuccessful. He's worried about her shoulders and said wen if I try vaginal delivery a c/s is still possible to prepare me ... T this point I just want her here healthy and don't care how she gets here ... @ kimbuss22 good grief 3 days?!? Looks like it'll be a long road for me ... Hoping she drops over the weekend ... Sigh I was induced with both pregnancies due to low fluid (I'm was also GD for both). DD1 @ 39w and DD2 @ 37w I think it has a lot to do with how ready your body is and your build more then baby size. DD1 I wasn't dilated or effaced, but she was low. I had Cervidil, fully dilated in 7 hours and then it took 3 hours to push her out after I got the epi. She was 8 lb 13 oz and I had no issues delivering her and no tearing, etc. DD2 I was 1-2 cm and 50%. Aftet the 12 hours of Cervidil I had progressed to about 3 and then had to have pitocin. That stuff is the devil so I ended up with the epi and delivered her after 17 hours total. She was 7 lbs 14 oz and only tool about 20 minutes of pushing. If your GD is well controlled and there are no other issues with your baby, placenta, etc. I would be hesitant to move forward with induction. Continue reading >>

Will My Induction Be Different If I Have Gestational Diabetes? (video)

Will My Induction Be Different If I Have Gestational Diabetes? (video)

Will my induction be different if I have gestational diabetes? (Video) Our midwife explains whether induction of labour is any different if you have gestational diabetes. Dr Cate Bell, RM, RGN, DMid, MSc, PgCHSCE, is a practising midwife in Sussex and a hypnobirthing practitioner. If you have gestational diabetes, induction of labour is no different to if you're having your baby induced for other reasons. The only difference may be that it might take slightly longer, because most women with diabetes are induced prior to their due date. Therefore your body may not be quite ready to go into labour, so it may take slightly longer. Join now to receive free weekly newsletters tracking your babys development and yours throughout your pregnancy. To give you the best experience, BabyCentres website and emails use cookies and similar tracking systems to personalise the content and ads we provide to you. We use your health information to make our site even more helpful. By clicking the button, you agree to our policies and to get emails from us. 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 >>

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 >>

A Gestational Diabetes Induced Labour Story...

A Gestational Diabetes Induced Labour Story...

A gestational diabetes induced labour story... Had to be induced at 39 weeks as I had gestational diabetes. So, called the hospital on the 25th of April to find out if there was a bed free in the induction suite that night and was told there was. Partner and I turned up at the ward at about 7.30 that night, while my older sister got there around 9. Quite frankly, the induction suite was quite boring. Four beds of women all waiting to see a doctor and get their induction going. At midnight I was finally seen and told that they would insert a pessary that night- though it might take 24 hours to work and that they gave it two attempts (so a 48 hour stay on the induction ward might be necessary). However, on examination (ouch that really stung!) it turned out I was already two centimetres dilated, so they skipped the pessary and instead applied a gel to soften my cervix. My OH and sister were sent home and told to come back the next day at eight. At 6 the next morning I was woken and told I was being moved to labour and delivery, and luckily my OH arrived early with my sister, because just before eight the doctors arrived to break my waters. I had a personal midwife for the whole of labour and delivery and she was extremely surprised to find my contractions began just five minutes after my waters broke. The early contractions felt like really bad period pains, and for an hour I was able just to breathe through them. However, they needed to insert two IV drips for syntocin and insulin and two midwives and one doctor couldn't do it. After three very sore attempts (one hand is still bruised and swollen) they finally called the anaesthetist to do it, and she numbed me up beforehand. I finally took gas and air after two hours of contractions so the midwife could do a vaginal ex 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 >>

Gestational Diabetes Birth Stories

Gestational Diabetes Birth Stories

After experiences of your labour and birth for those who had gestational diabetes Gestational diabetes occurs when your body can not cope with the extra demand for insulin during pregnancy and results in high blood sugar. When gestational diabetes is well managed you can reduce the risk of complications to mum and baby. Read our expert advice on what gestational diabetes is and how to manage it. Get educated I had gestational diabetes and had the best pregnancy and birth. I managed my sugar levels through diet and exercise – it was easy to do and I felt great. By the end of pregnancy I gained only 8 kilos, which is now all gone since I continued my diet after I had my boy. I have always been on the smaller side so we little people can get diabetes too (it runs in my family). The birth was as easy as a birth can get – my waters broke and 3 hours later my little man arrived naturally. He was 10 days early and he weighed a tiny 6lb 4oz., which was fantastic. Actually a lot of my friends have had gestational diabetes and said it was the best thing for them because it forced them to eat properly and exercise. If you get the right education and manage your diabetes properly then you will be fine. Good luck Mai Footless baby jumpsuits for regular sugar testing Bring in jumpsuits with no feet, and buy baby socks, that way you don’t have to undress them every time they need to test babies blood sugars. It will make it so much easier on both of you – Sarah Regular growth scans I was on metformin and had regular scans tracking bubs growth. A week before due 1 had a one off high bp reading but that meant I spent the next week have daily appointments with gp or midwife or bloods or scans. I got a call 2 days before due date to go to hospital to be induced as blood flow to bu Continue reading >>

Managing Labor And Delivery Of The Diabetic Mother

Managing Labor And Delivery Of The Diabetic Mother

Managing Labor and Delivery of the Diabetic Mother Hen Y. Sela, MD; Itamar Raz, MD; Uriel Elchalal, MD Expert Rev of Obstet Gynecol.2009;4(5):547-554. The rates of induction of labor are steadily increasing in recent years. Induction of labor is performed in almost 24% of pregnancies between 37 and 41 weeks of gestation in the USA.[ 52 ] The justification for performing an elective delivery in a patient with DM includes a potential reduction in perinatal complications, especially those related to macrosomia.[ 53 ] In a recent review discussing the indications for induction of labor, it was shown that induction of labor in suspected fetal macrosomia (without DM) does not improve outcomes; however, the quality of evidence was moderate and the grade of recommendation against induction of labor was weak.[ 54 ] Another conclusion of this review was that induction of labor may increase the rate of Caesarean deliveries. The level of evidence was, again, low and the grade of recommendation against induction of labor was poor. There is only one randomized, controlled trial that addressed the issue of induction of labor in women with DM treated with insulin at term.[ 55 ] In this study, 200 such women were allocated to receive either induction at 38 weeks of gestation or expectant care. This study found no difference in the rate of Caesarean delivery between these approaches but found that fetal macrosomia (birthweight > 4000 g) was significantly reduced by induction of labor (relative risk: 0.56; 95% CI: 0.32-0.98; number needed to treat: 8). The birthweight of 23% of the babies born to expectantly managed women was at or above the 90th percentile compared with 10% of the babies born to induced women. There were more cases of shoulder dystocia in the expectantly managed group, Continue reading >>

Inducing Labor - American Pregnancy Association

Inducing Labor - American Pregnancy Association

Inducing labor is the artificial start of the birth process through medical interventions or other methods. Induction not done for medical reasons or as an emergency is considered elective. Induction of labor has recently been on the rise for purposes of convenience or to accommodate busy schedules. However, according to the American College of Obstetricians and Gynecologists (ACOG), labor should be induced only when it is more risky for the baby to remain inside the mothers uterus than to be born. What are some medical reasons for inducing labor? When a complication develops such as: hypertension, preeclampsia , heart disease, gestational diabetes , or bleeding during pregnancy . If the baby is in danger of not getting enough nutrients and oxygen from the placenta. The amniotic sac has ruptured but labor hasnt started within 24-48 hours. The pregnancy is prolonged beyond 42 weeks with possible risk to the baby from a gradual decrease in the supply of nutrients from the placenta. There is an infection inside the uterus known as chorioamnionitis. Labor can be induced by the following methods: Prostaglandin: Suppositories are inserted into the vagina during the evening causing the uterus to go into labor by morning. One advantage to this method is that the mother is free to move around the labor room. Oxytocin: The body naturally produces the hormone oxytocin to stimulate contractions. Pitocin and Syntocinon are brand name medications that are forms of oxytocin. They can be given through an IV at low doses to stimulate contractions. What are the advantages of taking oxytocin?Oxytocin can initiate labor which might not have started on its own, and it can speed up the pace of labor. What are the concerns when taking oxytocin?Labor can progress too quickly, causing contract Continue reading >>

Induction Of Labor In Gestational Diabetes

Induction Of Labor In Gestational Diabetes

Induction of Labor in Gestational Diabetes Available for download in Word Document format The goal of management of a diabetic mother should focus on the prevention of stillbirth, prevention of asphyxia and minimizing maternal and newborn morbidity associated with delivery. In order to achieve those goals it is important to select the proper timing and the best route of delivery. Delaying delivery as near as possible to estimated due date helps to maximize cervical ripeness and improves the chances of spontaneous labor. On the other hand, yet the risks of fetal macrosomia, birth injury and fetal death increase as the due date approaches. Those two mentioned approaches are a subject of controversies in the management of labor in a diabetic woman. The optimal timing of delivery is agreed by most of experts in the field and ranges between 38.5 and 40 weeks gestation. At that stage lung maturity is obtained and it is calculated that by inducing labor then the chances of a macrosomic infant are reduced from 23% to 10%. In this presentation we would like to report on our studies and results of labor induction using the double balloon device. This method of labor induction might be the method of choice for labor induction in women with an unfavorable cervix as we often meet before term. The following four studies are presented in order to demonstrate our experience using the double balloon device (ARD): 1. Induction of labor by the double balloon device: experience of 250 cases 2. A randomized comparison of labor induction by PGE2 vaginal tablets, oxytocin and the double balloon device (ARD). 3. Induction of labor by the combination of the double balloon device and half doses of PGE2 vaginal gel. 4. The outcome of pregnancies following labor induction by the double balloon de Continue reading >>

More in diabetes