I am not quite sure how I feel about this. I had my DS at 37 weeks in 2004 and he was soooo sick! His "prematurity" in combination with the effects of my Gestational Diabetes was a bad combination. Soooooo, my point is- I think I would rather risk having a large baby than go any earlier than necessary. Or am I crazy?
WDYT?

Jennifer

I would say no. They cannot force you to have an induction. Unless you have a history of very large babies and cephalopelvic disproportion or shoulder dystocia (which I think Aphil could tell you all about), then their mere belief that your baby will be big isn't a good enough reason for an induction. Ultrasound estimates of fetal size are notoriously inaccurate, especially at the extremes. (There's a pretty good article on it here, though I don't agree with her overall anti-ultrasound slant.) How did your son's estimated weight stack up against his actual weight, if you remember?

Of course, 39 weeks is not 37 weeks. Even an extra fourteen days can make a world of difference in terms of fetal development. But then, if they want to induce you only a week "early," you'd be right to question why they want to do so at all. Your having gestational diabetes does indeed complicate matters somewhat, but at the least I think you should get a second opinion. Your experience with your first pregnancy should not be discounted. Here is a link discussing GD and its possible complications. It seems that the main concern is indeed merely size, not placental degradation or something of the sort.

My advice: Get a second opinion, and remember that you have a legal right to refuse any medical intervention. I'd demand a better reason for induction than "We think he's big." Don't let yourself be pushed into anything; don't let them play on your fears. Research it, and in the end do what you feel is healthiest for you and your baby, whether it is going ahead with the induction at 39 weeks or holding off for the natural onset of labor.

I was induced only 10 days late. The reasoning behind it was that they took the first available bed at the hospital. They probably could have done it later, but it might have gone over 2 weeks. You might want to ask the doctor the reason they want to induce earlier.

There is NO evidence to support elective induction in order to avoid having a big baby. One is far more likely to have a baby come down in an odd manner and then require surgical intervention with an induction than if you let the kid navigate the pelvis when he or she is ready.

Any benefit of induction to avoid a large baby is the opinion of your provider and is not supported by research or national organizations.

Now...the diabetes is another story. If you are on insulin there are benefits to induction at 39 weeks, mainly avoiding fetal death post term. If you are not on insulin, but you are keeping your sugars normal with diet and exercise, then you have created a normal environment for the kiddo.

I agree with GBMM....get a second opinion and get it from someone not in the same practice.

But here are a few things you ought to know.

*this is my 5th baby- all were LGA. #1-8lb14oz, #2-9lb3oz, #3-9lb14oz, #4-7lb11oz(at 37weeks, although assessed at 35 weeks gestation)
*yes, I am on insulin- I have been since 9 weeks. With my last pregnancy my GD was poorly controlled despite strict medical intervention and compliance on my behalf. HOWEVER, this time it has been very controlled (I know it is early). My hgb A1C was 5.3 last week.
*There was an issue with shoulder dystocia with my DS who was 9lb14oz. (thank god I chose to have an epi with him-it was my 1st epi!)

I am just so frightened to have another sick baby. We almost lost Matthew. It was a really scary start. He was on a vent, got surfactant, had severe hypocalcemia, RDS, sepsis and ended up blowing a pneumothorax. I truly feel I would rather risk having a big baby and a c-section than go early.


Jennifer

One of the moms in my playgroup is friends with a lady whose baby is in the hospital right now on ventilators and everything because he was born at 36 wks gestation. Her DH was in the military and she tried homeopathic self-induction techniques to get the baby to come on early so she could be settled when DH got there at 37 wks (dont' ask me why the heck she didn't want to have DH at the birth...sounds a little flaky). Anyway, I have no idea if her efforts were the cause, but the baby did come at 36 wks and is on ventilators in the nicu right now. My nephew came at 36 wks and he was perfectly fine. You're absolutely right...a successful delivery is one where the baby is healthy...whether that is in the OR or in a delivery room. Do what you feel is best!

If you have good dating, 38 weeks would probably be okay. 39 weeks would probably be even a little better, but then you are running into maybe another shoulder dystocia.

A question for your doc might be about assessing fetal lung maturity. It takes an amnio, but might allay your fears of another kiddo needing help after birth.

Best of luck and health to you and your baby.

Jennifer, with your history it looks like a pretty good idea. And like I said initially, there is a world of difference to be had with another 14 days to bake. It just seems a bit odd to induce a week early under those circumstances, KWIM? Because it is so close to when you'd probably have the baby anyway, like Midwife said you might run into the dystocia problem anyway. I assume they are trying to balance the concerns with lung maturity against having another dystocia, and that's why they're delaying it. It's a good thing they're not saying "Oh, it was just a fluke, let's go on ahead and do it at 37 weeks again." Still, I don't think a second opinion would hurt, and it might be helpful to have a different set of eyes take a look at things.

I know what you mean. Each PG is different as is each child. It might not be a bad idea to have them check the lung maturity before induction to help ease your fears.

I'm having my c-section at 37 1/2 weeks. That's what's on the books now. They normally schedule the repeat c-sections at 39 weeks but I ended up a week earlier with William due to me deteriorating I guess. My BP continued to rise, my creatinine levels were dropping and the doc moved my c-section up a week. The only reason they schedule these at 39 weeks (at this hospital) is to hopefully keep you from going into labor before your c-section.
If things are going well a couple of weeks before, I do plan on asking if we can't move it back a week or so. Luckily William wasn't in the NICU but I believe he did end up with jaundice and has had asthma, tons of ear infections and ended up with tubes.

Shoulder dystocia is NOT fun-for mom, or for baby.

If they are inducing early because of concerns that the baby is big-then they really need to do some measuring via ultrasound-and do it often near the end. The weight "guesstimate" calculations that they do with the ultrasounds can go about a pound either way in weight...but the calculations that they do to judge the "frame" of the baby are more accurate.

Basically, if the baby is 8-12 pounds of "chubby" you can have it naturally without too much issue...but a baby with a larger than normal bone frame is where the problems can begin. Fat can smoosh its way through...but huge shoulders cannot. My kids are not only big pound-wise, but big framewise as well...and their calculations that my son (induced at 36 weeks) had a 15" head were DEAD on. Both my kids had a 15" head and chest.

My son was only induced at 36 weeks because they guessed him with a 15" head, and about 9 pounds at that time-a couple days later he was 9lbs, 4oz with the 15" head. At the time, they were trying to avoid a c-section apparently-so they chose to induce early. He could have been around 11 pounds at my due date.

With this baby, I am leaning more towards a c-section, once I am near the end and they have looked at the baby's size a few times. I would honestly, rather have a c-section at about 38 weeks, rather than be induced and birth vaginally at 36 weeks. At this critical time in the pregnancy, 2 weeks can do a TON for the baby's final lung development.

I suggest that you talk with your doctor about measuring the baby's frame-head, shoulders, etc. via ultrasound more than the poundage...REQUEST this before you agree to be induced.

Honestly-I don't see inducing at 39 weeks doing a whole lot. At that point, the baby is putting on about 1/2 pound a week in fat...but the basic frame size is already there at that time. So, I say either induce earlier at 37-38 weeks...or not at all and let you go when your body is ready.

Hey,
Just wanted to add my two cents in:-)!
I was induced at 39 weeks. My baby was 7 lb 12oz, and perfectly healthy. Normal APGARs and all that. The following will probably upset some people who get upset when they have their babies earlier for non-medical reasons I was induced at 39 weeks because my husband was mobilized to head to Iraq with a very short (a days notice) warning. I was selfish, and wanted my husband and the birth, so I consulted with the doctor and had an induction, so he could be there... If I had chose to wait for "nature to take its course" he could have been out of the country by the time I was in labor.
I was also dilated and having mild contractions from the stress of the situation...
Good luck and best wishes for a healthy baby!