hi,
This is taken from the Australasian diabetes in pregnancy society and the
medical journal of Australia:-
The possibility that diagnosis of GDM may lead to increased obstetric
intervention, including
induction of labour and caesarean section,36 is a concern. Delivery before
full term is not indicated unless there is evidence of macrosomia,
polyhydramnios, poor metabolic control or other obstetric indications (eg,
pre-eclampsia or intrauterine growth retardation).37 Continuation of the
pregnancy in uncomplicated GDM to 10 days beyond term is acceptable provided
that indications from fetal monitoring are reassuring.
The presence of GDM has implications for both the baby and the mother.
Although there is no evidence that perinatal mortality is increased in
pregnancies with treated GDM, some studies have shown perinatal mortality to
be increased in untreated GDM.2-4 GDM is associated with increased perinatal
morbidity, the characteristics of which are the same as for infants of
mothers with overt diabetes (eg, macrosomia, neonatal hypoglycaemia,
hyperbilirubinaemia, respiratory distress syndrome).5
So in a nut shell, if you have been well controlled in your pregnancy there
should be no reason for an early induction and as it's not recommended for
vbac's anyway I wonder where your obstetrician gets his fear from.
Lisa Barrett
----- Original Message -----
From: "The Johnsons" <[EMAIL PROTECTED]>
To: <[email protected]>
Sent: Sunday, February 12, 2006 2:25 PM
Subject: [ozmidwifery] VBACs, Gestational diabetes and insulin
I would appreciate comments from midwives and women who have dealt with or
been through pregnancies involving gestational diabetes, insulin
dependence
(for gestational only) and VBACs. I am 28 weeks into my second pregnancy,
on
insulin and hoping for a VBAC. My obstetrician has told me that he wants
to
do a repeat Caesar at 38 weeks because he was concerned about placental
failure. I felt that this was a bit premature and may have been more what
suited him than what was best for me, especially 10 weeks out.
What is the current thinking on VBACs, gestational diabetes, and placental
failure due to insulin?
Is it safe to continue the pregnancy, with monitoring beyond 38 weeks? Is
induction a viable alternative at 38 weeks considering it will be a VBAC
attempt?
I would like to attempt a VBAC, but not at the cost of my baby's health.
Any information or comments that can be
offered to help my husband and I to make a decision would be appreciated.
Comments from women who have been in this situation would also be
appreciated. As it is ultimately my decision and my responsibility I want
to
make the best informed decision I can for both myself and our baby.
Responses can be sent to [EMAIL PROTECTED] if you prefer.
Thank you
Mindy
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