Wednesday, February 6, 2013

pregnancy: 35 week midwife appointment

Appointment in a nutshell:  No weight gain, fundal height 35 weeks, LL's heartbeat 140, bp normal, satisfied with past week's glucose numbers (sigh of relief) so continuing with midwife care, GBS test done, dilation check (yeouch!) today, evening primrose oil starting at week 36, growth ultrasound week 37, membrane sweep, nipple stimulation, and colostrum collection at week 38, they didn't directly say it, but I'm feeling "prepped" for them wanting a medicated induction by week 40 if necessary.  Thank you for your support and understanding of our unique pregnancy circumstances. 
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The whole story:  Now, to get on the same page about how this pregnancy will be ending.  I know that I am part of a (on a whole) naturally minded pregnancy and labor community.  I also know that women are super judgmental of other women's choices, especially when babies and children are involved.  I ask that you be kind and respect the path that my husband, midwives, and self choose as we get down to our final weeks of this pregnancy.  I will have waited, worked, and spent significant emotional and financial resources over the past 4 years to have a healthy baby in my arms.  I keep all of this in mind as I research options and make (and make peace with) decisions.

If I was with traditional OB care, most likely I would be drug induced at 39 weeks due to my gestational diabetes.  Babies can grow very large causing shoulder fractures during birth and complications way beyond that from placental issues to stillbirth.  If you'd like to read more about potential consequences of gestational diabetes on birth weight and placental function, please check out this article. Another great article about hyperglycemia and adverse pregnancy outcomes can be found here.

The midwives feel that if I want a vaginal drug-free birth, we need to do some natural induction methods to get the ball rolling at week 38 with an ideal birth at 39/no later than 40 weeks. The hope is that these more natural methods of induction will prevent the need to have a drug induction, give me the best outcome of a natural vaginal delivery, and help me deliver a healthy baby.  She didn't come out and say it, but I have a very strong feeling they will want to induce with drugs at 40 weeks if it hasn't happened on its own at that point.  Often due to their larger size, gestational diabetic babies come somewhat earlier on their own, so hopefully we won't have to get to the point that we are making 40+ week decisions.

Normally, I don't think it is wise to rush the baby-baking process.  My personal philosophy is that if baby wants to stay in 42+ weeks and there are no signs of stress or foreseeable/probable complications, so be it.  I do believe that babies come when they and your body are ready.  If you have a normal, healthy pregnancy, I strongly support being patient and trusting the process as much as possible. But sometimes there are unique circumstances (in my case, gestational diabetes) that require doing things differently than what others normally would do.  This isn't coming from a place where I "want this baby out."  I have very much enjoyed my pregnancy and even now, still love being pregnant.  This is coming from a place of rational compromise, wanting the very best health outcome for both my baby AND myself.

We did my group B strep test today and while she was down there she tried to check for dilation.  I will get my GBS results back next week.  Baby's head was nice and low.  My cervix was quite high and posterior and I was experiencing quite a bit of pain as she was trying to reach it.  She decided to stop and wait until next week to check it, so I don't know the condition of my cervix.  

Plan for natural induction if needed:  I have been advised to start evening primrose oil by week 36 to help soften the tissues of the cervix and perineum.  I have had 2 surgeries on my cervix in the past that can leave scar tissue that prevents normal cervical ripening, so the hope is that the evening primrose oil will make it more favorable.  I will also increase my red raspberry leaf tea consumption at week 36.

Week 37 will be a growth ultrasound.  I am well aware that ultrasound weight measurements are often off by a pound, give or take, so I will keep that in mind as decisions are made. 

Week 38 we will do a membrane strip.  A membrane strip works well for some and for others has little to no effect.  We will also begin nipple stimulation with a breast pump for 5 minutes, three times per day starting at 38 weeks.  In an ideal situation, these methods will naturally induce labor by 39 weeks. I will also be freezing any colostrum collected for Little Laundy as it may be needed at the hospital if his blood glucose levels are low after his cord is cut and placenta is no longer functional.

I understand that there can be consequences of an earlier induction despite being past 37 week's classification as "full term." Typically issues may include that little one's lungs and brain may not be as developed as a 40+ week baby and difficulties breastfeeding.  Also, sometimes gestational diabetic babies lungs are slower to mature than babies experiencing a normal pregnancy.  These are all things we will keep in mind as we make decisions. The last thing I want is my son spending preventable time in a NICU.

At this point, my gestational diabetes is being managed by diet and exercise and I am happy (and motivated) to stay with midwife care.  I feel that it is MY best possible chance at an empowered delivery.  My weight and Little Laundy's size appear to be normal as well.  If needed, I will consent to weekly ultrasounds and non-stress tests in order to keep this little guy growing inside of me for as long as is healthy for the both of us. We will make decisions as we go along based on our very best judgement as informed parents.  I sincerely appreciate your respect, understanding, and continued support as we try to remain adaptable as this pregnancy nears its grand finale.  This community means the world to me and I couldn't imagine this process without you along for the journey. 

2 comments:

  1. I think this is an awesome plan! Do what is best for you and the little man and everything will be ok!

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  2. I think this plans sounds well thought and the best one. I'm glad that you are setting a plan in place. I can't wait to see pictures of you holding sweet baby Laundy. <3

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