cranberry987
Mum after ttc 16 cycles
- Joined
- Jul 17, 2010
- Messages
- 10,818
- Reaction score
- 0
Hi
Thought Id kick this thread off so that those of us with diabetes/GD can pool our information and give each other a bit of support
The main issue for me at the moment is refusing induction at 38w due to diabetes.
This is my summary of the research around induction and risks, not particularly comprehensive but its where Ive got so far.
Induction in diabetic women is a policy based on three studies of insulin dependent women, all with small samples. I am not currently insulin dependant.
-Hawthorn found that 4.8% of a sample of 300 women suffered stillbirth/death in first month of life compared to 1% in non insulin resistant.
-Casson looked at 462 births, the same 4-5% was found however these included unviable miscarriages, preterm births and abortions. With these removed the statistics drop to 2.5%. It is not known whether induction would have saved these babies.
-A third study again with a small sample showed that induction at 38weeks made no difference in outcome
RCOG say that their recommendations for induction in diabetics are based on usual practice rather than sound research
Risks of induction itself
Pre term birth can lead to breathing problems
A study by Tew showed that interventions caused additional risks and mortality rates were higher.
Cardozo showed that induced babies had a lower AGPAR score and poorer birth outcomes.
Prostoglastins and ARM often fail due to cervix not being ready. Prostoglastins carry the risk of fetal distress due to strong contractions. ARM has the risks of infection, cord prolapse, fetal distress and bleeding. The next step is synthetic oxytocin.
Risks of synthetic oxytocin
-Stronger contractions leading to fetal distress
-Stronger contractions leading to more need for pain relief then we get into associated risks of epidural (lowered BP, slowing labour and 2nd stage, c section risk increased 2-3 times (C section carries all the usual risks of major surgery plus the negative affect it has on the babys breathing (3.5% compared to 0.5% in vaginal delivery).4 times greater risk of maternal death (1 in 2500 compared to 1 in 10k)), more risk of instrumental delivery, abnormal fetal hb, there are effects post birth on baby eg difficulty in feeding/suckling).
-Bonding and breastfeeding are harder due to natural oxytocin not being produced in high enough levels. Chance of PND also increased.
Sacks' study on induction of labour vs conservative management in diabetics says that they benefits of induction are unclear
Anyone else got any good resources on Diabetes/GD and home birthing, refusing induction, that sort of thing?
Thought Id kick this thread off so that those of us with diabetes/GD can pool our information and give each other a bit of support
The main issue for me at the moment is refusing induction at 38w due to diabetes.
This is my summary of the research around induction and risks, not particularly comprehensive but its where Ive got so far.
Induction in diabetic women is a policy based on three studies of insulin dependent women, all with small samples. I am not currently insulin dependant.
-Hawthorn found that 4.8% of a sample of 300 women suffered stillbirth/death in first month of life compared to 1% in non insulin resistant.
-Casson looked at 462 births, the same 4-5% was found however these included unviable miscarriages, preterm births and abortions. With these removed the statistics drop to 2.5%. It is not known whether induction would have saved these babies.
-A third study again with a small sample showed that induction at 38weeks made no difference in outcome
RCOG say that their recommendations for induction in diabetics are based on usual practice rather than sound research
Risks of induction itself
Pre term birth can lead to breathing problems
A study by Tew showed that interventions caused additional risks and mortality rates were higher.
Cardozo showed that induced babies had a lower AGPAR score and poorer birth outcomes.
Prostoglastins and ARM often fail due to cervix not being ready. Prostoglastins carry the risk of fetal distress due to strong contractions. ARM has the risks of infection, cord prolapse, fetal distress and bleeding. The next step is synthetic oxytocin.
Risks of synthetic oxytocin
-Stronger contractions leading to fetal distress
-Stronger contractions leading to more need for pain relief then we get into associated risks of epidural (lowered BP, slowing labour and 2nd stage, c section risk increased 2-3 times (C section carries all the usual risks of major surgery plus the negative affect it has on the babys breathing (3.5% compared to 0.5% in vaginal delivery).4 times greater risk of maternal death (1 in 2500 compared to 1 in 10k)), more risk of instrumental delivery, abnormal fetal hb, there are effects post birth on baby eg difficulty in feeding/suckling).
-Bonding and breastfeeding are harder due to natural oxytocin not being produced in high enough levels. Chance of PND also increased.
Sacks' study on induction of labour vs conservative management in diabetics says that they benefits of induction are unclear
Anyone else got any good resources on Diabetes/GD and home birthing, refusing induction, that sort of thing?
