Late Diagnosis of Gestational Diabetes at 36 Weeks

My son had shoulder dystocia (I think this is what you mean) because he was big, and I had a vaginal birth. If the people delivering the baby actually know what they are doing, shoulder dystocia is not that big a deal. With me, my homebirth midwives used something called the Gaskin Maneuver, in which they quickly flipped me over to dislodge the shoulder from being stuck. My son had minimal damage to his shoulder, nothing broken, just a pinched nerve which was fine in a week.
If you are not OK with the planned c-section, dont allow them to do it because you are having a big baby. A big baby is not justification for a surgical birth. Its just easier for the doctors.

I actually had this happen to me with my 3rd child at 34 wks, which made me wonder if i had it late in pregnancy with the others but it wasn't caught. I understand how scary it can be, but once you follow the diet, you will feel so much better & you will stop growing at such a fast rate. The doctors during delivery will monitor the heart rate & it may be a slightly more cautious delivery than a delivery without Gest. diab. My first 2 children were 8lbs 10oz either on time or late so I had big babies & delivered naturally. They monitored the 3rd after my diagnosis & I did an amnio about 2 weeks prior to due date to see if her ears had fully developed. Once they had confirmed they had developed we scheduled a natural birth with the understanding that it may end up c if there was a problem. Because of my earlier larger births, & because they had monitored the babies weight inside my belly, she was born naturally at 8 lbs 9 oz (this was 2 wks early!!) If she had gotten to 10 lbs (without the diet & monitoring) then I would have had to have a c.
Take the drs. advice & follow that diet, you won;t be able to make your baby smaller, but you will feel much much better yourself & the baby will not grow as rapidly. Also the baby will be healthier when born. The amnio is also a scary thought, but it was painless & they were able to deliver her earlier than expected!
Good luck!!

I can't speak to the diabetes end of it. But be aware that the recovery time for a c-section is longer than the vaginal delivery. I was almost 37 when our son was born, and it took me 6 weeks to feel back to normal. (Maybe I'm a wimp but I generally don't think so! : ) )

We intended to have a vaginal birth but our son's heart rate went WAY down with each and every contraction, so we opted for the c-section. Just an hour and a half after we got to the hospital, he was born--healthy baby VS problematic birth.

That being said, it depends on how invested you are in the vaginal birth VS c-section. If you are fine with the c-section, go with it. If you really want a vaginal birth, there are plenty of big babies born vaginally. But it is best to weigh all the known risks and decide for yourself.

Are there any additional complications, besides size, for you or your baby? After we had made the decision to have a c-section, the nurse confessed she was SO glad we had made that decision. If not, she would have tried hard to help us make a different decision because of the danger to our son, while still allowing us to make the final decision.

During the birth, I was awake but numb where I needed to be numb. It was so cool. I actually felt his volume being removed. He just came out a different opening. And I had a healthy baby in the end.

I went to a support group for c-section moms after our son was born. I was surprised how many moms felt like a failure for having a c-section. To us, it was a medical decision that was kind of a no-brainer. Our son was in danger. But each person is different.

Best of luck with the remaining month, your health, your baby's health, and your final decisions.

B., I am a full time diabetic and had a very healthy 8 lb boy about 10 days before my actual due date. As far as the upper body being bigger...in diabetics; the baby's shoulders grow a little quicker so it's little harder to deliver (I delivered vaginally with a little help from the vacuum). Once the baby is born, the rest of the body catches up and evens out. So, just watch your diet (which will help you and the baby in the long run.)...best of luck!

Hi B.,

This happened to me with my second pregnancy and everything turned out fine! I just stuck to the diet & had to test my blood sugar three times a day til my scheduled c-section. The diet actually kept my weight in check tho I was kind of ticked that my 'eating for two' fun was curtailed! : ) Relax and enjoy!

Barb

I see two red flags here. The first being that ultrasound at this point in pregnancy can be off as much as 10% in determining size or the amount of amniotic fluid. Also shoulder dystocia in a vaginal delivery happens very rarely with big babies and actually occurs more often in babies weighing less than 9 pounds. The problem with gestational diabetes during pregnancy is if it isn't kept under control and I assume if they are only telling you to watch your diet that it isn't that bad at all. It seems like the careprovider is fearful and placing fear on you. You should tell yourself that your body grows a baby that is the perfect size for you to birth vaginally. A c-section isn't usually recommended because a true sd can not be predicted. My advice if you are not comfortable with the planned c-section and your careprovider will not allow you to labor naturally then you should switch careproviders now the earlier the better. There are many maneuvers they use if there is a true sd including having you get on your hands and knees its best not to suction the baby until he/she is totally born if at all. Visit ronnie falcos gentlebirth website as well as the march of dimes site for information on diabetes and sd.

Hope this helps.

I was never formally diagnosed with GD, but I had the same experience. At 32 weeks, I was measuring 4 weeks ahead so I was sent for an ultrasound and they said the baby was 5.5 lbs and I went again at 34 weeks where they said he was over 7 lbs. After that, they stopped measuring all together. I had a c-section scheduled at 39 weeks, but never made that date because I went into labor at 37 weeks (repeat c-section). He was 8 lbs, 10 oz. and 3 weeks before my due date. They think I may have actually had GD, but said that after the fact. (I failed the first glucose test, but passed the 3 hour test.) Good luck.

Hi B. - like you I did not have GD. However, after having my gallbladder out at 36 weeks I went into labor and delivered vaginally a 9lb, 4oz huge baby girl!!! Her lungs weren't developed and she suffered shoulder displaysia, a huge black eye and face and cone head because of the team of doctors having to use the vacuum to try and get her out as she was stuck in the vaginal canal and wasn't budging. I had had been full opened from mid-chest down my right side to get out the gallbladder so they didn't want to open me up to do a c-section; too risky. So, I had a team of 20 doctors standing by in case I ripped open all the staples, to help me get the baby out vaginally because I was so heavily sedated from the prior surgery and to help with the neo-natal baby once she arrived.Looking back it was like a 3 ring circus...After a few hairy weeks in the NICU, my beautiful daughter is now an active and still big 15 year old with no lingering problems. She is still a fighter today!!! Her pediatrician says the only issue she may face is diabetes as she was a big baby at birth and she is checked every year for that. I have 6 children (she was my 2nd) and I can say that the ultrasounds were off with most of them. My advice would be to talk to your Dr. again at your next visit and do another ultrasound. Depending on what that shows ask him if he will let you try to deliver vaginally. If he feels that there is a medical problem with you and does not want you to go for it make him spill it out. At least you will go into this with everything out on the table. That will make you more calm knowing you asked the questions you needed answers too. Keep us posted and good luck!! M.

I don't know anything about gestational diabetes, but I agree with your first responder that a big baby is not justification for a C-section. There might be other reasons the doctor is recommending this, and I'm not saying to necessarily go against the doctor's advice. Just make sure you understand the situation and that you keep in mind that a C-section is safer and easier for the doctors. Of course, part of this is less of a chance you will sue them if things don't go well ... but if a vaginal birth is important to you, make sure you really understand the options and consequences. Also do keep in mind that this late in the pregnancy, doctors are not very accurate at guessing the baby's weight (I read somewhere that moms are more accurate at guessing than doctors, but neither group is very good at it!). My second baby was half an ounce shy of 10 lb, and no one had a clue he'd be so big (I also delivered him naturally and very quickly with no complications). My sister-in-law had a 9 lb and then an 11 lb baby, both vaginally with no complications.

I honestly don't know what I'd do in your situation -- I wouldn't want the C-section, but of course you also want to do what's safest for your baby. Vaginal birth is best for you and the baby if it's safe, but you want to make sure it's safe. Good luck controling the diabetes and deciding what to do.

I would not follow the advice of getting insulin just so you can eat what you want. If you can control your sugars with diet then two weeks of doing it isn't bad. I had GD with my last and found out when you go for the test so had about 2 months of watching my diet. And let me tell you a little something about those ultrasounds for measuring size. Towards the end of the pregnancy they really aren't all that accurate. My first daughter was 8 pounds 12 ounces. I was worried with my second about her being just as big. The doctor was estimating about a 7 1/2 pound baby, but she was my biggest at 8 pounds 15 ounces. And neither of my girls I had GD with. Then my boy was the one I had GD with controlled with diet and he was my smallest at 7 pounds 10 ounces. I did have a c-section, but not because they thought he was big. Although, the doctor was saying it looked like he would be bigger than his sisters. He was breech with the cord wrapped around his neck twice. So that was why I had the c-section. I would have tried to deliver vaginally if they would have allowed me to deliver breech, but they wouldn't. Doctor have to be very cautious with all sorts of lawsuits out there and all. I don't know how big your other two were, but given that this isn't your first you might want to consider delivering vaginally. Assuming the doctors will allow it and assuming that's what you want. It's a tough choice. I could have tried to have my son turned at 36 weeks, but if anything went wrong we would have been having an emergency c-section anyways. I preferred having it planned and not being in an emergency state. So I went with my gut and didn't have him turned. I figured he was in that position for a reason and it was a good thing we did. So you'll have to do some serious talking with your doctor I think and really decide whether or not you feel you can deliver this baby vaginally or if it would be safer to do the c-section. It's a tough choice, but definitely go with your gut in this situation and be aware that those ultrasounds definitely are not too accurate in the last months of pregnancy for measuring size.

I agree with Molly. My third baby got stuck and my homebirth midwives also used the Gaskin Maneuver. I flipped over onto all fours to rotate the baby and then they put their fingers under her shoulders and popped them off my pelvic bones. She came right out and she was my biggest at 8 pounds 12 oz. (This was after an ultrasound at the OS's office said her head wasn't as developed as her body and that she weighed 8 pounds 2 ounces. Her head size ended up being perfect for her body so I don't hold much weight with ultrasound measurements.)

My first baby also got stuck but I had an OB then in birthing Center. He weighed 7 pounds 11 ounces. The OB used the suction vacuum and it was most painful part of the entire labor. My son ended up with shoulder dystocia, a pinched nerve in his upper arm, that went away within a few weeks because instead of turning him to release him from the bones they just pulled him out despite the bones.

Look into the Gaskin Maneuver, read Ina May Gaskin's book "Ina May's Guide to Childbirth" and talk to your Dr. about it. You can read about the manuever here http://www.inamay.com/gaskin_maneuver.php.
I would gladly use this method again before using the suction.

Good luck!

I've had gestational diabetes with all three of my girls and the strict diet will help you to keep the baby from growing much bigger. All my babies were very big - the biggest being 10.7 lbs (all c sections). The babies are large but there were no other health issues with my girls (who are now 11, 9 and 3) so you and your new baby girl will be just fine. As long as you lose the weight after this baby, the gestational diabetes will go away again. They will test you a few weeks after you have her. Enjoy her!

B.,

I am diabetic regularly so when I had my son it was very hard emotionally to manage my desire to eat and the health of my boy. I might ask my doctor to put me on insulin to give yourself a little lattitude eating wise. There is tremendous societal pressure to eat like a pig "because you can". I am not suggesting that you should but I was on such a strict carb per meal allowance I had a hard time, especially at the end. My favorite snacks were those fruit cups (15 carbs, perfect!) and soy milk (less carbs and more nutrients than dairy.

I had a C-Section which was emergency, I can say that I don't feel that I missed out on the birth experience. I almost feel that it was a better deal because I was less exhausted after and could enjoy the time better. Also stay in the hospital as long as you can. It really makes a difference especially with little kids at home.

This is hard to do, period. If you follow your doctor's orders you and the babe will be just fine. There are a million things that can go wrong but don't let them scare you. Thousands of women a year get gestational diabetes and have happy healthy babies.

W.

Hi,
I also had g.d. that was found late in pregnancy (32 weeks). I tried the diet first and was still not able to control my blood sugar, then I tried a med and that did not work for me either. I did end up meeting with an endocrinoligist and having to take insulin. I should say that I was doing ultrasounds once a week from 32 weeks on and they had measured my baby at over 9lbs at 38 weeks and he ended up being only 7.14 at 38 weeks. Unlike the other responder though, I would rather be safe than sorry and have the baby out via c-sect if their could be any possible complications. I have a close friend who pushed (no pun intended) for having a vaginal birth against dr reccomendation and the baby got stuck in birth canal and had a loss of oxygen and subsequent issues. The risk of having a very large upper body really only applies if teh G.d. is not brought under control. I was really worried when I found out too but it all worked out fine. At the time it seemed like the end of the world but now 11 months later we never even think about it any more. good luck and you can send me a personal message if you want.

even though you have had a late diagnosis doesnt mean the end of the world. Although ultrasounds can give the wrong size and weight (both ways...bigger or smaller), you really need to listen and talk to your doctor about your concerns. He or she only want to help you deliver your baby in the most safe and healthy way for both you and your baby.
I dont want to scare you but one of my close friends(actually has type 1 DM...but very well controlled) also with third baby, measured fine all the way through, had a 9+lb baby with shoulder distosia and an emergency c-section. Baby has spent 2 weeks intubated in the nicu at Eastern Maine Medical Center only to be transfered to Portland last week.
Remember your goal is to have a healthy baby no matter the way the baby is delivered.
Good luck and let us know what you decide.
Nicki

I had a slight shoulder dystocia with my first son, so when I was due with my 2nd son, at 35 weeks, the dr who delivered my 1st strongly recommended a planned c-section. I said no thanks - I want a natural birth just like the 1st time. I didn't want to think about recovering from a c-section with 2 kids, and felt that natural birth was "better". But then I started to worry about the safety of my baby if he did get stuck too. Even though many said ultrasounds are not accurate at the end, I wanted one anyway to help me with the decision. I felt I was much larger with the 2nd, and I just felt he was going to be really big. The ultrasound at 38 weeks showed 9lbs 9oz. At that moment I decided c-section, as my first son was only 8lbs 12 oz. I just knew that if something happened to my 2nd I wouldn't be able to live with myself knowing that my choice harmed him. In the end the baby was 10 lbs (very close to the ultrasound prediction) and it was just as great as my natural birth. He had broad shoulders, just like his brother, and when I saw how huge he was, I felt very happy with the decision. The recovery from the c-section was a breeze. I only took ibuprofen when I was home, and was off of it at 10 days post op. I was so scared that I would be "laid up", but honestly it was nowhere near as bad as I imagined. I was so opposed to all the intervention, the drugs my baby would receive and the non-naturalness of the procedure, but in the end my son was perfect and safely delivered, and that's all that mattered.
You will never know what would have happened if it went the other way (natural vs. c-section), so do your soul searching, make up your mind, and then focus all your energy on a great outcome and don't look back. Good luck to you... you will do great!

I was not diagnosed with my first child..never had the test but was later told I prob. did have it. My first was born c-sec taken early due to other complications and was just fine.
My second child, I was diagnosed and it was diet controlled. Again I was huge and he was huge when born (9lbs 11). Again while he was big, he was fine.
My third child I was insulin controlled and they tried to induce early but she had plans of her own. They were concerned about lung development due to the insulin injections. But she was fine.
None of my children looked any different shape wise...they looked normal, no over big on top etc.

I had GD and our birth plan was to try for a vaginal delivery, but have a low threshold to go for a c section to avoid issues. I did have a c section. Though there is a margin for error with ultrasounds, remember that they could also measure a baby as smaller than she is. Your doctor will probably have you get another ultrasound closer to your delivery date to double check the size. Good luck!

Ultrasounds can be off by as much as 2 lbs, and it's position, not size, which is the strongest factor in whether the baby can be born vaginally.

I had some sugar sensitivity and borrowed a friend's blood glucose monitor to be sure mine stayed in the acceptable range.
I hope you can maintain the strict diet, and if it brings your sugars under control then try to put off the section.

May the rest of your gestation be peaceful.

Your baby may not be as big as they are saying. I had an ultrasound done right before the day before I had my son and they told me he would be right around 8lbs 8oz and you want to know what he weighed...6lbs he was a peanut! That said I know plenty of people that have delivered some pretty big babies. My neice was 9lbs 13oz, a friend delivered at 10 lbs 10 oz and my nephew was a 10 pounder too. Stick to the diet keep checking your sugar and if its under control by the time you deliver your baby will be fine.

Hi B.,

I'm pretty sure I had undiagnosed gestational diabetes with my pregnancy. My midwife had been out of town but my OB was fairly certain. Try to follow the diet and not further complicate your life with insulin. I vaginally delivered my son, 10 lbs, 1.5oz. For me, if the OB had said a C-section was necessary, I would have wanted more evidence that a c-section was necessary than the projected size of the baby. Something would have had to happen during labor that was not going well...baby's heartbeat, or more than 24 hours with no progress, etc. As women, we are designed to deliver vaginally, even big babies. Our medical support team is there to ensure our (mother and baby) safety. They worry about liability, I understand that. There is usually plenty of time to make a determination about whether you need the major surgery or not, during the labor process.

Best of luck.

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