Type 1 diabetes

[1stimestar]

I have an initial interview tomorrow with a client with controlled type 1 diabetes. She changed doctors as previous dr. said he would induce at 38 weeks. She is seeing an acupuncturist as well. Sounds like an exciting person to work with and seemed fairly well self educated. Have any links for me so I can read up? Is the proposed early induction simply due to fear of big baby?

[dorothyh]

Yes, fear of big baby.

A woman with Type 1 diabetes is much more likely to have a baby over 9 lbs, and with any size baby her chances of shoulder dystocia are much higher than usual - 2 to 3 times more likely than a woman who has the same size baby but not Type 1 diabetes. For example, a non-diabetic mom having a baby over 4500 grams (9 lb 14 oz) , chance of shoulder dystocia is normally anywhere from 2.7 to 22.6%. A woman with diabetes has a 20-50% chance of shoulder dystocia if her baby is over 4500 grams.

Even the progressive doctor in my area induces at 38-39 weeks for a mom with type 1 diabetes. I've had two births with a mom who had type 1 diabetes, both inductions, one at 39 weeks and one at 38 weeks. Both times the mom tried to get labor started by other ways, but it didn't work. Both babies were born healthy, but they were both over 9 lbs, one was over 9 1/2 lbs. Both vaginal births, no shoulder issues.

Any doctor that your client interviews, she should find out how often they will do a scheduled cesarean for Type 1 diabetic moms - ACOG recommends a planned cesarean for moms with Type 1 diabetes if baby is over 9 lbs 14 oz - some OBs will come up with any reason to do cesareans on them all. And of course their induction policy.

Here was a link I found:
http://www.uptodate.com/patients/con...~X1_z7ZpZvSOGF

What bugs me too is when doctors treat moms with gestational diabetes as though they have Type 1, even though there are no statistics backing that up at all.

[Doula Janeya]

One of my sisters has type 1 diabetes and she had her babies 7 and 9 years ago and the prevailing theory then (not sure if it still exists now) was that babies of diabetic mothers could suddenly die at term for no reason. she was made to have weekly ultrasounds starting at about 34 weeks and ended up having c-sections with both babies. The first because they suddenly decided there wasn't enough fluid and the second because her water started leaking and they gave her 24 hours to have the baby and she didn't have it in the time.