Sunday, November 6, 2016

Week 36: Hello, Full-Term!

I am officially full term today. Should labor begin tonight, no one would try to stop it. Hooray!

I visited my OB on Friday. Over the last few weeks of pregnancy, I'll be meeting several of the doctors that work at the practice in the hopes that the face of the person who delivers my baby will be a familiar one. No matter, though. I think only one of my previous four babies was actually caught by the doctor treating me during pregnancy. I usually push them out too fast. Here's hoping for a repeat performance, because the pushing part is the one that makes everyone most nervous when you're looking at an increased risk of shoulder dystocia...

One lovely part of my most recent visit was all the detailed questions the obstetrician who examined me on Friday asked me about diabetes. She was so genuinely curious about the CGM, the pump, and my past experiences being pregnant and giving birth with Type I diabetes. Forgive me if I use the word too often, but the term "refreshing" comes to mind. At this point, though, I'm really looking forward to those first few hours after delivery when I can turn my pump way down and think about something other than my blood sugars for a while.

I also had a positive experience with my doctor's office when scheduling induction last week. At my 35-week visit, the doctor I saw then (a caregiver previously unknown to me) had recommended scheduling the induction for 39 weeks. When I pressed her on the point, citing my previous experiences with labor that begins spontaneously at 39 weeks or later and the ease of delivery, the health that my babies and I have had with all my labors, and the discussions I'd had with other OBs in the practice, she said we could schedule it "between 39 and 40 weeks."

Well it turns out that "between 39 and 40 weeks" is Thanksgiving Day, and hospitals and doctors don't like to schedule routine induction on major holidays. (Duh). So when the scheduler from the OB's office called me mid-week, I found myself having to negotiate the induction date once again. There were no appointments except on Monday that week, which would be only one day past 39 weeks and a few days earlier than any of my other labors began spontaneously. I once again explained that I'd done this before, had considered the risks (shoulder dystocia) in light of the facts on the ground (my previous labors, growth ultrasounds during this pregnancy), and that I'd really prefer to give myself a few extra days to go into labor spontaneously in the hopes that labor might proceed more smoothly if it began on its own. The best news of the week came about an hour later when the scheduler called me back after discussing the case with one of the practice doctors and they found it acceptable to postpone induction until the Monday following my due date (40w1d). One way or another, I should have a baby out of this weary body of mine and into my expectant arms on or about November 28. I hope it's on terms set by baby.

Also, I just came across this study in which the researchers are no longer recommending induction for diabetics until "approximately" 40 weeks gestation unless baby's weight on ultrasound is estimated to be greater than 4500g (9 lbs 14 oz). "Early delivery without maternal or fetal indication in women with diabetes is no longer the norm unless fetal lung maturity is documented." I have no idea where that recommendation comes from, but it's at least there in this study from India published in 2012. As far as I can tell, the recommendation for induction at 39 weeks was always somewhat arbitrary, anyway. 

In other news, contractions have increased in strength and frequency over the last couple of weeks. I have a few hours-worth of contractions every evening before going to bed, and cervical dilation so far confirms it. I was 3 centimeters dilated on Friday. Hoping for a baby this week (because who isn't excited for pregnancy to be over already?), but prepared to wait a few more. Come on out, baby. We're as ready as we're ever going to be!

2 comments:

  1. Very excited for you!! I am pretty sure you will have yours first :)

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    1. I seem to recall I had a bout of false labor contractions that sent me to the hospital at 36 weeks with my last pregnancy, but baby still wasn't born until 3.5 weeks later. Babies can be tricky that way. I'm still not counting out the possibility of a due date delivery this time around!

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