help standing up to obstetrician re: GD

[shellshell]

Hi all,

I know I have read somewhere that a woman with GD who manages her BGLs well has the same pregnancy outcomes as women without GD... can someone help me find an article or two stating this??

I really need help with my obstetrician - he is going crazy over this thing, but I am very well-controlled. In fact I didn't even do a test that definitely shows I have it (I refused it, on the grounds that from home monitoring, my levels were great, and when I asked an obstetrician (my obst was away and I had to see another one) he said they would just ask me to keep monitoring my BGLs to see that they stayed in the "normal" range if I did the test again and it showed GD, so I decided to not do it again, as home monitoring is exactly what I am doing now and my levels have been good).

My obst is going crazy over this thing, telling me I need another ultrasound to check the size of the baby - but in the next breath he says its head is "well down" which indicates I would "labour well" anyway, even if the baby was big. I don't want the ultrasound, I think it is unnecessary, and it won't prove anything. The obst thinks the baby might be big... but I think he has the wrong due date for me, and when I asked him if the due date was slightly out would that account for the size of the bub, he said that it could! As far as I am concerned, the baby is a healthy size, and he has the due date wrong, and another ultrasound is not necessary.

Please help! He is driving me nuts, creating problems where there are none, as far as I am concerned!

Thanks,
Michelle

[BellyBelly]

Please help! He is driving me nuts, creating problems where there are none, as far as I am concerned!

Do you think this is a good trait to have leading up to labour? A bit of a preview of how you might get treated not only about this but other issues? Why do you want to stay with this Ob? Because in labour, you wont have the energy to fight him.

[shellshell]

Hi Kelly,

Thanks. Yes, that's true. My DH and I are just talking about changing obs. My DH is really supportive and thinks I should find someone else. I'm pretty close to deciding to do it... probably just need a little bit of a push and I'll do it!

I've been pretty stressed about the whole thing since the appointment on Wednesday. My Ob has been away for a while and I hadn't seen him since November (have seen other people instead). They made me feel great about the pregnancy and the health of my baby, but my Ob made me feel like rubbish. I came out of the appointment and felt like crying. And I have felt really stressed about it all since - churning it all over in my brain and not being able to feel calm and relaxed about things. That is not a great way to be feeling in pregnancy, and can't be doing the baby any good.

I'm going for a swim to try and clear my mind and get rid of some of this stress...

Thanks,
Michelle

[Trillian]

Hi Michelle. It really is draining when we have to deal with something that can be aptly described as an imaginary condition in a lot of cases when we should be focusing on the important stuff, like how we want to give birth. You seem to me like you have everything well in hand and know what you are doing and more importantly you trust that your body knows what it is doing.

There is a fab article by Henci Goer about GD and when I was having trouble with my Dr about it with my last pg, I read this article and it made so much sense to me and made me feel confident that it was a non-issue, particlarly when there is no need for further intervention such as insulin. Also there is no conclusive proof that having GD will give you a macrosomic (baby over 4kg at birth) baby and that in itself is no reason to worry either - women can and do give birth to large babies with no problems at all.

Ask you OB exactly what his concerns are and don't stand for vague references - if he is this antsy about it he may only tell you the 'bad' things. Also there is no reason for an early induction either.

This is the article - Gestational Diabetes - The Emperor Has No Clothes by Henci Goer read it and take from it the ammunition you need to get through to him, Im my experience with Drs they are more likely to be on the level with you if you research your options and appear to have knowledge of your problem instead of blindly accepting what they tell you. Also, who are your support people for the birth? Is it just your DH or do you have a Doula or a friend supporting you too? Make sure that they know what you want and are on the same page as you - its easy in the excitement of impending labour that a Dh, though well meaning, is often the one to crumble from being told only the worst case senarios by an Antsy Ob.

[dee73]

I had gd last pregnancy and ds came naturally at 39 weeks with no worries about his size. I controlled my bsls with diet alone even though my initial test showed they were very high. DS was 8 pounds 8 ounces when born, so certainly not a giant considering myself and dh are both tall.

As Kelly said, if you think he's over-reacting and are not happy with the way he's acting, then maybe you need to consider a change. Otherwise he might try talking you into courses of action you're not happy with... Can you change to the OB you saw while the other was away?

[Tobily]

I've had GD "twice" (according to my OB at the time) and in my experience most obstetricians absolutely freak out about it.

My obstetrician with my last pregnancy was still demanding I be induced at 38 weeks because I had insulin dependent GD with my first baby - even though the second pregnancy I passed three GCT's, was self monitoring my BSL's at home (which were fine) and was following the GD diet. I didn't have it, he was convinced that I MUST have it because I was insulin dependent first time so there was just no way I couldn't have it. Idiot.

I agree that if he's freaking out about something that isn't even an issue yet, and getting you wound up about it as well he's probably going to be someone you're going have to battle with in labour...you don't need that, if you can change I would consider it.

I wouldn't waste your time or precious energy at this point trying to convince him with research etc. If he's over reacting like that it doesn't matter what you show him he is not ready to accept that his view on this issue has no scientific basis. Far easier to find someone who you don't need to convert iykwim.

[fionas]

Absolutely agree with Tobily and previous posters. Even if you manage to convince him on this one, in the back of your mind the trust will be broken and you'll probably just start wondering what's the next battle you're going to have to fight him on. No point having an ob that you don't trust. When you're in labour, trust is vital.

My ob was very low intervention - so they do exist! He reassured me that no, he wouldn't be giving me a caesarean unless the baby was in danger, that I could labour hanging from the ceiling if I wanted to (then when I freaked and went from no, no drugs to I'm scared witless at 39 weeks he reassured me again and said that being scared is no reason not to have a baby and we would manage the pain - either naturally or with drugs). Then when I was scared he would want to induce me because my waters had broken, he reassured me AGAIN telling me that he HATED inducing women and would only do so as a very last resort. So by the time I did go into labour, I trusted myself to make good decisions and trusted him to respect and understand those decisions.

So I think if you're hearing warning bells, find someone else that you're comfortable with.

[Artechim]

I was on about 120 units of insulin a day by the time my bub was born, but my BSL's were almost always within limits. I had the sizing scan and it showed he was about the 60th percentile and was born 8 pound at 39+3 weeks. I made the doctor print out some info from the med database that the hospital uses. It suggested that as long as BSL's were controlled there was no more risk to the baby than a non-diabetic pregnancy. It also said there was little proof that induction provided a better outcome for macrosomic babies, it only led to more incidence of c-section. I would send it to you but we are in full packing mode to shift house and I have no idea where it has gone to.

I would definitely suggest changing Ob's, you don't need that sort of pressure. If you can control it with diet and your BSL's are within a normal range then I don't see how your pregnancy is different to any other.

[shellshell]

Hey ladies,

Thanks for all of your great replies. I rang up this morning to see about changing obstetricians to the one I saw when mine was away, but was told I couldn't.

My DH is going to come with me for my next appointment and we are going to try to chat about things. If things don't go well, I am just going to have to make sure my DH is 100% clear on what I want and don't want for labour and that he is clear that he MUST stand up for me, if I can't! (Actually, I will do this anyway!)

It is very comforting to hear that if your levels are normal, there is no increased risk.

I will admit that I took it all personally when he started going on like that in the appointment. I have worked so SO HARD for a chance at a healthy pregnancy, in terms of exercise and diet (knowing I was at increased risk for complications like GD). It has been the last 3 years, 1.5 months of my life. I just wasn't prepared to hear someone go on like that when I feel like I have busted my gut for a chance at having a healthy pregnancy.

Thanks again,
Michelle

[Trillian]

Its a shame you can't change as I feel your trust in this one may not be there 100% anymore. Have you considered getting a Doula to help support you and your DH for the birth? If you feel that your DH might need a bit of help if he needs to advocate for you, a Doula can be very reassuring for you both. Sometimes when the time comes and you are in the throes of labour you can't always be sure that you will be able to advocate for yourself and our DH's, while they have the best of intentions, can often be swayed into thinking that you need more monitoring or intervention etc. Something to think about anyway. Good luck and let us know how you get on with it all.

[BellyBelly]

How come you can't change? Are you private or public? I know lots of people who change last minute so I hope they aren't trying to be difficult. Because they haven't attended the birth if private then they don't get that item fee charged... so it's not payable unless he's attended the birth.

[shellshell]

Hey Kelly,

Can you please explain that? What fee exactly are you talking about? I just got another bill in the mail from my obstetrician today. It says "final obstetric gap fee (not claimable)". I've also paid a huge amount last year that I could claim through Medicare.

I am private ... was told by everyone who wanted to give me advice that it was the way to go... and now I am regretting it. Wish I had gone birth centre instead. Lesson learnt for next time, hey?!

I rang up and asked and was told it wasn't possible to change. Plus the guy I wanted to change to wasn't taking any new patients.

Yeah, they were probably being difficult if you know many people who have done it...

Thanks for your help,
Michelle

[BellyBelly]

I'll have to check what they did to sort it out, but try ringing Medicare and talking to them about it.

Surely it cannot be legal to charge someone for something when they haven't even provided a service for you - consumer affairs would be onto that I reckon!!! But people do do it, they are just being difficult. Attendance at a birth cannot be charged if they have not attended.

[fionas]

I think there was something about this on a legal phone-in on 774 (Melbourne station). The circumstances were different though - the woman had decided she didn't want the ob at the birth but didn't tell him beforehand so even though he wasn't there he was still entitled to the money.

However, I would think that this would work the same as any other 'contract' - you're terminating the contract ahead of the fee for attendance at the labour so I don't think it could be charged. Is there a Medical Ombudsman type place you could check with? Or maybe the Australian Medical Association? Or even your private health insurer? I'd google for you but about to go to bed.

Hope you're able to sort out and swap to someone you're more comfortable with.