Induction postponed

To say that I am pleased would be a gross understatement.

I met with the obstetrician yesterday. (Backstory here, here and here.) It was lovely! I know it probably sounds a little weird calling a meeting with an obstetrician "lovely", but that's exactly what it was to me. I felt listened to, respected, supported and validated, all the things I think are so important when heading into this last stage of being pregnant which is essentially... waiting.

And I also felt grateful. Really, really grateful.

There was no arguing, no coercing, no liability leaflets. Instead, I told the obstetrician pretty much the same story I've told on this blog over the last few weeks - how I cannot see why an induction is really necessary, not according to the reading I've been doing, and would she please explain to me what their thinking on this topic is - and she then explained and confirmed to me what I'd been thinking all along, and that is: postponing induction is a valid decision to make. She didn't have a problem with that, or me, or anything else I was saying.

Turns out, I was right: women with gestational diabetes who (manage to) keep their sugar numbers well-managed aren't technically that different from women who don't have diabetes to begin with. Yes, risk factors go up - but it's really hard to say by how much exactly. Most of the research seems to lump women into one big group under a label "gestational diabetes", rather than split them into two groups of "well-managed" and "poorly managed" (even though the outcomes and underlying physiology may be very different) and as a result, risk factors get lumped over the general population also.

(When I met with my diabetes physician half an hour earlier, I outright asked her that if I am not getting spikes or lows in my sugar numbers - which is where damage to cells would otherwise be done - are there any other ways diabetes can affect my health and the health of my baby? And the answer was: no, not really. Diabetes works through its end result (high sugars, low sugars), rather than through having the condition itself.)

We also talked about being a VBAC, which is now more and more widely accepted as a valid way of giving birth after having had a Caesarean section in the past. Again, it does come with risk factors - everything does - but there isn't a reason for pushing for an early induction with a VBAC alone, not unless something else is wrong also.

We talked about how being a potential VBAC with gestational diabetes - but with well-managed sugar numbers - we are really looking at a part of obstetrics where good research simply hasn't been done, not in a way where we could look up some numbers and then weigh it all statistically. It's a bit of a guessing game, and it's got lots to do with hospital policies and people's attitudes to it, rather than research.

What we could essentially do was to simply look at the risk factors of giving birth on its own, compare those risk factors to healthy VBACs, and then maybe only guess at what the gestational diabetes on top of that would be capable of doing because in the end, we really do not know.

And in the end, when it came down to stillbirth statistics of 1.06 per 1000 births at 40 weeks, versus 1.27 per 1000 births at 41 weeks - a number that applies to giving birth as it is, regardless of whether there's anything else going on with health, or not - I just could not equate that number in my head to 1 in 200 chance of rupturing my uterus if I were, indeed, induced with Syntocinon at 40 weeks.

Yes, risk factors change, I can see that. But the question is: by how much? And what would I replace it with if I were trying to avoid the risk?

It's, like... driving a car - I drive. Riding a bicycle on public roads - I do. Skydiving - I have. Everything I do in this life comes with risks, including breathing, and avoiding all risk full-stop is simply not an option, not if I am interested in living - and especially if I am interested in living AND experiencing things!

What is an option, instead, is weighing risk according to what I am comfortable with, and making as good of an informed decision as I can, and leaving the rest to... God, religious people would probably say here; I'd like to say leaving the rest to life.

I walked out of that hospital yesterday happy, and so did The Man, and I think even the obstetrician might have. It felt as something I imagine maternity care should be like - should feel like - and instead of dread or resentment what I have is... calm.

Every now and again practice contractions come up: some rhythmically, some not so. Next week I will pop into the hospital to check how the baby is doing, and the same the week after that, too - unless she decides to come before then - and whilst I am waiting, I will try to relax.

And feel grateful.

2 comments:

  1. That's great to hear Maria, she'll arrive when she's ready which is most often better than intervention.

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    1. yup! thanks rachelle =)

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