Ob no longer delivering me due to having GD and insulin dependent, 35 weeks - what to do?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I would call this doctor back, say no OB would take me at this late date and let him know that you’ve decided to have the baby at home. Preferably leave that as a message.

She's already been discharged from care due to being high risk (insulin dependent, out of control blood sugars, macrosomia) and her original OB cannot care for her anymore, it happens. She has already been referred, but doesn't want to see that OB for whatever reason. Your advice would make her seem crazy.

OP It doesn't seem like you understand you are a high risk patient, and both you and you baby can have serious outcomes during pregnancy, birth, and even after birth. You really should see who were referred to.

Op here. The baby hasn't been diagnosed with macrosomia yet btw and my blood sugars are 95% under control. I am only on bedtime insulin at a low dosage and my MFM said my case isn't that serious at all. My last growth scan was 32 weeks and baby was measuring in the 99th percentile (he's also very tall btw). I will have another growth scan soon to see where he is at. I may be diagnosed with macrosomia then, but not yet.

It's not possible to diagnose macrosomia until after the baby is born, because late pregnancy prenatal measurements can be wildly inaccurate. All they can do until s/he is born is make an educated guess.

There is a great article on Evidence Based Birth about macrosomia and the shoulder dystocia risks for a baby whose mom has insulin-dependent GD.

Op here. Do you mind sharing that article? Would love to read it, thanks!

I think this is the one: https://evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/

As a PP said, ultrasound measurements, particularly weight estimates, late in pregnancy are notoriously inaccurate. I had several friends due around the same time I was. All were under the care of OBs and were sent for growth scans. All were told they were having babies over 8.5 pounds. Only one baby ended up over 8. I saw midwives and zero ultrasounds after my 20 week anatomy scan. 2 days before baby was born, midwife estimated baby to be 7 pounds 14 ounces and 21 inches long ("he's lanky!"). He was 8 pounds exactly and, yep, 21 inches.

OP doesn't have "big baby." She has insulin-dependent gestational diabetes with a suspicion of macrosomia.

GD babies are often very big.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I would call this doctor back, say no OB would take me at this late date and let him know that you’ve decided to have the baby at home. Preferably leave that as a message.

She's already been discharged from care due to being high risk (insulin dependent, out of control blood sugars, macrosomia) and her original OB cannot care for her anymore, it happens. She has already been referred, but doesn't want to see that OB for whatever reason. Your advice would make her seem crazy.

OP It doesn't seem like you understand you are a high risk patient, and both you and you baby can have serious outcomes during pregnancy, birth, and even after birth. You really should see who were referred to.

Op here. The baby hasn't been diagnosed with macrosomia yet btw and my blood sugars are 95% under control. I am only on bedtime insulin at a low dosage and my MFM said my case isn't that serious at all. My last growth scan was 32 weeks and baby was measuring in the 99th percentile (he's also very tall btw). I will have another growth scan soon to see where he is at. I may be diagnosed with macrosomia then, but not yet.

It's not possible to diagnose macrosomia until after the baby is born, because late pregnancy prenatal measurements can be wildly inaccurate. All they can do until s/he is born is make an educated guess.

There is a great article on Evidence Based Birth about macrosomia and the shoulder dystocia risks for a baby whose mom has insulin-dependent GD.

Op here. Do you mind sharing that article? Would love to read it, thanks!

I think this is the one: https://evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/

As a PP said, ultrasound measurements, particularly weight estimates, late in pregnancy are notoriously inaccurate. I had several friends due around the same time I was. All were under the care of OBs and were sent for growth scans. All were told they were having babies over 8.5 pounds. Only one baby ended up over 8. I saw midwives and zero ultrasounds after my 20 week anatomy scan. 2 days before baby was born, midwife estimated baby to be 7 pounds 14 ounces and 21 inches long ("he's lanky!"). He was 8 pounds exactly and, yep, 21 inches.

Did you or any of your friends have gestational diabetes controlled by insulin?

Stop it with suggesting that OP turn to non-medical sources for her care. She needs to see an OB.

Huh? Everyone on here has recommended seeing an OB. EBB is written by a nurse PhD and medical researcher in consultation with physicians.

Does information scare you?

Evidenced-based birth is a website written by a non-medical professional selling medical advice (that is now several years outdated).

OP needs to talk to an actual doctor.

Only if she doesn’t want to die during childbirth.

[Anonymous]

OP: I had the worse possible outcome at Sibley a few years ago because they are not prepared for anything out of the ordinary. My next two high risk pregnancies (not GD) were managed successfully from beginning to end through MFM care at Georgetown. If you doctor refers you to an MFM at Georgetown, why on earth would you not just do that? Because Sibley is nicer and that's where the rich deliver? Please. Do the right thing and take care of your baby and stop being stubborn.

[Anonymous]

OPs MFM has given her exactly one recommendation and that's to go all the way to Shady Grove. It is not like she got referred to Georgetown and is rejecting that. Her oh-so-fabulous solo practice OB suggested she just show up at Georgetown or GW. Such a responsible, caring physician.

(This has to be Footer, no?)

[Anonymous]

Why did your OB give you insulin and not offer a pill? I’m the pp who delivered at Sibley and took a pill (glyburide). I couldn’t get my fasting number under control but all other numbers were fine. Also my baby was 2 weeks early and only issue was low blood sugar. Did Foxhall say no?

[Anonymous]

Anonymous wrote:OP: I had the worse possible outcome at Sibley a few years ago because they are not prepared for anything out of the ordinary. My next two high risk pregnancies (not GD) were managed successfully from beginning to end through MFM care at Georgetown. If you doctor refers you to an MFM at Georgetown, why on earth would you not just do that? Because Sibley is nicer and that's where the rich deliver? Please. Do the right thing and take care of your baby and stop being stubborn.

Op here. I was actually the one that brought up delivering at Georgetown knowing that it would be safer for my baby, Ob has only pushed for Sibley and the moment I mentioned a different hospital he said he'd drop me. My current MFM is not at Georgetown btw.

I'm in touch with Georgetown trying to get an appt with an Ob there. Might end up transferring my MFM there too, we'll see.

[Anonymous]

Anonymous wrote:OPs MFM has given her exactly one recommendation and that's to go all the way to Shady Grove. It is not like she got referred to Georgetown and is rejecting that. Her oh-so-fabulous solo practice OB suggested she just show up at Georgetown or GW. Such a responsible, caring physician.

(This has to be Footer, no?)

Op here. Did you have Footer as an Ob?

[Anonymous]

Anonymous wrote:Why did your OB give you insulin and not offer a pill? I’m the pp who delivered at Sibley and took a pill (glyburide). I couldn’t get my fasting number under control but all other numbers were fine. Also my baby was 2 weeks early and only issue was low blood sugar. Did Foxhall say no?

Op here. My MFM was the one that prescribed the insulin because glyburide crosses the placenta and insulin is considered safer. I did some research on my own and felt more comfortable with insulin as well. My only issue is fasting too - everything else is under control by diet and exercise.

[Anonymous]

You should ask your OB to transfer you to an OB at Georgetown. Their office should do it if he is refusing you as a patient. Or call your MFM and talk to them. But it is going to be a lot harder for you to make this switch on your own.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Why did your OB give you insulin and not offer a pill? I’m the pp who delivered at Sibley and took a pill (glyburide). I couldn’t get my fasting number under control but all other numbers were fine. Also my baby was 2 weeks early and only issue was low blood sugar. Did Foxhall say no?

Op here. My MFM was the one that prescribed the insulin because glyburide crosses the placenta and insulin is considered safer. I did some research on my own and felt more comfortable with insulin as well. My only issue is fasting too - everything else is under control by diet and exercise.

Oh man, I am sorry... I can completely relate. Just want to share a happy baby outcome. My DC did have low blood sugar as mentioned but recovered quickly and is a totally happy healthy toddler. Also, with my second pregnancy I didn't even have GD. Go figure. Good luck and I hope this all works out. If you do deliver at Sibley, it is a great hospital and they are equipped to handle babies that need extra care. The new hospital even more so than old (baby 1 was at old, baby 2 was at new).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I would call this doctor back, say no OB would take me at this late date and let him know that you’ve decided to have the baby at home. Preferably leave that as a message.

She's already been discharged from care due to being high risk (insulin dependent, out of control blood sugars, macrosomia) and her original OB cannot care for her anymore, it happens. She has already been referred, but doesn't want to see that OB for whatever reason. Your advice would make her seem crazy.

OP It doesn't seem like you understand you are a high risk patient, and both you and you baby can have serious outcomes during pregnancy, birth, and even after birth. You really should see who were referred to.

Op here. The baby hasn't been diagnosed with macrosomia yet btw and my blood sugars are 95% under control. I am only on bedtime insulin at a low dosage and my MFM said my case isn't that serious at all. My last growth scan was 32 weeks and baby was measuring in the 99th percentile (he's also very tall btw). I will have another growth scan soon to see where he is at. I may be diagnosed with macrosomia then, but not yet.

It's not possible to diagnose macrosomia until after the baby is born, because late pregnancy prenatal measurements can be wildly inaccurate. All they can do until s/he is born is make an educated guess.

There is a great article on Evidence Based Birth about macrosomia and the shoulder dystocia risks for a baby whose mom has insulin-dependent GD.

Op here. Do you mind sharing that article? Would love to read it, thanks!

I think this is the one: https://evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/

As a PP said, ultrasound measurements, particularly weight estimates, late in pregnancy are notoriously inaccurate. I had several friends due around the same time I was. All were under the care of OBs and were sent for growth scans. All were told they were having babies over 8.5 pounds. Only one baby ended up over 8. I saw midwives and zero ultrasounds after my 20 week anatomy scan. 2 days before baby was born, midwife estimated baby to be 7 pounds 14 ounces and 21 inches long ("he's lanky!"). He was 8 pounds exactly and, yep, 21 inches.

Did you or any of your friends have gestational diabetes controlled by insulin?

Stop it with suggesting that OP turn to non-medical sources for her care. She needs to see an OB.

Huh? Everyone on here has recommended seeing an OB. EBB is written by a nurse PhD and medical researcher in consultation with physicians.

Does information scare you?

Evidenced-based birth is a website written by a non-medical professional selling medical advice (that is now several years outdated).

OP needs to talk to an actual doctor.

Why don't you "stop it" with the medical paternalism? Suppressing/discrediting valid information is not ok. Telling people what to do, also not ok. Where do you think YOUR OB gets the info to make evidence-based care decisions? That's right, from PhD researchers like the author of EBB (who meets the definition of a medical professional), combined with their own judgment.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Why did your OB give you insulin and not offer a pill? I’m the pp who delivered at Sibley and took a pill (glyburide). I couldn’t get my fasting number under control but all other numbers were fine. Also my baby was 2 weeks early and only issue was low blood sugar. Did Foxhall say no?

Op here. My MFM was the one that prescribed the insulin because glyburide crosses the placenta and insulin is considered safer. I did some research on my own and felt more comfortable with insulin as well. My only issue is fasting too - everything else is under control by diet and exercise.

Oh man, I am sorry... I can completely relate. Just want to share a happy baby outcome. My DC did have low blood sugar as mentioned but recovered quickly and is a totally happy healthy toddler. Also, with my second pregnancy I didn't even have GD. Go figure. Good luck and I hope this all works out. If you do deliver at Sibley, it is a great hospital and they are equipped to handle babies that need extra care. The new hospital even more so than old (baby 1 was at old, baby 2 was at new).

Op here. Thank you for sharing your happy outcome I'm less scared of low blood sugar issues in my LO (since it's likely to happen anyway) and more worried about breathing/underdeveloped lung issues, since that requires a higher level of care.

[Anonymous]

I hope you find a good Dr. OP. I am a type 1 and delivered in another state. I worked with both a group of Obs and a MFM. A random doc from the group that I had never met started my delivery and another one finished it. So the important part is to get in with a group that can handle you and your baby and have the baby at a hospital that can handle high risk. BTW my baby was perfect. A little over 7 lbs and no blood sugar issues. I bet you have better blood sugars than I ever had. Good luck!

[Anonymous]

I don’t think an Ob can discharge a patient this late. I’d complain to the medical board.

I had a hard time getting a new Ob to accept me and I was much earlier in my pregnancy than you. If I were you, I would go to the Georgetown Er with a complaint (like another poster said). They will give you an Ob so that someone is familiar with your case. Also, go pick up your records from your old Ob. Some offices take weeks to transfer records.

[Anonymous]

I was diabetic before being pregnant and was immediately put on insulin by my endocrinologist (I didn't take insulin before pregnancy). I was told that the recommended diabetic protocol was having frequent monitoring ultrasounds, and that they wanted the baby delivered before 39 weeks, and preferred it to be a scheduled c-section. I was scheduled for a c-section right at 37 weeks and went into labor a few days before. My baby was just under 7 pounds at that point, and had low blood sugar issues but we ended up supplementing with formula. I'm flabbergasted that your doctor didn't figure out his/her discomfort with this until now. In terms of shady grove, I guess if you're going to be scheduled early as a c-section, it's manageable. But what a crappy situation all around!!!