To not have steroids before a 38 week delivery?

[Givinguph0pe]

It seems there and now newish guidelines which say that if you are having a planned c section before 39 weeks you have to have two doses of steroids the week before.

I'm a type 1 diabetic so will be delivered at 38 weeks. What puts me off is I will have to be admitted to hospital for 48 hours as the steroids massively raise your blood sugars. In fact in my experience they raise sugars for around a week (had a previous dose of steroid once when not pregnant) and no amount of insulin really touches them.
I believe the research into the benefit is dubious and I feel so stressed out at the thought of having super high sugars, I think even with hospital management most people find that they still have quite a bit of trouble. Also if I then went into labour before a week after having them - which is possible as ds came on his own at 37 weeks - I would be battling high sugars at the time.

Basically the whole thing makes me feel very anxious. If they weren't going to raise my sugars I'd probably have them although there is some provisional research which may link them to reduced fetal movement and autism.

Aibu to turn them down?

I can't advise either way - all I can say is that DS was born naturally at 38 weeks and had absolutely no problems breathing (the steroids are to develop the baby's lungs, I believe).

If you think the research is dodgy then say no.

It is your body and your baby, and the responsibility for medical decisions is yours.

That said, maybe discuss the research with a specialist MW or consultant if you can beforehand.

I had DD naturally at 38 weeks with no steroids and no probs

Surely you are under some sort of care for your diabetes and the consultants will have had experience with this situation, you are better off talking to your endocrinologist or diabetic nurse specialist. Not all steroids are the same, so you should at least find out which one you had before, even finding that out might put your mind at rest.

The provisional autism type research is probably cherry picked internet mumbo jumbo, so don't bring this into your sensible conversation with your medical team, they will take your valid points less seriously.

Get more information and make a more informed decision - YABU if you take this incomplete picture, add advice from random people on-line and then make a decision. Good luck, I hope it goes well for you and neither scenario is really worth being anxious about.

I had a 38 week induction 4 years ago with DS for GD - no steroids then so must be very new guidance. He was fine - I thought 38 weeks was counted as term anyway?
I'd talk it through with your diabetic team and see what they say.

When I had my dd by planned section 16 yrs ago it was routine to do them at 38 weeks and we didn't have steroids and had no problems .

It is new guidance.
If I had a natural delivery - even an induced one - they won't give them. It's only if you have a c section.
The diabetes guys don't really get involved but it's what the specialist consultant told me. She only mentioned it in passing a while ago but when I went last week it was a different consultant who told me about being admitted and the affect on my blood sugars.
Google confirms it to be true. Basically I won't be able to eat anything until the resistance wears off as I'm already experiencing insulin resistance due to being pregnant and barely eating as it is. I can't stand the thought of my sugars being super high.

It is your decision. Is the c-section planned because of problems with the pregnancy, or could you delay it to a date where the steroids wouldn't be a topic anymore?

Not wanting to raise your blood sugar at a time when you will potentially have to take care of a baby is completely reasonable.

All diabetics have babies at 38 weeks so I will be induced or have a section.

YANBU

I had a section with ds as he was breech. I did contemplate trying a vbac but the midwife said I had failed induction and c section 'written all over me' which put me off!

Why do you think the research is dubious?

When you're admitted if you have them a sliding scale is done at then amen ime as the steroids so you wouldn't be battling high sugars if you went into labour on your own because the sliding scale would have stabilised them.

Personally I think yabu. But then before this guidance come out ive seen the unexpected results from planned sections at 38 or 37 weeks with no steroids. Rare, but it did happen.

But the sliding scale is only for 48 hours - the steroids will be in my system for a week or so. Past experience has shown this to be the case.

What were the unexpected results?

If the diabetes type I means your body isn't capable of carrying a baby to term, then I think it rather counter-intuitive to meddle with your blood sugar by taking steroids.

@Who: What exactly does happen?

Elective section at 38 weeks and baby got respiratory distress and died.

This wasn't the only case and it's because of such incidents the guidelines were introduced.

It's completely irrelevant whether people on the Internet had sections at 38 weeks without steroids and their babies were fine. This is all about probabilities. So having a baby before 40 weeks by cs increases the risk of breathing difficulties. I assume the new guidance is based on research showing that giving steroids prior to cs at 38 weeks reduces the probability of breathing difficulties.

To make an informed choice, you really need to be able to have a discussion with your consultant or other suitably knowledgable person and talk through the relative risks. It may be that you are reducing a very small risk to a really tiny one and you decide it's not worth it. Or not.

And fetal lung maturity is often further delayed in diabetic pregnancy. So you have more risk than a non diabetic mum.

God I wish I wasn't diabetic.
I shouldn't have got pregnant in the first place. Nothing is natural. Everything is high risk.

I had a baby who had respiratory distress after cs. It's not really relevant to this as he was 6 weeks early and I had had steroids, but although he was fine it was a pretty horrible time. I think before that I imagined respiratory distress as a few minutes of spluttering and being rubbed by a midwife, not 5 days on a ventilator, endless weeks on oxygen and turning blue every time he fed.

Sorry givinguph0pe, I cross posted. Wasn't meaning to scaremonger. If it's any consolation, I started out perfectly healthy and ended up really high risk - you never know how these things are going to turn out!

Sorry. It must be shitty being diabetic and pregnant. But I would honestly follow the advice that your obstetrician gives you.

The research changed maybe two years ago and we saw quite a difference in the number of babies being admitted to NNU.

You need to talk through the risks with your consultants, to understand the rationale for the steroids and to make up your own mind whether it is worth the additional blood sugar problems and whether they can be mitigated. Ultimately it's your choice.

Have you read or heard of the Montgomery case? A diabetic mother who has changed the course of consent giving forever.

I know.
I'm just fed up. Other people get to enjoy their pregnancies but mine is micro managed. I know it's for the baby's safety but any joy or hope has long since been sapped out of it.
The thought of 48 hours in hospital checking my sugars every hour day and night and despairing at them and being unable to eat anything has just tipped me over the edge! Ideally I'd like a low intervention birth but I guess a lot of people don't get the births they hope for.
I know it could be a lot worse, I'm just a bit emotional I think. The consultant last week went on about how I'm at a raised risk of stillbirth - which I already knew - but I don't feel I can plan anything for this baby. She has one outfit which I thought she'd need even if she was stillborn.

I probably sound like a selfish asshole, but if the choice was between having my own blood sugar soar sky-high due to the steroids, with all the associated risks, or the mere possibility that the baby would have to be given oxygen for weeks ... I would opt for the latter.

And I don't even have children - if I had, I would consider that an even better reason to not endanger myself.