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?

Discuss your concerns with your consultant.
Pregnancy with a pre-existing condition can be extra stressful but your consultants should be able to help steer you through that stress.
I've got RA and am on steroids throughout pregnancy and that comes with its own stresses and problems. I've done one pregnancy like this so it's a little easier this time round but my obstetrician and rheumatologist are also there to answer all my questions (even if they are daft ones)
I'm also booked in for c-section at 39 wks

Sympathies. I also have diabetes and the impact of my pregnancies on my blood sugar levels was unbelievable.

I found that the steroids didn't have a prolonged (more than 2 days) impact on my blood sugar.

My case is different as I delivered at 24 weeks and my LO has chronic lung disease after being ventilated for a long time. But I'm so pleased I had the steroids as I don't think he'd have made it this far without them. It's also much safer for the baby for you to have steroids when pregnant than for the baby to have them after the birth (if required).

Good luck with whatever you decide.

It's only for c-sections before 39 weeks that steroids are administered. Natural and induction don't need them as the act of travelling through the birth canal forces all the mucus etc out of babies lungs.

It's standard protocol now for pre-39 wk c-section. That said, you are are perfectly within your right to refuse but it's for the baby's best interest

I've got "potentially may require steroid injection for early delivery" written on my notes so will see if I need them!

I am sorry you are having such a difficult pregnancy, I am not diabetic, but I know what it is like having every aspect of your pregnancy micro managed, and it is pretty grim.

However, having also had a ds born with respiratory distress, which meant I couldn't even touch him let alone cuddle, for days, then having to spend weeks in scbu, away from my other children, I would go for the steroids to protect from issues to the lungs, which can have long term effects for your child.

Oh OP

I'm so sorry you're in this situation.

Can you ring and say you want another chat as you are considering going against the guidance due to your concerns? Bet they could make time for you.

Also if course you should have got pg! I had a totally natural delivery but I have kidney disease and following DD birth thus year I am looking at another big op. Gets me down sometimes but hey, it's the way my body is and I'd rather have my lovely baby :)

Just think soon you will have one of these

OP, why don't you have a read at the NICE Guidelines "Diabetes in Pregnancy"? They were published in February & will explain the rationale/evidence behind the recommendations.

You could consider asking to delay delivery till 39 weeks, but bear in mind the evidence of late intra-uterine death in type 1. Maybe worth a discussion with your team?

I'm diabetic and they don't want to induce me until 39 weeks. No mention of steroids.

I'm also micro managed but I'm very grateful - it can be a pain at times. I already have a DD and her birth was very medicalised, again induced at 39 weeks.

I just had a section at 38 weeks (placenta Previa/vasa Previa) and I didn't have steroids... But, I think the situation is a bit different if you're diabetic. Honestly, I'd take them.

I do understand re: the micromanaged thing. I had to have a section - not really any choice with the complications I had. I spent my last trimester absolutely cacking myself that I was going to bleed. I'd wanted a low intervention birth but I gave myself a stern talking to and told me that thank f I was in a country where this stuff doesn't mean me and babs wouldn't survive.

It does suck, pregnancy is stressful as it is, and I can imagine you feel things are out of your control. Can you try to take some of that control back? Not by refusing the meds (if the guidelines are there, it's because of good evidence) but in other ways?

Go buy some nice things for your baby - whether you do or don't will have no influence on the outcome so maybe deliberately doing this will reframe things into it WILL be ok? ... and something nice for you too. Be kind to yourself and good luck.

Despite my hba1c being in the excellent range (40) apparently my baby is big (80th centile) which I've found really tough as basically I feel like all my hard work has been for nothing. However ds was also big and is still big now at 6 and dh is 6 foot 5 and was over ten pounds born so possibly my babies would have always been big. Her stomach isn't particularly fat, but her legs are long!
So I doubt they will let me go to 39 weeks. I just feel like it's always choosing the 'least worse' option. There are no good options.

Sorry op I can't answer your question but I wonder do you have to go in for 48hrs because of your diabetes or would anyone having the steroids have to stay in hosp 48hrs before the c section? Thanks

No I have to go in for 48 hours or more when the steroids are given due to the hideous affect on my blood sugars.

If I wasn't diabetic then no I wouldn't have to stay in.

I'm really hoping she comes on her own just before 37 weeks like ds did and then I will attempt a natural birth. They said I'd have delivered ds well on my own if he hadn't been breech. I bet she won't though!

It's just the worry of the steroid, being away from ds, the blood sugars, the reduced movement vs the worry of respiratory problems. See, no good options. If I have them and the baby stops moving and is unwell for any reason (even if unlikely to be related to steroids) I will blame myself and if I don't have them and she has problems breathing I will blame myself. No good options.

Thanks for your reply :)

Im not sure I understand, could they not induce you for a natural birth?

They could but it would be at 38 weeks and my midwife seems to think it would fail and end in a c section anyway.

Gosh. I had a baby 3 years ago before the new advice at 37 and 4. T1. They assured me lungs were ok by 37. How awful. Especially as high sugars might mean more time for baby in sbcu ( it's not uncommon for them to be there for a few hours so stabilise sugars). I would absolutely ensure your diabetic obstetrician and team are fully comfortable with this plan and seek reassurance

Op I'm sorry you are so anxious, I truly do understand to a point , ds1 was brought at 37/1 and I received the steroids I was on an insulin drip , I will say I did not experience high sugars at all or reduced feral movements, I understand those are possible side effects but not definite

Ds 2 will be brought at the very least 38 weeks (possibly before ) and I will again be given steroids .... I have gone over the risks with the obstetrician and it's scary

I also have obstetric cholestasis as I did with ds1 and have had in depth conversations about the risk of still birth as a result of both conditions.... It is terrifying but please take a step back

The fact that you have only bought a single outfit suggests you've been badly affected by the risks in the pregnancy and god knows I understand, when I should be recovering the nursing chair I bought I'm lying in the monitoring unit being checked twice a week with blood tests and monitoring but please listen I went through the same thing with ds1 and he's as happy as a clam 3 year old who conned me into a paw patrol toy today :-)

Please talk to someone about your anxiety

And please be careful making medical decisions based on your anxiety.... The high sugars if you get them suck but the research against steroids is somewhat cherry picked.... Get a second medical opinion by all means, do as much research as possible but it does sound like your decisions are also wrapped up in your emotional response to your pregnancy disappointment ..... That's a bit concerning.... I know my area has a specific anxiety midwife and group .... Their poster is in the monitoring unit maybe ask if there is something like that

Good luck op I really mean that

I'm concerned that I'm not being offered steroids now.

My last hba1c was also excellent (below 40) through supreme effort, although I have too many hypos. My baby is still 97th centile but DD was and was long / is now tall for her age.

They don't want to induce me before 39 weeks but I'm unhappy waiting that long.

I'd take the steroids. The evidence is actually reasonably good. Babies whose mums are diabetic often have respiratory distress when born, at a gestation that you wouldn't expect respiratory distress at (regardless of delivery method). Elective section babies often have respiratory distress. Steroids reduce this risk. If movements do drop off, you will be in the right place to be monitored, at a gestation where delivery is generally safe - and you will have already had the steroids to help out the lungs.

I work in NICU - I hate taking babies away from their parents and putting them into incubators. I hate putting babies on a ventilator, putting lines in, not feeding them... I've also had a near-term stillbirth, and if I am lucky enough to get pregnant again, I will likely be looking at a preterm induction/section - I will be grabbing the steroids with both hands.

It's be steroids all the way for me.

Hope all goes well for you both

DD was an elective c-section at 39 weeks and had breathing problems. This was due to her lungs not being squished by labour. She was fine in the end, and in fact never even needed oxygen, but was in SCBU for a couple of days, which was horrible of course.

I felt terrible that I had opted for elective section over VBAC (had had emergency section with DC1) because I thought it was safer for her.

I would have taken steroids for DC3 without hesitation . . . BUT I am not diabetic.

I think this is one of those issues where you get an obstetric consultant who decrees one thing because it is best for the vast majority of patients. Yet your diabetes consultant might well have a different view. This is the problem I find often - you rarely get a Doctor who is prepared to treat the whole you, they just address the part of you that is their specialism. I can't help feeling that if this treatment made you ill, the obstetric consultant would just shrug, call the diabetes consultant and let him/her get on with it.

I can't make out whether you have seen your diabetes consultant or not from your posts.

All the best though, it must be hard for you

Could someone clarify are steroids recommended fir all c sections before 40 wks. I may need one due to placenta previa. Also having extra scans as I have big babies ie 10lb 13oz. All my other births were vaginally and at 42wks so a c section before due date will be a change for me and I want to make sure I know all I need to

Op I think you need to talk to your Dr's, push and get s second opinion.

And sizing scans are not known for accuracy...

Hard decisions.

Royal college guidelines 5mad - steroids recommended before 39w.

I had an elective section st 37+1 two years ago for placenta previa

It was booked weeks in advance with no mention of steroids. Baby was absolutely fine. 37w is full term! They aren't premature.

I'm diabetic and was induced at 38 weeks both times. Both inductions were successful, both babies took the traditional route out (even though DC2 was 10lbs 12oz!) and neither had lung issues. A section certainly isn't a foregone conclusion.

OP - re the reduced movements, I had the steroid injections just over a week ago at 28 weeks due to a bleed and a low lying placenta and haven't had any problems with reduced movements (fetal or feral!)

I work with pregnant women with diabetes and at our centre we don't routinely offer steroids to women with diabetes having elective sections after 37 weeks as we feel the risks outweigh the benefits. I don't think we've had any cases of respiratory distress in the babies.
Do you see an obstetrician with an interest in maternal medicine? I know that most of those without an interest would give steroids, having some understanding of the issues facing a mum with diabetes helps IMO.