meltdown over massive baby, GD, ketones and probable early c-section :(((

[scarednoob]

please help me!! if you can't be bothered to read the issues (perfectly understandable as I seem to have written "war and peace" here...), questions at the bottom! thanks ladies...

feeling very worried and nervous about the baby and the next few weeks. I feel that the hospital hasn't really picked up on some issues until i pushed for them. in particular I had to push for a GD diagnosis/monitoring, as my GTT came back 0.1 below the borderline so they wanted to tell me I don't have GD. despite the fact that a growth scan showed the baby has a massive stomach and high amniotic fluid and my blood sugar readings are higher than a normal person, albeit within GD guidelines.

on Monday the baby wasn't moving as much as I was comfortable with, so I went in to get checked, and suddenly all hell broke loose:

• as it was the second reduced movement episode, they wanted me in overnight and did 4 CTGs
• in the morning, the registrar wanted a second growth scan, even though I had one 11 days ago
• new growth scan showed the baby at 6lbs 8oz at 34 weeks, with a big head, abdomen off the charts, and 97th centile femurs - OH and I could both lose a few pounds, but we're quite small framed!

• midwife confirmed blood sugars are well controlled and no need for metformin or insulin (yet)
• I queried why they kept finding 2+ and 3+ ketones in my urine - this has happened loads of times and various midwives have just dismissed it as dehydration. now looking at the fact that the baby is so big, I think something has been going wrong with the sugar levels for a long time. she looked a bit concerned, went to speak to doctor, came back and gave me ketone strips. now I've read about what ketones can do to the poor little baby, including reducing her IQ, and I'm torn between utter panic and fury that this wasn't mentioned before
• then I queried the amniotic fluid, which has dropped from 19cm at 27 weeks to 14cm at 32 weeks to 8cm at 34 weeks. I know 8cm is still normal, but if it keeps dropping at that rate, the baby could have a real problem. only then did the midwife look at it and say that the dropping amniotic fluid and increased resistance on the umbilical flow could mean the big baby is challenging the placenta

-finally she went to see the consultant, who has classified me as high risk, asked for DAILY CTG monitoring and wants to see me next week to talk about bringing the baby at 36-37 weeks and probably by C-section.

sorry for the massive spiel, but I am panicking about:

the size of the baby - is there something wrong?!
the C-section - I am not someone who had a fixed idea of birth, but the idea of such a major operation is a bit traumatising; does anyone have any experiences to share?
the ketones/sugar - have I hurt my baby??

so stressed and unhappy, especially as I have so much work to get through before I can leave :( :( :(

Hi scarednoob, I'm not sure if I can give any good advice on this, so mainly just bumping it for you.

The only thing I know is about ketones - I had them once in my urine and when I asked my consultant (I've got GD as well) she said to me as long as they are below 4+ it's nothing to worry about. So I'm pretty sure no harm was done for your baby.

Another positive thing is the fact your glucose tests came back normal. When I had my one done, it was 13.9 (random) - just so you don't get too upset about being close to borderline.

Got no knowledge re amniotic fluid, so can't really say anything, so hoping someone who knows more will come along.

Good luck, keeping everything crossed for you!

you've made me nearly cry with feeling much better, thank you!!!

You are very welcome, glad I could make someone feel better, as this is my first pregnancy and normally I'm not very good with advising since I'm so clueless myself But when it comes to GD I feel like I've got something to offer - having been on metformin and insulin since 16 weeks, you can just imagine the amount of research I've done! I really genuinely think your baby will be fine - back in the days they were not even testing for GD and some women just 'happened' to have big babies! They were otherwise healthy though.

I can only comment on the c-section. Mine was an emergency so yours will fingers crossed be much calmer and you can plan for it.

TBH it wasn't half as painful as I imagined - i didnt feel a thing during surgery and I got through the recovery on paracetamol and ibuprofen. I was like a shuffly old lady for maybe a week? But I know we were out doing short walks in the park at 10 days and I was driving by 3 weeks (checked with insurance first). You can also take arnica to help any bruising.

Will your DP/H be supportive?

Honestly, the section wasn't that bad. Good luck OP

I second LastOne - C-section is absolutely fine. I had an emergency one too, aged nearly 40. I was back to normal almost within a week, driving and doing Zumba after 3 weeks. IME it's really not a biggie.
I hope all is well for you and good luck for the rest of your pregnancy.

Don't stress too much about the ketones - think of all the ladies who have horrific sickness the whole way through and still have strapping great babies.

Ketones are produced by our bodies for a reason and are actually incredibly useful in some situations. If the mother is starving for example the ketones are used by the foetus. bunny's consultant is right - it's not the presence of them per se! It's the level that they look at. Your lipid metabolism changes a lot during pregnancy - you build up fat stores at the start and use them towards the end, to put it very simply, and it's not at all unusual to have +1-2 in the urine during pregnancy.

As for your GTT .... 0.1 below the limit is still below the limit - diabetes isn't a cut and dried thing. People have a wide range of normal responses to sugar and there's a continuum between normal metabolism, via metabolic syndrome all the way through to uncontrolled diabetes. The limits in pregnancy I think are actually a bit lower than non pregnant women, so you're ok there.

I can't give you much advice on the section - I just found I may need one too and got some lovely replies to my thread www.mumsnet.com/Talk/pregnancy/2455303-Make-me-feel-better-about-elcs

Overall, it's great they have you under close observation. Your sugar metabolism may just be a bit awry (which is very often only picked up later on) so they'll be able to do what's best for you and your little one. Good luck!

Don't panic! I remember your original posts about GD.
Lots of people say that elective section is the least risky delivery method and a completely different kettle of fish to emergency section.

It sounds like you have a whole load of things on the borderline but only the babies size is far off normal level. Also babies whose mothers have had undiagnosed GD tend to have large stomachs only (that's why there is a risk shoulder dystocia(sp) - head goes through but body won't fit). It sounds like your baby is just a whopper generally :)

It sounds like they are monitoring you very closely so try to find that reassuring. Imagine if you hadn't had the gtt/growth scan.

I know it's tough though. Is there something lovely you can do to try to relax and forget about all these complications for a bit?

Ps I wasn't able to control my sugars very well at the end of my last pregnancy and it looked like ds was larger than average. In the end he was 7lbs at 38.5weeks and is as bright as a button.

thanks everyone, I feel a lot calmer and more reassured. last night I was hysterical!

unfortunately the something lovely is trying to work as much as possible to get everything ready for handover; I thought I'd have another 3 weeks, urrrrrgh. and I did read somewhere that stress can also cause ketones, so I guess that isn't helping.

really good to hear positive stuff on the C-section. I will check out your replies skipton, as I am a bit petrified about the whole thing!

I can only reiterate other people's comments about c-sections - I had an EMCS after a very long, unsuccessful labour, and it was absolutely nothing to worry about. Pain wasn't too bad at all, and the recovery was MUCH better than I'd expected. So much so that I'm considering an elective this time round!

Don't panic!

I frequently had ketones (not exactly HG but real probs eating) and didn't seem to cause any problems. DS was ELCS at 10lb but only ELCS because breech, which nobody picked up on until a sweep.

ELCS was brilliant, got myself up the morning after and shuffled off to shower, bit tender for a week or two but at least I didn't need to sit on my stitches (which in sure would have been inevitable if I'd tried to deliver a 10lb baby myself!), was driving 3 weeks later (having been passed by GP as fit) - so try not to worry about it all, it'll be find and you'll have your baby son and wonder what the fuss was about!