GD and homebirth

[gemasita]

I'm just wondering what your homebirth midwife says about GD and delivering at home. I may be way ahead of myself but my homebirth midwife had me do my own blood sugars (fasting and 1 hr post meal) for 2 weeks so that we could see what they were on a regular diet before I did my GTT at the family practice that provides my parallel care. She said they should be under 100 for fasting and under 140 for 1-hour. Only two of mine were higher than 100 and I could justify both (used a throat lozenge that I didn't realize had glucose syrup in it before one reading and ate a cookie in the middle of the night for another). All my 1-hour's were under 140.

So I went to the family practice today, not worried about a thing. The CNM there looked at my numbers and said the fastings were a concern because they want them to be under 95 and only about half of mine were. She said I could just consider myself gestational diabetic and the "treatment" would be seeing a nutritionist and exercising, do the 1-hr GTT and see if I pass, and then she said that if I risk out of a homebirth because of this, they can't provide my parallel care if I still choose a homebirth. She did say that if I needed oral meds, that shouldn't risk me out. But it might if I need insulin.

So I think I'm just thrown off because I thought everything was going to be fine and she made it sound like I have GD based on my fasting numbers. I put a call in to my homebirth midwife but haven't heard from her yet. Again, I'm probably way ahead of myself but was wondering what others' midwives have to say about GD.

[msmiranda]

It's totally absurd how strict the medical-minded folks have gotten about glucose numbers -- if you were a non-pregnant person, they would not classify you as diabetic until your fasting was 120, and you have to be above 100 to be considered impaired. But for pregnant women, whose blood sugar normally rises slightly toward the end of pregnancy, they demand under 95, or at my previous OB/GYN, under 90, which I could not accomplish -- my fasting is in the mid-80s when I'm not pregnant!! (And that is a totally healthy non-diabetic number).

Anyway, homebirth midwives are much more likely to take a skeptical view of the overdiagnosis and overtreatment of GD. My HB midwife was fine with my readings during my last pregnancy -- my fasting went up into the 90s (but almost never over 100) after 30 weeks, and I was able to keep my 2 hr postprandials under 120 with diet changes.

I would suggest that you alter your diet, and that will most likely lower your numbers. The guideline I used was 30g carbs for breakfast, 45g at lunch and dinner, 15g for snacks. It is very easy to exceed this exponentially, so I pretty much had to quit eating bread, pasta, rice, and beans for the duration. Cakes, cookies and the like were out of the question. It was hard, but worth it. I ate a lot healthier because of it and gained less weight in my pregnancy.

In my view, the whole GD spiral (they keep lowering the numbers to trap more and more women in their net) is part of the liability mess -- they can't predict shoulder dystocia, it drives them nuts, so they create more and more excuses to give prophylactic c-sections to avoid the proverbial bad outcome. You don't want to get caught up in that mess. You're probably perfectly healthy. Just quit eating so many carbs, show them your great numbers, and hopefully they will lay off. If not, try to find another care provider. I chose HB precisely because I knew that if I took the GTT I would be diagnosed with GD and I did not want that big red C on my forehead. It is not a good label to have if you want a normal birth.

[gemasita]

msmiranda - thanks so much for the reply!

I finally talked with my hb mw and she said a lot of the same things you did. She said they keep changing the definition of GD but probably half of the practices in our area still say under 100 for fasting is fine and the other half say 95. My after-meal numbers were fine because I'm pretty familiar with how I respond to carbs - I've always had to keep mine pretty low just to not have blood sugar swings. She said she really wouldn't worry herself unless my fastings were in the 115 range - and then she would tell me to start walking every day and that would probably do a lot to fix things on its own.

The mw at the family practice said the "challenge" part was what was important during pregnancy. But I don't understand that. Like you said, if under 120 is normal for non-pregnancy, and pregnancy makes us slightly less able to process glucose, why would a pregnant women need to be under 95?

Anyway, my hb mw seems to have the same take on things as you do so I am happy about that.

Thanks so much for the thoughtful response and the good information.