Decling the Glucose tolerance test. « Back to Group Discussions

[Dakota1235]

So I've declined my glucose tolerance test twice now. Initially one of my hospital based midwives wanted it done @ 20 weeks. I didn't go, borrowed a glucometer from my doula and checked my sugar 2-3 times a day for a  week. At my 24 week visit I explained that although I understand I have some risk factors for GD (overweight and over 25) I would not be drinking the glucola and had monitored my blood sugars instead. That particular midwife was ok with it, and asked if I'd do the test at 28 weeks. I told her I'd think about it. They seem mostly concerned because I have gained too much weight (at 24 weeks I had gained 21 lbs, due to my beginning weight they wanted a max weight gain of 20 pounds).

After discussing with my doula (who is also a homebirth midwife) and doing more research I decided to decline the 28 week test as well and simply test my sugars again for a week prior to my appointment. So I did that and noticed that my sugars were a little higher than the first time I monitored, although they were still within normal range.  I've been focusing on watching my carbs, I really eat very little sugar, but using the glucometer I have been able to see how my body handles different kinds of carbs. I notice that potatoes raise it higher than anything else. I explained all this to the midwife and that I am committed to watching my carbs and sugar and continuing to exercise which I have been doing all along. I also have an appt to meet with a nutritionist, and am willing to keep checking my sugars prior to each appointment. I just think that stressing out my pancreas, baby, and body with that much sugar and dye isn't healthy. I'm also concerned about the number of false positives. And frankly the first treatment for GD would be diet and exercise, which I am doing already.

She was not pleased and I explained that I really felt I was already being pushed in a direction I did not want to go, namely the "your baby is too big and we need to induce you" train. I also explained that their constant focus on my weight has gotten to the point where I dread going to visits. We did agree to a sort of compromise, they had already done a fasting glucose on me for my 28 week lab work (it was 89) , and so we agreed that I'd go to the lab 2 hours after eating a regular meal and get a blood draw, which I did today.

I'm hoping that's the end of the discussion about this. However, she also said she's never had anyone refuse the test and she will have to dicuss with one of the other midwives if this alternative test will be sufficient. So after this whole long story, here's what I'm asking. Do any of you ladies have any suggestions (aside from just take the test) you can offer about what to do/say if they decide that my 2 weeks of self test, a fasting and a 2 hr post meal test are just not sufficient?

[kellybeth]

sorry you're going through this. i really didn't want to take the test simply because the thought of it grosses me out and i hate sugary things, but it is not an optional test to birth where i am birthing, and my doctors require it. hopefully you can come to an acceptable agreement/compromise that you are comfortable with. 

[HouseofPeace]

sorry you're going through this.  my birth center did a similar thing as i couldn't opt out of the test, but i was able to do the fasting glucose, followed by a meal, and then 2 hours later another blood test to check the sugars.  i did this w/ my first 2 pregnancies.  i never did the drink.  it wasn't a big deal.  they should be able to give you the option of eating a meal instead of the drink.  i always felt that was better for me and baby.  my fasting was 75, and my second draw was 72 or so in each pregnancy.

my homebirth midwife looked at my diet and lifestyle and allowed me to opt out of the test in my last 2 pregnancies.  

my last friend who had the same issues you did ended up finding a new care provider so she could monitor and take control of it herself.  

as for the weight gain, that's hard.  i have a friend who i counseled through GD (i'm a health counselor) and she kept her weight gain to 19lbs, had a healthy 9lb 1oz baby, but was stressed a lot during the experience (same birth center as i saw for my first 2 births).  it was wheat bread and potatoes that spiked her long term.  it also did not go away immediately after birth, but she had blood sugar issues for a few months.  FYI.  she did really focus on exercising AFTER each meal when she found that really kept her blood sugars way lower after meals.

i know the big fear for them is that you're NOT controlling it and putting yourself and your child at risk, and then they face that responsibility at birth.  it's just hard to trust that someone is really doing everything possible to protect themselves when there is no real way to know for sure.  they're trying to keep you and the baby safe, but it's hard to not be trusted on something that only you can really take care of!  

blessings and peace-

[LadyCatherine185]

I would personally have the test done. I am all for opting out of unnecessary tests, especially if they harm you and baby, but a simple blood test is hardly invasive or harmful. like houseofpeace said, they really are just trying to keep you safe and baby safe.. GD can cause real problems, and even if you are following a really healthy diet and exercising, it may not be enough. A friend of mine, who is very fit and has always eaten very healthy and exercised, had GD with both of her babies. Her blood sugar levels were so high with normal, healthy foods that she had to be put on a really special diet. Not saying that will be the case with you, but I think it is always good to have a trusting relationship with your care provider, and if you don't feel like you can trust your care provider with the information of your blood sugar then perhaps you should find another OB/MW that you would trust?

[Dakota1235]

Thanks everyone for the advice.

I am considering switching from this practice to having a homebirth with my doula (who is also a midwife). My one concern is I do have a condition that can very slighlty increase the risk of placental abruption (by 1%). It's a very small increased risk, but I am not sure I'm comfortable with it.

It is certainly important to have trust on both sides. I just find it very frustrating that while they have no trust that I am exercising daily and not binging on junk food, I am supposed to trust that they are not going to push unnecessary interventions on me.

I am not opposed to a simple blood test, I am opposed to the glucola. My blood sugars eating my regular diet have all been within normal and have not been anywhere needing insulin. I am very close to their lab so I have no problem going in and getting blood drawn. I did the fasting blood glucose which was 89, normal, and yesterday I did a 2 hr post meal (tuna fish on pumpernickel and broccoli) and that was 90 (their cutoff was 134). In fact I'd be willing to go multiple times and have fasting and postprandial blood draws done to prove that I do not have  GD. I am also willing to monitor my blood sugars at home to verify that I have not developed GD later on. 

The bottom line for me is that I have not met any of the diagnostic criteria for GD. My blood sugars fasting and postprandial are within normal range, and a fasting glucose has been shown to be a much better indicator of blood sugars than the GTT. The GTT results can vary greatly, and there are a number of false positives. A woman can fail one day and then take it a week later and pass. Their concern is based on the fact that I have exceeded some arbitrary weight gain that they like to see in their patients. I sort of feel like I don't fit on their assembly line and I'm not willing to simply agree to this just to make them feel better.

Well hopefully they accept this most recent proof that I don't have GD, and we can move forward. I guess we'll see at my next visit, in the meantime I'm just going to keep doing my thing and skip the potatoes and pie at Thanksgiving.

[odinsmama]

Originally Posted by Dakota1235 

Thanks everyone for the advice.

I am considering switching from this practice to having a homebirth with my doula (who is also a midwife). My one concern is I do have a condition that can very slighlty increase the risk of placental abruption (by 1%). It's a very small increased risk, but I am not sure I'm comfortable with it.

It is certainly important to have trust on both sides. I just find it very frustrating that while they have no trust that I am exercising daily and not binging on junk food, I am supposed to trust that they are not going to push unnecessary interventions on me.

I was wondering if changing your plans with this practice was an option for you at this point. It sounds like you've been very flexible and your limitations are well thought-out. I guess, like you said, see how they respond to your most recent test and see if it is "enough" for them.
I would also be concerned about potential future (while in labor!) disagreements about care when they really seem to be pushing this one so hard even though you've made it pretty clear you're taking care of yourself and not being careless with diet.
Hope things work out well for you!

[loveandgarbage]

How frustrating for you! You are doing everything right and yet... that's not good enough for them. Hopefully this next test comes back normal and you can put it to bed.

[LadyCatherine185]

ok, i see now! I thought that you didn't want to do any blood tests at all. well yes, that is very frustrating then if they are trying to push the glucola on you. ((hugs)) so sorry mama! I hope you can find a compromise that will give you peace

[HouseofPeace]

it sounds like you've gone along and the tests aren't proving you at high risk.

you're willing to monitor, and that is huge!  so, i think the mama's above are right and you might need to find a care provider willing to give you more leeway on the weight.  but i'll throw out a hope this satisfies them and that you can move on thought as well.  i know it was a huge issue for me in both my first and 2nd birth, but once the tests were done, they looked back and then kept going as nothing was showing issues.  so it was a big deal, but it did pass.

i wish more care providers would have less strict weight measurements.  another thing that stressed me at each visit was being a lb or 2 or 5 over what the charts suggested.  at the end i wasn't gaining a lb a week, but only 1/2 lb, and that also became an issue. i'm not tiny, i'm not big, i gain a good amount of weight and have average babies, but the stress of my weight being addressed at each visit (depending on the midwife i saw, i preferred to see the ones who never commented on it!) without any real solution for me (already exercising, eating well, and no junk food!).  my homebirth midwife was and is a much better fit!

[mama3blessings]

I hope they will leave you alone about this now. I have declined mine as well and have checked my levels at home as well. The midwife at the clinic I go to has now given up to get me to take it, lol.

[mariee]

Have you offered to come in on certain dates to have blood draws, then?  That seems like a great offer to me.

I think to a certain extent that all health care providers try to do the best they can to verify things in their presence and in a controlled environment.  (in the office)

Sadly, for every genuine, honest, and dilligent patient (YOU) there are 20 other patients who do not follow through, do not comply with advice, etc.  

You are certainly being reasonable!  Sometimes providers just don't know how to react, cover their own liability, and still care for your needs when patients request something that is different from "the usual".  

I wouldn't worry about it too much, and I wouldn't worry much about anyone pushing you down a path where they will expect you to have interventions.  They probably view the glucose test and actual interventions during birthing very differently.  I think they should certainly be willing to accept your offer of a few blood draws along the way as sufficient!  

[Dakota1235]

Thanks so much ladies. I took a week off from monitoring and then have been doing it again this past week. (all's well) I have a midwife appt tomorrow, so we'll see how things go. I'm hoping she's satisfied.

I am really hoping that you're right and they view the test and interventions differently. My doula and husband are super super supportive and are totally on board with what I want. It's nice to have that support, and it's great to have a doula who's a midwife to bounce things off of. I pretty much call her before or after every visit to run stuff by her. She's also done a number of births at this hospital with these midwives so she's pretty aware of their practices and has given me heads up on  things that they are pushy about.

We'll see, I keep doing my positive pregnancy affirmations and try not to worry, lol. Esier said than done sometimes.

[Dakota1235]

aaaand.... had my appt today, she was happy with the latest blood draw, and asked me to keep monitoring my sugars, which I am happy to do. It also probably helps that I didn't gain anything since our last appt 2 weeks ago, though I've been eating very frequently, lol.

So it seems like they're going to leave it alone, and we did come to a mutually acceptable compromise. =0)

[odinsmama]

Great news!

[HouseofPeace]

YAY!!!

[mariee]

Awesome!

[titus2mama]

My Dr.s allowed me to check my sugars for a week and were satisfied.

I WILL NEVER put that amount of sugar in my body at once...are they crazy!

What do you expect is gonna happen! Your gonna react somehow and some people could really be pushed over the edge with this kind of sugar level being introduced to the body. I always refuse them. 4th baby now and have not done them since the first.