Hey there mamas,
I'm looking for some advice... I've been grappling with the gestational diabetes diagnosis for about 5 weeks, and I would love to hear some fresh perspectives.
A bit of background: I was diagnosed with gestational diabetes at around 28 weeks. The results of my 3-hr test were: 84 (fasting), 196 (1-hr), 186 (2-hr), and 136 (3-hr). This is my second pregnancy. I did not have GD with my son, but it's been implied that there might have been a "missed diagnosis" with him, as my 1-hr glucose test was very close to being too high (137), and he was "so big". (He was 8lb3oz, which doesn't seem unusually huge to me, and besides, in my family, we tend to have big babies, even though the women tend to be small.) No one in my family has diabetes. For this pregnancy, I am with a hospital-affiliated midwife practice that (I've since learned) works under the close watch of an OB, who seems to be the one calling the shots.
After following the gestational diabetes diet for two weeks, my glucose levels were fine (fasting levels usually in the 90-100 range; my practice prefers below 90, but was comfortable with these levels, and post-prandials were always below 120), but I lost 5 pounds. The OB (had to switch to seeing him because I'm now "high risk") took me off the diet, and had me go back to eating normally. My glucose levels stayed fine; the fasting levels actually improved a bit. Even the OB conceded that my levels on the 3-hr screen were pretty borderline, and called me "glucose intolerant". I thought this meant he'd be willing to treat me like a "normal" patient again. Boy, was I wrong!
At my most recent appt, he and the midwife on duty that day gave me a stern talking-to. What set them off was me questioning their decision to induce me on my due-date if I haven't gone into labor on my own by then. Their reasoning is simply that this is the "standard of care". I could not get them to give me a more compelling reason, ie, one that relates to me as an individual. Instead, they played hardball, and even asked me, "Don't you want your baby to be safe?"
I decided to search for another midwife... not really what I wanted to be doing at 33wks, but it was becoming more and more clear that this practice was just too medical-model-oriented for me.
I interviewed with another midwife practice who operates out of a birth center. They, too, would want to induce me at 40wks based on the GD diagnosis, and the midwife I met with said I was at an increased risk of having a stillborn baby. A second midwife practice gave me the same story.
Finally, I met with a wonderful independent midwife who does mostly homebirths, but who is also hospital-affiliated. She said that she had always been trained that if gestational diabetes is under control, there is no reason to treat the woman as anything other than a "normal" pregnant person, and to proceed accordingly. She also said a lot of things that just made sense to me: if a baby's not ready, induction won't work, and I could be getting set-up for surgical intervention. She also talked about gentler methods of getting things going: acupuncture, evening primrose oil,... She also suggested we think about non-stress tests and biophysical profiles before talking induction. She said she saw no reason--at this point--to talk about inducing me right at 40 weeks. I told her that I wasn't sure if I'd have the courage to go past 40 weeks. (I just can't get that word "stillborn" out of my head... I can imagine how terrified I'll feel if I go one day past my due-date. I know how silly that is. We all know how accurate those little wheels are, and I even know for a fact that I don't have a 28-day cycle.) She said we could see how things go, that this was my pregnancy, and I got to decide what direction we would take with respect to induction.
Sounds like she's the one for me, right? Well, at first, I felt so wonderful after talking to her, but then the doubts started to set in. It's almost like I've been trying so hard to get everyone to calm down about this diagnosis, and then, when I finally find someone who agrees with me, it really unnerved me. It was almost like, "Shouldn't you be freaking out like everyone else?! Can I trust you, if you're not pressing the panic button, too?!" I know this midwife used to be affiliated with a local birthing center (it closed recently), then she spent some time with a hospital-affiliated midwife practice, but left because she just couldn't take all the rules. In my heart, I know I can trust her, that she's very experienced, very highly regarded, and that she just doesn't want to follow the medical model, but... she seems like such a rogue compared to everyone else!
I would love to hear your thoughts on this. Would you go past 40 weeks? Are the NST and the BPP likely to give me any useful information, or are the false-positives/negatives with them? Am I crazy to think my diagnosis of GD may not be the incredibly serious situation everyone else seems to think it is? (I should admit that I have a lot of trouble with the diagnosis of gestational diabetes in the first place. Especially after reading Henci Goer's articles--if only I'd read them before consenting to the screen in the first place!--nevermind all the things like stress, certain vitamins, etc that could impact glucose absorption.)
Anyway, I just don't know what to do anymore. My brain feels totally fried, and I think I'm just researched out. Thanks in advance for sharing your perspectives and experiences, and many thanks for reading.
Monica
I'm looking for some advice... I've been grappling with the gestational diabetes diagnosis for about 5 weeks, and I would love to hear some fresh perspectives.
A bit of background: I was diagnosed with gestational diabetes at around 28 weeks. The results of my 3-hr test were: 84 (fasting), 196 (1-hr), 186 (2-hr), and 136 (3-hr). This is my second pregnancy. I did not have GD with my son, but it's been implied that there might have been a "missed diagnosis" with him, as my 1-hr glucose test was very close to being too high (137), and he was "so big". (He was 8lb3oz, which doesn't seem unusually huge to me, and besides, in my family, we tend to have big babies, even though the women tend to be small.) No one in my family has diabetes. For this pregnancy, I am with a hospital-affiliated midwife practice that (I've since learned) works under the close watch of an OB, who seems to be the one calling the shots.
After following the gestational diabetes diet for two weeks, my glucose levels were fine (fasting levels usually in the 90-100 range; my practice prefers below 90, but was comfortable with these levels, and post-prandials were always below 120), but I lost 5 pounds. The OB (had to switch to seeing him because I'm now "high risk") took me off the diet, and had me go back to eating normally. My glucose levels stayed fine; the fasting levels actually improved a bit. Even the OB conceded that my levels on the 3-hr screen were pretty borderline, and called me "glucose intolerant". I thought this meant he'd be willing to treat me like a "normal" patient again. Boy, was I wrong!
At my most recent appt, he and the midwife on duty that day gave me a stern talking-to. What set them off was me questioning their decision to induce me on my due-date if I haven't gone into labor on my own by then. Their reasoning is simply that this is the "standard of care". I could not get them to give me a more compelling reason, ie, one that relates to me as an individual. Instead, they played hardball, and even asked me, "Don't you want your baby to be safe?"
I decided to search for another midwife... not really what I wanted to be doing at 33wks, but it was becoming more and more clear that this practice was just too medical-model-oriented for me.
I interviewed with another midwife practice who operates out of a birth center. They, too, would want to induce me at 40wks based on the GD diagnosis, and the midwife I met with said I was at an increased risk of having a stillborn baby. A second midwife practice gave me the same story.
Finally, I met with a wonderful independent midwife who does mostly homebirths, but who is also hospital-affiliated. She said that she had always been trained that if gestational diabetes is under control, there is no reason to treat the woman as anything other than a "normal" pregnant person, and to proceed accordingly. She also said a lot of things that just made sense to me: if a baby's not ready, induction won't work, and I could be getting set-up for surgical intervention. She also talked about gentler methods of getting things going: acupuncture, evening primrose oil,... She also suggested we think about non-stress tests and biophysical profiles before talking induction. She said she saw no reason--at this point--to talk about inducing me right at 40 weeks. I told her that I wasn't sure if I'd have the courage to go past 40 weeks. (I just can't get that word "stillborn" out of my head... I can imagine how terrified I'll feel if I go one day past my due-date. I know how silly that is. We all know how accurate those little wheels are, and I even know for a fact that I don't have a 28-day cycle.) She said we could see how things go, that this was my pregnancy, and I got to decide what direction we would take with respect to induction.
Sounds like she's the one for me, right? Well, at first, I felt so wonderful after talking to her, but then the doubts started to set in. It's almost like I've been trying so hard to get everyone to calm down about this diagnosis, and then, when I finally find someone who agrees with me, it really unnerved me. It was almost like, "Shouldn't you be freaking out like everyone else?! Can I trust you, if you're not pressing the panic button, too?!" I know this midwife used to be affiliated with a local birthing center (it closed recently), then she spent some time with a hospital-affiliated midwife practice, but left because she just couldn't take all the rules. In my heart, I know I can trust her, that she's very experienced, very highly regarded, and that she just doesn't want to follow the medical model, but... she seems like such a rogue compared to everyone else!
I would love to hear your thoughts on this. Would you go past 40 weeks? Are the NST and the BPP likely to give me any useful information, or are the false-positives/negatives with them? Am I crazy to think my diagnosis of GD may not be the incredibly serious situation everyone else seems to think it is? (I should admit that I have a lot of trouble with the diagnosis of gestational diabetes in the first place. Especially after reading Henci Goer's articles--if only I'd read them before consenting to the screen in the first place!--nevermind all the things like stress, certain vitamins, etc that could impact glucose absorption.)
Anyway, I just don't know what to do anymore. My brain feels totally fried, and I think I'm just researched out. Thanks in advance for sharing your perspectives and experiences, and many thanks for reading.
Monica
I would not be induced at 40 weeks because I would feel like the risks would be greater than continuing on.
I think the latest midwife sounds like the only reasonable person you've talked to thus far. I get how the others have scared the crap out of you though. I think you know what you *should* do but probably feel in the back of your mind that if you let yourself be "managed" then you're absolved of responsibility of a potential bad-outcome (like if something were to happen b/c you went past 40 weeks). Does that make sense?
