MW probably dropping me this weekend

[heathenmom]

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[skueppers]

I'm so sorry. I wish your midwife were being more accomodating, and that stuff about the heart defect doesn't even make any sense. Since when is gestational diabetes connected with heart defects?

If you do wind up with a hospital birth, I really think finding the right OB is the most important thing in avoiding a c-section. While I don't have GD, I'm obese and of "advanced maternal age," and my OB doesn't treat me any differently from anyone else. There was certainly never any doubt that I would have a vaginal birth with my first (despite a 30-hour labor in which the baby didn't descend below -2 station until after transition -- no one was even the slightest bit concerned), and I can't see any reason it would be different this time around.

Good luck. I hope you're able to find a way to have the homebirth you want, and if not, that you find an OB who treats you like an individual.

[heathenmom]

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[skueppers]

Originally Posted by heathenmom

I'm pretty sure she thinks that I am/was already diabetic, even though I had a cbc at 15 weeks with a fasting bG of 85 (she has a copy of the lab work). My sister is diabetic and I get tested at least once/year just to keep check on things. I don't eat a lot of sugar & crap, and I'm NOT diabetic. But because she believes that it's a problem .... it's a problem, you know?

Ugh. Now that's really classic fat-phobia in action. She thinks you're diabetic because you LOOK LIKE someone who ought to be diabetic? Even though your blood tests show otherwise?

This is one of the reasons why I've been with the same OB/GYN for almost 15 years. He's willing to ignore my weight unless it's medically significant, and we've yet to encounter a situation where it was a real issue. He does watch me somewhat more closely for signs of GD than he would someone who weighed less, but that seems only prudent.

[mwherbs]

did you carb load before the test? if you have been eating low carb and then went and did the test it will be abnormally high! this was found by O'Sullivan I think I will have to look it up- in any case the false positives are very high without carb loading
For 3 days before the test you should have eaten a diet high in carbohydrates. You can obtain a menu outlining a 150 gm per day carbohydrate diet

also fasting bs should be done 8 hrs after last meal and 12 hrs is too long -- when fasting too long the body shifts things to raise blood sugar or no coffee or things to drink other than water when fasting.

[BelgianSheepDog]

GD is correlated with some heart defects...but...

That said, I had a baby at home with a congenital heart defect that would not have been detectable on ultrasound afaik. I declined the GTT and had very good random glucose levels. I'm currently 285 lbs and tend towards mild hypoglycemia. My baby was over nine pounds at birth.

NO ONE, not even the mean night nurse in the NICU suggested that I caused my baby's heart defect or that it was in any way related to diabetes, blood glucose, her size, my size, ANYTHING like that! The cardiologist said over and over again "you did everything right, there's nothing you could have done to prevent this, you did nothing to cause this" etc. So I'm inclined to believe that if your random glucose is good, then it's really not something you need to worry about.

Further, my baby even had the kind of defect correlated with GD, a ventricular septal defect (VSD.) Now I don't mean to minimize heart defects in the slightest, but the pediatric cardiologist even said if he had to choose a defect for himself or a loved one to have, it would be the VSD because nowadays they are easy to treat and monitor compared to many other heart problems. We took my baby in when she was three days old and really she was only kept to be on the safe side, she likely would have been just as fine without ever being hospitalized. And the defect, like most of its type, closed on its own. No meds, no surgery.

I guess I am just saying all this to take the edge off the fearmongering. I hope my rambling was helpful. And I really wish you the best of luck finding a less ridiculous care provider!

[heathenmom]

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[heathenmom]

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[anj119]

oh, my!

that midwife is a cretan, for sure.

i have never heard of that before...... dropping you because you failed the glucose tolerance test? what a butt!

in fact, before reading your post i never even realized that i would be considered a risk .... since i am right now 272 lbs, 34 years of age. none of my health-care providers have ever made me feel like they consider me 'risky' because of my weight or age.

i think that midwife is a big loser and I'm glad you found out now instead of later. i would be HOWLING about my 750.00, though!

-anj119

[mwherbs]

cause for a re-test the first could have had falsely elevated levels because you were not prepared for the test properly 3 days in advance... yes eating carbs that have a low glycemic index does make a difference-- the diet sheet that they would give you for that much carbs would be white bread and other non-fiber carbs...
or you could always say that you messed up and had Juice before the test when you first got up and took your prenatals---KWIM you were half asleep when that happened-- so the test is false and time to do another test--
---------------------

as far as increase in defects including ventricular septal defect my understanding is that it is related to True diabetic mothers and not GD - here is an abstract about I will be snipping the text for copyright reasons-

Teratology. 2001 Feb;63(2):87-93.
Atrioventricular septal defects: possible etiologic differences between complete and partial defects.

Loffredo CA, Hirata J, Wilson PD, Ferencz C, Lurie IW.

Cancer Genetics and Epidemiology Program, Department of Oncology, Georgetown
University School of Medicine, Washington, DC 20007, USA.

RESULTS: Complete and ventricular forms of AVSD had a similar proportion
of isolated cases (12.2% and 15.6%, respectively, without associated
extracardiac anomalies) and high rates of Down syndrome, whereas the atrial form
of partial AVSD included 55% isolated cases. Trisomy 18 occurred in 22% of
infants with the ventricular form, compared with <2% in the other AVSD groups.
Analysis of potential risk factors revealed further distinctions. Complete AVSD
as an isolated cardiac defect was strongly associated with maternal diabetes
(odds ratio [OR] = 20.6; 95% confidence interval [CI] =5.6-76.4) and also with
antitussive use (OR = 8.8; CI = 1.2-48.2); there were no strong associations
other than maternal age among Down syndrome infants with this type of heart
defect. Isolated cases with the atrial type of partial AVSD were associated with
a family history of heart defects (OR = 6.2; CI = 1.4-24.4) and with paternal
occupational exposures to ionizing radiation (OR = 5.1; CI = 1.4-27.4), but no
risk factors were associated with Down syndrome. There were no significant
associations of any risk factors in the numerically small subsets of isolated
and Down syndrome cases with the ventricular form of partial AVSD.
----------------------------
here is a quote from a follow-up study focused specifically on diabetic
" Preconceptional maternal diabetes was strongly associated with CVM of early embryonic origin (odds ratio [OR] = 4.7, 95% confidence interval [CI] 2.8-7.9) and with cardiomyopathy (OR = 15.1, 95% CI 5.5-41.3), but not with obstructive and
shunting defects (OR = 1.4, 95% CI 0.7-3.0). There was heterogeneity within
these developmental categories: among laterality defects, diabetes was
associated only with cardiovisceral and atrioventricular discordance (OR = 10.0,
95% CI 3.7-27.0); among outflow tract anomalies, the risk was strongly
associated with normally related great arteries (OR = 6.6, 95% CI 3.2-13.3) but
not with simple transpositions; and among atrioventricular septal defects,
diabetes was associated with the complete but not with the partial forms "

[avasmom]

Wow I can't believe she would drop you for that, especially if your blood sugars are under control.
I failed the GTT with my son, and I had to keep records of my blood sugars but they never got above 120 the whole time (even after olive garden with cake on my birthday) ( I think the test was wrong). However my midwife did not drop me and I ended up having a wonderful homebirth with no complications, to a 7lb 12 oz baby boy.
Is there another midwife you could talk to? I'm sorry you are having to deal with this, the stress can also cause your blood sugars to rise.

[Doula Gina]

Just a couple of thoughts-

It's awful that you were misled before taking the test. It would have been nice to know her protocols as well as her recommendations from the state for this type of result to the GTT.

But

If you do change care, you can work with a CNM if you have GD. I think it's a great idea, too, to consult with an endocrinologist (you know, a doctor who specializes in disorders like GD?!) instead of relying on an OB's care for this type of problem. Why? An endocrinologist can help you look at the bigger picture, can give you tons of reassurance (with mostly low numbers, you are going to feel much less threatened working with someone who will likely see you as borderline in comparison to most of her caseload); and they are specialists with experience in the long-term results of the outcomes of their treatments. Perhaps your mw will consider keeping you on if you consult with a specialist? If this doesn't work, and you can't find a CNM to work with in hospital who you like, you always have the option of working with a nice holistic family doc, a naturopath, or an osteopath who have OB privileges at your hospital of choice. An obstetrician is a specialist in surgical birth. Because most of the other choices do not perform cesarean surgeries, their investment in helping you to achieve a positive vaginal birth is in their best interest as well.



Best of luck for you-

Gina

[mamaverdi]

Are there other midwives in your area? It sounds to me like this is a blessing in disguise. She has told you who she really is. Believe her.

[flapjack]

The risks to you of a c-section, as a plus-size mama, are far greater than the risks of a homebirth. I'd strongly, strongly advise asking for a repeat of the test, if someone can cite a study that shows that eating a low-carb diet renders the test inaccurate?
There is absolutely no evidence whatsoever that shows that hospital is safer than home for a plus-sized mama. In fact, the opposite, because the consequences of medical intervention are greater. Given that, if what mwherbs says is right, you believe the GD test was not carried out properly AND she lied to you, you could have legal recourse.

[BetsyS]

I didn't pass the 1 hour GTT in my pregnancy, but my midwives had me do a more involved 3 hour test that included 4 values (fasting, 1 hour, 2 hour, 3 hour) That one, I pased all 4 numbers. I had worked all night the night before the 1 hour test, and I think my fatigue had something to do with the numbers.

Maybe you could do the 3 hour test?

[chaoticzenmom]

Originally Posted by mamaverdi

Are there other midwives in your area? It sounds to me like this is a blessing in disguise. She has told you who she really is. Believe her.

By the way....Isn't that an Oprah Quote?? I love it. When someone shows you who they are...believe them! I hope you can find someone to help you through this. I think it's obesity discrimination. I'm average weight and always refuse the 3 hour test, even though I always fail the 1 hr test. Nobody gives me grief about it....not even my obgyn's when I used them.

Lisa (mom to 3 wonderful children)

[heathenmom]

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