What's the deal with homebirth and gestational diabetes?

[Katielady]

I'm at slightly elevated risk for GD due to my PCOS. My midwife doesn't do the GTT unless it's indicated, which I'm sooo happy about as it made me really sick with my first pregnancy. First time around, I failed the 1-hour but passed the 3-hour. I just started testing my blood sugar on my own to make sure I'm within range, and my sugar definately spikes if I eat meals that are too carby. It started to make me a bit nervous. I don't want to end up with a "big baby," or have her blood sugar crash dangerously after birth.

I found this great article by Henci Goer though; it's a skeptical look at how GD is diagnosed and managed:

http://parenting.ivillage.com/pregna...,,9z3m,00.html

Sounds like the whole thing is a lot of hoofrah based on old, shoddy research, and the risks of big baby and the whole blood sugar crash thing are very low and not well linked to GD diagnosis.

So what happens, hypothetically, if I *do* develop GD? Would that risk me out of my HBAC? I'm nervous to even bring it up with my midwife, although I probably should.

[StarMama]

I 'had' GD with my first (diet controlled) and it was fine. The midwives I've phone interviewed have all been fine with diet controlled GD as well and still homebirthing. Hope that helps.

[phatchristy]

If you're worried about it, then try to follow a diet which is less carby. Aren't you already trying to get a good 90-100 grams of protein in each day? If you temper your carbs with protein at each meal you shouldn't find any big spikes in your blood sugar. And be picky with your carbs. Nothing with a large glycemic index. Think *whole* grains.

I used to be a TOPS leader, and they used the diabetic exchange plan, and knew some diabetic people...including my MIL. That's what they do.

Personally, I've taken the GD screening my first two births, then after that I declined it last time because the MW told me I could decline it and not to worry about it LOL. I too read some research and was pretty skeptical of it anyhow after that, though I'm sure I would have passed if I had taken it again (I always have 7-8 pound kiddos at around 40.5-41 weeks), pretty normal. This time I'll decline it again, though they do a finger prick test anyhow at the office just so they have something to write down on paper if you're transferred.

Where I go, they told me they do concurrent care with doctors *if* there are blood sugar issues. They've got a couple of doctors they work with. Apparently along as things are under control you can still have a homebirth or a birth center birth (to birth in the center you have to have a doc sign off on it though...as weird as that is, for homebirth no though LOL).

[Otterella]

My midwife is very vocal about her disapproval of the current methods used to diagnose and "treat" GD. Since I also supposedly had GD last time, she is helping me treat my body right now at 12 weeks so it doesn't become a problem later. She has me taking 400 mcg of GTF chromium with each meal (ask your midwife about this before just taking it, because that's a lot more than the bottle says to take). She's also really "strict" (that's probably not the right word, but you understand what I mean by it) about diet, GD or not. When it comes down to it, I'm sure she won't risk me out just for blood sugar (unless it gets to a point where it IS truly dangerous), but she might strongly suggest I see someone else if I ignore her advice and don't take care of myself.

[Lit Chick]

My MWs watched my diet closely, and gave me a talking to when I got too sugary/carby/general crappy. I wasn't at risk for GD and never bothered with the test. They said that most diagnosed GD would be treated with diet anyway.... and they used good diet to avoid the bigger and more real threats of pre-eclampsia.

I know a LOT of women who failed the 1 hr and passed the 3.... and they way the test is given makes utterly no sense to me... so I'd not worry a bit about your HB.

[Katielady]

Thanks, everyone. I think the blood sugar testing is actually making me a little crazy and obsessed. I'll keep going for a full week, and then just take fasting levels from there on it. I figure that would catch anything truly problematic.

I know what to eat that's healthy for me. I just have to do it. Last night I had a big plate of pasta with some chicken for dinner- blood sugar too high. Today I had salad with chicken for lunch- blood sugar perfect. It's not rocket science. But pooh, I love carbs!