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Old 06-27-2014, 09:28 PM - Thread Starter
 
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Type II Diabetes

Could someone help me out. I have tried researching this, but must not be looking in the right place. I have had two births, including a homebirth with my most recent. Over the course of these two births, I have worked with two midwives who both agree I did an awesome job taking care of myself the last time. However, if I get pregnant again, neither will take me because I am on oral medication for diabetes. Can anyone explain why this would be different than having diabetes and not taking medication for it?
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Old 06-27-2014, 10:53 PM
 
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did you have diabetes when you were pregnant before?
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Old 06-27-2014, 10:58 PM
 
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I don't have any experience with diabetes, but with a quick search, I did find that apparently while in labor/delivery your levels need to be evaluated regularly. Perhaps, they don't want to take the risk of not properly maintaining your levels during that time?

here is the site I found the above info on.... http://www.diabetes.org/living-with-...ons/pregnancy/
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Old 06-28-2014, 10:31 AM
 
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Because they probably aren't allowed due to the state rules and regulations, which is ridiculous. YOU are the one who gets to make these choices for you and your baby. They likely are just scared of the repercussions on them professionally. I would sit them down after you have done all of your research and tell them that you understand the risks and that you ARE having a homebirth and that if they respect women and believe they can make their own choices, that they will support you and work with you. I am so tired of midwives saying they are "with women" when they really are "with state". I'm sure they are intelligent enough to collaborate with you and come up with a reasonable and appropriate plan for your pregnancy and birth. There is a lot of information out there about recommended management of things like Type 2 Diabetes. Learn what a doctor would do, research whether or not those practices are evidence based, and then decide what YOU want and are most comfortable with.
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Old 06-28-2014, 11:41 AM - Thread Starter
 
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Quote:
Originally Posted by BlessedOne View Post
did you have diabetes when you were pregnant before?
No, I did not have diabetes before. They may need to monitor, but I see no difference in what they would need to do while I am on medication. They will take me if I was not on oral medication.

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Old 06-28-2014, 11:43 AM - Thread Starter
 
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Margo, that would normally make sense but they are not licensed. Midwives here operate illegally anyway, so they are not worried about the states "rules." I am trying to do research now. These midwives know I can do this. I gave birth in one of their homes!

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Old 06-28-2014, 11:53 AM
 
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In my state (VT), licensed midwives (CPMs) aren't allowed to do homebirths for clients with any type of diabetes, along with a pretty long list of other conditions (breech presentation, multiples, less than 18 months since C-section, thyroid issues). If they're saying they can't/won't do your homebirth because of state rules/regs, you might be able to find a lay midwife who would be willing to take you as a client. They may also feel that even with well-controlled diabetes, you are not a low-risk pregnancy, and it's a risk they aren't prepared to accept.

I have T2 diabetes as well, treated by oral meds outside of pregnancy. I have been told that I'll need to take insulin during pregnancy--because (a) the oral meds aren't approved for pregnancy (ironic, since Metformin is often prescribed as a fertility drug, so is frequently taken by women while TTC and through the first trimester), (b) the BG numbers you are supposed to meet during pregnancy are so strict that my fairly good control pre-pregnancy won't be good enough during pregnancy (some doctors want fasting BG readings to be under 90, where the non-pregnancy goal is under 100), (c) insulin resistance can increase dramatically during pregnancy, so that you may not be able to stay on just oral meds. With that presumption on the part of the medical establishment, I can understand their blanket "no homebirths for diabetics" stance, even if I'm not thrilled about it, and I don't personally think that well-controlled diabetes should risk you out of homebirth.

Given all that, I'm pretty resigned to having a hospital birth. Luckily, there is a very natural birth friendly hospital with great midwives near me, so I'm hoping that I'll be able to have a low-intervention pregnancy and birth despite my diabetes. I do worry that once they'll peg me as high-risk, I'll be on a totally different, high medicalized "track," but I guess I'll cross that bridge when I come to it.

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Old 06-28-2014, 01:06 PM
 
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Even unlicensed midwives generally (and should!) follow a set of risk guidelines. In most states, a midwife can't attend your birth at home if you are diabetic and require medication to control your blood sugar or have diabetes predating pregnancy.

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Old 06-28-2014, 04:19 PM - Thread Starter
 
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I suppose I am trying to find out why being on medication matters vs. not being on medication for diabetes.

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Old 06-28-2014, 06:43 PM
 
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If you need medication to control your diabetes, it adds a layer of risk to your pregnancy.

Here's some information:

http://www.marchofdimes.com/pregnanc...-diabetes.aspx

http://www.nhs.uk/Conditions/pregnan...-pregnant.aspx

Midwife (CPM, LDM) and homeschooling mama to:
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Old 06-29-2014, 07:58 AM
 
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My understanding is that the bigger risk is to the baby after birth.
If your diabetes is controlled by medication the babies blood sugar levels are also controlled by that medication. Once the baby is born their system needs to take over insulin production/levelling and that can be a bumpy ride for them. That is why they also pay close attention to sugar levels every little bit during labor, so they know just what is going on with the baby at birth. I am not sure, but that's what I have gathered.
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Old 06-29-2014, 10:56 PM
 
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I think it goes back to you doing the research about how you would be managed in a hospital, figuring out what is evidence based or not, deciding the management you want, and if you could do it at home yourself. If you present your midwives with the plan, I can't see why they wouldn't support you. You likely can do all of the management yourself and they can just attend you like any other laboring woman. I've certainly read diabetic homebirth stories, but don't have the links handy at the moment.
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Old 06-30-2014, 10:32 PM
 
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"If you present your midwives with the plan, I can't see why they wouldn't support you."

One reason is if it violates their practice protocols.

Midwife (CPM, LDM) and homeschooling mama to:
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Old 07-01-2014, 03:28 PM
 
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Right, but if a midwife is presented with a well researched and sensible plan, and a woman wants her assistance, I would hope that she would extend her support, particularly since in this case they are not bound by regulations. I wouldn't have made the same comment if she had said her chosen midwives were licensed. I'm not currently practicing, but plan to in the future (in an unregulated state) and that is what I would do as a midwife/birth attendant. I have heard of plenty of midwives attending women in similar situations, so it isn't far fetched.
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Old 07-01-2014, 04:10 PM
 
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Following on fillefantome- if you need insulin during labor, are the midwives comfortable being "in charge" of that. Your needs will be different in labor than in pregnancy, so you won't perhaps be as comfortable managing it. Are they comfortable making the call about what diabetic meds you need during pregnancy. Who will write the prescription (I believe it will be for insulin, but I'm not certain). Primary care won't want to if you're pregnant, I bet. Are they comfortable managing a hypogylycemic newborn, or mom for that matter. I get that a lot of these are bridges you may never come to, and you are saying "just trust me, I can manage my own BS levels in labor" but maybe in the moment you won't be able to. And the midwives will have put themselves in a position where they are outside their comfort zone. Midwives may be comfortable managing the birth itself, but are they comfortable managing a woman with diabetes.
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Old 07-06-2014, 04:28 PM
 
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"are they comfortable managing a woman with diabetes"

And keep in mind that it's well outside most midwives' scope of practice.

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Old 07-07-2014, 07:26 AM
 
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But why wouldn't the midwives be comfortable attending your labor if YOU are in charge of managing those things which are outside their scope. I would just make it clear that you will be managing your blood sugar, and they are welcome to help with that if they want, but otherwise they are there to attend your labor like anyone else. If you take full responsibility of your birth, and make it clear that they are there in the role of helpful advisors and hands on support if needed, then what is the problem? I'm so tired of midwives deciding who "can" have a homebirth or not. Help women birth at home if that is what they choose. Women are not stupid. I get worked up about this because I'm not "allowed" to birth at home with a LM in my state, and most midwives would not be comfortable with my "managing" my health situation either. Good thing it isn't up to them!
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Old 07-07-2014, 08:07 PM - Thread Starter
 
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Thank you for all the replies. I am trying to research this more, because I will be doing it at home next time, with or without a midwife.

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Old 07-07-2014, 10:37 PM
 
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I am sorry you are facing this.

After two successful homebirths, you would think you could do it a third time. As previous posts have informed you, the baby needs special attention at birth to adjust the blood glucose levels and keep them even at birth in addition to all of the other things

A homebirth story from nearly 100 yrs ago in New Jersey may let you know why.

The mother was an Italian immigrant who was having her first baby. The mother was diabetic and the baby was very large. After a difficult labor, the baby was born at home, and 15 lbs.! But he appeared to be dead. The midwife did several things to get the baby to breath. The baby finally took his first breath when she ran some cold water on the baby to shock him into breathing. He cried! His lungs filled with air. He was Frank Sinatra. He was also the ONLY child born to this Italian family, a rarity in that culture.

There are variations to this story, but that is the basic story. Yes, diabetics have had babies at home, but not without plenty of problems. So in our day, the hospital is considered the best place to deal with such problems. Anyway, I hope you can make peace with the situation and let us know what happens.

http://schreibe.wordpress.com/2011/0...aumatic-birth/
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Old 07-08-2014, 09:58 PM
 
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Margo B- there probably are some midwives who approach their role and general calling like that- like a menu from which you can order. Labor support yes, managing certain complications of labor no (such as what labor can do to moms metabolic state). But many would view it as they are there to care for the whole woman, probably because that is what most women expect (even some who may say otherwise, not to imply the OP doesn't know what SHE wants, but SOME women may be this way). And imagine being a midwife at a home birth, watching a mother or baby seize due to hypoglycemia, not knowing what to do or even knowing what to do but also thinking, this is what I wanted to avoid... Or a shoulder dystocia that may have happened anyways, and that they are trained to manage but are still nightmare inducing, and all the what-ifs.... The midwives have a right to say no to those fears (and of bringing those fears to a moms birth, which is no good for mom). The midwives don't say who can home birth- you can of course do it on you own and UC. They do have a a say in their own careers, and what home births they go to.
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Old 07-08-2014, 10:07 PM
 
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I don't mean to be fear-mongering with my above what-ifs- they are probably very uncommon (although I don't think there's reliable data about it in a HB setting, b/c it is uncommon for insulin-dependent women to birth at home)- just talking about the fear the midwives may bring with them to the birth, and why if you felt very comfortable with it, you would probably have more success UC-ing with support people who could help you with any diabetic issues (like, if your BS gets low and it makes you goofy enough that you don't even realize you BS is low, but a friend could notice you slurring your words and give you some glucose then protein etc) than finding a HB midwife to convince to attend.
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