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#1 of 16 Old 06-08-2009, 10:07 PM - Thread Starter
 
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Can someone explain to me what the controversy is all about? Any good resources?

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#2 of 16 Old 06-09-2009, 08:46 PM
 
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I'm not totally sure what you are asking here. I can tell you I personally declined the glucose tolerance test and think it is unhealthy and unnatural to force pregnant women to drink glucola. My midwife did a postprandial with a glucometer after I had had a typical breakfast for me, and my numbers came back fine. This article by Henci Goer (author of "Obstetric Myths Versus Research Realities" and "A Thinking Woman's Guide to a Better Birth") pretty much outlines why our approach to managing GD is faulty. Hope this helps!

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#3 of 16 Old 06-09-2009, 10:18 PM
 
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another reason for controversy is that testing is not standardized. There are seemingly random protocols. Each care provider has their own way of doing things. Explained here
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#4 of 16 Old 06-09-2009, 11:20 PM
 
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I have not done the test since my first pregnancy. The above Henci link is what I suggest reading too.

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#5 of 16 Old 06-10-2009, 12:28 AM
 
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There is some controversary among "experts" as well as to whether or gd is a real thing as a lot of the risks associated with it are extrapolated off of what they know happens with women with type I or II diabetes that is not well managed. There is very little real, concrete data on it & the risks are very much blown out of proportion (ie. it is easy to find lists of risks but much more difficult - close to impossible - to find the amount your risk is actually increased for these things if you have unmanaged gd).

There is also the fact that every pregnant woman's blood sugar is higher in pregnancy (it's because of the functioning of the placenta) but if you have gd you are required to maintain VERY low blood sugar levels - lower than that of the average unpregnant person.

The use of different medications to control blood sugar can be controversial as well. Some doctors refuse to use anything but insulin (which adds a huge level of stress to an already stressful time as insulin needs to be injected) whereas others will use different diabetic drugs.

For those with difficult to manage gd (myself included) there is a LOT of guilt heaped on the woman that it is somehow her fault when in reality for some women they can be PERFECT with diet & activity & still be unable to control her blood sugars without medication. Ime there is some disagreement within the medical community as to whether or not this is a real situation (I was actually hospitalized to get my blood sugars under control basically because the endo did not believe I was following the diet strictly & he refused to up the insulin enough. Being in the hospital proved that it wasn't what I was eating but what my body was doing that was the problem).

There is a LOT of guilt & fear mongering involved with gd combined with a lack of concrete information which creates an atmosphere of distrust & controversy

Surviving sleep deprivation one day at a time with dd (Oct '11) & ds (Oct '08).

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#6 of 16 Old 06-10-2009, 12:21 PM
 
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I agree with PPs and I, too, declined the glucose tolerance tests. I have a monitor at home and will check mine periodically. To me, that's far more accurate anyway. My sister had to give up her planned HB with both her first and now her second births because of GD. They have her on such a strict diet, it personally scares me. The articles my MW gave me and stuff I've researched on my own show that women's bodies respond differently to being PG and elevated blood sugar doesn't necessarily constitute a crisis. Also, in order to accurately get a reading on the glucose tolerance tests, you are supposed to fast for at least 12 hours, which I agree is a really BAD idea when PG.

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#7 of 16 Old 06-16-2009, 04:13 AM - Thread Starter
 
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Thanks for all the info and links. I'm trying to prepare for #2 well ahead of time. I made a few decisions blindly trusting my midwives, and I just want to make sure that in a future pregnancy I am accepting or declining testing based on my own knowledge and not my birth attendant's.

I declined the GD test in late pregnancy because my midwives seemed to think it was unnecessary. They said that the disease is not taken seriously in other countries. But, they also told me the Brewer's diet would prevent pre-e. Well... I ended up developing HELLP. I feel the need to be more balanced (conventional vs. holistic) in my approach to prenatal care.

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#8 of 16 Old 06-16-2009, 04:20 PM
 
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My understanding is that the research is unclear whether and to what extent diet can help prevent preeclampsia, though the Brewer diet/protein intake has been shown not to be as important as once thought. HELLP syndrome can develop in the absence of preeclampsia, so probably was not caused by anything you did or didn't do diet-wise, and probably would have happened regardless of who your care provider was.

Either way, imo the "risks" of GD are in a completely different class from preeclampsia/HELLP syndrome -- GD is much, much more benign, and many of the interventions that typically follow from it if you are in the care of an OB are unnecessary. That said, I do think it is worth using a glucometer, either at home or with your care provider, to check your blood sugar, particularly if you have risk factors that may make you more prone to GD, and controlling it with diet and continued monitoring if your numbers are high. I do not think it is necessary to take the glucola test (either the screening test or the 3-hour fasting test) in order to make sure that you don't have uncontrolled GD.

The controversy is more about the treatment of GD and its benefits than whether or not it "exists." Thus, I think the thing you need to watch out for, should you select an OB as your care provider next time and are diagnosed with GD, is that many will ask you to maintain very, very low blood sugar numbers and recommend insulin if you can't get them that low. Then many will recommend additional monitoring starting at 32 weeks (weekly or biweekly nonstress tests) and ultrasounds to "estimate" the baby's size (which are notoriously inaccurate) and then come the recommendations to induce early or schedule elective c-section so that the doc doesn't have to worry about shoulder dystocia, even though SD is not highly correlated with GD, particularly in cases that are well controlled with diet. My understanding is that OB-supervised CNMs will risk you out to the OB if it is determined that you "need" insulin. It's worth checking with your provider beforehand to see how strictly they treat GD if you think you might be at risk of being diagnosed with it. Particularly if you want to have a VBAC.

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#9 of 16 Old 06-19-2009, 12:17 AM
 
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Originally Posted by lifeguard View Post
For those with difficult to manage gd (myself included) there is a LOT of guilt heaped on the woman that it is somehow her fault when in reality for some women they can be PERFECT with diet & activity & still be unable to control her blood sugars without medication. Ime there is some disagreement within the medical community as to whether or not this is a real situation.

There is a LOT of guilt & fear mongering involved with gd combined with a lack of concrete information which creates an atmosphere of distrust & controversy
I agree! In my family, we have a history of GD and as a result very large babies. My first pg, I gained a large amount of weight but had an average sized baby. Second pg, I ate the same, maybe even healthier imo, and gained way less...had an 11.3 pound baby. In that 2nd pg, I tested positive for GD with a doc, had the longer screen at the hospital and narrowly escaped the parameters. Given his size at birth (and, mind you, I was more active than the first pg), I believe GD was to blame. However, at the birth and even throughout the pg, I was made to feel guilty by my mw for the amount of protein I ate being to blame for baby's size. Basically, I was told it doesn't exist and my diet was to blame. I still carry unsettled feelings regarding that experience. Definitely guilt.

Sorry to hijack, just wanted to give my experience.

 

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#10 of 16 Old 06-19-2009, 12:20 AM
 
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Originally Posted by magnoliasmama View Post
I feel the need to be more balanced (conventional vs. holistic) in my approach to prenatal care.
So very important as a consumer and mother! I agree with you. Just as one wouldn't walk blindly through a doctor's care, one shouldn't walk blindly through a mw's care. I believe there is a good balance to be achieved based on your personal situation. And if the health care provider you're working with won't accept that, then it's definitely time to find someone new who trusts you and your feelings.

Best of luck in your plans!

 

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#11 of 16 Old 06-19-2009, 01:02 PM
 
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I'm considering not taking the GTT if I'm still feeling good @ 28W, as I have no other risk factors. Has anyone declined the test with a doctor as your care provider? Is it worth the hassle to go take the test just to get them off your back for the rest of the pregnancy?
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#12 of 16 Old 06-19-2009, 01:59 PM
 
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Originally Posted by nina_yyc View Post
Is it worth the hassle to go take the test just to get them off your back for the rest of the pregnancy?
I've never declined a GD test, but if you really feel you don't need it, then I'd decline. I've declined other blood tests that the doc felt were absolutely necessary, and they were angry, but tough. Why waste the money and suffer through an unnecessary test if you truly don't want it?

 

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#13 of 16 Old 06-19-2009, 05:21 PM
 
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I would decline if I felt I was making an informed choice but NOT based just on how I felt. My blood sugars were grossly out of control (again, despite my BEST efforts) & I honestly felt FINE. This is obviously different for everyone but the only time I felt at all off was when my sugars were dangerously low.

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#14 of 16 Old 07-05-2009, 08:41 PM - Thread Starter
 
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Originally Posted by Thandiwe View Post
I agree! In my family, we have a history of GD and as a result very large babies. My first pg, I gained a large amount of weight but had an average sized baby. Second pg, I ate the same, maybe even healthier imo, and gained way less...had an 11.3 pound baby. In that 2nd pg, I tested positive for GD with a doc, had the longer screen at the hospital and narrowly escaped the parameters. Given his size at birth (and, mind you, I was more active than the first pg), I believe GD was to blame. However, at the birth and even throughout the pg, I was made to feel guilty by my mw for the amount of protein I ate being to blame for baby's size. Basically, I was told it doesn't exist and my diet was to blame. I still carry unsettled feelings regarding that experience. Definitely guilt.

Sorry to hijack, just wanted to give my experience.
Thandiwe, I'm sorry to hear about your experience It seems as though midwifery can sometimes be just as dogmatic in their views as doctors. You shouldn't feel guilty, and your midwife should not have laid a guilt trip on you. I hope you at least had happy, empowering birth.

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#15 of 16 Old 07-06-2009, 09:45 PM
 
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Originally Posted by lifeguard View Post
I would decline if I felt I was making an informed choice but NOT based just on how I felt. My blood sugars were grossly out of control (again, despite my BEST efforts) & I honestly felt FINE. This is obviously different for everyone but the only time I felt at all off was when my sugars were dangerously low.
:

I've had severe GD in all three pregnancies (requiring insulin)... yet I never felt that my blood sugar was out of whack. It was always a surprise to see just how high they were with my meter.

I ended up with 3 babies near 10 pounds too... but healthy.

I actually think that testing your blood glucose with a meter 2 hours after meals and in the morning before breakfast for a few days is a much better test that the GTT. However, I realize that not everybody has access to a meter.

Mom to DS(8), DS(6), DD(4), and DS(1).  "Kids do as well as they can."

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#16 of 16 Old 07-07-2009, 08:55 PM
 
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Thandiwe, I'm sorry to hear about your experience It seems as though midwifery can sometimes be just as dogmatic in their views as doctors. You shouldn't feel guilty, and your midwife should not have laid a guilt trip on you. I hope you at least had happy, empowering birth.
I did, thank you for asking. I felt happy and empowered. Ironically, my midwife only showed up for the last 15 minutes of the birth, so maybe that made a difference?? Anyways, this time around, we've found a new midwife, one that I hope will continue to blend with my views better.

 

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