Gestational Diabetes and Rhogam worries!! - Mothering Forums

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#1 of 13 Old 10-13-2005, 01:16 PM - Thread Starter
 
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Hi,

I have two major issues going on right now. Our little boy is due January 6th, 2006. I had gestational diabetes with my first pregnancy which was undiagnosed and therefore untreated. My daughter had a number of problems due to this and was in the NICU for 6 days after birth. It was definiatley not the beautiful homebirth we had planned!! This pregnancy I am being managed medically because of the previous diabetes. I have found a terriffic doctor who is very natural birth oriented and has a section rate of only 8%, which is practically unheard of. I am very comfortable with her. However, she has recommended the Rhogam shot for me because I am neg and dh is pos. Last pregnancy I did not have the 28 week shot, I wanted to wait until the baby was typed. She was O- just like me, so no worries. That was with a lay-midwife though and it was not even an issue. My doctor does have the murcury free shot, I already read the package. However, it seems like there could be a number of other issues with Rhogam. Does anyone have any good links with solid study information? I want to be able to show my doctor I have done research and that although I respect her opinion, I still want to wait until after the baby is born. I have been doing a lot of looking around, but it seems most of the information is opinion, and I want facts, studies, hard numbers.

Also, my diabetes problems have reared their head, I failed second one-hour test and I am having to have a 3 hour now. I have already had a one hour and a three hour about 6 weeks ago, they are testing me frequently to keep an eye on things. I passed the 3 hour just fine. I know that GD is something that shows up later in pregnancy, with my dd it was probably around 32 weeks that things went wrong. Because of the many problems she had I am convinced I should listen to my doctors advice to control the situation. Does anyone have success stories where they were diagnosed with GD, but had good natural births? I am so scared of things going like they did last time, a horrible c-section and a very sick baby. I just need some hope! I am really discouraged that even with huge changes in my diet I still failed the test. Any stories with good outcome will be so appreciated!! Thanks!

Alice
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#2 of 13 Old 10-13-2005, 02:52 PM
 
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Can I tell you half a good story? I had gestational diabetes diagnosed late in my last pregnancy. I wound up on insulin, went from wonderful midwives to a medically managed situation. My dd was born by caesarean for reasons totally unrelated to the diabetes- she was breech with one leg up and one leg down- truly stuck.
The good part was that her apgars were 9 and 9. I nursed her 20 minutes after her birth, and she never had a moment of health issues. If your blood sugars are managed, you shouldn't expect your baby to be sick at all.
Can I make a suggestion? If I were you, rather than continually taking those nasty drinks, I'd get a monitor and start some testing at home. I honestly think that would give you a better idea of what's going on.
Good luck,
Mary
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#3 of 13 Old 10-13-2005, 08:28 PM
 
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Hi Alice,

I am afraid I don't have any good links to offer you in regards to the Rhogam shot. I too had read some things that made me question whether or not the 28 week shot was really necessary. It is incredibly difficult to find solid sources on this topic it seems.

I spoke to my doctor about it and she said that they only use the mercury free form here and that she adamantly says I must have it. Her reasoning was that even if you haven't had any spotting or invasive proceedures, they can not guarantee that there has been no mixing of maternal and fetal blood prior to birth. Once you develop the antibodies, you have them for life and the impact that this can have on future children can be extremely serious. My doctor is very open-minded and does not prescribe something without due cause. I also spoke with my midwife (midwifery professor and practicing midwife for 25 years). She agreed whole heartedly with my doctor that the risk of not having the mercury-free rhogam at 28 weeks is much greater than any possible side effects of having the shot.

This was enough to convince me. So I will have my shot next week.

Best of luck with your decision, I know it is not an easy one whichever way you decide.

~Stargirl

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#4 of 13 Old 10-14-2005, 01:09 AM - Thread Starter
 
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Well, after a lot of reading and thinking I have decided to forgo the Rhogam shot. From what I have read the pre-birth shot only drops your chances of becoming sensitized by 1-2%. That is almost a negligable amount. I talked to the nurse at my doctors office today and she told me that my bloodwork came back negative for sensitization, which I figured, so I see no reason to do something that is not necessary. Another fact that helped me decide no is that in Europe they only do the shot after birth, never before. Europe in general tends to be a lot more consertive medically, and if there were babies or mamas dying or getting really sick from this condition they would not have such a standard. In Europe the drug companies don't have nearly as much clout as here in the US since most places have socialized medicine. From what I read the drug companies have done all the push on the 28 week shot here. And why not, they make twice as much if they can make everyone do it twice!! Anyway, I will definiately have the shot if this baby comes out + though. The stuff I was able to find said that with a shot within 72 hours of birth your chance of ever getting sensitized is only 1-2%, which means 98-99% of women are protected just fine. Additionally, I am really not too concerned about being sensitized because we are planning for this to be our last baby anyway! So, it's practically a non-issue. If anyone has other info. or opinions I would love to hear them, it's so interesting to learn from others!!

Thanks!
Alice
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#5 of 13 Old 11-07-2005, 03:03 AM
 
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Hi Alice,
You posted this a while ago, but I just read it now and it's been up for me since I'm 28 weeks along and just had this conversation with my midwife. My first dd was rh+ so I had the shot after her birth. I had an early miscarriage in December and my md didn't think to give me a shot and I didn't think of it either. I tested the sensitivity early on in the pregnancy and it came out negative. This week I took the gestational diabetes test (still waiting that result) and another rh sensitivity test.

I have chosen not to get the shot but have agreed that if I have a fall/accident/some sort of physical trauma to my body before the baby is born then I'll come in for a (mercury free) rhogam shot.
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#6 of 13 Old 11-07-2005, 08:12 PM - Thread Starter
 
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I did test positive on the 3 hour test for diabetes, in-fact I failed all four blood draws. I am now checking my levels 4 times a day at home, and am keeping things in check by watching my diet. The only worry has been that my fasting reading when I wake in the morning is consistantly high, for some reason my body just stops making insulin when I sleep!! There is a possibility that I will end up on just an evening dose of insulin, but we'll see. In the mean-time I have figured out that I absolutly cannot drink milk. My brother-in-law mentioned to me that drinking milk is the only thing that seems to keep his blood-sugar levels high (he is monitoring because he is boarderline diabetic), so I did some experimenting and found that the same is true for me!! In fact, I can drink fruit juice and my sugars balance as they should, but if I drink milk they stay high for too long! I find it weird, but facinating! Since I have cut milk from my diet I have had very few high readings during the day. The same is true for my BIL. So, if you are trying to balance your sugars I suggest cutting milk out, it's worth the try!!!

My doctors are still very positive that I will have a successful VBAC, but I would love to hear from those of you who had GD and had a good birth just for the sake of my morale!!

Thanks!
Alice
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#7 of 13 Old 11-07-2005, 09:03 PM
 
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Thanks for the tip about the milk! I was diagnosed GD almost 2 weeks ago, but didn't get the testing equipment and training and nutrition education until Friday.

Today, for the first time (I usually only drink milk in the evenings), I had milk at lunch and I felt terrible all afternoon. And my numbers were slightly outside of target and stayed that way for hours.

This is my 5th pregnancy, and my first GD diagnosis. I'm still in denial mostly.
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#8 of 13 Old 11-07-2005, 09:26 PM
 
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It is very interesting to read about the milk. I tested positive for GD at 9 weeks (I think-- long story) and recently switched to soy milk only because cow's milk has so many carbs, and when you are only allowed 25-50 carbs per meal (depending on the meal) you don't want to "waste" carbs on something you drink! I have noticed that my levels have stabilized since I started drinking soy (they were never very high, but now I get less "over 130" readings).

I have to take insulin at bedtime. My Dr. says it is very common for GD patients to do this, even if you are watching your diet, and exercising (walking is the best form of exercise right now ). Your hormones create more blood sugar at night, which is why it gets so high. I was able to regulate my blood sugar by walking ALOT. I walked after each meal and just before I went to sleep. However, I haven't been as diligent about that, and the further along I get, the more insulin I need (this is also normal for a GD patient).

Did your doctor talk to you about induction at 38 weeks? My doctor wants to induce me no later than my due date. She cites higher in utero mortality as the reason. She also mentions macrosomia, although she is willing to try the Gaskin maneuver (rolling onto all fours) before c-section.

Feel free to PM or email me if you have questions or suggestions!
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#9 of 13 Old 11-09-2005, 12:11 AM - Thread Starter
 
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I am not sure about the induction at 38 weeks. We are going to do an ultrasound at 36 weeks to estimate size and such, and then go from there. This is my second baby and will be a VBAC, I had GD the first time also, but it was undiagnosed and therefore uncontrolled and I had a huge baby (10 pounds 12 ounces!!). That's another story for another day though!! My doctor is very leary about using induction for a VBAC, so my best bet is to keep things controlled. I am hopeful that we will have a normal, natural birth, and I am keeping my fingers crossed!! As long as the baby is not huge we will be letting things take their natural course.

How is it you were diagnosed so early in your pregnancy? That's amazing! I passed a 3 hour test at 24 weeks, but failed at 28, go figure!

Alice
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#10 of 13 Old 11-09-2005, 02:31 PM
 
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I have actually heard that GD testing early in pregnancy isn't always accurate. I had several factors that led to my early diagnosis:
1. My Dr. is one of the Diabetic Specialists on staff.
2. I have (had?) PCOS, which is caused by Insulin Resistance: it can lead to Diabetes later in life.
3. I have several of the factors for GD: I am 100 pounds overweight, and I have a family member with Diabetes (1 grandma who was over 200 pounds overweight, and had several other complications which eventually led to her death in the 70s).

I really thought they had misdiagnosed me, but my sugar spikes occasionally during the day, and always at night. I decided I would go along with their diagnosis because I didn't want to harm my developing fetus if I had "actual" diabetes.

I hope you will be able to go on baby's own time! I wasn't looking forward to getting induced, but have since come to terms with it.
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#11 of 13 Old 11-09-2005, 09:16 PM
 
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I don't know what I'mdoing about Rhogam. I'm past the 28 wk mark, which is when our back-up OB recomends getting it. I did it at 32 weeks with both previous pregnancies (and post-partum). I'm 30 wks now. I can't find anything that really moves me in one direction or the other about getting it antenatally. I'll probably go ahead and do it if they have the mercury-free version. Previously I never had the titre drawn, this dr does draw the titre, which is nice. The only downside is that it's a 35-minute trip each way for me to get the blood draw and shot. They give me the shot to take home actually. I dunno. I have to call them soon if I'm going to do it. I'm certain that if I'm in some type of accident or anything liek that that I will take it then, immediately. If I keep stalling, I guess I'll be only taking it post-partum

Namaste, Tara
mama to Doodle (7), Butterfly (2), and Rythm (due at home 1/06)
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#12 of 13 Old 11-11-2005, 11:13 PM - Thread Starter
 
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I saw the doctor today and I was told that we most likely will induce at 38 weeks. We will have an ultrasound at 36 weeks to guesstimate the baby's size and go from there. Due to my failure to progress the first time with a 10 pound 12 ounce baby she wants to have my labor start with this baby at under 9 pounds so I have a better chance of doing things naturally. Of course, inducing raises the risk of things not going naturally, so I am kind of between a rock and a hard place!! I trust her though, and I know she really wants me to succeed with a VBAC. We also finally decided on a doula and we will be having our first pre-natal with her next weekend. I can't believe we are in the home stretch, if we induce at 38 weeks I only have 6 weeks left!!! Wow!!

Alice
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#13 of 13 Old 11-13-2005, 01:20 PM
 
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Alice--
Because I know my Dr. wants to induce at 38 weeks, I have been taking stuff to get me ready. I am taking RRL tea (which is good anyway) and EPO (orally right now; vaginally at 36 weeks).

I am also planning on getting a massage the day before my desired due date. This is supposed to jump start my labor. If it doesn't, I will at least feel relaxed for my labor .

I have really had to come to terms with being induced. I kn ow it isn't the best way to birth my baby; but at the same time know that this may be the best shot for a healthy baby.

My Dr. had originally said that she would induce at 38 weeks at the latest. Because my GD has been under control all pregnancy ( Dxed during 1st trimester) she has since pushed that date back to 40 weeks; saying she will let me go to my due date, but no further. Talk to your doctor, and see if s/he can be that flexible.

Dr. is now seeing me weekily, and giving me non-stress tests each visit to check on the health of this baby.

I am telling you all this, so you might know what to expect ( or know your options before you need to user them).

Happy rest of the pregnancy, Mama!!!
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