[mrsfatty]

So, I've seen a spattering of OBGYN's since my doctor is out on maternity leave (she's back in two weeks--WOOPWOOP)...and the doctor I saw today FREAKED that I didn't take the glucose tolerance test, my BMI is over 30 so I HAVE to get weekly Bio-physical-profiles (BPPs) and NSTs, and my nurse practitioner measured me last week at 32 weeks (which was fine since I was 31.5 at the time)--and the doctor TODAY measured me at 43 weeks (SAY WHAT???)...

So, I'm 33.5 weeks right now. I'm overweight (started this pregnancy 10 pounds heavier than my last pregnancy--which was NOT this "managed"). My blood pressure was a bit up (but I was chasing my kiddos and anxious)--but not over the 140/90. No sugar or protein in my urine.

I feel like she had a HUGE overreaction to me not taking the GTT and the slight BP increase and is just insisting I take the weekly BPP and NST because I'm fat--not because there is an actual medical reason for it. Oh, and she's insisting that because I measured so big today I MUST have GDD and I'll need a c-section (ummm...no)...

SO...what are the benefits/risks (not that the tests themselves are "risky") of weekly BPP and NST? I agreed to do one next week--but don't want to do anymore (unless there's a problem)...because I feel like it'll be an "excuse" for the doctors to push for earlier delivery and/or c-sections unnecessarily--and I'd rather not "arm" them with that kind of "information"--(even though I KNOW ultrasounds are NOTORIOUSLY wrong at this stage in the game and I wouldn't depend on that info for deciding for interventions--I don't want to deal with the pressure they'd put on me based on their "facts" they'd collect from those tests)...any people been there done that, thoughts, comments, fellow overweight mamas deal with this kind of stuff?

 

[soxthecatrules]

BTDT w/both pregnancies--no weekly BPP though. I was overweight before both of my pregnancies. I ended up developing both pre-e (DS only) and GD w/both and was watched over like a hawk. I had 2x weekly NSTs for the last 6 weeks of both pregnancies. DS ended up being born 4 weeks early due to the pre-ec and DD was 1.5 weeks shy of her due date as my BP was starting to rise (not officially pre-e though).

I have consulted w/both of my doctors (OB and GP) and they both indicated that my being overweight was not the root cause of my problems. I would have had these problems even if I was at my ideal weight. My extra poundage may have aggravated the issues but were not the main cause.

My point is to not let the doc bully you simply b/c you're overweight. I would think you only need these tests if something were truly wrong.

 

[abigail_b]

Well, most probably won't agree with me, but I would go with the weekly NSTs if they are recommending them because they are non-invasive and I don't think will be likely to cause any other unnecessary interventions. If anything looks iffy on the NSTs then they would order a BPP, but I don't think a weekly BPP is going to help anything- because as you said the U/S weight estimations are usually quite wrong at this point.

I had a lot of NSTs at the end because my son was barely moving and it was really stressing me out. I didn't find the NSTs to be a big deal, and normally I left with my mind at ease. There was one time where the heart rate dropped so they ordered a BPP, but everything looked find on the BPP. I ended up having my membranes stripped at 39 weeks 0 days and then had him at 39 weeks 6 days (not sure if it was because of the membrane stripping or not) I had an uncomplicated birth and he was born at 8 1/2 pounds, and it turned out he had a true knot in his cord, so I was really glad that I had him when I did, since if he had gotten too much bigger the knot could have been pulled too tight.

So in summary, I agree do not let them bully you because of your weight, but going in once a week for a NST is probably not a bad idea just to make sure everything is okay.

 

[Amydoula]

I've got GD with this pregnancy and have been doing weekly NST's since 32 weeks (35 weeks now), and I start the weekly ultrasounds next week at 36 weeks. They really aren't bad, it just makes my appointments last forever. I'm thin and have low blood pressure and I still have to go through all the interventions......

 

[cristeen]

Well, my first issue would be that you supposedly jumped in size from 32 to 43 cm in a week. That's not terribly likely - but just to be sure can you call the NP you saw last week and arrange to have her measure you again? If the measurement is truly that drastically different when done by the same person, then I would say do the tests, there's something not right. But if the NP comes up with a more reasonable figure, then I'd say wait until your OB comes back from mat. leave in 2 weeks and not deal with that doctor between now and then.

Honestly, any doctor who is going to freak out that much at a pregnant woman is not someone I would trust with my care - or to interpret test results. Because statistically reliable or not, many doctors treat those tests as gospel, and that doctor's attitude up to this point would make me suspect she's one of them.

Not to mention being obviously fat-phobic.

 

[OneLove]

I am 33.5 weeks too!

I just took the 3 hr GTT at 30 weeks and had one reading off, they ordered a second test (at 32 weeks) and my middle 2 readings were high. So, now they have diagnosed me with GD and I just got all the glucose testing stuff yesterday. I think I can control it with diet, since my fasting and final readings were fine. (They set their acceptable glucose level relatively low for GD, bc it is a university hospital and they have a research specialist that wants to catch everyone; Otherwise, I might have just been clear of the diagnosis if I was at a different practice).
Still, I was surprised that after lunch yesterday, which was all really healthy, high fiber carbs and some fish...I had a 136 reading! So, basically I can't eat hardly any carbs. I was fine with a dinner of salad and protein only.

I am on my 3rd child and I'm 37 years old. Before the GD diagnosis, they already wanted to do weekly NST bc of my age. I was trying to avoid the NSTs, but now that I've been labeled GD, they want to do 2 NSTs a week and an ultrasound at 36 weeks. That seems like a bit much to me! (I agree with you about all the issues of the NST leading to increased, unnecessary, inductions as well as the invalidity of these ultrasounds to measure size).
I am torn, bc I wanted to birth in the hospital birthcenter, and if I refuse things I am out of the BC.

I am going to meet with a midwife next week to discuss a homebirth, which my insurance will not cover, but at least it gets me out of the hospital.

Are you refusing the GTT? What if you take it and pass? Will that satisfy them? I asked for it, bc I had noticed that I was tired a lot, and craving carbs.

I gained a ton of weight with my first child and started off heavy with my 2nd child - I just missed GD with my second. My kids were 8lb 11 oz. This pregnancy, I have not gained as much weight, but I start off 20-30lbs heavy.
I am starting to believe that I had insulin resistance with my 2nd child, and his birth was fine.

A little bit of the NST could be helpful, bc you do want to avoid pre-e, but it sure sounds early for them to start all that testing (it is bc of your blood pressure?). Otherwise, I would wait until the last month? (like 37 weeks?) Or, if you do this one now, and then your blood pressure is okay, you should be able to skip the rest, unless you have something else happen.

(I know all this medical testing is so stressful! I am wondering if that is why my insulin levels were high, bc yesterday was very stressful for me and that's when I had the high post-lunch reading).

For me, the pain is that I have my 2 kids with me all the time, and dh is working on his doctorate right now (besides work all day). I also breed dogs and have 2 females due in a couple of weeks, so it's really hard for me to get away for super long appointments. And I have no signs of any problems.

Andee

 

[AGierald]

I did weekly NSTs because of PTL, but no BPPs until i was 40w. Your doc will be back in 2 weeks, right? I would do one week of NST and BPP and then blow off the rest if the results are good, IMO. Or, do the NSTs only, but theres no way I'd be doing weekly BPPs for no reason.

And I dont like the concept of the GTT either. I got sooo sick because I put myself in a glucose situation Im not normally in... drinking no water, gulping orange soda and not eating. Thats abnormal, so I don't understand how test results can be accurate when taken under circumstances that I wouldn't be in otherwise. Sorry, ranting, lol.

Good luck!

 

[cristeen]

Quote:

Originally Posted by OneLove (They set their acceptable glucose level relatively low for GD, bc it is a university hospital and they have a research specialist that wants to catch everyone; Otherwise, I might have just been clear of the diagnosis if I was at a different practice).

Hate to say it - but this doesn't "catch everyone"... falsely lowering the numbers winds up medicalizing otherwise healthy people and pregnancies. The numbers generally used are the numbers that have been studied for non-pregnant women to begin with, to lower them even further is ridiculous, IMO.

 

[mrsfatty]

Quote:

Originally Posted by cristeen Well, my first issue would be that you supposedly jumped in size from 32 to 43 cm in a week. That's not terribly likely - but just to be sure can you call the NP you saw last week and arrange to have her measure you again? If the measurement is truly that drastically different when done by the same person, then I would say do the tests, there's something not right. But if the NP comes up with a more reasonable figure, then I'd say wait until your OB comes back from mat. leave in 2 weeks and not deal with that doctor between now and then. Honestly, any doctor who is going to freak out that much at a pregnant woman is not someone I would trust with my care - or to interpret test results. Because statistically reliable or not, many doctors treat those tests as gospel, and that doctor's attitude up to this point would make me suspect she's one of them. Not to mention being obviously fat-phobic.

No, I do not believe the doctor today measured me correctly at all...hard to explain. When my NP measured me she was very careful to press down and find the top of my uterus--she kinda jiggled the uterus (top to bottom) to get the right feel for it and took those measurements. The doctor today just placed the paper tape measure on my pubic bone and up to the top of my belly bump (which is at my bra line)--so basically she loosely measured my torso height, not my fundal height (in my opinion).

I do also think it's important to mention that I've gained 17 pounds this pregnancy--and no weight in the last 2.5 weeks (which I've been told it's completely fine if there are weeks I don't gain)...so it's not like I packed on a ton of weight and then had a larger measurement...I think she is just fat-phobic...

My real doctor is back in two weeks...I'm so thankful!

 

[mrsfatty]

Quote:

Originally Posted by AGierald I did weekly NSTs because of PTL, but no BPPs until i was 40w. Your doc will be back in 2 weeks, right? I would do one week of NST and BPP and then blow off the rest if the results are good, IMO. Or, do the NSTs only, but theres no way I'd be doing weekly BPPs for no reason. And I dont like the concept of the GTT either. I got sooo sick because I put myself in a glucose situation Im not normally in... drinking no water, gulping orange soda and not eating. Thats abnormal, so I don't understand how test results can be accurate when taken under circumstances that I wouldn't be in otherwise. Sorry, ranting, lol. Good luck!

That's what I am going to do--one week of the test results...if they are fine, I'm not even going to think twice about it...if they come back with possible problems, I'm going to discuss it with my regular doctor who comes back the last week of April.

Thanks!

 

[mrsfatty]

Quote:

Originally Posted by OneLove I am 33.5 weeks too!

YAY! How fun!

Quote:

Originally Posted by OneLove Are you refusing the GTT? What if you take it and pass? Will that satisfy them? A little bit of the NST could be helpful, bc you do want to avoid pre-e, but it sure sounds early for them to start all that testing (it is bc of your blood pressure?). Otherwise, I would wait until the last month? (like 37 weeks?) Or, if you do this one now, and then your blood pressure is okay, you should be able to skip the rest, unless you have something else happen.

I refused the GTT...mainly because they "forgot" to have me take it in the "normal" 24-28 week range. Then I had an appointment with a doctor (different doctor in the practice--again, I've been seeing a spattering of doctors, since mine is out) and they noticed I hadn't taken it yet--we talked it over and he didn't think it was necessary for me to take it...he was more like, "I mean, you CAN take it if you want to, but after talking with you, I don't think you NEED to take it"...and when I told the doctor from today about that, she just responded, "oh well he's just like that"...as if she always thinks he's wrong or too laid back or something. I don't know. I don't feel like anything is wrong. Yes, I've had a "big" baby (9,1)--but he was a late baby...*shrugs* I just don't feel the need to take it if I don't think anything is wrong (I totally would if I were worried about it...but after passing it with both my previous full-term pregnancies...it just seems like a waste of time and energy)...

She told me straight up that she was ordering the BPP/NST only BECAUSE I have a bmi over 30....she added that she thought that the increased blood pressure (but, it's not over the range for me) and the fact that I haven't had the GTT testing and that I've had a big baby and that her observation is that I'm big (yes, I know I'm fat, thanks for reminding me) was "all the more" reason to do it.

I have my regular doctor back in two weeks...I can't wait...ugh...

Thanks for your input!

Best wishes with the rest of your pregnancy!

 

[cristeen]

Quote:

Originally Posted by mrsfatty She told me straight up that she was ordering the BPP/NST only BECAUSE I have a bmi over 30....she added that she thought that the increased blood pressure (but, it's not over the range for me) and the fact that I haven't had the GTT testing and that I've had a big baby and that her observation is that I'm big (yes, I know I'm fat, thanks for reminding me) was "all the more" reason to do it.

Honestly, this attitude would have me writing a letter of protest and complaint to the head doctor of this practice. It is completely unacceptable to discriminate based on your size, and that's what she's doing. And that she TOLD you that's what she's doing is even worse, IMO - because she's being blatant about it, probably because nobody has ever called her on it.

 

[mrsfatty]

Quote:

Originally Posted by cristeen Honestly, this attitude would have me writing a letter of protest and complaint to the head doctor of this practice. It is completely unacceptable to discriminate based on your size, and that's what she's doing. And that she TOLD you that's what she's doing is even worse, IMO - because she's being blatant about it, probably because nobody has ever called her on it.

I am considering it.

It is not the first time I've experienced it in this practice. There is a nurse practitioner that I will never see again because of how awful she was to me about my weight. It's so hard that I found a doctor I love and can work with (and who works WITH me)...when her practice isn't as natural/friendly as she is (the nurse practitioner I see now is really good too)...the doctor (who I saw once before her leave) and my nurse practitioner have both been supportive of me nursing through my pregnancy, me making my own informed choices, and been supportive through emotional times for me (I have had four pregnancy losses--one of which was a second trimester loss--my doctor has personal experience with losses, and we've bonded over it, among other things).

I really appreciate you weighing in!

 

[Talula Fairie]

Quote:

Originally Posted by cristeen Honestly, this attitude would have me writing a letter of protest and complaint to the head doctor of this practice. It is completely unacceptable to discriminate based on your size, and that's what she's doing. And that she TOLD you that's what she's doing is even worse, IMO - because she's being blatant about it, probably because nobody has ever called her on it.

:

The way she is treating you is horrible! And way too interventive.

A sudden jump in fundal height can be a sign of problems, such as polyhydronosis, but it sounds like from reading your posts she just didn't measure right.

 

[sunflwrmoonbeam]

If I were you, I'd complain about this doctor's treatment, refuse to see her again, and refuse the GTT, NST and BPP until your doctor is back.

I have a pre-prego BMI of 31 and the last time I saw an OB was at my 20 week appointment. My BP came back 135/70 (something like that), and the nurse was all "That's a bit elevated." Well, I had just found out the sex, was happy, and had not 2 minutes before been jumping around all excited, literally. No wonder my bp is ever so slightly elevated!

 

[OneLove]

Quote:

Originally Posted by AGierald And I dont like the concept of the GTT either. I got sooo sick because I put myself in a glucose situation Im not normally in... drinking no water, gulping orange soda and not eating. Thats abnormal, so I don't understand how test results can be accurate when taken under circumstances that I wouldn't be in otherwise. Sorry, ranting, lol. Good luck!

You can drink water. I kept arguing the same thing about it being an "abnormal" testing environment that didn't really show how I ate. But lo and behold, now that I have the meter, I can see that I am not as low as I thought I would be after eating. I can also see that even really great, healthy, fibrous whole grains cause my insulin levels to be higher...

Maybe you can ask for a meter to do some of your own readings with at home with your own food.

The reality is that many "fat" people are on their way to becoming diebetic (not all are), but a lot of the reason people are overweight is bc of insulin issues -- read any book by an endochronologist - sorry can't spell

(I personally love and highly recommend Sandra Cabot, following her advise 3 years ago and the weight just fell off and I was in a beautiful mood all day long, unfortunately I have other food/family issues that often drag me back into some bad eating habits...).

Andee

 

[OneLove]

Quote:

Originally Posted by cristeen Hate to say it - but this doesn't "catch everyone"... falsely lowering the numbers winds up medicalizing otherwise healthy people and pregnancies. The numbers generally used are the numbers that have been studied for non-pregnant women to begin with, to lower them even further is ridiculous, IMO.

That's why I included the fact about their numbers being lower than others.

I hate all this medicalization and was pissed, I had just switched to this practice and might have slid by if I had stayed with my other Dr (but then I would have been at a hospital where everyone I know gets C-sections).

I can't argue that he is "falsely" lowering his numbers because he is a research scientist and somebody has to do the research, right? Isn't that what you are saying, that the numbers are based on non-pregnant women, well this guy and his team are specialists in the field of GD - it's not like he is some random Dr that is just following "rules" set in place by somebody else.
But, I do agree it sucks for me.

OR does it, I am now being forced to have a homebirth

.

But about the GD diagnosis, like I said above, the reality is that now with my meter testing with healthy food (and lots of protein and little carbs), it is showing my numbers to be higher than I would have thought. And this is with me not eating any sugar! or any deserts at all, which, I would have still been eating some sugar and some bad carbs if I wasn't testing my blood levels.

In thinking about my last pregnancies, I am starting to believe that I was borderline GD. And isn't it healthier for the baby to have the mom's focus on eating right. I think the main issue is that if the mother eats right and is not showing any problems, they need to lay off with the other tests (NST etc..), however if the mother is showing other signs of problems, like high blood pressure or increased swelling, well then you might want to worry about your glucose levels...for the future health of the baby.

But, I have done so much reading on health and hormones, in general, I would say that if you are overweight, you might want to worry/test your glucose levels. period.

Do it after your pregnancy, if the issue is trying to avoid a GD diagnosis for birthing reasons.

Andee

 

[OneLove]

Quote:

Originally Posted by mrsfatty YAY! How fun! I refused the GTT...mainly because they "forgot" to have me take it in the "normal" 24-28 week range. Then I had an appointment with a doctor (different doctor in the practice--again, I've been seeing a spattering of doctors, since mine is out) and they noticed I hadn't taken it yet--we talked it over and he didn't think it was necessary for me to take it...he was more like, "I mean, you CAN take it if you want to, but after talking with you, I don't think you NEED to take it"...and when I told the doctor from today about that, she just responded, "oh well he's just like that"...as if she always thinks he's wrong or too laid back or something. I don't know. I don't feel like anything is wrong. Yes, I've had a "big" baby (9,1)--but he was a late baby...*shrugs* I just don't feel the need to take it if I don't think anything is wrong (I totally would if I were worried about it...but after passing it with both my previous full-term pregnancies...it just seems like a waste of time and energy)... She told me straight up that she was ordering the BPP/NST only BECAUSE I have a bmi over 30....she added that she thought that the increased blood pressure (but, it's not over the range for me) and the fact that I haven't had the GTT testing and that I've had a big baby and that her observation is that I'm big (yes, I know I'm fat, thanks for reminding me) was "all the more" reason to do it. I have my regular doctor back in two weeks...I can't wait...ugh... Thanks for your input! Best wishes with the rest of your pregnancy!

Hey Katie,

It does sound like that Dr. is over the top and not really helpful. She sounds like she is they type that blindly follows standards.

Luckily, I am seeing a midwife and she is very helpful (especially in helping me negotiate their system) and I am surprised that I also feel like all of the nurses are being helpful - in trying to get me to qualify for their Birthcenter. But, I am hoping to not birth the baby there, especially because of this...but I was already getting nervous about it, bc of their classification of me being older at age 37. I don't trust any hospital birthcenter at this point.

I am seeing this as a kick in the butt for me to have a homebirth.

Good luck to you!

Andee

 

[Talula Fairie]

I'm fat and my blood sugar + cholesterol is excellent, I believe my doctor said, "the lowest she's ever seen" (in reference to my cholesterol). I had it tested becuase I took Zyprexa (which caused the weight gain) and can cause those issues in some cases. My thyroid is also normal. Some people just tend to be bigger than others. Neither of my parents are thin, lots of obesity in my family, my entire adult life pretty much I've been slightly overweight or just barely obese (I fluctuate). Some of that I can blame on bipolar meds but...I'm just saying, not all people who are fat have blood sugar problems.

 

[boscopup]

Personally, I'd probably get a second opinion from one of the other OBs or NPs in the practice on the fundal height measurement, and if it's really 43cm, then I'd do an u/s to check that out. But I'd bet that it really wasn't 43cm. And actually, you can measure yourself at home. Have you done that? If you don't have a measuring tape, just grab a piece of string or something, then stick it up against a ruler or yardstick to see how long it is after measuring your belly. It's not hard to get a fundal height measurement.

I worry that with your previous 9 lb baby, this OB would use any u/s size info to say "See? You're going to have a HUGE baby!!!", and send you on a cascade of interventions. You currently have NO medical reason to suspect anything is wrong, assuming that the 43cm was a bad measurement (and I'm sure it was).

Testing with a glucometer at home would probably help your situation, just to show them numbers and say "Hey, I don't have GD." I refuse the GTT, but I test at home a couple days and make sure my blood sugar is fine. I do a fasting measurement, then 2 hour postprandial, and I include a dessert type meal in there so I prove that I can handle something really sugary with no protein in sight. My OB has been fine with that both of the last two pregnancies, and my numbers have been *awesome*, despite having a BMI over 30 and type 2 diabetes running in my family.

Good luck!