30 week visit--failed 1-hour GTT :o(

"Em" wrote:
"zeldabee" wrote in message
[...]I really want to avoid a
high-intervention birth. I'm worried that I might risk out of the
birthing center I want to go to.
snip

[...] Apparently, they won't take a client who has
pre-pregnancy insulin controlled diabetes. With regard to gestational
diabetes, you will still be able to have your baby at the birth center as
long as the diabetes is diet controlled. Even if it is diet controlled
though, you are still required to have a "consulting physician" involved
with your care & not just the birth center doctor.

This birthing center is actually in the hospital, one floor below the
regular L&D floor. Also, my OB and midwife work in the same practice, and I
*think* my OB is going to have some involvement in any case, though I'm not
clear on exactly how much, or how that works. I'll ask my MW the next time
I see her.

This particular birth
center doesn't do the traditional glucola GTT though, just a
post-prandial, & I suspect that they are not so quick to "diagnose" as a
more mainstream doctor may be.

Post-prandial would seem (intuitively) to give a more realistic picture,
but surely there must be some cut-off point for diagnosis, some point at
which the mother should watch her diet to avoid the baby getting too much
sugar...I mean, GD is real, right?

Good luck! You will probably pass the 3-hour & can move on to worrying
about what if you have pre-eclampsia and have to risk out, etc!

Oh, that's the next thing to obsess about, is it? ) Ok, then.

--
z e l d a b e e @ p a n i x . c o m http://NewsReader.Com/

"Cheryl S." wrote:
zeldabee wrote...
This worries me, as I read that c-section rate is higher in
women with GD, since they tend to have "big babies"...I
really want to avoid a high-intervention birth. I'm worried
that I might risk out of the birthing center I want to go to.

At the birth center I'm planning on going to, you're only risked out if
you require insulin treatments. If you have GD but it is
diet-controlled only, you are still OK. I think that the higher C rate
among women with GD is probably, at least somewhat, a case of
self-fulfilling prophecy on the part of the OBs involved.

But isn't that so often the case? I'm always amazed, when I watch
"Maternity Ward" or similar, how *necessary* the interventions always seem,
and how they're never questioned or really explained...they're just
routine. It makes it seem like before pitocin and c-sections and epidurals,
birth just wasn't possible. However did our ancestors manage?

Mind you, I'm grateful for the technology that allows diagnosis of
genuinely risky conditions, like placenta previa and so on, but it was so
refreshing at my last OB visit, which turned out to be my first midwife
visit, to have her just feel the baby and listen to his heart, rather than
automatically go for the ultrasound. But I digress...

Also they
tend to induce women with GD, and as all we good mkp readers know ;-),
induction increases your risk of C-section. So maybe it's not
necessarily the fact they had GD, but that they were induced, that was
directly responsible for ending up with a C. GD would just be an
indirect factor, in leading to the doctor wanting to induce in the first
place.

Is it a valid reason to induce if the baby *is* big? Say I go all the way
to the average 41.5 or so weeks, and they think the baby is big. As long as
his head isn't really big, shouldn't I be able to get him out anyway? Would
the baby also tend to have larger shoulders, or just have more body fat?
I'm not especially tall, but fairly wide-hipped, if that makes a
difference.

Anyway, I'll go the the orientation for the birthing center next week, I
can ask them then what their policy is re GD.

--
z e l d a b e e @ p a n i x . c o m http://NewsReader.Com/

zeldabee wrote:


Post-prandial would seem (intuitively) to give a more realistic picture,
but surely there must be some cut-off point for diagnosis, some point at
which the mother should watch her diet to avoid the baby getting too much
sugar...I mean, GD is real, right?


Depends on whom you ask. Some would say it isn't--or that if
it is real, treatment doesn't make a significant difference anyway.
Personally, I think it likely that unless you are an undiagnosed
true diabetic (or on the brink), it probably isn't a significant
issue. Others would disagree ;-) There's a decent discussion of
the issue in _A Guide to Effective Care in Pregnancy and Childbirth_
by Enkins et al. and in Henci Goer's _Obstetric Myths versus Research
Realities_.

Best wishes,
Ericka

zeldabee wrote:


This is interesting. Is there a way to tell if a pg woman might have had
undiagnosed diabetes pre-pregnancy? In other words, is there any difference
in response to the tests?


Not with the glucose challenge tests. Does anyone know if
the A1C (is that the right alphabet soup?) test would be of any
use in figuring out whether a pregnant woman was diabetic prior
to pregnancy?


I won't sign up for anything without looking into it, but I don't know how
much I can resist pressure.


Yes, that's always the rub, isn't it? I'm not very good at
resisting pressure, which is why I opted for homebirth and opted out
of the glucose challenge test all together ;-)

Best wishes,
Ericka