# My Gestational Diabetes Induction Plan



## Minkel23

Hi all,

Well, after working really hard with my diet to control my GD I had my last clinic appointment yesterday (am 37+6). I had been told if my numbers were good they would let me get to my due date of May 2nd... but turns out that won't happen. My consultant yesterday has booked me in for an induction on April 25th, starting at 6pm. I feel slightly let down, as my numbers have been good (highest was an 8.1 over three months). But, the consultant has decided- for whatever reason- that with a due date of May 2nd, I should be induced at 39 weeks. 

I've just about packed everything I need... a few more bits and pieces to go. The consultant worked through my birth plan with me and went point by point over what will happen with blood sugar control during labour.

Until you are in established labour you have to manage your GD as you have throughout your pregnancy. Once you are in established labour your blood sugar will be monitored hourly (at my hospital the midwives and nurses will moniter it for you, but this does differ from trust to trust). Your levels are expected to stay within 4-7 mml- if it goes above 7mml they will start you on insulin intravenously. Once you are in established labour you should stop taking all GD medication. It is only if you go above 7 they will medicate you with the insulin themselves. 

Following the delivery of the placenta no further medication will be given. However, they will moniter my blood sugar for the next 24 hours. If your readings stay between 4-7mml then you are considered free of GD. If your readings go above 7mml they will moniter for another 24 hours. If your readings are still high you will be referred to a diabetes clinic, as it most likely you have developed type 2 diabetes. If any of your readings go above 11mml they will start diabetes treatment immediately.

The baby will have their blood sugar checked after birth. If it is found to be low, they will ask you to breast feed the child, and then they will check their levels again. If it is still low, they may take the child into special care (at my trust you will go with the child- they don't believe in separating mother and child) until blood sugar levels have stabilised. 

6 weeks after delivery, you will have to have a GTT to make sure the diabetes has gone. You should have another test every year afterwards. 

I'm being induced next Wednesday and will try and let every one know how things pan out.

All the best.x


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## mightyspu

Hi Minkel,thanks for starting this thread and sorry that you're not getting to go to term. I hope at least you'll get to into spontaneous labour, I would like to avoid induction myself. We are due a week apart, and I've also managed to control my numbers through diet, again the highest I've had is an 8 and that was in the beginning. I'll be very interested to see how your journey pans out. Did they say why they'd changed their minds?


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## Minkel23

My consultant simply said it was best to induce early with all gestational diabetes cases, regardless of how good your numbers have been during pregnancy. I suspect I would have been induced this week if it hadn't been for the bank holiday last monday- my clinics are on monday, and so I didn't have an appointment last week for them to organise delivery for this week when I am 38 weeks. Thus, I am being induced at 39 weeks. I suspect very few women are allowed to go to their due dates- perhaps my consultant used it as an incentive for me to work hard at my diet?

Feeling some fear about labour and delivery now (this is my first baby). Trying hard not to think too much about it!x


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## mightyspu

Boo, surely healthy Mumma, healthy Baby is incentive enough? 

I think also it depends on the consultant's personal opinion. I've had 2 different outcomes told to me already, so I'm not taking anything as "set in stone" until at least my next appointment!


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## madmae

Good luck with your induction Minkel.....some of it sounds like what happened with me last time...though some differs.

Again I am jealous you are so close to meeting your baby. Don't worry to much about labour and delivery....fingers crossed it'll be fine and I did find last time that the midwives and doctors were a lot more attentive with me than previously which did make me feel a lot more secure.

My little boy needed to go to scbu due to low sugars....it wasn't pleasant, not horrendous though, but if yours does need to go I hope its for a very short stay....though from what you've said about your numbers being so good it hopefully won't come to that.


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## marley79

Thanks Minkel. That's some good info for us all.
It reminds me how my consultants were last time. i got told I had gd at 34 weeks and only got told the week before they wanted to deliver that she was coming early. I had no idea and they'd obviously known all along. 
They've been clear this time that 38 weeks is set in stone but I keep thinking maybe 39 :0)
Good luck with the induction - enjoy meeting your little one. The hospital bag packing is exciting in itself. Do you know what you are having? So excited for you and ha! slightly jealous that your nearly there - i still got 8 weeks - lol!
Big hugs xxx


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## Minkel23

He's a boy! Benjamin David John... his bag is all packed with his little bits and pieces. I can't wait to see if he looks like his daddy! I have to say, I think 38 weeks is the norm with gestational diabetes... I was all set to ask them to let me go to May 4th (when I would have been 40+2) but April 25th is the date they've set and I didn't really get a say in it. Really hoping he doesn't have to go to SCBU... but at least they've prepared me for the case if he does.x


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## mightyspu

:hugs: we'll all be eagerly waiting for the outcome. And rooting for you :D


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## marley79

So cute to think his bags are packed - bless!
Yes 38 weeks is the norm and I'm sure they are doing best for you and him. Enjoy your first cuddles - can't wait to hear birth story. x


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## mummy1985

They sound more prepared than mine were. I never got told any of this and I was never told there was a chance she would spend 2 days in SCBU which I couldn't go with her so was stuck on a ward with women and THIER babies and not mine :(

Good luck :)


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## HellBunny

Looks like you are all set Minkel! :D
You seem to of gotten some fab advice, not long to go now! xxx


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## madmae

mummy1985 said:


> They sound more prepared than mine were. I never got told any of this and I was never told there was a chance she would spend 2 days in SCBU which I couldn't go with her so was stuck on a ward with women and THIER babies and not mine :(
> 
> Good luck :)

I can't believe they didn't warn you about that. I know what it's like being on the ward babyless while everyone else's is there. Luckily I was offered a parents room on scbu 24 hrs after mine was admitted.


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## marley79

question about labour - if you haven't been on insulin in pregnancy do they still put you on it. I'm on metformin. Also can eat and drink during labour?


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## Minkel23

marley79 said:


> question about labour - if you haven't been on insulin in pregnancy do they still put you on it. I'm on metformin. Also can eat and drink during labour?

I was told to bring healthy snacks and lots of water for labour (even if I'm on a drip to bring on contractions). They told me that they only refuse to let you eat and drink if you have an epidural for pain relief. Even if you haven't been on insulin during pregnancy, if your numbers rise above 7mml during labour they will put you on it in your drip to help stabilise your blood sugar. I was slightly concerned by this as I have been working really hard at my diet to stay off medication... but the consultant basically told me that once I'm labouring what they put into my drip will be the last thing on my mind, and that they do everything for the best of the baby and mother. I've packed some sugar free sweets for labour to keep my mouth moist, some sugar free diabetic shortbread (Boots, I love it), oatcakes, and have a list of fresh fruit to pack next week. I was also told that sugar free jelly pots by Hartley's are brilliant for labour, being easy on your stomach... and easy to throw up (which can happen when your digestive system becomes slow during labour). 

I feel like my consultant and midwife have prepared me for what might happen during labour and delivery. She said to keep an open mind was the most important thing, as anything can happen, but to always remember they want to see a happy and healthy baby at the end of this as much as my partner and I do, and that my health is paramount to everything.

Dreading it all... but also wanting to get it over and done with too, if that makes any sense?x


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## marley79

You sound like you have a great team - I hope mine give as much info - v. reassuring. Not sure I'll be allowed to eat due to it being a vbac but fingers crossed. xxx


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## Techie

I'm only at 33 weeks and was diagnosed with GD about 3 weeks ago. But I've already been told it's likely that they will induce at 39 weeks. I was really hoping to go all 40 and let him come on his own schedule. For those of you who have been induced, was it terrible? I'm worried it's going to be extra hard on me and on the baby. If I know my kid and he's anything like his dad or me he's going to be super stubborn. We were both 2 weeks late when we were born!


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## mightyspu

I was not fully induced, but had the drip when my labour failed to progress, and no, it wasn't pleasant. But.... Everyone is different so it may not be the same for you. My mw has changed her tune though and after saying they will not let me go over, they will let me go a week over if things look favourable. 

At the end of the day, it is your body and your birth, they can't make you do anything you don't want to do. If you have good reason to avoid it that is. 

You can start some natural induction methods to increase your chances though from around 37 weeks.


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## HellBunny

Techie said:


> I'm only at 33 weeks and was diagnosed with GD about 3 weeks ago. But I've already been told it's likely that they will induce at 39 weeks. I was really hoping to go all 40 and let him come on his own schedule. For those of you who have been induced, was it terrible? I'm worried it's going to be extra hard on me and on the baby. If I know my kid and he's anything like his dad or me he's going to be super stubborn. We were both 2 weeks late when we were born!

Mine went well, i was induced with a pessary i must admit that wasn't pleasant but the labour/induction went well overall, he was in a back to back position which i think made it more painful. xx


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## mummy1985

I too had the pessary and it was uncomfortable but not painful. As has been said though everyone is different. Good luck!


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## ravi

Best of Luck to your Healthy Child Birth. . . . .


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## Techie

Thanks everyone! I think it helps to know what you're going to be up against. Now I'll just hope my sister-in-law is a little late with hers (she's due a week before me) so that we aren't in different hospitals on the same day!


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## sweetpeaxo

I have GD as well and my Dr won't induce me! :( I want to be induced though, my numbers aren't always perfect, the diet has been a little bit of a struggle. I don't understand why Drs in the U.S. are so against inductions. I was hoping to go at 38 or 39 weeks. Instead they told me I could go overdue and they will not induce. How safe is that?! Plus I have high blood pressure as well!


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## mightyspu

It may be because induction carries a higher risk of c section. Have you asked them why they won't consider it? maybe they're happy with your numbers and you're doing well with the diet?


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## Techie

Sweetpeaxo - I agree with Mightyspu's suggestion of asking them why they won't induce you. Sometimes they have a good reason. Plus, you can always get a second opinion if you don't like their answer. 

I really wanted to go 40 weeks and was expecting to be more around the 41.5 mark before the kid decided to show up. We'll see what happens.


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## momto3kiddies

I have GD and my doc said he will not let me pass 38 weeks. I have had all 3 of my kids on their time and was never induced so Im alittle worried as well because I have heard its a harder labor when induced:shrug:


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## HellBunny

Sweetpea how are your numbers?

I've had different opinions, one consultant said she is happy for me to go to 40 weeks, but another one said he would induce at 37-38, i really hope i get him next time!


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## marley79

Annonying consultants - they all say different things. Mine want me at 38 weeks but I am wanting to go to 39 weeks. I would consider going to 40 myself but not a day over but I think growth wise wouldn't be able to. x


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## mightyspu

Marley, have you got another growth scan booked in?


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## marley79

mightyspu said:


> Marley, have you got another growth scan booked in?

yep, next one is on Tuesday (1st May). My last one at 28 weeks bubs was on approx the 70th percentile looking at the graph - so really hoping growth is around the same and not shot up.

Do you have another scan booked? Can't beleive you are now 38 weeks - so exciting, could happen anyday. Are they forcing a delivery date or allowing you to wait and see what goes? I've been doing some reasearch and found out my hospital now uses balloon cathethers for induction, so decided I want one of those as rupture rate lower but no idea if they will then allow me on drip etc. I'm partly wondering to go past 38 weeks and trying to weigh up risks of degrading placenta against risks of rupture with induced vbac. Hard decision. though a lot will rest on this scan, if baby is too big it's back to cs. (boo!)


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## cupcake

I had an induction at 40 wks for gd, i too was well controlled throughout pregnancy, but its a precaution they take, because it was so "early" ie first baby and not ready to come yet it took 24 hours, and I had an epidural, it was a vacuum delivery, baby had low sugar at birth and they asked me to give formula after colostrum did not bring the sugar up, I was so upset at having to give the formula but almost four years later I realize how silly that was, my son never had formula again after that but he needed it then, so just be prepared, no one told me about that and I would have been calmer if they had. baby was born at a great weight. good luck!


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## mightyspu

marley79 said:


> mightyspu said:
> 
> 
> Marley, have you got another growth scan booked in?
> 
> yep, next one is on Tuesday (1st May). My last one at 28 weeks bubs was on approx the 70th percentile looking at the graph - so really hoping growth is around the same and not shot up.
> 
> Do you have another scan booked? Can't beleive you are now 38 weeks - so exciting, could happen anyday. Are they forcing a delivery date or allowing you to wait and see what goes? I've been doing some reasearch and found out my hospital now uses balloon cathethers for induction, so decided I want one of those as rupture rate lower but no idea if they will then allow me on drip etc. I'm partly wondering to go past 38 weeks and trying to weigh up risks of degrading placenta against risks of rupture with induced vbac. Hard decision. though a lot will rest on this scan, if baby is too big it's back to cs. (boo!)Click to expand...

Yes, I have a scan on the same day, lo has always measured right at the top of the scale, but then so did Jack (non GD) They will let me know what their plans are for me then too!



cupcake said:


> I had an induction at 40 wks for gd, i too was well controlled throughout pregnancy, but its a precaution they take, because it was so "early" ie first baby and not ready to come yet it took 24 hours, and I had an epidural, it was a vacuum delivery, baby had low sugar at birth and they asked me to give formula after colostrum did not bring the sugar up, I was so upset at having to give the formula but almost four years later I realize how silly that was, my son never had formula again after that but he needed it then, so just be prepared, no one told me about that and I would have been calmer if they had. baby was born at a great weight. good luck!

Thanks for the info. Have been hand expressing so do have some stockpiled, but yes, it's good to know that it could happen.


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## lollybabe2011

The norm here is induction at 39/40 except baby is expected to be very big. 
My consultant told me the last time, that the main risk is in post date baby and risk of IUD in diabetics. So he allowed to wait until 39+6, but not over, I was on insulin though.

I got a gel at 9am, getting pains within 1hr, they broke my waters few hours after that and put on drip. All in all only spent less than 6hrs in labour room, but baby was back to back so pushed for 1hr 45min. I was the last person to get gel in the induction room, I was 1 1/2 hrs late, but I was the first to leave for labour ward. All in all was not a bad experience. Will be induced at 39+ again.


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## Techie

mightyspu said:


> Thanks for the info. Have been hand expressing so do have some stockpiled, but yes, it's good to know that it could happen.

I didn't know you could pump before the baby came? :blush: I haven't had any leaking or anything yet...is it still possible or do I have to wait until stuff starts flowing?


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## mightyspu

Techie said:


> mightyspu said:
> 
> 
> Thanks for the info. Have been hand expressing so do have some stockpiled, but yes, it's good to know that it could happen.
> 
> I didn't know you could pump before the baby came? :blush: I haven't had any leaking or anything yet...is it still possible or do I have to wait until stuff starts flowing?Click to expand...

I've been hand expressing, not pumping, which is a little more vigarous. If you give your boob a gentle fondle you may see some colostorum. Though this would be best done after 37 weeks, because nipple stimulation can be seen as a natural induction method. I'm not gettting much, max of 10ml a night really, but it can all add up. I'd discuss it with your mw. Am happy to answer any questions about it though :)


Minkel, I see you were due your induction yesterday, I hope all has gone well for you and little one.


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## Spunky

So interesting how different everyone's cases are! I was diet controlled and had great numbers to the point where I didn't get any extra ultrasounds or monitoring than anyone else would. I went 10 days overdue (my numbers started creeping up at the end!) and the only reason I was induced at 11 days over was because my blood pressure was starting to get high! I had 4 pills of cytotech. 2 vaginally, 2 orally. I was 1 cm when I entered the hospital and after 4 rounds and 30 hours I was still 1 cm. They gave me pitocin and that's when things got going. Took 50 hours total to get him out (and a vacuum delivery). My nurses only checked my blood sugar after meals (and gave me special low sugar meals). James' blood sugar was not goo after birth. It kept going down (over the course of 3 hours they checked hourly and it kept declining). He was BF like a champ so they talked about formula or an IV even!!! turns out they stick his feet and his feet hadn't started circulating blood yet. Once his feet pinked up his numbers shot up!

They didn't check my blood after I had him and gave me normal meals and even a cupcake to celebrate the birth. At my 6 week postpartum check up I got the GTT again and I was found to be prediabetic (not type 2 YET but getting there). They didn't care anymore though. I wasn't referred to anyone for advice. I'm not pregnant with #2 and I know they'll do the GTT at my first appt (on May 24th) to see if I have it yet. I'm hoping if/when I do it'll be able to managed by diet again. I have lost 10 additional pounds after James, so I'm hoping that's enough to not have it (I didn't really have any really bad numbers while pregnant with James, so I'm hoping I was just borderline then)

I hope all of your labors go smoothly and you progress with the least amount of intervention as possible. My advice is if you get the IV drip of pictocin get the epidural. Was a life saver for me!


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## marley79

Good luck Minkel - all the best!!!

Mightyspy - 10mls a night - that's really good! I'll have lots of questions for you when I get to that stage but you maybe busy with a newborn then :0)

Lolly - whereabouts are you? that's great you can go to 39/40 weeks. i was diet controlled last pregnancy and they still insisted 38 weeks. If I had known more I would have declined 38 weeks. But i only found out few weeks before and I didn't have time to get used to it all or do my own research. This time I'm medicated and struggling a little with numbers and so I wouldn't want to go past 39 weeks. They still want 38 but I'm trying to go with the flow a lot more. Good luck all. xx
ps - about supplementing in hospital - my little one was also given formula in hospital on top of breastmilk but then didn't have it at all the next 9 months that I breastfed, so I agree don't worry - if they need it then just go with the flow and of course prepreparing some breastmilk is a fab idea - just be careful to make sure you do it in a very sterlised manner. xxx


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## lollybabe2011

Techie said:


> mightyspu said:
> 
> 
> Thanks for the info. Have been hand expressing so do have some stockpiled, but yes, it's good to know that it could happen.
> 
> I didn't know you could pump before the baby came? :blush: I haven't had any leaking or anything yet...is it still possible or do I have to wait until stuff starts flowing?Click to expand...

Techie,
You can it is called colostrum harvesting, but like mightyspu said best not do this before 37 weeks.
It is now advised in a lot of places for pregnant diabetics especially GD on insulin and Type 1, but hypoglycaemia can happen even without insulin therapy but more common with it.

Mine was given bottle in hospital, also ended up been jaundice later and needed phototherapy and they had to be supplement for 3 wks in total, we then went on to breast only after that. I felt once he was having bottles, it was difficult and to took some time to get supply to match up.
I will be doing this like mightyspu from 37wks, you do only get a small amount though 5-12mls per day is norm.


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## lollybabe2011

marley79 said:


> Good luck Minkel - all the best!!!
> 
> Mightyspy - 10mls a night - that's really good! I'll have lots of questions for you when I get to that stage but you maybe busy with a newborn then :0)
> 
> Lolly - whereabouts are you? that's great you can go to 39/40 weeks. i was diet controlled last pregnancy and they still insisted 38 weeks. If I had known more I would have declined 38 weeks. But i only found out few weeks before and I didn't have time to get used to it all or do my own research. This time I'm medicated and struggling a little with numbers and so I wouldn't want to go past 39 weeks. They still want 38 but I'm trying to go with the flow a lot more. Good luck all. xx
> ps - about supplementing in hospital - my little one was also given formula in hospital on top of breastmilk but then didn't have it at all the next 9 months that I breastfed, so I agree don't worry - if they need it then just go with the flow and of course prepreparing some breastmilk is a fab idea - just be careful to make sure you do it in a very sterlised manner. xxx

marley, I am in republic of Ireland not UK


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## lollybabe2011

Minkel - Goodluck


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## Techie

> Techie,
> You can it is called colostrum harvesting, but like mightyspu said best not do this before 37 weeks.
> It is now advised in a lot of places for pregnant diabetics especially GD on insulin and Type 1, but hypoglycaemia can happen even without insulin therapy but more common with it.
> 
> Mine was given bottle in hospital, also ended up been jaundice later and needed phototherapy and they had to be supplement for 3 wks in total, we then went on to breast only after that. I felt once he was having bottles, it was difficult and to took some time to get supply to match up.
> I will be doing this like mightyspu from 37wks, you do only get a small amount though 5-12mls per day is norm.

The things no one ever tells you! Maybe I'll give it a try...probably not till around 38 1/2 weeks though. I need my last couple of paychecks in order to pay for my maternity leave. Thanks for the info!:thumbup:


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## mightyspu

Well I've been 'harvesting' for over a week now and haven't gone into labour! My supply is increasing and I managed 20ml tonight!


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## lollybabe2011

mightyspu 20mls is good
Techie better not leave it too long, as intially you get very little. The risk of going into labour is low with hand expression anyway, and some pregnnat women breastfeed while pregnant with no problem of going into labour.
37wks is advised, as a precaution since baby born after this stage usually do okay.


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## mightyspu

Yes, I started out getting less than 1ml! Although 20ml is good, its very little in the grand scheme of things, so I need to keep stockpiling :)


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## Minkel23

Had my little boy! Very positive induction/epidural story to come later... just very happy with my new 7 pound 7 (some large gestational diabetic baby he turned out to be!) little baby.x


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## mightyspu

Woo! Congratulations Minkel, can't wait to see the birth story :D


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## marley79

yeah Minkel. massive congrats!!!!!!!!! 7lb 7 is a lovely size not a beast :0) how many weeks+days was that gestation wise? Welll done can't wait to hear your story - so glad a positive one. Well done! xx


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## madmae

Congrats on your 'giant' GD baby xx


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## lollybabe2011

Congrats minkel!!!!


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## HellBunny

Aww congrats Minkel! Fab weight also! xxx


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## Minkel23

Have popped my birth story into third tri forum but will also post it in gestational complications- it's a little long!xx


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## Techie

Congrats Minkle! That's tiny as far as I'm concerned. I was fully expecting at least a 9 lb. baby before I found out about the GD. My sister's first was 10.5 lbs and she didn't have GD. (My family has big babies).

Maybe this is a stupid question for the rest of you, but what is the difference between pumping and hand expressing?


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## mightyspu

Pumping is with a machine, hand expressing is with your hand only. The latter is a bit more gentle, especially as there's not actual milk yet. :) 

I was always expecting a big baby, just hope the shoulders aren't too big!


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## Techie

mightyspu said:


> Pumping is with a machine, hand expressing is with your hand only. The latter is a bit more gentle, especially as there's not actual milk yet. :)
> 
> I was always expecting a big baby, just hope the shoulders aren't too big!

Stupid question, plus probably TMI, do you squeeze the breast or the nipple?


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## mightyspu

Not stupid or tmi at all :) I squeeze the boob, just behind the nipple.


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## Techie

mightyspu said:


> Not stupid or tmi at all :) I squeeze the boob, just behind the nipple.

Thanks :thumbup:


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