Hey Natural_Mamma
I had a home birth with confirmed gestational diabetes.
I had a level of 8.5 mmol/L in my blood 2 hours after drinking the glucose solution. So not really high, but enough for a positive diagnosis.
The worse part for me was I was immediately offered consultant lead obstetric care, along side a specialist diabetic nurse, my community anti-natal midwife, consultant endocrinologist and a dietician.
So in appointments alone - it was very busy!!! Esp towards the end of pregnancy where appointments were made for me to see all 5 once a week with a scan to boot!.. Plus doing finger-prick tests at home 2 hours after I had eaten anything! All this, when all I really wanted to do was be at home and relax - I know I could have refused, but I did go initially as, I like to know what they say and then make up my own mind.
The Mws were great and still relatively positive about my home birth plans, However the endocrinologist wasn’t very helpful at all. One of the first things that she said to me was “you won’t be allowed to birth in the birth centre” I calmly exploded at her to be honest - and told her, I was having a homebirth, and she isn’t ALLOWED to tell me how or where I give birth, and in no uncertain terms to “watch her language!” Well that was the end of that conversation!
One of my consultant Obstricians was really helpful and pragmatic. She understood that I wouldn’t be deviating from my homebirth unless there were any clinical evidence that I should.
So what is GD? (I’m sure you can find better explanations, so forgive me mine) Essentially what happens is that the hormones in pregnancy interfere with the effectiveness of insulin (another hormone) produced in your pancreas. The insulin is produced regulate your levels of blood sugar and convert high levels glucose to glycogen, where it can be stored in the liver if it is needed rapidly, or converted to fats. Without this mechanism working correctly your blood sugars after eating can become quite high (you might have symptoms of hyper-glycaemia… feeling a little shaky and on edge, just like a sugar rush). If it is really high, this will be a problem for your body, and it may be recommended that you have insulin injections to control your sugar levels. More often , women with GD don’t have very high levels and they can be controlled by diet alone.
So what happens to baby?
The placenta enables all the nutrition from your blood to pass through a membrane to the babies blood (Oxygen and Glucose etc) So if your blood is rich in glucose, then this is passed to babies blood. As your baby is a separate body to you, baby receives the high glucose, and as there is nothing wrong with babies insulin production (the hormones inhibiting your effectiveness are not effecting baby) So the babies pancreas produces lots of insulin to counter the rich blood. The babies liver then converts the excess glucose into fat. So problems that arise for baby are from your baby laying down lots of fat - they can be very cubby!!
This isn’t a major concern in early pregnancy, but more so in late pregnancy, where baby naturally lay down more fat, so they can wait the few days it takes after birth for your milk to come in.
The risks
So what is the problem with a fat baby?
Essentially it is a size issue - if baby has become so fat that the body (as it is the abdominal circumference which is important here), might not be able to descend through the pelvis and get stuck. This can be checked with late scans - My last was at 39+6. SO you should know if you have a potential problem before hand - if you don’t, and baby is within normal ranges. There is NOTHING to stop you from having your HB.
The second issue is that after birth baby can potentially have hypo-glycaemia (low blood sugar) This is very rare and easily solved. This can happen where your blood sugars are high in labour, so babies is high in labour, so baby makes lots of insulin to counter and once baby stops getting nutrients from the placenta and your blood, the high insulin remains longer than the sugars.. So baby can have very low sugar levels, causing hypo-glycaemia and making them listless.
It is rare because mum is unlikely to have high sugar levels in labour - you are going to be working hard, and unless you plan on having a carb or sugar rich food in labour, you blood sugars will be low.
It is advisable to have a physiological 3rd stage and NOT to immediatly cut the cord, so baby gets your nutrients for as long as possible after birth, and it is also advisable to try and feed baby as soon as you can to solve babies low blood sugar. If you don’t get a latch right away - that isn’t a problem, you can express by hand some of your colostrom and baby has a lapping instinct so can take this from a thimble or little cap.
There are all the risks that are associated with ANY pregnancy and it is important to know if the treatment would be any different at home from the hospital (talk to your MW) For example - the big ones are:
*Post-partum haemorrhage. (after your baby is born) The midwives at home (just as in hospital) will bring clotting drugs (Syntometrine or Ergometrine - this one can contract you uterus down in less that 45 seconds following IV administration) and IV fluids, but they won't be able to do a blood transfusion - you will have to transfer for that. (as you would have to be moved in hospital actually!) However, you are more likely to have a physiological 3rd stage at home (which reduces the incidence of a retained placenta), and not use these drugs to deliver the placenta, but they can be used if you have a large bleed.
*Shoulder Dystocia. But the treatment and management of this is exactly the same as in hospital - they will ask you to try and adopt an optimum position (which you are more likely to be in at home anyways - rather than on your back! This is confirmed by NICE‘s Interpartum Guidelines - where data has indicated a lower incidence of shoulder dyscocia in home births), then when all else fails (i.e reaching in a pulling baby out, next step involved is breaking the babies clavicle - just the same as in hospital, so the hospital doesn’t hold any advantage on this one.
*Failure to Progress. You are far less likely to have this problem at home - you will be more relaxed, less inhibited, and not on a time schedule, unlike in hospital, where arbitrary time limits seem to be set, and discourage and worry mothers - further compounding problems. This is the most common reason given for a necessity of a c-section. Where as the ONLY physiological reason for a failure of the cervix to dilate beyond a certain point should be cephalo-pelvic disproportion (I.e babies head is too large for your pelvis)
*Fetal distress. The only way that fetal distress is measured is with monitoring of the babies heart beat - it is worth noting that fetal monitoring is a fairly recent routine medical technology. So it is unclear whether some of the changes in fetal heart rate, are not just the normal consequences of labour for the baby, as there is little data available. (infact what has been shown is that fetal heart rate will dip in a contraction, and that is very normal) However, below 100 bpm or even over 160bmp could indicate the cord has become restricted. You will not be overly monitored at home - the mw don’t carry CGT for constant monitoring.. So it is every 5 to 15 min with a Doppler and much less restrictive! Another sign of fetal distress is meconium staining. - midwives are under instruction to take women to hospital with meconium staining - though, light or old, rather than fresh, wouldn’t be an indicator to transfer.
Please don’t let your medical professional give you the impression that these above risks are associated with solely Gestational diabetes - they are NOT. I encountered this.
It is important to make your decision based on the evidence of how you are presenting and not policy or potential risks that you are not even indicated for. One consultant automatically wanted me in at 40weeks to the day to be induced - I wasn’t measuring big.. So there wasn’t a reason to do this. He conceded I was right at the end of the appointment.
So even if you have a confirmed diagnosis of GD. You can manage it well through diet or injections, so your sugar levels don’t go high, and you won’t have a disproportionate baby to your body. Doing regular blood sugar level reading after each meal will help you manage and keep you in normal ranges, so it doesn’t become a problem and you won’t need to choose to go to hospital.
So you CAN have your homebirth.
XxX
P.S - Sorry for the massive reply!!! ;-)
My GCT showed my levels to be at 9.8 after an hour and I'm not too sure how much it would go down after 2hrs, hopefully enough!
