GD & Labour

[Newky]

Hi, for all the ladies with GD, do any of you know if when you are actually in labour you are under the care of a specialist diabetic midwife? Or just a 'standard' midwife? I really hope it will be a specialist, as the midwife who has just taken my antenatal class was really black & white in terms limitations for ladies with GD, it got me quite miffed to be honest, and now I feel really uneasy.

Obviously this midwife didn't have a clue about my history/sugar control, but she kept making sweeping statements about me and the two other ladies with diabetes in the group. When talking about spotting signs of labour she mentioned that 'this won't apply to the ladies with diabetes, as you will probably already have your induction dates or be getting them soon'. Umm actually no, I will only have to be induced if I get to 41 weeks as i'm succesfully diet controlled. When I mentioned this to her she said, well you still might have to go on insulin yet! I know this is true, and there's still plenty of time for things to go pear shaped, but I don't think there was any need to piss on my chips like that! Also when pointing out the fetal monitoring kit in the delivery room she made a comment that 'high risk pregnancies, such as the the three ladies with diabetes will need continous fetal monitoring'. Again, I have been told by the diabetic team that should everything continue to go smoothly I won't need to be continuously monitored .
I'm going to clarify these points at my midwife appointment next week, but i'm really worried now that if it isn't going to be part of the diabetic team actually delivering the baby, that a normal midwife will just see GD on my notes and strap me to a monitor without question. I really don't want this, I want to be able to move around! This midwife also mentioned that once labour starts I will need to go into hospital earlier than a normal pregnancy. Does anyone know if this is true, as so far no one on the diabetic team has mentioned this? If so, at what point are you supposed to go in? With a normal pregnancy they recommend ringing the hospital when contrctions are 5mins apart?

Sorry this has turned into quite a rant! Thanks for reading.

 

[nljackson]

Sorry to hear all the problems you've been dealing with. I had gestational diabetes with my daughter. I had her naturally, no induction. My water broke naturally. You are allowed to get up and move around if you go in before your water breaks, or at least that's how it is here. I was diet controlled just as you are, but I needed no specialist or special instructions when I went into labor, for me it caused no compilications. I was never even told I would have to do anything special when I did deliver...all they told me is as long as it was diet controlled I would deliver just as any normal pregnant person with out GD. lol Hope this helps you

 

[Wotsit]

Hi Girls, I have been thinking about the labour non stop for a few weeks now. I am starting to get really stressed out about it. I am totally confused and really unsure of what i should do?

I had a stillbirth at 39 weeks in Jan this year and now i am 28 weeks pregnant with GD and am having to use insulin. The Dr's say they will induce me around 37 / 38 weeks because of the GD and the previous stillbirth and asked me if i wanted a C-Section.

Last time i was in labour for 48 hours and the whole experiance was so traumatic that i really don't want to go through it again but feel that i need a good experiance of a natural labour?

I also HATE hospitals and want to get in and out as soon as poss.

So do i have a C-Section - This way i will know that i will have my baby that day and that he/she will be ok but then i have to stay in hosp for 3 to 4 days

Or do i try a natural? I have heard that being induced may still take anywhere from hours to days to actually work?

All i want is a happy healthy baby and for both of us to get home safely as quickly as poss!

Any advice whould be helpful!! x x

 

[Newky]

Hi Wotsit so sorry for your previous loss. I think only you can really make that decision. What did the Dr's say about the C-sec option? I too have heard that induction can make labour last much longer, and you are more likely to end up with an emergency C-section than if labour starts naturally. Saying that though there are loads of ladies on here who have been induced and had no problems, think it's just one of those things that no one can really predict. x

 

[nljackson]

Hello, I am also sorry to hear about your previous loss, I could not imagine. I agree with Newky, only you can make that decision for yourself. I have never really like the thought of inducing, and I too have heard it sometimes ends in emergency c sections anyways versus naturally going into labor.. I wish you the best with this baby and hope you make a decision you are comfortable with. What does your doctor say about the risks or benefits of both?

 

[Wotsit]

Thank you - I have tried to speak to our consultant about it but he says it's too early to discuss it! I on the other hand think it's never too early and i'm a bit angry that he's not putting my mind at ease!

I think i'll do a bit more research and write a pro/con list? My OH thinks i'm going to drive myself nuts thinking about it and i should just try to relax and forget about it for a while but it's not that easy?!

On a different note - I thought i was going into early labour last night! I had tightening in my upper bump and so much pain in my lower bump. It felt like the baby as sat on my bowl and bladder and had got it's head stuck in my pelvic bone!
The only comfy position was on all fours with my bum in the air and my head down. I thought my OH was going to have a heart attack flapping around like a headless chicken lol!

It lasted from 11:30pm to 2:30am and then just stopped!? I called the MW and she says it's nothing to worry about and its just my uterus getting ready!

I can't wait for the baby to be here! x x

 

[TripleB]

Hi Newky. I was really worried about this too when I was put on insulin to bring down my fasting blood sugar. Although it may not apply in your situation if you continue to be diet-contolled (although in my hospital you would still receive diabetic care - having your and your baby's sugars checked just for the fact you have GD and treated if necessary), I think its really important to get your head around the possibility of induction and the additional monitoring - which could happen to anyone, with or without GD. I have really accepted that they will do whats best for me now and I am ok with the idea and all it entails e.g. I thought I would be absolutely against epidural but now I know I will do it if the pain of a syntocin drip is unbearable there's no shame in having one. Best to be prepared hun. xxx

 

[Newky]

Hi TripleB, thinking about it the diabetic midwife did mention that they would monitor blood throughout labour via finger pricks, so maybe this means that I will be under the care of a diabetic team, hope so! If it came to it and I felt it was best for me/LO (i.e. if I was strongly advised by my diabetic team!) I would have no problem with induction/monitoring, as I know that it often comes to this even if you have a completely normal pregnancy. What just really riled me was that this other midwife was just pigeon holing me, without knowing any of my medical history, and making me doubt what I had previously been told by the diabetic team. I've calmed down now but her attitude did upset me at the time, as I felt very ostracised from the 'normal' ladies in the group. I'm sure this wasn't her intention as she seemed a nice enough lady, but I felt she shouldn't have made such sweeping statements without a, knowing any of my history, and b, in front of 30 strangers (i'm v shy with people I don't know ) x

Wotsit, I don't think it's too early to discuss it either! They're probably thinking that the situation might change further down the line, so why bother talking about it now. That shouldn't stop them giving you the facts though, and talking through the pro/cons from a medical standpoint now. Surely they must realise that the decision will be playing on your mind! x

 

[TripleB]

Oh I completely agree hun - I absolutely hate it when they say "normal" pregnancy, implying that those with GD are abnormal - especially when you've managed to control by diet alone!

Do you find its sometimes hard to convince medical staff that you've got a brain in your head and we don't need information to be withheld from us!

xxx

 

[AmeliePoulain]

I was continuously monitored in labour but although my waters went of their own accord my contractions wern't really getting things progressing so I was put on a hormone drip to speed things up - it might have been because of this they monitored me throughout.

The consultant I saw before the birth also said that if I went into labour naturally to come into hospital earlier than normal just to be checked over.

I was diet controlled and I had to take my blood sugar every few hours during labour.

The main irritation I found to do with the GD was having to have baby's foot stabbed every 3 hours. I got a bit fed up with it and asked the nurse if there was some truth in the fact all newborn babies may have slightly low blood sugar....which she admitted was probably the case!

The main thing though is there is such a variation accross the country as to how GD ladies are dealt with - I had to be induced at 39 weeks even though OK on diet control and growth scans all ok!...then they were all a bit shocked when Ivy came out weighing a dinky 6lb 7oz

 

[TripleB]

Big congrats on your baby girl AP! And thanks for coming back to tell us about your GD labour experience. xxx

 

[cupcake23]

It really depends on the plan of care set out by the diabetic team and the protocal of the hospital you are in.

What you need to do is discuss this with your mw, make a birth plan and see what they suggest/ advise. You may need monitoring for a number of reasons but you need to be informed and consent has to be given before they do anything to you.

https://www.nice.org.uk/nicemedia/live/11946/41320/41320.pdf

Chapter 6 is what you need, its a long read but its what hospitals base they guidelines on.

Good luck to you all.x.

 

[inxsmhpy]

I had GD when I was pregnant with Skyla which I controlled well with diet alone. I was induced at 39 weeks because the consultant thought baby was big (she was actually only 7lb 13oz). I didn't have a specialist midwife or continuous,restrictive monitoring just regular checks of my blood sugars with a finger prick.

Good luck..it's soooo exciting

 

[Newky]

I was continuously monitored in labour but although my waters went of their own accord my contractions wern't really getting things progressing so I was put on a hormone drip to speed things up - it might have been because of this they monitored me throughout.

The consultant I saw before the birth also said that if I went into labour naturally to come into hospital earlier than normal just to be checked over.

I was diet controlled and I had to take my blood sugar every few hours during labour.

The main irritation I found to do with the GD was having to have baby's foot stabbed every 3 hours. I got a bit fed up with it and asked the nurse if there was some truth in the fact all newborn babies may have slightly low blood sugar....which she admitted was probably the case!

The main thing though is there is such a variation accross the country as to how GD ladies are dealt with - I had to be induced at 39 weeks even though OK on diet control and growth scans all ok!...then they were all a bit shocked when Ivy came out weighing a dinky 6lb 7oz

Congratulations, so glad everything went well for you ! ! I haven't even been offered any growth scans yet, so think the care does vary quite a bit across the different trusts!

How many times did they test the baby? The midwife did mention that they would test LO blood to make sure he isn't hypoglycemic, but I thought they would just do it the once, didn't realise it would be every 3 hrs x

 

[Newky]

It really depends on the plan of care set out by the diabetic team and the protocal of the hospital you are in.

What you need to do is discuss this with your mw, make a birth plan and see what they suggest/ advise. You may need monitoring for a number of reasons but you need to be informed and consent has to be given before they do anything to you.

https://www.nice.org.uk/nicemedia/live/11946/41320/41320.pdf

Chapter 6 is what you need, its a long read but its what hospitals base they guidelines on.

Good luck to you all.x.

Thanks for the link Cupcake, that will give me some light reading now i'm on maternity! x

 

[AmeliePoulain]

They tested every 3 hours for the first 24 hours - always before feeds. She had one reading that was just below acceptable (2.6) so they made me feed her loads and then tested her after.

She had very very bruised feet, poor little thing!

 

[andrea675]

Hi Newky,

I went into labour naturally, waters broke on a saturday morning, and was looked after throughout by midwives with no specific diabetes training. On the other hand, they were all up to date, there was a straightforward protocol in my notes and they did discuss with me at all stages what I wanted.

Once at hospital my contractions tailed off and I was treated just like anyone else, went for a mooch around the hospital, had lunch etc etc. The policy at my local hospital is for continuous monitoring once in active labour for women with diabetes, however I had quite a bit of scope for moving round when the monitor was on and spent most of the time on a birthing ball - I also had bad pelvic pain and was uncomfy on a bed. It did mean there were lots of wires to trip over!!! Every once in a while I would have half an hour off the monitor to properly move about - baby was clearly fine and not distressed on monitoring so that was easily agreed.

I had been on insulin so once in active labour was only allowed water rather than food/hot drinks, but my labour became stalled and my blood sugars dropped and rather than have a dextrose drip put up I persuaded the midwives to give me some tea - I was starving! I think this had to be agreed with the supervisor that afternoon as it did break policy.

My sugars were taken once every hour in labour, this seems to be a standard policy, but didn't cause any great problem. I lost track of time but the midwives and my husband kept an eye that they were done.

I would try and discuss with the diabetic midwife a personalised plan for you, allowing that things might change once you're in labour, and make sure your birth partner knows your wishes. I didn't feel the diabetes affected my labour greatly and no-one got stressed about it, which was my worry. If you are at odds with the midwives ask to see the supervisor of midwives on duty and see if you can reach an agreement that works. Hope this is some help!

Andrea

 

[TripleB]

I've been researching this today and the above post is fab (thanks Andrea) and confirms my hopes, not my fears which is great! Can I ask about the sliding scale / dextrose drip. I assume they put a canula in ready but only use it if/when you need it, according to your blood sugar monitoring? xxx

 

[andrea675]

Hi tripleB,

They did put a cannula in once I'd gone down to the delivery suite, but like you say it was just in case they needed it later. I'll try and think of anything else useful and post again,

Thanks
Andrea

 

[Tanikit]

I am a type 1 diabetic so on insulin all the time, but it seems the birth I had was very similar to GD births - I was induced at 38 weeks and DD was 8 pounds 3 ounces. Despite an induction and the diabetes I did not have continuous monitoring until after the pitocin had been put up and also after an epidural which made sense and I couldn't move around after that anyway, but before that I certainly did even with a drip attached. I also had to take sugars every hour and made my DH responsible for that - they added the insulin and glucose/dextrose to the drip as necessary.

I think the most important thing is that baby comes out healthy and that you stay healthy too - if you keep your mind on that then while there is an ideal way to give birth which you may want you won't be too disappointed if things don't run exactly the way you want (this should apply to any pregnancy, not just higher risk ones) Try and speak it through with the doctors/midwives - my first pregnancy they wouldn't til the end and this pregnancy I am trying to get them NOT to discuss it til closer to the end else they keep telling me they think a C-section is better but how can I or them know either way which will be best by the end - I'd rather wait and see and then push for teh option I think is best towards the end when I will know better myself.