GD & Labour

[LouLou78]

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.

With regard to having a standard midwife, at my unit the specialist diabetic midwives only work in the antenatal clinic and don't work on labour ward looking after labouring women. The midwife who will be allocated to you on labour ward would have had experience and guidelines to follow regarding women who are Diabetic or Gestational Diabetic insulin or not. That midwife who was at your antenatal class, was she a community midwife, if so their input with Diabetic labouring women won't be as much as your Labour Ward Midwife.

To be honest, there isn't much that has to be done in labour with regard to your diabetes especially if you are diet controlled, compared to what your labour ward midwife has monitor just for the labour itself. There are guidelines to follow and the Doctor on Labour Ward that day will be made aware of your presence as well.

As for continous monitoring it will depend on the unit, NICE guidelines and your pregnancy history etc. If you were at my unit, with diet controlled gestational diabetes you wouldn't have to come to labour ward early or be continuously monitored unless there is a concern with your blood sugars recent, scans and baby growth is normal and you are well in pregnancy etc. Fingers crossed.

 

[andrea675]

Hi,

I did think of a couple of other things, like loulou says above, the antenatal classes are run by community midwives and my experience of them here is not good, hence I didn't attend anything they ran. When I saw one postnatally, she enquired after the lovely diabetic consultant Dr X, and he retired around three years ago!!! That's how up to date some of them are..........

When my waters broke, I rang the delivery suite and was treated just like anyone else, not told to go early or anything different. The only problem was there is a policy when waters break to deliver within a certain time, and this is shorter with diabetes, which no-one realised till I got there! The policy locally is to allow 96 hours in low risk pregnancy but only 24 hours for high risk, including diabetes. I was told there is a higher risk of infection with diabetes and waters breaking. Just a weird thing to be aware of.

I stayed in for 24 hours after birth to monitor baby for hypoglycaemia, the local policy here is for 3 blood sugars above a certain level - it's a lot lower than our levels - maybe 2.8? Probably in NICE guidance. As long as those three are OK they don't test anymore. They were done after feeds, i think, and advised to feed often as possible so they babys blood sugars stay stable and the testing can be over with!

As for me and GD, I did one fasting sugar the morning after delivery which was normal, and go to GP's in a couple of weeks for a further fasting sugar (but not another GTT like after dd, hurrah!).



Andrea

 

[Newky]

Thanks Andrea, Tanikit and LouLou, your posts have really helped to reassure me. I think the midwife was a community midwife, so it makes sense that she probably isn't all that up on GD. I have another antenatal class tonight, so will she how she is tonight!
Andrea, I didn't realise you would still have some mobility if on the monitor, I assumed you would be bed bound, so if I can still move around then I would have no problem with it.
I have my 36 week appointment tomorrow morning so hopefully I will be able to clear up all my concerns. I've been pretty laid back at all my previous appointments, the midwife won't know what's hit her when I go in and bombard her with all these questions I'm also going to ask about a growth scan, i've never been offered one, yet all you ladies on here seem to be getting scans left right and centre? x x x

 

[andrea675]

Dear Newky,

The only limit is the length of the leads for the monitor, I got badly tangled a couple of times with the gas and air pipe which was coming from one side and the cables for the monitor, losing the final bits of dignity I had in an ungainly mess!!!!!!!!!

Good luck for the antenatal class, it will hopefully be a different midwife, fingers crossed!

Andrea

 

[TripleB]

I had my 36 week appointment today and growth scan. Abdomen is measuring on 97th centile and amniotic fluid level is slightly high so I'm being induced at 38 weeks (I am so excited now!). Even though I have been injecting the slow-acting insulin at night for 2 weeks now, because its such a low dose I won't need a sliding scale in labour and will only need the CTG monitoring if syntocin drip is needed - very happy about that! I wasn't told to go in early if I go into labour before my induction date and was reassured that apart from testing my blood sugar in the usual way, I will be treated as anyone else during labour.

Newky - seeing as you're diet-controlled (and I recall your hospital doesn't have an early induction policy?) I think your outlook is even better than this for your natural birth! Hope you get some answers at your appointment.

xxx

 

[Newky]

Well i'm pleased to report that both the class and appointment today went really well! It was the same midwife as last week but she didn't get on my nerves half as much this week! We went through complications during labour and I actually found it oddly reassuring, kinda put the GD into perspective really. DH did not find it reassuring though, bless him! Came out with a face as white as a sheet!

At my appointment this morning the diabetic Dr was v happy with my BS and told me that I don't have to see him now until my check up 6 weeks after I give birth! I need to keep monitoring and if a problem does arise then obviously I can make an appointment, but apparently it's highly unlikely for BS to rise after the 36 week point. Both the Dr, and then the midwife confirmed that I can go to 41 weeks before induction, and I don't have to go in any earlier if labour starts naturally than anyones else would. My BS will be checked every hr once at the hospital and should the readings be ok then no action will need to be taken, no drip, no monitoring and I can go in the pool if I want. If any or my readings go over 7 though I will be put on a drip/insulin, more to keep the baby's BS levels steady rather than mine. Even if it does come to this though I don't think I will be too dissapointed, there are worse things that could happen! Dr thinks it's unlikely anyway as long as I avoid big meals during labour. As I think the chances of me getting a roast dinner brought up to the delivery suite are slim (as are the chances of me wanting a roast dinner!) I will hopefully be ok!

TripleB that's great news for you as well! Hopefully we will both be getting the labours we want, fingers crossed . And you will be having a 2010 baby, how exciting! Must admit I kinda hope this little man makes a slightly earlier appearance as well, would love to bring in the new year with my baby. It's getting so exciting now! x x x

 

[TripleB]

That's great news Newky - sounds like your hospital has a refreshingly relaxed view on controlled GD.

I can't wait for my 2010 baby now - hopefully yours will be along a little early too.

xxx

 

[LouLou78]

Brilliant, I am so pleased for you Newky