Diet Controlled Gestational Diabetes - Actual medical risk for HB (bit long)

[iris66]

I'm a bit stuck/confused and hope you experienced people can help

Im 31+3 with DC3 and have pretty well controlled GD on diet. I had GD last pg (not as well controlled but diet only all the same) and my sugars were fine through labour and DS was fine after (they didn't even feel the need to check his sugar levels)

Previous birthweights were 8lb 3 & 8lb 2 respectively and this one seems to be following a similar line for growth.

I really want a HB as I felt very controlled in hospital and was treated as if I was brainless (particularly last time when they wouldn't believe my waters hadn't gone despite 2 sweeps so my BP went through the roof & they "made" me stay in for induction, strapped (metaphorically) to the bed and having to beg, in tears, to go onto all fours to deliver).

Anyway - I have plenty of info, on optimum positions to deliver for maximum room for LO etc, and I'm aware that this LO may be a lot bigger than before because of GD and the risk of shoulder dystocia but nobody seems able to give me enough info to make a proper decision with regard to the risk and I feel I'm being pushed into delivering in hospital again.

I suppose my main questions after all that are:

1. what are the risks of having shoulder dystocia and the MWs being unable to help me get the LO out?
2. What do they do in those circumstances that they can't do at a HB? (given that a CS will be impossible)
3. Is there an increased risk of cord prolapse, the more pgs you have? (only ask because neither of mine engaged fully until labour & last one was literally just before delivery - I felt him drop & thought I'd dislocated my hips lol)

sorry to have waffled on but I would really appreciate some input from you lovely ladies Thanks in advance.

bump?

Hi Iris, have you looked at www.homebirth.org.uk? They have some great information on shoulder dystocia, and certain positions that can be used to get the baby out.

Have you spoken to your MW about all of this? The Ob's put a lot of pressure on me about wanting a HB and the risks of shoulder dystocia etc etc. However I had a great team of MW's who were happy about me having a homebirth even though they were expecting a big baby.

It ended up that I laboured at home, but transferred to hospital and had a cs. However it's a long story, and I think I got caught up in the hospitals desire to control my birth. Needless to say, it won't happen next time and I'll be going for a VBAC at home.

Good luck xx

Hi there, not a proffessional opinion here, but, I believe, that it will help greatly that your Bloodsugars are well controlled...and I would think, that tehrefore the growth of your Baby isn't affected...but I might be wrong of course...but my impression is, that it's the uncontrolled sugar that causing a Baby to gain more then normal weight...because the Baby will get more glucose through the placenta if there is more then should be in the moms bloodstream....well, something along teh lines!
Shoulder dystocia, I think is rare, but if your Baby would be large then that would be the cause...however, good positioning, etc...should help avoiing it! There is some good infor on the radical midwifes website (sorry no link, but if you goodle radical midwifes you should stumble across it!)!
I don't really know enough about Shoulder dystocia, but was undr the impression that if it comes to a shoulder dystocia, it is to late to have a C-section anyway, as the Baby would be to far out of the Birthcanal (the Head would already be out then, so, no way they could pull a Baby back out???), I would think a Episiotomie (sp?) would be the action taken.
On your 3. point, I have never heard of an increased risk of cord prolapse in relation to number of pg's....only ever in connection with certain breech positions.

I hope someone with more knowledge will come along.

I went for a Homebirth with my ys (after having being talked out of it with ms, due to develloping GD, grr)...and I am sure that I had as "much" GD with him as I had with my ms, but because I refused the GTT and had a different bloodtest done (which measure long term glucose levels, so, it measure how your body has coped with glucose over a longer period of time, and it does not require loading up on high sugar drink, etc...which, imo, can't be good) and did my daily Bloodsugar profile as I had in the pg wtih ms, and my sugar levels were similar ( I also did eat a Diabetis diet) in both those pg's, so, either I hadn't really had GD with ms, or I had it with ys, aswell...however, because there was no diagnosis I was treated as non diabetic.
MY Homebirth didn't go to plan, and I ended up being transferred into Hospital and with an E-C-section . However, should I ever have another child, I would plan a Homebirth again. Because I don't , for one moment, regrett my choice for Homebirth!

There is a fantastic Yahoo Homebirth group and a yahoo group called Uk-midwifery, both groups are a fantastic source of Information

Homebirth group

UK midwifery group

radical midwifes website

thanks ever so much for your posts and the links. I had a consultants appointment this afternoon and basically the upshot is that if my levels aren't under better control by next week it's insulin (and therefore hospital birth). The paed consultant did have a chat to me afterwards and was lovely but kept on about placental failure (another factor I'd not considered). They did take bloods to do the long term sugar readings so I only hope they'll be better as I keep going really low (was 3.2 when I got back only 4 hrs after lunch!) I really thought I was doing well as I know my sugar is better controlled this time than last I think I'll just have to wait and see what the next week brings. Thanks again

Iris...arm yourself with as much Info as possible...defiantely ask about all off this on UK midwifery especially...there are a fair few independent midwifes and other midwifes that just feel very strongly about a womans right to Birth in a positive way.
Because, sadly often Consultants aren't the best to ask when it's about natural Births....obviosuly they often only ever see where things go wrong, which will impact on their view.
I am not saying that in your position it may well not be safer to Birth in Hosptial, as I don't know enough about this and your personal circumstances.
However, I distinctly remember that on Homebirth UK there is even a story of a Baby being born at home, and the mother was diabetic and on insulin before she even was pg.
I just find that Consultants are often slightly scaremongering, and trying to frighten mums to be out of homebirths, etc...!
If you decide (and it will always be your decision, even though the Proffessionals often don't quite put it that way, and make it seem you don't have any options and no voice)to have a Hospital Birth, then maybe having a Birthdoula with you could help. But of course it depends on your finances.

3andnomore - I will go on the websites a bit later (I'm a bit teary still atm). Thanks. I know what you're saying about consultants though. There's a fantastic MW who's been giving me loads of support and keeps reiterating that it's MY choice. It's so difficult to maintain an objective view about the risks though...

I know, I really feel for you! I hope you can find the right info, to make the decision that you are comfortable with!

Iris66, I would second the Homebirth Uk website recommended, I had my second DD at home in March this year, and I had diet controlled GD.

I was under a consultant at the hospital, a diabetologist (sp?) and a specialist midwife, and was put under enormous pressure to deliver at the hospital in the consultant-led unit, however I resisted - even when they insisted that I needed to go onto insulin - I researched it all thoroughly and made my own mind up.

It is up to you no-one can make you do anything, you always have the final say in what you are prepared to do medically, for your own health and that of your baby.

I was told that shoulder dystocia was more likely for a GD mother (this is based on studies of insulin-dependent diabetic pregnancies, not necessarily GD pregnancies), and all that would be different at home is that there would be less people to help at the press of a button.

Ask your consultant what research and studies their policies are based upon, get a copy of the hospital's protocols for dealing with gd labour/birth/babies, and stick with your midwife!

I wonder how many babies your midwife has delivered in comparison with how many the consultant has delivered?

You could also ask your midwife if she has ever had to deal with a shoulder dystocia, how she would deal with it should it happen etc.

I found that knowing all the facts, and statistics helped me make a balanced decision, but I also negotiated that I would only go into hospital to labour and give birth if I could go into the midwife-led unit, with my midwife...

(This was by me being extremely stubborn, well-researched, and asking for actual scientific studies/data to back up what all the professionals were telling me - I didn't make myself popular, but I firmly believed that it would be better for me and my baby to be at home, relaxed and with people I trusted).

It all worked out well for me in that I had a two and a half hour labour in total, and my second stage was over with in four minutes , which certainly beat the four hours of pushing and forceps with DD1

But only you can decide what is best for you and your baby, sorry about the long rambling post, but I feel very strongly about this, and only hope this helps a little .

Good luck whatever you decide

Diabetic home birth

Some more here

snaf - thanks for your links

1973magpie - I really appreciate your post. Especially as you've been there and can fully understand how the proffesionals tend to scaremonger.
The MW I've been talking to isn't technically mine - she works in the assessment unit and doesn't deliver anymore (mores the pity) but even she has reservations. Mainly due to the resuscitaion issue if there's a problem. I've posted on the UK Midwifery group website for further advice and intend to ask for the research they're using to support their policies.

I'm feeling a bit more positive today (despite my attractive puffy-eyed look from all of yesterdays crying ) Thanks again everyone

Iris....glad you are feeling a bit better..it cna be so daunting.
As for resscuss....as far as I am aware Midwifes do have rescuss eqipment at homebirths available...but not sure if that depends on your area or something...! However, I would think they would have to be able to deal with any such situation, as theoretically, if someone was being negative now, something could always go wrong, and I am sure they have to be prepared for all eventualities.

Another thought though....when you have a Homebirth, you receive one-to-one care from 2 MW's....sometimes throughout, sometimes,t eh 2. midwife is called out nearer Birth, and they can monitor the labouring woman much closer, and they will pick up any problems usually much earlier before they actually become problems, iykwim.

Mws carry much the same resus equipment as is available in hospital and all mws are fully trained and updated yearly in neonatal resus techniques. It's true that they don't carry the resus drugs (eg adrenaline) but these are only ever used on severely compromised babies. Given your medical history, if there are any signs of fetal distress during your labour you will be advised to transfer immediately anyway.

Glad you're feeling a little happier today