Labour with gestational diabetes - what were you told to do? Esp at John Radcliffe Oxford

[mrsgboring]

Feeling rather down. Am having a high risk pregnancy anyway - baby has a lung abnormality (which now looks less problematic) and I have had a previous stillbirth as well as a healthy DS.

So I am definitely going to be induced at 38 weeks exactly for those reasons anyway. But now they've started to "suspect" gestational diabetes. I've been put on the diet, given the test strips, numbers looked at and I appear to have good control (it is not at all clear if I really have it or not anyway).

What will they require that I do in labour? I really hate the idea of being on insulin. I don't know what I can eat. I don't basically know anything. Nor is it well documented in my notes, so if I wanted to, I suspect I could get through labour without anyone knowing about this, so I need to ensure the right things happen.

I feel like I've had this "diagnosis" dumped on me and now have NO FURTHER FOLLOW UP appts. with the consultant. I have checked with them and this appears to be right. I have no Community MW to turn to either since she has been off sick since my booking appt.

I have no-one to ask except MNers, it would appear. So please, can you tell me what your experiences were, especially if you were at the JR and therefore know the hospital specific rules for labour with GDM.

Please, anyone? Doesn't have to be JR just anyone anywhere would be a start.

Sorry I know nothing about GD and the specifics of your post, but wanted to ask what consultant you're under at JR? I've delivered all 3 of mine there (with some considerable complications, though different ones to you). I've insisted on being under Silver Star - the high risk pregnancy unit, although don't really qualify. I'd imagine you would, with previous stillbirth (so sad ). I've steered the course there with my own complications and may be able to help point you in right direction of who further to talk to - feel free to contact me.
If it reassures you at all, as a large teaching hospital in a top university Town, you're likely to get much better treatment there than most other places...

Thanks for this, hedgiemum. I am Silver Star (well, Fetal Medicine, which seems to count as Silver Star for some things but not for others) Cons. is Impey.

My previous stillbirth didn't actually qualify me for Silver Star last time but I got similar treatment with a different Consultant.

I am completely staggered that they apparently don't want to see me for the next two weeks - last time I had daily monitoring by the end and was again induced at 38. They may yet ring me back and say that I can come in, but according to the current paperwork I've no need to return. They may yet call me back in though - have left several messages with people saying that I think I ought to be seen.

Bank Hols don't help. Sigh.

I had GD with last pg but my situation bit different from yours - i wanted home birth and i got one in the end - you can read my story at homebirth.org.uk - email addy is on there if you want to ask any questions.

Look for the "you cant homebirth because you have GD" and you will find my story - Im Rachel

I don't have high regard for Impey, to say the least. If I were you I would be phoning his NHS secretary (and if someone doesn't get back to you quickly, call his private work secretary as well! That'll annoy the hell out of everyone!) daily, saying you want daily monitoring, and whatever experienced mumsnetters recommend.

racmac, thank you. I think I'm even less "diabetic" than you sounded to be - I had a course of oral steroids which probably did push me temporarily into diabetes. But my sugars do spike quite high after a meal, then drop like a stone which isn't quite normal.

Hedgiemum, you're right, really, think I ought to continue to chase. Just don't know how much fight I've got left in me.

Still would like to hear people's experiences of labouring with GD (or the GD label) in hospital.

What did you eat to maintain blood glucose levels in the normal range during labour? Do you eat the same? More? (or seems unlikely less?)

I had GD with both babies, last one was 2 years ago, but I opted for a c-section as first baby was large (10 14) and this one was expected to be. I had gone into labour with the first one but needed c-section - didnt really try to give birth normally as was booked in for section anyway, so DH signed me up to a section when I was away with the faries on the gas and air!

So, having discussed with consultant second time round, I was given choice of VBAC or section at 38 weeks. Didnt fancy the induction route, as long winded, and baby was breech as well, so went for section. With regard to birth and GD, I had to go to hospital the night before for monitoring - which amounted to nothing more than one quick check where they decided baby was not breech, then when due for section was hooked up to insulin drip at 8am. Found it all a bit strange, as I was nil by mouth from midnight. They took lots of finger prick tests - seemed to be every hour - then once delivered, my levels were too low, so insulin drip stopped, but still attached - also had saline solution as well, so well wired up. No need for insulin at all later, but still did finger prick test every hour for the next 12 hours. Baby went to SCBU as his sugar levels and temp were low, so wasnt feeding, but was back 24 hours later.

Not sure if that above is of any use at all, but that was my experience! Godd luck!

I had GD for both pgs

I was insulin dependant at the end.

When I was taken to the delivery suite I was hooked up to an insulin drip and I woudl test my sugar levels hourly and MW would adjust the drip accordingly.

Points to note. I was induced via gel 2nd time around and I didn't take my insulin because I thought I'd be in delivery suite by teatime. I was told off by MW and DH had to bring in my insulin.

HTH - feel free to ask any more qus

Oh and teh MW should stay with you throughout the labour.

Thanks both - it is helpful. Have found the NICE guidelines which say I should be monitored hourly during labour, so expecting that. Am diet controlled - really well ATM - so hoping they won't put me on insulin. But the diet control leaves me feeling utterly starving and quite out of it most of the time (I don't have time to work out how to make it better for myself, as it's only 2 weeks so am just being strict as hell)

I had gd - diet controlled, and had a homebirth with an independent midwife.

What are you eating?

You shouldn't be hungry really on the diet or 'out of it'. Are your blood sugars low some of the time?

I had diet controlled gd with my first pregnancy and was only allowed to go 2 days over my due date as it was thought I was going to have a big baby (she was only 7lb 12oz). As far as I'm concerned I think my labour was pretty normal, (bar being induced), except being warned that I may need intervention at the end if the baby was big. I had a normal delivery though.

I had borderline gd, as you have by the sounds of it, so I wouldn't worry too much about it. The midwives will probably just keep a closer eye on you during labour.

My biggest problem was with my second pregnancy (when apparently I didn't have gd)when I wanted to labour in the birthing pool and I wasnt allowed to as I had a history of gd, was measuring big and it was deemed to risky if I needed intervention during labour. (I had a normal delivery and an 8lb baby).

Hope this is of some help.

I'm a bit confused about your community midwife - isn't she in a team (arranged by area)? I can get hold of any of the Abingdon group of midwives, not just my named one. Its an answerphone, but they are meant to return calls daily. You could also get your GP to chase up Impey - go to see him/her and explain that you're v worried and hospital hasn't returned your phone calls.

Don't give in and stop fighting, if there is reassurance or information that you need which you feel you aren't getting. I know how hard this is to do when you are heavily pregnant - do you have a dp who can help you with the nagging phone calls?

BTW, when are you due? I'm expecting DC4 to be born end of June (based on 5 weeks prem like my last 2 have been...).

It sounds as though you might be considered glucose intolerant...or bordline. Since it appears your level is under good control there really should be nothing different regarding your labour and birth. I had GD with my last two children and there was no difference in the care I received. I know many women will have an induction suggested simply because of a GD diagnosis, but if levels are maintained, there really is no need.

I was diagnosed with GD and was kept on a very strict diet for the last ten weeks of the pregnancy. I had to take seven readings a day and do ketone strips in the morning. I did receive some brilliant support (community nurse and dietitian) to get me started and I had to mail in my results each week so that they knew things were going well. I only had one appointment with a consultant and was threatened with more if I didn't make good progress. I was very lucky in that it was managed solely through diet and exercise (this helps bring the sugar levels down after a meal) and because my food intake was monitored, DD was born at 7lb 2 oz. As long as your sugar can be regulated through diet, my understanding is they will avoid insulin as much as possible.

Either way, if you do end up needing the insulin, it is for your health and that of the little one. And it's not for too long.

Hang on in there and hope it all goes well

Hedgiemum, yes she is in a team and has a locum to cover her clinic, but once the locum's filled the clinic (and it's on a Monday so there isn't one next week anyway ) you have to ring up and be put on the home visit list to be seen. Then they bitch about how busy they are and couldn't you have just booked your appointment earlier so you got in the clinic? And what are you being seen this week for it's not the right week? And I have to explain the history of my pregnancies AGAIN and they say they can't really help because they don't know the background. Yes, they can check BP and urine (which according to NICE protocols I don't need between 36 and 38) but not much else. I will probably end up asking for a midwife appt. even so.

Standanddeliver, I know I shouldn't feel terrible on the diet, but I do. I don't think I have GD, though I do think I'm massively insulin resistant - my levels spike up and then shoot through the floor. They will still do this even if I have a really nice low GI meal that gives me a 1hr post prandial of 6.1 - will be very low by bedtime. So in the absence of lots of time and professional support to work out alternative strategies, all I can do is live with the lows and not drive or operate heavy machinery.

I told the diabetes specialist that I was killing myself with the diet and felt terrible 85% - 90% of the time, she could see that my pre-prandial numbers are often low 3s but said it was fine, carry on. So I am for the good of the baby and the fact that it's less than two weeks to go now. But it makes it very hard to chase consultants etc. because half the time I can't remember my own name or stop crying.

Mrsgboring,

Can't answer your question on the labour aspects - in fact, starting to think that I need to ask some questions myself having read some of these posts, but I am 31 weeks PG with my first baby and was diagnosed with GD at 28 weeks.

My pre-GTT sugar level was normal but after was very raised. Initially started with diet but like you, found that I was hungry all the time. So they suggested that I should start using insulin, slow release, just at night initially.

What I will say, is that I was surprised at how easy it is to do the injections. I never realisd that when you inject yourself, if you do it at the right angle (they made me practice at the hospital and I thought I was going to faint before I started...), 90 degrees they suggest - it actually doesn't hurt AT ALL!! In fact, when I finally stopped shaking enough to try it the first time, I didn't feel a thing!!

So now I have injections three times a day and my blood levels range between 4.0 - 6.9 (rarely are they that high) and I don't have to cut out my fruit or my crisps!! Now I'm injecting, I much prefer that to starving, although they have told me to refrain from eating chocolate on Easter Sunday until after our little one is born - boo hiss!!

My MW said that they will try not to induce at 38 weeks if they can possibly avoid it, but obviously your situation is very different. I've got my next growth scan at 32 weeks to ascertain whether my baby is large, she was on the middle line at 28 weeks so not too big at that stage.

Anyway, I'm really waffling now... All I meant to say is, Insulin doesn't have to be the end of the world. Injecting is painless, quick and means that you don't starve yourself or your little one - hope that helps!!

xxx

Thanks for the info, DawnAS. Glad the insulin is working for you.

The reason I don't want it is there isn't time for me to get to grips with a new regime now before induction - I only have 11 days left till induction date and only four of those are working days because of Easter so there wouldn't be any help out there. I am controlling it with diet, so would prefer to carry on that way, even though it's pretty hideous.

I also like the fact that with no artificial insulin, there's no real danger of having any kind of harmful hypo if I screw up - I do go low but with my own natural insulin, I'm not going to go low enough to cause me to have fits or lose consciousness more than a brief faint, and I like that security.

So the same thing kind of applies to labour - I just don't like the idea of being out of control, and also I think being on insulin will make it more likely they will routinely take baby to SCBU (even though they shouldn't unless there's a problem). Plus I really honestly don't think that I have full blown diabetes (I think I temporarily slipped into it because of some drugs I was on but otherwise I am borderline/insulin resistant).

FWIW, what I've found out is the NICE guidelines say during labour blood sugars should be checked every hour and maintained between 4 and 7. The baby should be breastfed (or FF) ASAP at birth, and the baby's blood sugar should be checked between 2 and 4 hours after birth. (Baby should be treated for hypoglycaemia if sugars go below 2.6) Mother and baby should have stable BSs before being transferred to community care (i.e. being discharged from hospital). I think there may be additional requirements if you're on insulin during the birth (which you will be, given you're on it at the moment).

If you can avoid induction, it will make it easier for you in labour, but for me it would be the sane choice even without massive baby and possible GDM. I'm resigned to that, and think it's the best possible solution for me.