Pregnancy and diabetic clinic. What are my options for refusal?

[GwendolineMaryLacey]

Developed GD at 38 weeks pg last time, all check ups before then fine. A normal happy pg spiralled out of control from that moment and resulted in induction, very bad treatment and a total lack of bf support and bullying to use formula. I never did bf and am sure all this is responsible for the PND that I got. Diabetic clinic were no practical help btw, they moaned and tutted and bullied, no dietary advice or anything.

So, fast forward to now, I am 10 weeks pg and, amongst all my appointment letters are two for the diabetic clinic. I don't want to go. Let me be clear, I'm not running away from it, my dad has type 2 and I'm overweight so am aware of the risks. I am very happy to see their dietician and to monitor my own blood sugar and call on them if there is a problem but I do not want it to end like last time.

Am I able to refuse these appointments? The thought of going back in there is actually reducing me to tears

How about you go to the first appointment and see what they say? Tell them how unhappy you were last time - make your point that you are perfectly able to manage it yourself if need be and to call them if you need help. Show willing, and then they can't hold it against you.

You can of course refuse to go and more importantly refuse to stop seeing them at any point. Given your family history and the fact that you did develop GD last time, albeight late on, I would go. Take a list of all your concerns and make sure they are all addressed, also ensure that they are clear what help you want and how you felt last time.

Finally I would make sure that you research all you can, particularly with regards to breastfeeding so that you can get the support that you need. I hope it goes well for you. I had a similar situation in that I have big babies although no GD but kept going to consultant appointments only to see the house officer who was unable to give me any answers or make any decisions. In the end I told them that I refused to go back until unless I could see the consultant and get a proper plan of care put in place. This might be an option worth pursuing, when I requested this it was done without any fuss and from then on if I went to hospital and the consultant wasn't around I asked for them and they were fetched!!

Just wanted to add, at least this time you are prepared and have time. The last thing you want to do is put your baby at risk, but there is no reason why you should be subjected to poor care.

Decide what your limits are and what level of care is acceptable and state it clearly, and repeatedly if need be. Also might be worth seeing your consultant or the supervisor of midwives if you feel you are not getting what you want.

Thanks, you're all right I guess and I definitely don't want to put the baby at risk. I've got my booking in next week at the same hospital and I might mention it to the mw then. Would it be rude to request that it isn't one particular woman?

I also need to think about how I can address the bf issue. I vowed back then that I would have all bases covered before the birth next time so that if I struggled I knew exactly where to go and what sort of help to expect.

Can you try a different hospital to give birth in? If you can find one more supportive of breast feeding that might help. They may also have a different diabetic clinic. But with regards to not going at all, it isn't worth the risk in my opinion. There are serious risks of not controlling gestational diabetes, and whilst the diet is a real pain, it is insanely healthy. To get some of your own info look into low gi diets. There is.a thread on here for help and support with GD which has lots of advice on it. Good luck. x

I was debating changing hospitals earlier but this hospital is literally 5 minutes away. I think it would be madness to move to one further away. If they were equal distances I would change like a shot!

I only mentioned not going to this clinic. I am completely aware of the risks and how to control it, I would just rather do it myself, which I believe I can, rather than get them involved.

Hi there

I'm type 1 diabetic and have a similar outlook. I have had one previous pregnancy that ended in termination (a chromosomal defect). Because of my inexperience of being pregnant with diabetes I was kind of swept along into the bizarre situation where you feel like the whole thing is really about diabetes and the baby is just an extension (the fact that my antenatal appointments took place in the diabetes centre frankly P-d me off).

Now, just to clarify, I have excellent control of my diabetes and keep my HbAa1C below 6, ie in the 'non diabetic' range; previously swum competitively and basically use an insulin pump to make all the adjustments i need to my insulin in pregnancy and normal life. So I felt this routine was really un-necessary since my hard work ensures that my body does not behave like a 'diabetic' body. For someone who does not have demonstrably excellent control of their condition I think they need all the help they can get as pregnancy throws many more challenges. I'm just saying this really to provide context as I do feel that however it is done, excellent control is imperative for every mum-to-be with diabetes, and how this is achieved very much depends.

Anyhow, I had a conversation with the 'diabetic' midwife early in this pregnancy to establish the ground rules and we have reached a kind of happy equilibrium, where i can feel like I am having a 'normal' pregnancy yet we are in a position to be able to monitor if something isnt right. In short:

1. My diabetic control is not going to be discussed unless it becomes an issue and i will be left to adjust my doses as i would do normally (it wont be; ever).
2. I'm not going to be having the overly-frequent appointments (unless any problems are indicated by blood/urine tests)
3. baseline tests taken of kidney function and protein in urine - this is in order to work out whether any subsequent protein in urine is due to pre-eclampsia or existing traces. these will be followed up by periodic blood/urine tests (i believe like any other mum to be).

I deal with a wonderful diabetic midwife who totally GETS that i do not wish to be treated like im diabetic and understands that through my diligence and determination that it is fairly safe to go along with this. The key is here that great relationship and mutual respect; there is an unwritten clause that basically says if things dont go according to plan that I will revert to a more traditional 'high risk approach'.

Anyhow, I just thought I would describe my experience so you can have someone else's perspective. obviously its a slightly different condition, but the most important thing is that whether its managed by you or by someone else, you need to have excellent diabetic control to ensure a good pregnancy outcome.

Good luck x

I was diagnosed at 33 weeks in my second pregnancy and have found it all a bit of a shock to the system so can imagine how you must have felt at 38 weeks. I am lucky though in that my clinic, the obstetrician etc all seem pretty sensible and in fact are quite happy to discuss all options (including a home birth, as that's what I had last time) and don't seem to want to force me to do anything. I guess part of this is because I am managing to keep it under control through diet etc though.
I can understand why you wouldn't want to go to your appointments after having had a bad experience. Actually though, if you can go and, when and if you are found to have it, you can show you are doing all the right things then this might put you in a better position to discuss what you actually want this time round. The more informed you are the more in control you can be. Interestingly the advice here has been to am to breast feed within the first half an hour but no one has said we will need to use formula.
Do all your research, do the best you can to keep it under control and don't take any rubbish! Easier said than done I know but I wish you and baby all the best.

PS i just read your first post. the one thing the clinic SHOULD have offered you was a dietician appointment, presuming your GD was diet controlled. Im sorry you had such a bad experience. it doesnt have to be like that x