High Glucose result + home birth implications - please discuss with me!

[issynoko]

Just had a glucose tolerance test yesterday and midwife already called with results - they are:
After fasting - 5.6 (Should be 5.5 or less)
One hour after lucozade (urgh!) - 10.2 (should be 10 or less)
Two hours after lucozade - 6.7 (should be 8.6 or less)

So last result was fine and the first two were slightly over the 'safe' line. Have a meeting at the clinic tomorrow but was hoping, all being well, for a home birth and the midwife on the phone said "Hmm, I have to say I suck my teeth a bit at that idea in case the baby is very chunky". (This is my 4th and the 3rd arrived so fast I had no time to go to the hospital even though we were 5 mins away. Here we are over an hour away so in part I want to plan a home birth in case things go that fast again.) I'm not being irresponsible and know that if the baby's shoulder area is 'chunky' it might get stuck and it would be awful if emergency CS needed etc. My son was 'chunky' and was 9 and a half pounds but born at home, no stitches etc. And is now a very skinny little 6 year old. Anyone with any other stories about similar results? Am not fretting much since the 2 hour result was well within healthy guidelines but want to know how other people's results have affected their choices/how they were guided....

Many thanks!!!

bumping my bump query!

You are very much on the borderline of their statistics - and it seems these aren't consistent 'absolute' numbers. According to the data here www.patient.co.uk/doctor/Glucose-Tolerance-Tests.htm you'd be classed as fine.

I would see what they say in person, but I think I would go in with the approach that if they want to stop you having a home birth based on the results above, you'd like further testing / re-test to confirm them.

I'd also look at their other recommendations - if they suggest dietary changes and further testing, then it sounds more serious. If they don't suggest either of those, then I'd question why they want to prevent a home birth if they don't believe your condition is serious enough for further action.

Hope you get it sorted

Hi, i think they will probably want to treat you as though you have confirmed gestational diabetes with those results? cos main came back borderline 5.5 for fasting (afaik the others were okay as i wasn't told a concern for them) and straight away they came out with saying, will have to move from midwife to consultant care, and gave me the testing machine and said test 2x per day etc. For me even though it was only a border line reading, i did still end up with being on insulin and induced at 38 weeks (baby was never measuring big though, and was only 6lb at birth.. so maybe over cautious of them inducing at that date, in hindsight..)
If you want home birth I would think your best bet is probably take the testing machine, and if you are keeping all your levels down and not getting any high readings then they may be fine with it in the end? I think some ladies on here did go for a home birth with diabetes.. there was a thread around here before for gestational diabetes support and i think i remember some people asking about that. However if you end up on medication or insulin i think the hospital will probs strongly recommend that you don't go for a home birth, although if you do have them so quick that you cant get into hosp then it cant really be helped can it??
Are they thinking your previous one was undiagnosed diabetes, cos of his size? cos my 2nd one was also 9.5lb (born with no problem though like yours, although not at home) but based on that size quite a few midwife have said to me its likely i had diabetes in that pregnancy without knowing, even though the gtt came back okay for that, it may have developed later on.
i do think it would be a bit irresponsible to not go along with the blood tests or anything, now that you know there's a possibility of a problem. also if you have the full facts (based on testing your levels etc) you will be in the best position to make a good decision what to do.
good luck and i hope it works out for you

I have been advised against a midwife led unit due to the potential risks. Shoulder dystocia and babies blood sugar levels crashing after birth. I have had a chat with several midwives and a consultant. Even though my blood sugar levels are really good with only a couple of spikes and growth scan so far is average I have decided to give birth in hospital.

This was a really difficult step for me to take as I have real issues over past care.

Although a home birth may be your ideal choice do listen to, and question, the professionals so you make a informed choice.

I also thought the gtt 2hr was 7.8 as i was 7.9

www.nice.org.uk/nicemedia/pdf/CG063Guidance.pdf

NICE guidelines on management of diabetes in pregnancy and post natal care.

Have you had a look on the homebirth.org.uk site? There are several stories on there from women with GD/high blood sugar readings who have gone on to have home births :)

I would just be very cautious about planning a homebirth with those results. Obviously you may not have a choice if you have a speedy labour like last time.
But if things go wrong at home the results can be catastrophic, if you have any indicator that shows there may be a problem the hospital is the best place to be, as the transfer to neonatal care can be immediate if necessary.
I know how strong the desire to have a homebirth can be, but the most important thing is the safety of your baby.

I had a homebirth (had 3 homebirths and 3DCs) with DC3 and had a GTT result of 8.3. :)

should have said DC2 was 9lbs 13.5oz so a big baby, but I had no problems with delivering him. They said DC3 would be bigger but as it turned out she was only 8lbs 3oz and just as easy to deliver.

I did speak to three consultants, the diabetic midwife and the supervisor of midwives - the consultants were against it but the midwives were very supportive and the head consultant said my result was so borderline it would not be as big an issue as it might have been.

Hi - thanks for your responses. I will go with a list of questions - have had 2 fantastic home births and current midwife is concerned about speed of last labour so wants to have all the gear here in case - basically I was in no distress and thought it was early stages but went to loo and baby's head was crowning so would never have considered setting off for hospital yet anyway. Of course if gestational diabetes likely I might be induced earlier and that would change the whole story re when to go to hospital anyway.

Midwife on phone today did stress they are only very slightly above and it's up to me whether to attend her clinic so they aren't fussing about changing to consultant care yet. Had a spike of glucose with DD1 and was given the monitor which reassured everyone involved since levels never got high - just bruised fingers! Am very happy to be monitored, look at diet, tested further etc and make a decision based on how it goes. My friend had a baby that 'got stuck' and is now severely disabled as a result of oxygen deprivation in birth canal so not taking it lightly at all.

Any evening mums with anything to add? Thanks!

check out my story on www.homebirth.org.uk - diabetes part

Thanks. When people say 'my result was 8.6' (for example) are they referring to the fasting result or the after 2 hours result? Confused and assume my result is borderline (5.6 instead of 5.5) at fasting and fine after 2 hours. Also do you know if being ill makes a difference - had the test whilst suffering heavy head cold and laryngitis.

You are very borderline as was I. I managed to contol my sugars for the whole of the rest of my pregnancy with diet (was hell, am chocolate addict) and had to fight tooth and nail, but in the end was allowed to give birth in a midwife led unit.

I had a final scan at 38 weeks and though not totally accurate, they decided ds did not look big for dates.

I was so glad I went to the unit, I met someone at baby group later who had also been borderline, gave birth in hospital, was heavily and intrusively monitored and 'bullied' into bottle feeding as babies sugars would be low and it would take too long to faff about breast feeding.

Thanks WheretheWTW. Did you go into labour naturally? Constant monitoring and 'protocol' intervention are what worries me - regardless of my individual situation. I am already being considered for 38 week scan and have consultant app booked for 38 weeks due to wanting a home birth age 41 - they arranged all that at 12 weeks. If there are sensibly considered risks of shoulder dystocia etc I would rather be in hospital than at home since we an hour from the hospital (or more depending on traffic). The hospital has just opened a midwife-led unit so if I remain borderline and baby seems normal size for dates I wonder if I can lobby for that - and then am near help if needed. Having had 2 great home births (one with 9.5 lb baby) I feel very strongly that active birth - lots of movement etc - is hugely important to me. (DC1 a hospital birth - all slowed down and ended up with constant monitoring, on back with epidural.... home births was walking, squatting, standing and on all fours - so so much better.)

I hate the bullying into clinical birth at the slightest sign of a blip and while I appreciate the benefits of modern life saving medicine I really don't want to be strapped down just to suit the system. I want a healthy baby more than anything of course, but also feel active labour is very likely to open up your body and make a gentle birth more likely. Am I about to be a troublemaker?!

The thing to bear in mind is you can say no, the choice is yours at the end of the day. If you have weighed up the risks (to you not the general population as a whole!) then yours is an informed decision.

I didn't want to be induced so agreed, with the consultants, to frequent monitoring instead above and beyond what is normal.

Also, Midwives are trained to deal with shoulder dystocia so if you do have a homebirth and it happens, they will know what to do to get the baby out safely, I think it's called the McRoberts manouevre :)

I think they'll see you as a troublemaker simply because you won't do as you're told and fit into the one-size-fits-all system, but I like you, believe in allowing the body to do what it can without routine intervention and monitoring where possible, whether that be at home with midwives present or in a hospital with medical backup nearby.

Issy, I have diagnosed GD - results further above the cut-offs than you - and am going ahead with a home birth. The risks are certainly there, but they're not very common; if you look at various studies, then the risks of things like shoulder dystocia are still rare even with uncontrolled GD.

If you have GD but keep it well under control, then there shouldn't be any elevated risk of macrosomia, which is the main thing they look for, or the other effects of GD on unborn babies.

The risk that the baby will have a hypo shortly after birth is real, but can be counteracted just as well at home as in hospital. What we're doing is harvesting some colostrum prior to the birth and storing it, so that the baby can have a boost of colostrum if its sugars crash. That is exactly what the hospital did last time with DD (except nobody thought to harvest it in advance, so it was a matter of frantically hand expressing and using a syringe).
The last significant risk is placental deterioration. GD does make the placenta deteriorate faster, and so some practices want to induce on due date or before. You might want to look at some studies on the actual incidences of this and make your mind up whether it's a risk worth balancing against the risks of a hospital birth.

According to the doctor at the diabetes clinic they are better placed to do any manipulation on a stuck baby as they are more used to it.

I think she could tell by my face I wasn't impressed! I would rather an experienced midwife who had delivered hundreds than a doctor who sits in a clinic most of the day!

When my midwife who had previously fully supported my decision to have baby at mlu said I would recommend x hospital it made my decision easier.

At the end of the day choices comes with risks and we are responsible for any we choose to take. Im very risk adverse so for me the knowledge I was taking risks would be a stress in labour i don't need.

Hi, sorry to drop in with my own situation but might help. I've also posted on the gestational diabetes thread.
Similarly my GTT results were borderline (8.1 after 2 hours, 4.4 at fasting) and my blood sugar levels have been 'excellent' for the past month but was told yesterday at my midwife appointment that birth centre birth is out despite
reassurance that this was a distinct possibility should my sugars be well managed. Feeling quite cheated at the moment and considering fighting it, but it's such a fragile time and at 38 weeks I haven't got much time left to do it.
I guess what I'm saying is that it is a struggle and they tend to let you know last minute what their plans are with not enough consultation, so you need to be on guard and prepared if you want to do it another way.
There is a good account of GD and successful homebirth on the GD thread from highfibrediet who did a lot of research into her particular situation and decided to withdraw from hospital care. Happy outcome and baby was fine.

They do tend to put you in a box with GD diagnosis and ignore your specific risks.

wherethewildthingswere just wondering if you had any advice about fighting this decision. I was told I could meet with consultant but might be a delay and feeling like they could put this off until I go into labour.

I thought this decision was up to my midwife but she seems to have been overruled.

Hi OP,
I had a firm diagnosis of gestational diabetes with dc2 and dc3. Diet controlled in both pregnancies. I had a homebirth with baby number 2 and planned another with dc3, but ended up transferring in because of failure to progress. Had a normal birth once in hospital.

I was unable to get support for my homebirth from the community team and ended up employing an independent midwife. I hope that if you decide to go ahead with your homebirth you get good support.

One thing I would encourage you to do is buy some extra test sticks and start to really work on your diet. My second dc was 11lbs at birth, which resulted in a shoulder dystocia - was resolved fine and I was glad it had happened at home and not in hospital, but really didn't want to repeat the experience with baby number 3. With my second the gd was picked up late (I didn't see the dietician until week 35), by which time my ds was already very big. With my third baby I was given extra scans, which picked up that his head circumference and thigh length were longer than my second dc. I was determined not to end up with a 12 lb baby so did a lot of research into changes I could make to my diet which would bring my blood sugar levels under control.

From 32 weeks onwards I jettisoned pretty much all but a few handfuls of carbs a day from my diet. I ate lots and lots of green veg, olive oil, fish, lots of protein and nuts. Hardly any dairy (other than butter), and all refined carbs went. I allowed myself three small portions of slow release carbs in a day - oats, basmati rice and a slice of granary bread. Every meal with protein. No fruit juice. No bananas, limited fruit. Supplemented with half a teaspoon of cinnamon three times a day (cinnamon may be associated with increased risk of miscarriage in early pregnancy, but could not find any evidence of risk in third trimester - it reduces blood sugars)

Have to say - it wasn't fun, but when my son was born he weighed only 9lbs 3oz, the lightest off all three of my babies (my first was 9lbs 6oz), despite being the longest and having, by quite a long way, the biggest head circumference. He was skinny and long at birth, with very good tone and head control. Fed brilliantly. Now he's a wiry, super fit little boy of 6.

I've since discovered that the diet I made up for myself is pretty much the same that Gowri Mowtha recommends to mothers with GD on her 'Gentle Birth' method. here (she's a western trained obstetrician who uses ayurvedic techniques of birth preparation).

If you need more help and support you should contact the supervisor of midwives at your hospital.

You'll need to have some discussion around the subject of induction - which is pressed fairly firmly on mums with gd at around 40 weeks, because of the increased risk of stillbirth after this time with diabetic pregnancies. I found this very difficult to get information about - most of the research was difficult to extrapolate to my situation, as a non-obese mother with borderline diet controlled gestational diabetes.

I can only offer anecdotal evidence, but my glucose levels were borderline with DS1. My MW strongly advised me to scrap my homebirth plans and go to hospital - this was at 39 weeks pregnant, birth pool already bought etc! I was so upset at the time, BUT DS1 did end up with shoulder dystocia & it was a tricky one to resolve. Thankfully all was fine but it was rather hairy & personally I'm glad I was in hopsital so Paed could check my son straight away etc.

As I say, it's just anecdotal - I was again borderline for GTT with DS2, induced on due date, lovely easy labour and born naturally with no probs weighing 10lb 6oz (a whole pound heavier than DS1!)