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!!!

issynoko yes, I went into labour at 38.5. I was definately consisdered a trouble maker, stick to your guns!

Sprite21 I would push for a meeting with the consultant, but I didn't get mine until 38 weeks when I had had the growth scan, until then no-one can really say yay or nay. Should you keep your sugars under control and then scan looks fine then you will still be pushed to be high risk.

Do prepare yourself for some heavy going from the consulant, mine was incredibly belittling and finished the consult with 'well if you are hell bent on putting yours and your babies life at risk, then it appears there is little we can do to stop you' . If you take your dh/p with you, be prepared for them to try and get him onside with horror stories.

This is just my experience obviously, I had a wonderful community midwife who kept telling me she saw no reason why I should be high risk and fantastic support from the midwife led unit, who were more than happy to have me there (with the consulants say so). I just happened to have a consultant who appeared to be a misogynistic wanker.

Good luck.

Thanks for the advice wherethewildthingswere. Your fight does sound exhausting but worth it. I have managed to get an appointment with the labour ward consultant tomorrow (when I will be 38+2) so at least I'll be able to ask them lots of questions specifically about my situation and particular risks because I don't buy this whole categorisation based on one GTT test.

I'm not saying the diet hasn't been useful but the risks they state are based on women who had diabetes previous to birth and were on insulin.

I will have dh on hand so thanks for the forewarning about the horror stories.
I get the impression this is an ongoing struggle between consultants and midwives at my hospital and the latter have been recently overruled because of hospital protocol and liability concerns. Very frustrating.

Issynoko it seems to me that having a non-medicalised birth would actually be an easier sell at home than in a birth centre and that if I had planned for a home birth I would be better supported than currently. So don't be afraid to stick to your guns if this is what you decide on.

Hi. Went to my appointment yesterday and they confirmed gestational diabetes. Wasn't entirely satisfying because I was told that my hospital uses the American Diabetic Association guidelines and if they followed the WHO guidelines my glucose readings would be negative for GD. They said 'in other hospitals you this might be considered a normal pregnany but not in this unit'. So frustrated by that but have since read the guidelines are likely to change all over and that 2 to 3 times more women are likely to be diagnosed than before - so a positive spin is perhaps I'm lucky to have something potentially dangerous picked up early. Am not shocked but am disappointed since had my heart set on another natural home birth. Still, am now pricking my finger 4 times a day and having a scan next week so I guess will see how the blood sugars go and hope I don't end up on insulin. Also just read that developing Type 2 diabetes is 'inevitable' after GD but don't think this is ture ? and will do best with lifestyle not to!

Apparently my MLU will not consider women with GD even if blood sugars are well controlled so despite saying 'it's your choice' all the time yesterday the real picture is they would want to induce me at 38 weeks and have me on the clinical delivery suite. In some ways I would rather be 'safe' since we are very rural and a long drive from hospital if things did go wrong. But am desperate not to be made immobile if I am in hospital. Maybe need to start another thread about that! I guess it makes arranging childcare for the other 3 a bit more predictable if I'm booked for an induction...

I can see why you're frustrated Issynoko with them using the ADA guidelines, doesn't seem to make sense. 2 to 3 times more diagnoses seems staggering but maybe they willl have to take us more seriously now and be more flexible with our birth plans... (wishful thinking). At least you can keep an eye on your sugars now and I have to say that the diet did make me feel better and was probably worth it. It's just the categorisation and procedures that go with it that are frustrating.
I had a 38 week scan yesterday and baby has suddenly leapt into 97th percentile for size at efw of 8lbs 9, OMG! I don't quite understand this since two weeks ago she was in the 50th percentile, same as two weeks before that.
This meant one more thing the consultant could use against me and apparently they have had three cases of shoulder dystocia with GD cases where it was diet controlled in the past two months, thus the crackdown. No way was she signing off on a birth centre birth.

I'm surprised to hear about induction at 38 weeks on diet controlled GD though, at least they are 'letting' me go to term. Hoping she'll come a bit early though.

So sorry things don't look like they are going as you wished for both of you.

They don't always get it right at scan though, my best friend was told she was taking a big risk by having a home birth as she was small for dates so had a 38 week scan, she was told the baby would weigh no more than five pounds and her head was 50% larger than it should be.

She gave birth one week later to an eight pound baby girl with a perfectly normal head .

I have never read that type two is inevitable after gestational? Though I know it is a possibility. Interestingly I had it in my first pregnancy but not in my second.

It's not inevitable, it's just more likely that someone with GD will develop Type II than someone who doesn't have it.

Diagnoses are becoming more common, because latest research has turned up a number of risks that the medical profession was previously unaware of - not macrosomia related, but GD babies can have some complications that are more usually associated with prematurity, even if they're full term. So the recommendation is to tighten diagnostic criteria.

Nevertheless, I share your frustration that they want to induce at 38 weeks. That's a very, very interventionist approach.