Do I REALLY have to have a glucose test?

[StarshitTerrorise]

BMI is 31 and baby measuring big for dates. 35cm at 33 weeks.

How reliable is the test? How necessary is it?

Birthing unit insisting.

Heliobacter pylori, bacteria that live in the stomach.

More info here

There have some been studies showing a link between H pylori and hyperemesis of pregnancy but other studies have contradicted this. Some of the things you mentioned like bloating and burping, indigestion, acid and chest pains made me wonder though.

That's very interesting math. I had a suspected peptic ulcer in June and my digestion has always felt a bit sluggish.

I doubt anything woukd be investigated until after the pg though.

Well this isn't going too well.

They are insisting on a 'talk' a GTT AND a scan. I'm not happy about the GTT. Drowning my baby in glucose doesn't sound too good, but I'll be the first to admit that I've probably done it by a poor diet regularly anyway.

A 'talk' won't harm anyone although is a logistic nightmare.

However I cannot bring myself to agree to another scan. I know most consider them safe, but carrying a baby with a genetic predisposition to autism meant that agreeing to the first two was stressful and I just can't do it again.

Look - a GTT won't "drown your baby in glucose" unless you have GD. The scan will be because if you do have GD, your baby may be very big. I really would go to the GTT, taking your DC, and take it from there.

Agree with longtall a GTT won't drown your baby in glucose unless you have GD in which case it's what they get every time you eat anyway which is why you need to know so it can be managed. If you really don't want another scan don't agree to it sorry to be ignorant of it but what do scans have to do with autism though?

Autism is complex but it is becoming increasingly apparent that environmental factors play a part in 'triggering' it in those with a genetic predisposition. One of those environmental factors is ultrasound.

It doesn't mean it WILL do, however I went through enough agreeing to the two I have had already and won't be doing it again.

I spoke to diabetic midwife today. She said she'd accept my buying a machine and testing myself 3 times a day for a week, plus an appointment with her later in my pg. Much more positive.

Perhaps it's just a matter of getting to the expert.

You are not going to impress the medical team with ideas like that about autism.

Nobody knows what triggers autism. Nobody knows if there is a genetic predisposition.

You don't know if chocolate and fast food triggers autism. Nobody does.

You need to get a handle on the stress you are experiencing, the worries about the health of this baby. Please ask them to talk with you about your fears. Concern about autism due to environmental factors is going to be a red flag for them. It will signal to them that you are un-cooperative and willing to put your baby at risk because of unreasonable fears.

You need to accept where the medical team are coming from on this: you are at risk for GD because of your age and your diet, and the measurements they have made indicate the possibility that your baby is being affected already. The risks to the baby are significant, both in utero and at time of delivery (shoulder dystocia, insufficient nutrition and oxygen doe to placenta deterioration, premature delivery, respiratory difficulties, low blood sugar after delivery, seizures). The risks to you are also significant, both while pregnant (diabetic coma, eclampsia, pre-eclampsia, high blood pressure) and during delivery (need for emcs, internal damage due to large baby, high forceps). You need to take these risks seriously and do the GTT. If you do it and come up negative then you may not need the scan. Ask them.

Ask about the h pylori test too.

But please ask for a referral to talk with someone about the fears that are interfering with your ability to distinguish between real and improbable risks. Something is really bothering you about all of this and you need to get to the bottom of it.

This is what I meant when I said --
'I think I can see where the health team could get the idea that you are opposed to the test and are quite gung ho about this...If you focused on medical aspects of the question, seemed anti-hospital, and questioned whether the test was medically necessary when they seem to think it is, then they are going to draw the conclusion they have drawn.'

Max, you're right about them not knowing what causes autism, but there is published research that suggests a link with ultrasound.

Regardless of this I still had 2 scans as I believe in a balance of risks. However I believe a 3rd to be both unnecessary and potentially inaccurate and if I did have a risk of SD my research for ME comes up with a better outcome for all of us NOT in a hospital environment.

I am happy to be monitored for blood pressure (currently low end if normal), preeclampsia (hardly put on any weight with pregnancy, let alone swollen), diabetic coma (midwife wants me to turn myself in if I get a reading of 8 - all readings so far have been 4-6) etc. These things can all be monitored without a scan or GTT.

Btw, I'm not stressed about the health of the baby. I have a normal level of concern. Many mothers do not fly, drink, eat runny eggs, have flu jabs etc and do all kinds of things that are not proven to cause protential problems. It's a normal part of pregnancy.

I suffered assault during my first birth in a MLU attached to a hospital resulting in DS being born with trouble breathing, low oxygen and shaky. Neither me nor my baby are going to go through that this time. There is no point me talking to the medical staff about this as all details are omitted from my notes.

Starshit all I will say is that you need to remember that ALL tests are offered and cannot be insisted upon.

This includes blood tests, GTT, scans and 'chats'

Whilst there are reasons for tests being offered and whilst many women accept the offers willingly, if you personally choose to decline - for whatever reason and regardless of whether your HCPs or friends, family or MNers agree with your reason - then the choice is exactly that - yours.

It's not though is it Fiss. If I decline the test, then I will be refused the birth environment that carries the least risks for ME.

There is a lot of point talking to someone about the assault you suffered. I think you should make it a priority to find out where you could go to talk about this. Rape Crisis? Individual counselling? Birth trauma site

You can also go and talk about the childbirth experience and bring up something that is not necessarily going to be in the notes. In cases of birth trauma the notes are not going to show the feelings of the mother or how she experienced the medical procedures or how communication between the medical team and the woman was managed, and not an assault. Going over your experience afterwards with the professionals who were there is about communicating your perceptions as opposed to what your notes say.

When you get a GP, please ask for a referral. You need to talk about the effects of the assault on you and not the baby.

After a horrible experience like that it is very understandable that you do not want to suffer any form of coercion wrt delivery or medical care. Even a straightforward delivery can shatter a woman's confidence in the medical profession, and your experience seems to have been a far cry from straightforward.

If you turn out to be positive for GD you are going to have to resolve the issues you have about fear of autism and also reluctance to deliver in a hospital environment and your problem with any form of perceived coercion when it comes to pregnancy and delivery. Even if you test negative, getting help in the aftermath of the assault is vital just so that you can begin to put it behind you.

I think I can see how this GTT problem is surrounded by other problems and also how it is such a sticking block for you.

Balancing risk involves knowing the risk. I think you are trying to avoid the definitive yes or no that the GTT would give you because of the issues you are dealing with regarding the prospect of hospital delivery. You need to know the risk. You need to weigh the pros and cons of hospital delivery with all the information to hand, including whether you have GD. You need to know the reality (GD or not GD) and from there you can assess the risks for you and for the baby.

I also think that without knowing about the assault the medical team are going to think you are being cavalier about the health of the baby, refusing to alter your diet for the sake of the baby, and opposed to medical or hospital intervention because of fears about autism that they will discount.

I think they will see your agreeing to blood pressure monitoring, home blood sugar monitoring, etc as you agreeing to things with your fingers crossed behind your back, and they will suspect that you will falsify blood sugar readings since they will result in a definite medical plan that involves hospital delivery, perhaps induction. To the medical team you will look like someone who is ignoring a real risk in order to have the delivery you have set your heart on or because you have a layman's understanding of research about autism or because you are anti-hospital.

Please be open with them about everything you are concerned about that is highly personal to you, and do not get involved with them in any debate about autism, research you have read, medical issues, etc. I think the real issues here revolve around your traumatic experience and you need to get help in having that resolved or at least acknowledged by the medical team when trying to make plans for your delivery.

math, thank you. I can see a lot of sense in your post and I know that your advice about how I coukd cone across is sound and intended to be helpful. I will take heed of it.

However, I'm not going to have a GTT test to prove I'm not lying about my own readings. That is just insane and to be made to do so would reduce my trust further in the opinion of the HCPs.

In terms of counselling etc. I have had probably as much as I could have. The BTA were great, but I have also attended a number of courses about the physiology of birth and debriefed loads to my midwife cousin, not to mention used MN. I don't think there is much more I can do. Every HCP I have told have been doubtful of my experience and suggested it couldn't have happened. My labour is written up as text book and the apgar is given as 9 and then 10.

This isn't my second baby either. I have had an amazing birth experience since my first at the birth centre I am trying to get in. My BMI and diet was the same for that birth (although fundal height was average rather than above).

I'm not planning on debating the autism thing as it would go the way of the MMR debate. I know that. But I am at a loss for the moment how to explain scan refusal, which I will. Margin of error is one argument, plus even an accurate scan being unable to predict whether there will be any problems birthing the baby. Perhaps I need to get to the bottom of why they might want it and the consequences of different variables first.

No that would not be the reason to take the test. However, the reason they want to give you the Talk, is because they have formed an opinion of you as someone who is fighting them unreasonably just on the basis of taking the test so they have no way of predicting that you will be trustworthy when it comes to monitoring your own blood sugar.

They see you as a woman who is unreasonably unwilling to change her diet and also unwilling to face the consequences of your diet. They think the autism concern is a smoke screen that you are putting up to avoid dealing with your diet (and you are right about the MMR thing). They are really focusing on your diet here and looking at logical conclusions based on what they think of your diet. The diet is their starting point.

You need to open up with them and be frank about the experience you have had, tell them you have not resolved it. I think you should also ask about a h pylori test (you may have the problem and asking would also show willingness to be involved on a medical basis; also if it turns out positive then you will have gone a long way towards helping them see the diet thing in the right light, which could help them see your issue more clearly).

From a purely medical pov, you have aged a bit since the last birth experience with the same bmi and diet and age alone with the accompanying wear and tear on the digestive system and reproductive system means that once you cross certain thresholds then different things crop up, GD and the need for additional scans being two. The protocols are based on strong statistical evidence.

Thank you math.

Actually, my diet has improved a bit recently. Not hugely great but I started to pop renatadine again and it seems to have helped a bit. Plus this pg has gone like the others and my digestion seems to improve in the 3rd trimester.

To be fair to the HCPs involved, the birth centre midwife has not refused me on any basis, just explained that she has not the authority to override policy and so has put me into the system that might, starting with the diabetic midwife who has told me the same, that if I cannot satisfy her she also won't refuse but will refer me to a consultant for their opinion.

I do think that is fair, though it was actually a doctor that assaulted me in the first birth and I would prefer to keep them the hell away from me.

I'm not sure though that it was every my diet that was of concern. I've been whinging about it since booking in and I've always been dismissed and told to just eat better. The reason for GD referral at this point us BMI of 31 and measuring 2cm more. Diabetic mw didn't even mention my diet except to say DON'T change it while I am testing.

What a terrible thing to have happened Star -- really and truly one of the worst and most vile things any human could do to another in any circumstance but especially with you delivering your baby.

Well I just got a reading of 7.8 1 hour post breakfast (5.8) fasting. Does that mean I have to hand myself in now?

Math strangely the effect it had on me at the time, whilst shocking, wasn't what has affected me so much. It is the subsequent denial by those that WERE there (Dh excluded) that it happened as well as the insistence that having taken pethedine (without consenting and clear refusal in birth plan) I must have been confused.

star how are you doing now?

Dunno. I had lunch, then fell asleep for two hours (daughter is at the worst stage post-op so very disturbed sleep last night)

I'm shit at this.

Mw said to test after lunch OR dinner depending on which had the most carbs though so I have another chance.

Actually thinking about it, this morning's reading wasn't really a fasting one as every time I was woken up I had to eat a couple of rennies that have sugar in (sugar free not to be taken in pg according to box). I had at least 10.

I really AM shit at this then

Don't be too hard on yourself, can the doctors give you a different preg-safe indigestion tablet?
For what it's worth it sounds to me like your readings are ok taking that into account but I'm obviously not an expert.
Take care, keep posting if it helps I will keep checking in, feel free to pm me if you prefer

Hope your dd feels better soon too x

Hate to say this star, but the advice you've had from the midwife regarding blood glucose monitoring is questionable to say the least! Monitoring should be done at the following times: before breakfast, lunch, dinner & supper and/or 2 hours after meals/supper - ie at least 4 (sometimes 8) tests a day are necessary.

Having said that, monitoring is essential in established gestational diabetes - these tests will not give a diagnosis - only a GTT will do that.

Have you been given information on how to interpret & act on the results of your glucose monitoring? Ie target glucose results, when to ask for help etc? You may run out of strips for your meter, in which case you'd need a GP prescription or further supply. A diabetes nurse specialist can do all of this for you, plus more - not a midwife. Also, am hoping that the meter you've been provided with checks for ketones? Urinary ketone strips are not an accurate method nowadays & therefore a waste of time.

I hope what I've said here has highlighted the importance of engaging with your healthcare team to support you better. It sounds like you've had some real issues in the past, and I hope you will be supported better in the future - if you can allow yourself to be open to that. Support can take the form of Psychology & Psychiatry if necessary, to help you through this. Healthcare professionals have your interest at heart (and the baby's of course) - I hope you are able to move forward with this, for both your sakes.

Are things any better in terms of you being able to get to a hospital or GP surgery?

lotsofcheese, I don't eat meals. Sometimes I eat nothing, sometimes every 20 mins. My digestion has gone to pot.

Like today. I had some toast and cream cheese at 3pm. Absolutely forced it down so I could do a reading an hour later. Fell asleep. Missed reading.

Cannot imagine eating now until tomorrow morning. I can manage breakfast, but only breakfast.

After breakfast (which will keep me full to bloated levels until mid-late afternoon. Then I might have a slice of cheese at, 40mins later an apple, a chocolate bar 40mins after that, a glass of milk and then nothing in the evening as I'll choke on my stomach acid and throw the contents of the day up.

Because I don't have 'meals' the midwife has asked for reading on waking, 1 hour after breakfast (the one meal I promised I would try hard to do) and then an hour after I have eaten something substantial, whenever that may be.

I haven't been given any advice on levels only if anything goes above 8, to phone her, otherwise phone in a week and give the results.