Shoulder dystocia in last birth and gestational diabetes in current pregnancy-help

[AntoinetteCosway]

When I had DD she had shoulder dystocia. I was overweight but not obese and had none of the other risk factors. I had the GTT because my dad has early signs of Type 2; it was all clear. She was an average size. I ended up with PTSD as a result of the birth, DD was born blue, never latched on-it was all a bloody nightmare and it took me two years to get to the point where I would consider getting pregnant again.

This pregnancy I have been signed back to the midwives from the consultant because I want to have a normal birth if possible-there was pretty much no discussion, he just said ok and that was that. Now I've just had the GTT again (same reason as before obviously) and my post lucozade reading was 8. Apparently the cut off for normal is 7.8. This doesn't seem that high to me but apparently it's high enough. I don't know what it's out of and can't find the answer. Ironically I am far healthier this pregnancy than I was in the last one. Much slimmer, normal BMI, plenty of exercise, largely great diet etc.

So last time I had no risk factors for SD but did have it. This time I have two risk factors-I've had it before, and I have GD.

I have to go back next week to discuss it with them. My nightmare scenario is that I end up back under consultant led care, am induced (happened last time and I'm convinced was partly to blame for the SD), continuously monitored and not allowed a pool birth (which I wasn't allowed last time because my waters went first and then I had 'failure to progress', hence induction etc) or worse, told I must have a Caesarian. I know it's ludicrous but I am absolutely shit scared of c-sections. I cannot bear the idea of it. I had an epidural last time after the induction and it didn't work properly. The idea of the anaesthetic failing literally gives me nightmares.

I hate that I have to wait until next Tuesday to discuss all this. I was so blasé this morning-I really thought it was ridiculous that I had to have the test at all.

Has anyone been in this position and does anyone know what the hospital's likely recommended course of action is going to be?

Would it be naive and stupid for me to go in ready to argue for a normal, midwife led birth? I obviously don't want to give this baby SD. But I also don't want to set off the same train of events as last time by having an induction-a train which led to SD anyway.

I'm so confused and sad

hi antoinette I'm sorry you've had a bit of a shock today and that it's thrown your plans into disarray. Presumably you had the GTT at the normal time of 28-30 weeks so you have plenty of time to come up with a birth plan. The first thing to get straight is nobody allows you to do anything. The doctors discuss with you the pros and cons of the available courses of action and you make an informed decision what happens. Your body, your baby. I'd see the few days you need to wait for an appointment as an opportunity to do your research and go with a list of questions.
You should be given some advice on managing the GD and I would think additional scans to make sure baby is not getting too big. The fact that you are slimmer must be in your favour and I would think your wish for a natural birth and to be upright would probably also help.
I have no experience of SD, but have just had a similar discussion with a consultant to try to prevent a repeat PPH. I went into it well informed, listened to what he said, stated what I could and could not accept and we came up with a plan.
The Royal College of Obstetrics and Gynaecology publish guidelines for dealing with various birth problems which are evidence based - that would be a good place to start. I'd also post on the childbirth board to get some experiences.
Good luck. I hope by Tuesday you can approach it in a good frame of mind.

Thanks bakingtins. I've been googling as much as possible and am going to take as much evidence as I can find in with me next week I think-I know you're right that they can't 'make' me do anything, but in reality it's hard to say no in the face of medical advice so I think I need to understand as much as possible before I see them. Your consultant sounds good-and like he listened to you as much as you listened to him, which is nice! My consultant appointment was a joke at 20 weeks (though I was glad of the outcome) so I'm hoping whoever I meet next week is more willing to have a conversation.

It does seem low doesn't it - my bloods came back at 7.9 and I am still under consultant led care! But to be fair, I was expecting it (unlike you) as I had GD in my last pregnancy.

I have never met my consultant, only ever seen locums who are ok but never the same one. My advice (which I haven't followed) is to make a list of questions and concerns and voice them, loudly!

On a positive note, my growth scans, which I have every 2-4 weeks, have put DC2 slap bang on the central curve. Only two weeks to go, so fingers crossed this doesn't change.

Good luck xxx

I was diagnosed with GD in my last pg with a reading of 7.9 - so not far off yours. One of my friends was also diagnosed with GD and she horse rides, is veggie, super slim size 8... I'm about a size 12 but still not obese. It's not necessarily always linked to your normal weight or size.

I'm guessing you'll be asked to monitor your blood sugar four times a day. My friend kept hers within limits and hired a private midwife, so she could have a home birth. If your bloods are ok and baby's size is ok (you'll get extra scans to monitor this as you have GD), perhaps your midwife-led unit will also be ok?

I had an ELCS (not because of GD though) and it was absolutely fine, BTW. I'd have thought the only reason they'd look at one for you would be if baby was clearly huge.

Do most people manage it with diet then? The receptionist who told me my results today was very doom and gloom about injecting insulin. I am going to look at the diet they suggest as we eat pretty healthily already-no refined white carbs etc. I am sure there are things I can do to help though.

So potentially if I do keep it under control through diet they won't insist/advise on an early induction? I really want to avoid forcing the baby to arrive early. I am convinced my induction last time was partly to blame for the SD.

I am diet controlled only and my bloods have been fine. It's the random things that put mine up - peas, non-UK grown fruits (oranges, pineapple etc) as the warmer their growth climate the more sugar they contain. Interestingly, but not very healthily, fat seems to stop me absorbing sugars as fully, so cheese on toast is fine!

Unfortunately though, I was still induced on my due date last time. There is more chance of the placenta failing with GD so they tend to want baby out as soon as. However, it is your decision and with your history, you need to be vocal about what you want and need.

Hope it all goes well. Keep us updated.

Peas! That's unexpected?! Do you know of any websites that have accurate dietary suggestions for people with GD? I've found a few but they seem to vary a lot so it's hard to know which are 'official'.

I don't mean 'how is that unexpected?!' about peas btw, I mean genuinely that I didn't expect that! Rogue punctuation

I bought a GI Diet book. This one is handbag sized so handy while you are out and about www.amazon.co.uk/Diet-Pocket-Guide-Revised-Updated/dp/0753510324/ref=pd_bxgy_b_text_z

It's not the perfect solution but it definitely helps to weed out the unexpected ones! Caffeine is another weird one for me - a full caffeine coffee can shoot my bloods up.

Brilliant-thanks for the recommendation. I'm not drinking caffeine at the moment (apart from the odd diet coke) due to the pregnancy but I'll keep an eye on that.

I found eating avocado with a meal sorts my blood sugar - guess it must be the fat content. As long as your sugars are under control, I can't see that anyone would want to put you on medication. There seems to be a lot of unnecessary scaremongering around GD but if you're borderline/under diet control, there's no reason to worry.

BTW, growth scans showed DC1 was about 8lb at 38 weeks and my consultant asked me what I'd been eating... He was 6lb 13oz at delivery a week later...