Does GD mean continuous monitoring in labour?

[Tootsiepops]

I'm approaching 34 weeks.

I was diagnosed with gestational diabetes at 29 weeks. Around the same sort of time, I started NCT classes which have given me the absolute fear of giving birth on my back in a bed (my mum had a difficult delivery with me and swears blind it was partly because they wouldn't let her off her back to find a more comfortable birthing position).

My GD didn't respond to diet control (overnight blood glucose levels were Not Good despite best efforts), and I'm currently on 4 x 500 mgs of metformin per day. I'm now worried this automatically means I'm going to be strapped up to a monitor for the baby's vitals and therefore confined to bed during labour. Does anyone know if that's the case?

TL;DR - does being on metformin for GD mean necessary continuous monitoring and therefore less chance of being able to be mobile during labour?

I can't answer your question about GD but if you do have to be continuously monitored, you don't have to be on a bed. As long as you're in a position that enables the monitor to pick up the contractions and baby's heartbeat, you can stand/sit/use a birth ball.

However, some midwives prefer you to be on a bed (I was induced so had to be monitored, and the first midwife made me lie on the bed; the second and third encouraged me to be upright). So if that's what you want, be prepared to argue and push for them to at least try monitoring you in your preferred position - you can always move if the monitor won't pick things up.

Hello, I had GD which didn't respond to diet control. If you are just on metformin you should still have quite a bit of freedom although they will want to monitor you. My GD got worse at the end (my diet control was so good I ended up losing weight but it didn't have any effect on the GD) so I had to take insulin in the mornings.

Because of the insulin need, I was brought in 2 weeks early for induction. Again this meant more monitoring but while in hospital I was free to walk around, use my TENS, birthing ball etc. I did end up having a CS so I can't tell you about later on in labour unfortunately. But my experience up to that point was that I was treated like a normal pregnant woman, would have been allowed to use the pool for pain relief etc. Actually the weirdest thing was that after weeks of the pregnancy being focused around GD, once I was in hospital it was almost like they weren't bothered about it any more. I'd been under the impression that they would be in a rush to deliver the baby but in fact they told me I could go home and come back in a few days to try again.

Anyway I really hope you get the birth you want, I think the key is to be clear with them and be prepared if you do go in early for there to be a lot of waiting around.

I had GD and was on insulin but only small amounts - they didn't give metformin at that point, I was monitored and fed glucose/insulin hourly from drips so it was immobilising but not overly restrictive. Having said that I ended up with a c section as was early and breach, although they didn't confirm this till after several hours of labour even though I was trying to tell them it wasn't right I was a) a first time Mum and b) grumpy due to diabetes apparently!! Make sure you have someone good with you that will stand up for you - my Mother was useless didn't understand the GD issues even though she is type 2 herself and kept telling me to shut up when I was trying to communicate concern to Drs and in the end I lost it and demanded to see consultant re glucose/insulin/food thing which they were not managing well and also the lack of progress and position of the baby - I had a full scan less than 4 days prior and been in bed since and not felt any significant movement so was fairly sure was still breach and was right. He went apeshit at the care I had been receiving and sorted things pdq and within 20 mins was delivering c section on a spinal.

I would not say mine was a typical birth BUT it is important where you have an issue like GD that you do have other support/voice in the room

You don't have to consent to ANYTHING at all.

I have no idea what the recommendations are re monitoring in labour for a woman with GD, but you can decline.

Having said that, I was most comfortable flat on my back with DS1 and found all the walking/crouching/kneeling utterly excruciating [congused]

Make sure you understand why whatever course of action is recommended and then you can opt to go along with it or not. CONSENT is yours to give or without; it's for anyone to tell you what you must do, although there are reasons for policies and guidelines/best practice.

Also, wait for the day to come; you may surprise yourself about how you feel about things when the time comes.
Good luck

I had a glucose/insulin drip in one arm and a syntocin drip in the other and then the monitoring stuff on top of that so was pretty immobilised.
Despite this I had two pretty positive labours with no further intervention required (although did have epidural in the first one).

I had GD and was monitored throughout the birth, but that didn't mean being stuck on the bed. They did regular glucose checks and I spent most of my time walking, then hobbling around and on a stool next to the bed.

It sounds as though I should be able to move around at least a bit - that's such a relief. It's hard to judge which position you're going to feel most comfortable in until you're actually in the throws of labour, and as a ftm, I have no idea what's in store.

I'm usually pretty good at being firm with people when I need to, but I feel very intimidated by being spoken down to by midwives and doctors (perhaps stemming from a bad experience following a first trimester loss) and am worried I'm going to get frustrated and cry. Which - for a 36 year old - is just bloody ridiculous.

I genuinely thought I wouldn't let all the pregnancy bullshit get to me (natural birth vs pain relief / breast vs formula), but I am very confused and do feel pressure on certain issues. It's a minefield out there!

At the end of the day you have to ask yourself what is more important to you- which I'm sure is the health of your baby. Diabetes has an increased risk of still birth the longer the pregnancy lasts (which is why they offer induction early). Babies of diabetic mums are often under developed (not in an obvious way) and there is more risk of placental insufficiency. For this reason you are continuously monitored during labour, whether you go in to labour naturally or whether you're induced. If you're on insulin you'll also be on a sliding scale drip, you may also have other drips going- fluids/syntocinon- which makes it difficult to be super mobile. They also need to get a good quality trace of babies heart rate which can be difficult if you're moving a lot. If your wish is to be really mobile then they may offer to apply a fetal scalp electrode to babies head so that there's a direct contact between the monitor and baby.

I had gd and currently have a three week old baby so can only relay my experience to you. I went in with preconceived notions of wanting an active natural labour, but no one managed my expectations of how painful induction would be. I managed to be on the ball for some of my early contractions and later on being upright against the back of the bed was fairly comfortable but the baby's heart rate was unstable for much of the labour meaning I pretty much had to be monitored continously. I was also on metformin but ended up on insulin during the labour but I think this was partly as the food options for GD were so bad in the hospital my blood sugar was low so don't just take snacks, prepare not to be catered for adequately.

My DH was amazing at sticking up for me and articulating my wishes when I was unable to so it's important your birth partner does the same; asking about any interventions before they happen and getting the facts.

Overall I would say just go in with a flexible outlook but prepare for the unexpected. Labour is unpredictable and different for everyone and from what I understand rarely goes to plan.

Ps- nct and bloody hypnobirthing classes also gave me the absolute fear about giving birth lying down and having pain relief both of which I had in the end and it in no way makes you a failure. I'm quite angry at how both of these topics were framed in those classes. Please pm me if you'd like to chat further.

With my dd I was continually monitored due to her pooing inside me. They wouldn't let me move as I was always strapped up to the monitors. It drove me crazy. Although with my ds I was continually monitored and was able to move around. Go to toilet bounce on ball stand up and walk on spot. I think it just depends who you have

Just to add my best birth was laying on my left side with my right leg propped up. DS shot out with 2 pushes. Anecdotally a few friends have given birth in a similar position and had positive experiences.

My contractions radiated down my thighs and I was on a monitor so there is no way I could have been active by the end but I remembered my NCT teacher saying 'if you find yourself on the bed try lying on your left side'.

Maybe just consider that as you don't know whether active birth will be for you. I really think it depends where you feel the contractions. Active birth makes a lot of sense for people having back labour but not so much for leg labours.

Good luck.

Oh. I say I was laying down but actually I was propped up on loads of pillows. Even the time I was 'on my back' I was sitting very upright with lots of pillows.