Declining GTT and Home Birth

[amitymama]

I am supposed to have the GTT in a couple months as my dad is diabetic. However, I feel that since the risk of me developing GD is so low and if I were to get it would present itself in other ways throughout the pregnancy, I want to decline it. When I was pg with DD I often tested positive for sugar in my urine and had the GTT and everything was fine. The MW said some pg ladies just have sugar in their urine and that is absolutely no indication that I have or will develop GD. I am 21 weeks and my urine has tested positive for sugar on the last two MW appts and is causing me anxiety about this GTT. There are no other indicators that I have GD.

So my question is, will declining/refusing the GTT raise any eyebrows with regards to my home birth? I don't want anything to endanger that and am not sure if taking it or refusing it is the better option.

Why do you want to decline a GTT?

It is only 2 blood tests (oh and the vile lucozade). I had mine combined with other sets of bloods so I had a needle in my arm for them anyway. It will be the earliest indication of gestational diabetes, before any other symptoms appear.

If it was me I would have the test and treat it as positive reassurance if it comes back negative.

As far as the home birth is concerned....I acn't see how this would im[act it. If you have GD it might but refusal of a test itself shouldn't be a problem.

I love homebirths, had 2 they are brilliant - however - before entering into one I would want to be certain that I wasn't somehow endangering my childs life.

I don't know what the implications of gestational diabetes are but I wouldn't want to turn my back on the test unless I knew that the result wouldn't put anyones health at risk.

Sorry if that isn't what you wanted to hear

Good luck

Why don't you get a blood glucose testing meter? If there is glucose in your urine you can then test your blood sugar yourself. If it's high, then you can present yourself for a GTT. If not, you can ignore it

I had sugar in my urine a few times whilst pg (I blame the Frosties!) but my blood sugar was always fine. My DH is diabetic so I borrow his blood glucose meter from time to time anyway just to have a check.

Take a look at: www.homebirth.org.uk/

If you refuse the test ( i refused mine with ds2) it does not mean anything regarding your planned HB.

If you have it and test ++ they may want to do extra scans etc due to possible size of your baby - this should not affect your HB either.

They may want to induce early or recommend a c/s if your baby is v v big. but scans can be around 25% out.

i am a diabetic and 29 weeks pg and insulin dependant twice a day
i asekd for a HB but was told to risky
my babies are always big at around 9 to 10 lb by 36 weeks
the prob;em is being a diabetic or having GD is they do not want your blood sugars going over 10 whilst in labour
it can make the baby have a low bloods when born and needing care asap
i have had this once
basically when we are in labour we dont eat do we
we just cant that makes your blood sugar eratic as it is,our blood sugar has to be stable or it can make the baby distressed
Why not get a testing kit and try yourself what your levels are after meals (2hrs)to give yourself an idea
the GTT isnt so bad,and it it makes it safer for you to know for you and baby surely thats a good thing

But GD often presents itself in ways other than the GTT, right? Isn't there swelling, measuring large for dates, etc.. that are indicators of it? Or is GTT the only way to find out?

The reason I was scared about this affecting my homebirth is that a MW mentioned that if I had GD they might not want to 'let' me have one. Well, I've done my research and there is no reason to think that I couldn't have GD and still birth at home. The only risk (and it's a small one) is that the baby would be so big that there would be shoulder dystocia. MWs are (or at least should be) trained in how to deal with that situation though, correct? I'm not worried about the baby being too big for me to birth, unless it was over 12lbs or something. I don't believe in Big Baby Syndrome to the extent that it is perpetuated in the media and by some medical staff. Most women can birth larger babies just fine without the need for early induction or automatic c-section and I get angry just thinking about them even suggesting that to me if I were to test positive.

See, this is why I'm wanting to decline the bloody test altogether, it gets my BP up because it makes me mad! LOL

disneystar, thanks for sharing your experience. However, is it different for a woman who was already diabetic and insulin-dependent than for a woman who develops GD? I thought GD was usually just controlled through diet,not insulin.

And what you say about women not eating during labour and they don't want the blood sugar going over 10...couldn't one make sure to eat small amounts of food while in labour and monitor their blood periodically with a glucose monitor to make sure everything was ok?

I'm not one to endanger my baby unnecessarily but I'm also not one to just be told 'No, you can't do that' if there's a way to monitor a situation to make sure it's safe. I really, really don't want to give birth in a hospital and so would be willing to do any amount of monitoring, prevenative care, etc.. to facilitate a HB.

I don't know why I'm stressing about this though, I haven't even tested positive for GD! I guess I'm worried since my dad is diabetic and there's been sugar in my urine twice now. Does that mean anything or does it have naught to do with my chance of actually having GD?

I had sugar in my urine when pg last time. MW got in a big flap and said I had to have GTT and if I had GD I wouldn't be 'allowed' a homebirth. It upset me and stressed me out a lot at the time (I was around 36 wks I think).

However, I had the test, all fine and DS born at home a couple of days after his due date.

I had sugar in my urine quite a few times. Was it + or +++?

I honestly think getting your own blood sugar tester is the way to go... they are fairly cheap now, you can get them for

MaeWest -- this is exactly what I don't want to happen. But I'm sure that everything will be fine, as it was with you. I suppose I'll take the test and then cross that bridge when I get to it if it's positive.

TigerFeet, it was only a little high, not overly. Where can I get a blood sugar tester from, any idea? Does that involve a finger prick each time?

Most chemists sell them, or Boots or Superdrug or similar. Yes, it involves a finger prick but it's painless. I am a bona fide dyed-in-the-wool coward and even I don't flinch any more!

GD isn't related to swelling at all, and you don't necessarily measure large for dates.

With GD there's a big difference between insulin dependent and controlled by diet and exercise. If you keep your blood sugar under good control through diet (basically a low-GI diet) then the baby is unlikely to have any effects and there's no reason you can't have a normal labour and delivery (some medical professionals will still stress at you, but many will be perfectly happy so long as you have consistently stable readings). If you need insulin then maintaining stable blood sugar levels is more tricky and it's more likely to be advisable to have a hospital birth. Most cases of GD are controllable through diet.

This is the blood sugar monitor I used to monitor my sugar levels. You do need a finger prick each time.

Thanks for the info everyone.

i had GD, controlled well through diet and dd3 still had to spend 24hours in scbu after birth as her blood sugars were too low, and she wasnt well.

amitymama i was only diet controlled diabetic before i got pregnant

i had to swithch to insulin at 14 wks as diet alone was not enough

i had no swelling,no signs whatsoever.

i am nearly 30 wks now and i do not want to be induced at 36/37

i am fighting this all the way and have another appt with consultant in 2 weeks

he says im compromising my babys health by not listening to what he has to say

i realy undertand what you mean,i want to be able to do what i want in birth
im not afraid either to birth a big baby,
im just worried that my blood sugar levels are so erratic now that they will harm him in labour and i cant afford to chance that
im still so unsure what to do!!!!

i think your own kit to test sounds a good idea at least you know whats going on us diabetic mums on here can tell you what your bloods should be or advise before the medical team know
they flap about over me all the time it seems sill to me really as all i feel is a bit tired breathless but im used to that at this stage of pregnancy
but at the back of my mind there must be a reason why they pester you like they do
ive already been told i have to hooked up to a drip during labour to keep my insulin levels stable
not my idea of giving birth all this medical intervention
i have hired a doula to help me overcome this and keep them away from me as much as possible,
good luck with what you decide let us know how you get on

thank you disneystar, and I hope that things go well for you. good on you for trying to preserve as much control of the birth as possible and being unafraid of a big baby. i think having a doula with you will be very beneficial.

can I also suggest that if you are concerned that they will refuse you a HB and you are not happy with the reasons, you ask to speak to a consultant midwife?

They generally seem very competant and knowlegable and will write things in big letters on your notes. Last time I saw one (for another reason but HB related) she put instructions on the notes but ALSO wrote her home number so they could call for clarification!

The main risk if you were diabetic is that the baby would be too large which would cause problems. Large babies from diabetic mums are more likely to suffer from shoulder dystocia and problems due to low blood sugar than babies of non diabetic mums, as they are large due to excess blood sugar, not just naturally large, if you see what I mean. If you were diabetic, and you had a homebirth, your baby could suffer from low blood sugars which could cause it to become seriously ill or even die. This is why it is so important to find out if you have it or not. I am very pro homebirth and will have one again if I have another baby, but diabetes is one situation in which I would never ever have a home birth. I think it is so important to find out if you do have it or not, and if you have had a normal pregnancy before you will probably have another normal one.

Hi ladies. I see disneystar here too

I was diagnosed with GD at 16 weeks (quite early) with no sign of diabetes in my family history nor my previous 3 pregnancies.

I was diet controlled at first but now at 22 weeks I'm finding it hard. I've had my insulin upped 3 times in the past week. I'm now on 8 units AM and 6 units PM.

I have no symptoms traditionally associated with diabetes - ok I might wee a lot but we pregnant ladies do that anyway!

It's been explained to me that my baby may grow large hence I'm having sizing scans at 28 and 32 weeks. Where I am now at 22 weeks, I'm told that most babies are around the same size.

I understand the implications for not treating diabetes in pregnancy can be quite serious. I'm having an elective C Section to be on the safe side and will be induced early depending on her size. This is my personal choice.

(this is all familiar to Disneystar I'm sure )

So, it's really up to the individual but the test itself is very easy to get through - the nastiest thing about it is drinking the yucky glucose solution and it's not that difficult

Please have the test amitymama. I am showing absolutely no signs of diabetes, but have had a positive GTT, and am now monitoring my blood sugar at home. I am 19 weeks.

There can be serious implications if GD goes undiagnosed.

johnworf - interesting that you have been diagnosed so early with GD. My clinic have advised that it's very early to get GD, and it is thus at least as likely to be type 2 diabetes, that I was simply unaware of before. Have your clinic suggested this to you too?

What 'hype' Leonie?

Hi CantSleepWontSleep. Yep, it was very early. It usually starts to show itself in urine samples around 28 weeks. They've said it's Gestational Diabetes although I may be susceptible to type 2 diabetes in later life. Just have to wait and see for that one

Just to note, my early urine samples up to 15 weeks were normal and showed no traces of glucose.

I'm coming up to 23 weeks which I'm told by the hospital is when your sugars start to climb. Probably why my insulin is being increased so much. I've also been told by the endocrinologist at clinic that I'll be mixing the slow release insulin that I'm already on with the fast acting. I think that time will be very soon the way things are going!!

Are you using diet alone at the moment? I started on low GI but then it wasn't enough...

Yes, I'm diet alone at the moment. Only saw the diabetic midwife for the first time on Thursday afternoon, so it's all quite new to me. Been monitoring bloods 4 x per day since. Doing a fasting one plus 1 hour after each meal. Was told should be 5 for fasting and less than 7 for the others. Highest was after breakfast this morning, when I got 9.5 . Only had shredded wheat and an orange, both of which they said should be fine, so it's not looking good! GTT was only just over their threshold - 7.9 vrs cut off of 7.8, so was hoping that all might be ok, but doesn't look like it is. Seeing lots more specialists tomorrow, so will hopefully find out more then.

Why were you sent for the GTT in the first place johnwort, as you seem to have no indicators for it at all?! There's lots of family history of diabetes for me (type 1 and 2), plus I am significantly overweight, which I think is why I was tested earlier this time. Didn't have it last time (at least not when tested at 28 weeks, and never in urine), but still produced a 9lb baby!

Apols, johnworf, not johnwort.