Gestational Diabetes - Chicago,IL

CONTACT WOMEN'S HEALTH RESOURCES AT RUSH HOSPITAL!
This is a high-risk practice that is awesome. They will not operate or otherwise intervene unless it is warranted. I promise. Drs are Michael Hussey, MD, Xavier Pombar, DO, and Howard Strassner, MD. Dr. Strassner is very kind, but extremely academic. I understand the other doctors better. Veronica del Rio is my preferred nurse practitioner.
BTW: I was referred to them by Homefirst--NOT an orthodox practice. I did not have gestational diabetes.
I cannot say enough good things about this group and the nurses at the hospital.
Amy

For me, the emergency c-section came with my first pregnancy when I didn't have gestational diabetes. As worried as I had been about that possibility, when it came down to it, I was so glad for the healthy baby. For my two pregnancies with the diabetes, I can't say I really loved being on such a strict diet or checking my blood sugar all the time, but other than that, all was well and pretty uneventful. No need for insulin, and vaginal deliveries. I didn't notice a significant difference in how I was treated at the hospital compared to my first pregnancy, although I was already working with an ob/gyn. I was induced for my youngest, due to concerns that he might get too big, and I found that the epidural allowed me to enjoy the birth experience as I hadn't before. You never know. I would agree that it is important to try not to worry, and no worry may be necessary here. Talk to your midwife about your concerns, and best of luck to you.

T.,
As an OB nurse and recent grad from midwifery school I have encountered many women with gestational diabetes. It can be a scary diagnosis, and frustrating when you feel your diet is well balanced and healthy. But different women respond differently to pregnancy and hormones, and gest diabetes is sometimes unavoidable, but not uncontrollable. If you do receive the official diagnosis of gest diabetes you will have a visit with a nutritionist to review the causes and effects of diabetes and a diet plan to best control your blood sugar. You will be monitoring your blood sugar several times a day to be sure it is staying in the appropruate range. Many women with gest diabetes never have to take insulin because they are able to control their blood sugar with diet alone. While this diagnosis puts you and your baby at higher risk for certain delivery complications, maintaining a well controlled blood sugar greatly reduces many of those risks. You should be able to coninue seeing your midwife, although if you ever require insulin many midwives will have to transfer your care to an OB/GYN, or at least work in close consultation with their collaberating physician. Induction may be necessary depending on the situation at the time, but remember that stress can also really mess with your blood sugar/insulin levels, so try to keep a positive outlook and not worry about how the end will go right now. If you are not exercising presently, talk to your midwife about starting mild to moderate activity, and practice relaxation techniques every day.
One inportant thing to remember is that having gest diabetes does put you at an increeased risk for type 2 diabetes in the future. Getting a fasting blood sugar with your annual physical will be an important test starting in a few years.
Good luck with everything, and most importantly -- enjoy that precious bay when he/she arrives.
S.

Hi T.,
You already have great advice from the other posters, but thought I’d share my experiences as well. I had gestational diabetes with both my pregnancies and had a great experience/no problems delivering in a traditional hospital environment. Like you, I was so frustrated and surprised because I was in good health with no family history of diabetes, so for me it was due to hormonal changes affecting my body. Luckily, my blood sugar was controlled by diet only and I didn’t have to inject myself with insulin. Both babies were born naturally with no interventions and were of average weights (my first was 7lbs, 7oz. and second was 6lbs, 8oz.). I understand your fear of being “strong armed” into a C-section. I told my OB I definitely wanted to avoid this, and she explained that if do my part with watching my carb intake and not going over my target blood levels and the baby is monitored carefully throughout the pregnancy for size, there really would be no need for a C-section if there are no other complications in play. She did explain, however, that if I didn’t have my baby by a week after the due date, she would be a little concerned and that I might have to be induced to avoid the risk of my baby getting bigger, (really depends on the baby's size around your due date). But with induced labors, there is always the risk that your body doesn’t respond properly which can result in a C-section after all, so I definitely did not want to be induced either, and was relieved when I went into labor by the due date for each baby.

Another thing, I had to get a second ultrasound about a month or so before the due date to monitor the size of the baby. I also had to get weekly non-stress tests a month prior to the due date to monitor the baby’s heart rate and movements. After my babies were born, they had to get a heel prick sample of blood to make sure their blood levels were okay, which they were.

So, if you’re getting all the necessary tests done and monitoring your blood level, I don’t see why there would be a problem delivering at home, just need to discuss this with your midwife of course.

My OB referred me to an endocrinologist whom I had to see once a month. I also had to meet once with a diabetes specialist to discuss using a monitor to check glucose levels. I also saw a dietician who explained that I was not to go past specific grams of carbs per meal, for example, breakfast couldn’t contain more than 23 grams of carbs (morning is when your body is least able to break down carbs), and my limit for lunch was 60 grams. I think this is calculated depending on your height and weight. She also went through some sample menu ideas. I could pretty much eat whatever I wanted, but I had to watch the total amount of carb intake for each meal, and make sure it was well-balanced (all food groups). The only things she recommended me staying away from were concentrated sweets, regular pop and to limit the juices. She stressed that I should never skip meals and that it was important for me to have a bedtime snack. If you’re already a healthy eater, I’m sure you can continue with what you usually cook, but you just have to start counting carbs and make sure all the food groups are still pretty much covered.

Good luck with everything and enjoy your pregnancy!!

First of all, you must understand that some women who get gestational diabetes do so because of the hormonal/physical changes that occur in the body during pregnancy and have NOTHING to do with being fat or eating poorly. (of course, obesity and poor nutrition can make some women more susceptible) I've known women who were in excellent physical condition with absolutely NO genetic or environmental/behavioral predispositions who had GD. Pregnancy hormones make it more difficult for your body to use insulin and to keep up, your pancreas work harder to create more insulin. Some women's pancreas simply cannot keep up, resulting in gestational diabetes.

I completely understand your desire to deliver as you wish, but you also need to keep the health of your baby in mind. Gestational diabetes can cause excess glucose to go to your baby, resulting in the baby being overfat especially in the upper body (macrosmia). This can result in the inability of the baby to enter the birth canal and get the head/shoulders stuck in the pelvis. You could experience a great deal more pain the vaginal canal or have tears/require an episiotomy during delivery. Other things that could happen: potential low blood sugar in the baby at birth, jaundice, low blood calcium, and you yourself are at a higher risk for preeclamspia. If you continue struggling with GD, your baby should probably be monitored to make sure he/she isn't getting too heavy. If your practitioner becomes concerned, he or she may recommend that you be induced or have a c-section...again for the HEALTH and safety of your unborn baby.

Take the 3-hour test and see how it goes. If you have an abnormal test where you 'fail' all three readings, then you may have to make some tough decisions regarding the remainder of your pregnancy and delivery. If you do 'fail' the test, hopefully your midwife will refer you to a nutritionist or allow you to take insulin shots to help manage the situation. You can also help your diet by doing the following:

-cut out all sweets, refined sugars, processed products (shopping the 'perimeter' of the grocery store will help)
-include food items high in dietary fiber (fruits, veggies)
-AVOID junk food and fast food
-include healthy proteins (egg whites, yogurt) and lean meats
-eat your meals at the same time every day to 'program' your body/pancreas
-light exercise daily (only with permission of your practitioner)

Hope that helps and good luck to you. While I personally 'failed' my 1-hour GTT, I had a 'suspect' 3-hour GTT which had my doctor put me on a GD diet/watch. For 6 weeks, I have 'behaved perfectly' as far as my diet is concerned and when I retook the 3-hour GTT NOTHING had changed; I got the exact same numbers! So, I'm still following a good diet at regular intervals throughout the day and allowing my doctor to call the shots as far as the development and progression of my baby is concerned. I want to have a healthy baby that isn't under stress, so if he wants to induce or c-section, I won't be happy but I'd rather have a healthy baby than worry.

My cousin was in your exact situation. She's extremely health conscious and has never been overweight. She ended up being surprised with the diagnosis too, but was told that it could happen to anyone and it's a matter of genetics. Being overweight or having bad eating habits is a risk factor, but not the reason behind the diagnosis for many cases.

As her pregnancy continued, my cousin, along with her midwife decided that a natural delivery might not be in her future. She did some reseach on c-sections, and just let the idea sink in a little so that if it was required she'd be prepared.

She ended up having really high blood pressure toward the end and an enormous baby--so a c-section was planned for a week before her due date. The baby was fine, as was my cousin. A healthy baby is the goal!

Best of luck to you!

Well, first off remember that the most important thing is the health of you and your baby so whatever it takes to get that is what you want. You should be prepared for what ever circumstances that may arrise. Since it has been a while since you posted this I will assume you have found out your results of the 3 hour test. I would definitely have long talk with your midwife and discuss how she handles patients with GD and ask her tons of questions. With that said I thought I would share my story with you. I was diagnosed with GD with my pregnancy. I was with an OB at the time. I kept my blood sugar under control with changes in my diet, no insulin needed. I had non-stress tests every week and a few ultrasounds near the end to check on babies size. My OB was worried that I was going to have a big baby and since I am only 5'2" he wanted to induce me 1 1/2 wks early. I was scared that I would not be able to vaginally deliver a big baby but knew people who had delivered vaginally when induced so I went with the induction. I went to the hospital on a Wed. evening to start the induction. I was given cytotec (which now I have been told was a bad idea. I know you can google it to find out more. but from what I understand it isn't recommended for induction or to be the safest for mom and baby.) I was given this wed. evening through thursday afternoon with no progress. Already my OB was bringing up the thought of going ahead with the c-section. I was very against it and said NO. I was very stressed and upset and couldn't believe he would want to do the c-section before we even tried pitocin. He said okay then we will go ahead and start the pitocin now then and see what happens but I really think you will need the c-section. I said I wouldn't and he said to prove him wrong. After all that drama I told them I didnt want anymore drugs and I was going to leave. I was not ready to start the pitocin. I was to stressed and emotional to start having the hard contrations that come with pitocin. So we agreed I could have the night off from all drugs and stay in the hospital and walk or do what ever else I needed to do. That was the best decision I could have made in my opinion. The next day, friday, I got my pitocin drip started at 11:00 and started having contractions at 11:30. I did end up asking for pain meds and was given staydol (sp?) and then an epidural a little later. the staydol was a little crazy. I dont know if they give a standard amount to everyone or if it is by your weight but that drug knocked me out. I slept through the epidural, my hubby had to hold me up for it. I received the drugs and epi when I was at 4 cm I think. I dont remember a lot after that, I slept throught the most of it. I woke up and started feeling I had to push. OB came back as I started pushing and within minutes was talking about needing to use the suction/vacuum. I kept interrupting his description of the vacuum and what he would be doing because I had to push and before he could finish talking her head was out. She was born at 5:29 at only 6 lbs 6 oz. I was only in labor for 6 hours and I proved my OB wrong and very glad I did. Needless to say I have found a midwife to care for my next pregnancy. Although sometimes c-sections are necessary. I went with my gut. I knew I didn't need one and wasn't going to give into one that wasn't needed.