There comes a time in your life when your plan changes. You're "thrown a curveball". Well, it's happened to me, again. As many know I was planning a HBAC (home birth after cesarean) in March with my son, Senna Neil. Then a few weeks ago life happened. I was diagnosed with Gestational Diabetes Mellitus (GDM or GD). I thought for sure my life was, or rather my perfect ideal birth was over. I assumed I would HAVE to have a repeat cesarean. I would be starving all the time because OMG NO CHOCOLATE. Boy was I wrong. There's a lot more to GD than I knew. So today we will be going over some things.
What is GD? How does it affect an expecting parent?
Gestational Diabetes Mellitus (GDM or GD) is described as a form of diabetes that develops during pregnancy, & usually goes away 4-6 weeks postpartum. In a pregnant person without GD the body works ‘as usual’. You eat, your stomach breaks down your food, you start to digest it, & the glucose from the carbohydrates in your food enters the blood stream. The pancreas gets the signal to secrete more insulin into the blood stream to help the cells absorb the glucose and convert the glucose into energy. The blood glucose level increases straight after a meal but as the glucose is absorbed from the blood & into the cells, the blood glucose levels decrease. The blood glucose readings fluctuate as normal, but remain within the ‘prescribed levels’.
In a pregnant person with GD the cells become ‘insulin resistant’. The pancreas makes ‘the usual’ amount of insulin to enable the cells to absorb the glucose, but because the cells have become ‘resistant’ to the insulin, the amount of insulin needed increases. Gestational Diabetes is when the pancreas makes as much insulin as it can, & the cells continue to struggle to absorb the glucose. The blood glucose levels in a person with GDM rise as normal after a meal, but stay elevated due to the cell’s inability to absorb the glucose.
Did I DO something to get gestational diabetes?
No, GD is caused by a hormone that is produced by the placenta. ANYONE can get it. While keeping yourself healthy can reduce your risk, there is nothing that can stop your cells developing insulin resistance from the hormones made by the placenta. Although there appears to be some risk factors which could increase the chance of developing GD (for example, age, ethnicity, weight, personal or family history of diabetes, or some hormone-related conditions such as PCOS), there are many who develop insulin resistance & GD who do not show any risk factors. Those with any type of Diabetes are often told “to keep your diabetes under control" or rather that it's "all your fault." Well guess what? You can’t control Gestational Diabetes. It happens sometimes & it's NOT your fault!
Will being sick raise my blood sugar?
Yes, a resounding, every time yes.
Will I HAVE to go on insulin?
No, most are able to control their sugars with a modified diet & exercise. However, if you can't please don't despair. There are pill medication options that can be pursued prior to using insulin. I know, insulin - even the word strikes fear in many's hearts. Here's a great link to a basic overview of insulin. How it works, how it can be administered and what's in it.
I got this CRAZY high reading on my meter & then took it again minutes later to have a more "normal" reading. What happened?
If the number on your meter is exceptionally high & you haven't had a significant amount of "off-limit" food then chances are your hands were not clean enough, you used hand sanitizer or alcohol & it wasn't completely dry or you didn't get all the soap off of your hands.
Do I really need an NST(Non-stress test)?
The short answer is YES, however some have refused which you can always choose to do with any medical procedure. In my experience NST's quickly allow doctors to address any potential issues, for me they are very comforting to hear the baby's heartbeat for awhile and relax. This link gives a good overview of what an NST is and what they are looking for when performing the test.
I'm on insulin. Will I need an insulin drip while I'm in labor/during the c-section?
This in the end depends on your numbers and the doctor. However I have seen lots of moms mention the possibility & only 2-3 actually end up on one.
I'm towards the last weeks of my pregnancy & my numbers are going all wonky is that normal?
Yes, this is not uncommon at all. Most are able to eat things they couldn't earlier in the pregnancy.
Will I HAVE to be induced just because of GD?
The short answer is: If your sugars are controlled & baby is a good size than no. Here is a great article on it over at Evidence Based Birth.
Can I still have a Home Birth?
This is extremely controversial & since there is limited statistical data on the subject it is hard to make an informed decision about this. Most midwives will transfer care to an OB or specialist & will not allow a homebirth. If you do some research there are a few documented stories of successful GD homebirths, but I doubt anyone would hop online & tell the story of how they ended up in the hospital after their home birth turned complicated - no one wants to relive complications especially of the life threatening kind. In the end I think that you need to sit down with your partner, discuss your local options, what your health team recommends & make a decision accordingly.
Vaginal vs. C-section
This is a great article about how moms with type 1/2 diabetes and high c-section rates are correlated. So if you end up with a c-section don't feel guilty about it. However, remember that a diagnosis of GDM does NOT mean automatic induction/cesarean/repeat cesarean. The key is to monitor your sugars, diet, medication if necessary, & find a good supportive medical provider & birthing location. I myself am still aiming at a VBAC though my locations sadly have changed. Also make sure to read my blog post on VBACs & Cesareans.