Gestational diabetes is a label given to women who are spilling extra sugar into their urine on a repeated basis during pregnancy. It is a relatively common situation, yet new research suggests that it is not a disease, rather as a pregnant woman’s metabolism changes, her sugar levels appear higher than normal, even if she is in good health. True diabetes during pregnancy is accompanied by other signs of challenge to the kidneys, such as ketones in the urine as well as the glucose.
Ways to prevent and treat diabetes include cutting out all sweets and simple carbohydrates from your diet as much as possible, encouraging metabolism through regular exercise, even if it is just a brisk 30 minute walk at least 3 or 4 times a week (gestational diabetes is a known complication of bed rest, because of the inactivity involved), and taking nettle leaf infusions or capsules can help strengthen your kidneys.
Unfortunately, once you are given the label of GB, even if you improve your diet and exercise regimen, you are still considered high risk. Once you are “high risk”, you start down a slippery slope of medical management. For one, your doctor is more likely to suggest an induction of your labor to prevent your baby from getting any bigger. labor induction is not medically indicated for those with gestational diabetes, even if their babies are estimated to be of larger size, because there is no exact way to measure either the baby or the mother’s pelvis. The only way to determine if the baby can fit well is by a “trial of labor”, and adding the risks of induction can make labor more dangerous.
As a high risk patient, you will probably be asked to stay in bed during labor so they can monitor the baby’s heart rate more frequently. Not only is a fetal monitor no more accurate in determining fetal distress than a hand-held doppler, being restricted to bed will make it more difficult for your baby to maneuver through your pelvis. With a potentially larger baby, you will need to be upright and mobile to allow your pelvis to adjust to the baby’s head, and allow him the most room that is possible to descend.
Also, even though women with gestational diabetes are more likely to have larger babies, using the glucose tolerance test in and of itself to predict a large baby is not good practice. Neither is it good practice to rely solely on ultrasound estimation in determining the weight of the baby, since they can be off by as much as a pound or more, especially in the second half of pregnancy.Prepregnancy weight, maternal weight gain, and a pregnancy past 42 weeks is more predictive of a large baby than the glucose tolerance test. Taking insulin and eating less sugar can decrease the size of the baby, but it has not had a significant effect on other outcomes such as the use of cesarean sections, shoulder dystocia (the big fear when delivering a large baby vaginally), or perinatal mortality (baby dying during labor). One trial assessed the use of elective cesarean section for “gestational diabetes” and found that while this resulted in more complications for the mothers, the babyies did no better than if they would have been born vaginally. In a trial using elective early induction of labor there were no significant differences in maternal or neonatal oucomes.
As for the glucose tolerance test, 5-70% of the time it is not reproducible. Meaning, the first time you take it you’ll have diabetes, and the next time you won’t. Another amazing statistic: “The majority of macrosomic infants will be born to mothers with a normal glucose tolerance test.” Testing for diabetes doesn’t garantee a certain outcome, and it has been determined that routine testing of women without symptoms is unlikely to have any signficant impact on perinatal mortality or morbidity.
So, how can you improve your chances of having a normal birth, even if you tested positive on the glucose tolerance test?
1) Ask your doctor if you have any other symptoms of gestational diabetes, and if not, ask to take the tolerance test again.
2) Cut all sweets and simple carbs out of your diet and exercise regularly.
3) Talk to your doctor or midwife about going into labor on your own, and express your concerns over the the lack of evidence suggesting it will help you or the baby.
4) Talk to your doctor or midwife about being able to remain active during labor, and having a nurse or your caregiver use a doppler instead of the fetal monitor, so that you can stay out of bed as much as you feel comfortable. Research suggests using the doppler instead of the fetal monitor is just as safe for your baby.
5) Do not push on your back! When you push on your back your baby’s body has to travel not only without the aid of gravity, but it has to travel up along your tailbone, thus, against gravity. It also prevents your pelvic bones from being able to move, leaving less room for your baby to come through. This can slow down labor, make it appear that the baby is too big to fit (or your pelvis is too small), and makes tearing or the need for an episiotomy more likely. Instead, push on hands and knees, in a side-lying position, in a squatting position (most birth beds are equiped with a squatting bar to assist you with this), or on a birth stool. All of these will open up your pelvis and allow your baby to move through, even if he is bigger than average. If you have a longer pushing phase (2 hours is not unusual for a first time mom) trying a couple or all of these positions can make progress more quickly.
