Tag Archives: gestational diabetes

I’m a mom again

We went, we delivered, and we are home. 🙂

It was quite an interesting saga, the lead-up to the birth. Because I have (albeit mild and easily diet-controlled) gestational diabetes, my midwives were itchy to get the baby out, and started talking an induction if I didn’t go on my own by my due date, as I have previously chronicled. I did my research and was OK with postponing any induction until Thursday, if needed. Well, Monday I had an appointment and midwife Sue was generally OK with the few days’ postponement, but we both agreed it would be reassuring to have a biophysical profile done (an ultrasound where they specifically check baby’s well-being, blood flow from placenta, amount of amniotic fluid, stuff like that). So I had that done on Monday as well, and while the baby was looking very healthy and everything else looked good, I was apparently low on amniotic fluid… which mostly means it makes it easier for the baby to accidentally wedge up against the cord in utero and cut off its own oxygen supply. Combined with the gestational diabetes, it was a good reason to not wait until Thursday, but given the baby’s otherwise very healthy status, Sue let me wait until Tuesday morning which also gave me an opportunity to drink lots of fluids and try to get the amniotic fluid up a little. I was told to report to the hospital at 6:30 a.m.

Well, long story short… some strong contractions woke me up at 4:30 a.m., and we left for the hospital at 6:15 a.m. I was, quite fortuitously, seemingly in labor, all on my own. Called the midwife from the car, told her we would be just a little late (there had been a little snowfall and the roads were a little slick) but that I was pretty sure I was in active labor.

Got to the hospital, got checked in and changed into hospital garb, my very awesome OB nurse checked, and I was already at 6 cm. That was about 7:30 a.m.

Continued to progress, got the all-clear to push around 8:40, which was good because I really really wanted to push. I think I was still only in transition because the contractions never let up. I JUST HAD TO GET THE BABY OUT. NOW. Her head emerged almost immediately, they got me to pause for just a second because she had the cord loosely wrapped around her neck, so they slipped it off, and I went about the very quick business of pushing out her shoulders. The midwife had me reach down and grab the baby and finish delivering, and lift the baby onto my own chest. So awesome!! She also asked me to do the identifying… “Lisa — what do you have?” she asked. My first delirious thought was “It’s a baby, duh!” but then I realized she was talking about looking for gender!! I took a very hard look, because even delirious I knew I didn’t want to make a misidentification, certainly my husband would never let me live that down. And once I was incredibly certain there was no penis to be found, declared “She’s a girl!”

She cuddled skin to skin with me on my chest until her cord stopped pulsing, then the midwife clamped it off and Frank did the honors of cutting it. I delivered the placenta and was just exhausted. I knew I’d torn a little (how could I not have, I delivered her way too fast…) and while my labor wasn’t very long, it was very intense. The OB nurse took the baby while I started to get stitched up and did all the weighing and measuring and other requisite birth things, and I took her back about 20 minutes later. She latched on at that point and nursed pretty well. I also decided, in an odd fit of whimsy, that we were going to keep the placenta and buy a new tree and plant it under the tree in the spring. Never even hearing of anyone doing this before, let alone with the complete absence of any discussion between us, my dear husband took these new plans in stride. 🙂

And our baby is, in a word, awesome. She’s a great nurser, she sleeps pretty well, she has amazing periods of quiet alertness where she just does her best to look around and see as much as she can (before her eyes cross from the strain, but then she just blinks a couple times and tries again). She is crazy strong, too… even the pediatrician at the hospital commented on it. If she’s laying on your chest, semi-upright, she can lift her head and chest up and do a little push-up. It took her about a day to pick up that little trick, mostly because it helps her look around better.

Since I avoid using real names for my kids on this blog I shall only give you her nickname, and that is Catie. She is perfect and I am in love. Her birth was a great experience and I am so happy and proud that I got to have another drug-free birth… but I am also quite pleased that I never have to do that again, since we have no intention of having any more kids.


Counting down and preparing for birth

I’m still pregnant. This coming Sunday is my due date and the baby still seems to be holding tight. I’m having inconsistent contractions, which are definitely uncomfortable but also very welcome because I know the more work my body does now to prepare, the shorter my active labor will be.

My gestational diabetes is still very well-controlled with diet, which is awesome and very fortunate. I had an ultrasound to estimate size a week ago and then the baby measured about 7 lb. 2 oz., which is much less than the 7 lb. 10 oz. Jake weighed in at birth, and the 8 lb. 4 oz. that Lane came in at. The ultrasound tech said that chances were good the baby would weigh less than 8 lbs. at my due date, which is welcome news. Of course those ultrasound estimates can be pretty far off, but given I received good news, and I know I don’t have a ginormous belly, I’m going to assume the estimate is at least somewhat reliable.

One thing that’s come up is my OB/midwives’ general policy of inducing labor for moms with gestational diabetes. I had an in-depth discussion with one of the midwives about it, and they as a practice are pretty adamant about inducing if I haven’t delivered by my due date, because, she said, there is an increased risk of stillbirth in diabetic pregnancies. The reason for this is that the placenta gets worn out a little faster because of the issues with diabetes, and can’t sometimes handle the stress of late pregnancy and labor. She told me all about her recent review of the available literature, blah blah blah. I told her I was very uncomfortable with a standard policy of induction being applied to me (as a well-managed gestational diabetic patient) without specific evidence that MY pregnancy and THIS baby was somehow at risk. But, I was still a week and a half before my due date for that conversation, and we agreed there was time for things to happen on their own before a decision needed to be made.

There are lots of reasons I want to avoid an induction. Labor induction leads to a greater incidence of c-section, which I would very much like to avoid because a vaginal delivery, I believe, is more healthy for both the mother and the baby. Labors that are induced can be much more painful and I desire a drug-free vaginal birth. I know I have handled my last two labors fairly well, but if the contractions were much more intense, I’m not sure I’d have the stamina. And, if my contractions are much more intense in an induced labor, I feel like that’s more stress that the baby and the placenta has to endure, and isn’t that part and parcel to the logic of why they want to induce in the first place? It seems somewhat like a flawed logic — your placenta might be deteriorating and might not handle the stress as well, so we are going to give you drugs that might create a more stressful situation than a spontaneous labor. That, to me, just doesn’t hold up well, especially in the absence of any evidence (like through an ultrasound or non-stress testing) that there’s any added risk in my specific medical case.

Well, I am a researcher. I decided to see if my desire to avoid an induction was grounded in science and could be backed by the opinions of people who have had peer-reviewed research published in major medical journals. Or, was I just being stubborn and fixated on an ideal that really wasn’t ideal given the gestational diabetes, even if it seemed my case was mild and well-managed?


What I learned is that gestational diabetes is divided into two classes: A1 and A2. A1 is me: glucose intolerance that is well-managed through dietary control. A2 are the more unfortunate women who need greater medical intervention to control their glucose levels — insulin injections, other diabetic medications, etc. and even with these sometimes their glucose levels are not well-controlled. It is believed that many of the A2 cohort are previously undiagnosed or borderline type 2 diabetics. My suspicion was that evidence of an increased risk of infant mortality (ie. stillbirth) was much greater for the uncontrolled or harder-to-manage A2 diabetics and that that risk was much reduced for women with A1 gestational diabetes. What I found, in reviewing a couple different studies and one metastudy is that my theory holds some water. Risks of stillbirth for the A2 diabetics are much greater than for those women with A1 gestational diabetes. For the A1 diabetics, the risk does seem to be slightly higher when compared to non-diabetic pregnancies, but having my condition be well-managed with diet only makes me much more confident that it is not a medical imperative that I be induced on my due date if I have not spontaneously gone into labor.

(I certainly don’t mean this as evidence for anyone else… I’m just thinking out loud here. This is for my own state of mind only! If you are finding yourself in a similar predicament, please do your own research and talk to your own care provider. I am NOT giving medical advice!!)

With my other two babies, I delivered the first (my daughter) at 3 days past my due date, and my son at 3 days before my due date. Length of gestation is very consistent for most women, so I am confident in my body’s intention to go into active labor sometime between right now and three days past my due date. Knowing there is some research that illustrates a very, very small risk (statistically speaking) of stillbirth, which isn’t too different for me than other pregnant moms without the label of “gestational diabetes”, I think I can confidently put off a scheduled induction. I won’t refuse it entirely, but I will compromise. If I haven’t gone into labor by four days after my due date, I will agree to an induction. Chances are pretty good that it will never get that far anyway. And if I don’t go into labor on my own, then chances are also pretty good that it will take very, very little “induction” to get labor rolling for me and the baby.

The sweetest little boy on the face of the earth

Hey all!

My pregnancy has been very uneventful.  So I guess it shouldn’t come as much surprise to have something crop up – that ‘something’ being gestational diabetes.  I also had it with my pregnancy with Jake, and it was managed very easily with some dietary alterations.  I only got the diagnosis this go-round a few days ago, so I’ve been back to testing my blood in the interim until I can see the perinatologist that my midwives recommend.  After a few days of testing and eating smaller, more frequent meals that are lighter on the carbs, I’m already getting the hang of it again, and I’d say that the diet modification should hopefully do the trick this time, too.

The kids have had very different reactions to seeing me test my blood.  Lane wants nothing to do with it and thinks it is completely weird and gross and generally runs from the room when I do it.  (Which I think is a very normal and healthy reaction!)  Jake, however… oh my goodness I could just eat him up.  He saw me testing for the first time last night, and his three-nearly-four year-old curiosity piqued. 

“What’s that?” he asked.

“Well,” I answered, “because I have the baby in my belly I have to make sure I don’t eat too many sweet things.  This actually tests my blood and tells me if I’m doing a good job.”

He was still very interested and wanted to see the whole process, so I showed him.  He saw the little dot of blood that emerged from my finger, saw me get my “score” on the meter.

“Can you test my blood?” he asked.

I explained that I would have to poke him with a lancet, and he would bleed just a tiny bit.  It might hurt just a little, but only for a second.  He was cool with it.  In fact he said, and I quote, “That’s OK mommy.  I’m brave.”

So I tested his blood.  He got his little poke, which he said didn’t hurt at all, and when his blood sugar came back at 114, he raised his arms over his head and cheered for himself like he’d just won a race.