Q: I was diagnosed with gestational diabetes during my first pregnancy. It was
controlled with diet until the ninth month, when I took a very small amount
of insulin each morning. My OB talked me into an induction one day after my
due date with a "better safe than sorry." Semiweekly NSTs were perfect.
Even though I had already dilated to 3 cm, she agreed to start with
Cervadil to see whether it would start labor because I was very against the
use of Pitocin unless absolutely necessary. My goal was a natural birth,
and aside from the use of Cervadil, we were successful. My son was born
after 7 hours of back labor (finally turned at the last minute), with one
hour of pushing. He was perfectly healthy, 6 lb 15 oz, no problems with
sugars for either of us. Although I had gone to the hospital ready for a
fight to keep interventions to a minimum, everything turned out great and I
felt ecstatic.
I would LOVE to have a homebirth with my next baby, but I am wondering
whether anyone will attend me at home if I am diagnosed with GD again. Or
even if I'm not, will having had the diagnosis before make me an automatic
"high-risk"? I know there is also some controversy about the GD diagnosis
itself. I am wondering if it would be irresponsible of me to try a
homebirth. With my last pregnancy and birth, I took very good care of
myself and always felt my baby was fine and that the birth would be fine. I
don't want to put my next baby at any unnecessary risk, but I don't want to
be "scared" into a hospital birth if there is no real need.
-Stephanie
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A diagnosis of gestational diabetes would not necessarily rule you out for
midwifery care or a homebirth, especially if you could avoid the insulin
during the last month. However, I think the best thing would be to find a
homebirth midwife who also has hospital privileges. This can be hard to
find, but in the event that a hospital birth would be a better decision for
either you or the baby, you would at least be with a caregiver you can
trust.
-Karla Morgan
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You have every chance of having a pregnancy without gestational diabetes.
It is all related to your diet and level of exercise. I've taken care of a
lot of moms who had this diagnosis in a previous pregnancy or in the
present one. When they come under my care and guidance they have always
been fine; however I'm really strict on them following the proper diet,
lifestyle, and exercise. You are right, Stephanie, there is a lot of
misdiagnosis of GD.
-Karen
Reprinted from Midwifery Today E-News (Vol 2 Issue 17 April 28, 2000)
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