What does having Gestational Diabetes mean for pregnancy and birth?
What does having Gestational Diabetes mean for pregnancy and birth? The good news is that controlling your levels of blood glucose during pregnancy reduces the chances of these complications for you and your baby. This blog was written by midwife Beth, with the help of obstetrician Victoria Medland.
What does having Gestational Diabetes mean for pregnancy?
Does Gestational Diabetes mean I will be consultant-led?
If you have gestational diabetes then you will have a consultant involved in your pregnancy care. Your care will be classed as ‘consultant-led care’. You will have a team of diabetes nurses/midwives, an obstetrician and also your won community midwife who you would have seen already in your pregnancy. If you want to be at a midwife led unit for your birth you will need to talk to your obstetrician about this, your own midwife and a lead midwife on the midwife led unit you’d like to give birth on. The advice that you get will be dependant on how your gestational diabetes is being controlled, what treatment you are on and what your baby’s scans are saying. Going into labour spontaneously or being induced can also be a factor in where you give birth. See more about this below.
Will I have extra scans?
If blood sugar levels are very high in pregnancy, it can cause baby to grow excessively large. This is called macrosomia. Because of this, you will be recommended to have growth scans in your pregnancy. It can be as regular as every two weeks from diagnosis of GDM depending on the growth of baby. You will also have regular reviews in antenatal clinic. This will allow you to discuss how your blood sugars are going in pregnancy, and for your team to advise on whether the current treatment is effective or needs changing.
What does having Gestational Diabetes mean for birth?
The advice you get with regards to where to give birth, whether you have an induction, if baby needs blood sugars after birth and how long to stay in after birth will very much depend on the treatment you are on in pregnancy and how well controlled your blood sugars are.
Remember though,
The government says everyone in the UK should be able to choose between giving birth in hospital, in a birth centre, or at home. You should be offered a full discussion of the risks and benefits of the options you are considering. If there is no birth centre in your area, or you want to use a different birth centre, you can ask your GP to refer you or you can refer yourself.” – Birth Rights UK
Will I be have to have an induction with Gestational Diabetes?
The current NICE guidelines recommend induction of labour by 41 weeks if GDM is diet controlled and earlier induction of labour if using metformin or insulin. This is because the stillbirth rate is increased in GDM. This is increased if insulin is required to control blood sugars.
It might be recommended to have the baby earlier, or possibly by caesarean rather than vaginal birth, if:
-You have a lot of fluid around the baby
-Baby’s abdominal circumference is very large compared with the baby’s head
-Your insulin requirements are falling rather than rising towards the latter stages of pregnancy
Sometimes it is recommended to have steroids if the baby is going to be born early. This reduces the chances of the baby needing help with breathing at birth. Unfortunately, steroids push blood sugar levels upwards. For this reason it will usually require a short stay in hospital to have something called a sliding scale. This is where sugar levels are monitored hourly and insulin is given by a pump in order to maintain strict control of sugars.
Can I give birth on a maternity led unit with Gestational Diabetes?
The advice on where to give birth will depend on what treatment you are on for your GDM and if your blood sugars are well controlled.
In labour, especially if you are using insulin in pregnancy, it may be recommended that your blood sugar levels are monitored up to hourly. If they fall outside of the normal range you may be advised a sliding scale. This is an insulin drip to control your sugar levels. This will need to be done on a consultant led unit.
In addition, if you are advised to have continuous monitoring of baby’s heart rate throughout labour, which is advised for those who are on insulin in pregnancy, this is done on a consultant led unit.
This means that your birth may look more medicalised than what you might have imagined. If you wish to chat through aspects of this with your obstetrics team it would be a good idea to raise these concerns sooner rather than later. This is so that you can discuss the strength of each of these recommendations and explore how you can navigate these.
Things to consider would be:
-The growth of your baby
-Your recent sugar control and what is required to manage it
-Your baby’s movements
-Any other conditions like raised blood pressure
-Whether wireless monitoring is available in your hospital.
5 Things to Do if you have Gestational Diabetes
Can I have a water birth?
The advice surrounding whether you can have a water birth will be dependant on the same above factors. It also depends on what is available in your area. For example, it may be that you are being advised to have your baby on a consultant led unit and there are no birth pools on there. So it would be that you’d then need to choose if you want to birth on a midwife led unit (potentially against medical advice) to use the birth pools. As above, it would be important to have an informed discussion with your consultant and your midwife.
If you are having your baby on a consultant led unit, find out if there’s a pool on there that you can use. Many areas offer continuous monitoring of baby’s heart rate that are wireless, so that you can walk around and even get in the water whilst still measuring baby’s heart rate.
Read about Beth’s water birth with gestational diabetes on a midwife led unit .
What will my birth be like with Gestational Diabetes?
As you can see from the above, the advice is very dependant on your current situation with GDM and how much it is effecting your pregnancy. So it may be that if all your scans are normal and your blood sugars have been well controlled then a water birth on a midwife led unit may be fine. If though, your blood sugars have been erratic or you have needed insulin injections, and your baby is also measuring on the larger side then you will be more likely advised to have closer monitoring for your birth on a consultant led unit.
What I do think it is really important to remember though is your birth can be amazing in whatever situation you are in.
You can have a very relaxing and ‘home from home’ birth even if you have an induction, or are on a consultant led unit when this may not have been your original plan. There are hypnobirthing techniques that you can use in all birth situations that will help you feel calm and in control regardless of what path your birth may take.
Gestational diabetes may mean that you choose a path for your birth that you weren’t planning on originally taking because it’s best for your baby. Hypnobirthing and antenatal education can help you make choices in your pregnancy and birth and help you navigate your birth options and keep your oxytocin levels high. Birth plans should never ‘go out the window’ just because a plan deviates from what was once originally thought. Your birth can be great, even if it wasn’t what you thought it was going to be like.
What will happen after birth?
After birth, babies should be offered blood sugar monitoring because they themselves can suffer low blood sugars. Baby should be fed early and often to counteract this. With this in mind, you should have access to information about antenatal expression of colostrum. This is so that you can have some ready to feed your baby, should you wish to breastfeed.
After the birth of your baby, unless admission to the neonatal unit is needed, it is recommended to keep your baby skin to skin. This will help to maintain their temperature, regulate their breathing and help promote early feeding. As mentioned previously, some monitoring of their blood sugars will be recommended and help with establishing feeding should be available to you. To prepare for breastfeeding, bottle feeding, antenatal expressing and the early days with a baby, take a look at The Baby Chapter, an online post natal & baby course.
If baby’s blood sugars have all been within normal range and you have been on diet treatment or metformin then speak to your midwife about going home within the first day. If you have been on insulin then you may be advised to stay in just over 24 hours so that you can be in a hospital setting if your blood sugars don’t return to normal after baby is born.
Click the link for more information about The Bump to Baby Chapter’s Hypnobirthing and Antenatal Online Course. Know what you can do to stack the odds in your favour for the birth that you want. Videos, checklists, audios & a support group all created by a midwife to get you feeling excited, prepared and confident for birth. This hypnobirthing course is suitable for those with gestational diabetes or pre existing diabetes.
