Apparently, the uteri were still responsive to Pitocin, so they do not think gestational diabetes affects the uterus’s ability to process Pitocin itself, but that it might have something to do with the Calcium receptors and Pitocin’s ability to increase the contractions.
What does this all mean? In essence, try to avoid Pitocin and artificial induction. However, if you do need to be induced go in well prepared. Speak with your medical provider about only increasing the dose by half a unit or a single unit every 30-60 minutes. You may have to remind your nurses because they will be accustomed to increasing it 2-4 whole units every 30 minutes. Don’t hesitate to turn off the Pitocin for a few hours once your contractions have established a regular pattern, and allow enough time for them to adjust to no more Pitocin. Then decide whether you should gently turn it back on or keep it off.
And remember, you are in it for the long haul. Your labor is more likely to take longer and progress slower. If you and Baby are not showing signs of distress, then there is no need to concern yourself. You have every reason to give your body time to labor. Eat, sleep, and get yourself comfortable as much as you can. Then don’t forget to change positions, receive massages & joint support/release (pelvic presses, knee presses, pubic symphysis releases, etc), and shift Baby into the ideal position. This is why doulas and midwives are crucial for mothers with gestational diabetes (especially if you are attempting a VBAC or VBAMC). Doulas reduce the risk of C-Section up to 39%, so definitely invest in a good one.
Unless your baby is showing other risk factors, such as disproportioned body (abnormal head to torso ratio, or drastic torso to femur ratios, etc), low amniotic fluid, distressed heart rate; or your blood glucose (BG) levels or blood pressure numbers have been completely whacked out, or other actual complications, you have no reason to get that baby out prematurely.
First of all, ultrasounds can be completely inaccurate at determining size of baby. Second, many studies have confirmed that size of Baby, and size of your pelvis doesn’t really matter when it comes to birthing children. Read “Ina May’s Guide to Childbirth” and “Birthing from Within” if you have concerns about your baby fitting through your nether regions. Unless you were malnourished or had rickets as a child (caused by Vitamin D deficiency), or experienced some trauma to your pelvic region that has not been properly treated, then you should not be concerned.
Do not let your medical provider scare you by saying gestational diabetes leads to increases in stillbirth. We will talk about this more in point #6.
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5. Gestational Diabetes can lead to high blood pressure and preeclampsia & vice versa
Studies have shown that women with gestational diabetes have a greater risk of developing diabetes later in life. Women who had preeclampsia are at greater risk for developing chronic hypertension later in life. Preeclampsia usually occurs in the first pregnancy and does not appear in future pregnancies. But for some reason, these women are more likely to develop gestational diabetes in future pregnancies (study here). Women who have gestational diabetes are also more likely to develop high blood pressure and preeclampsia. Researchers believe it is due to underlying vascular endothelial dysfunction (damage to the cells that line the blood vessels).
The only known cure for both gestational diabetes and preeclampsia is delivery of the child. Therefore, if moms have high blood pressure late in their pregnancy, OBs will prescribe an induction or C-Section. Only blood pressure readings above 140/90 measured 4 hours apart would indicate the mother needs to deliver early. Especially if there is no other organ damage, fetal distress, fevers, or protein in the urine. Swelling is a normal occurrence of pregnancy, so it is not a reliable symptom of preeclampsia.
I don’t have much experience with preeclampsia and hypertension, so if the doctor was getting concerned, I would look for third and fourth opinions, and pray about it (check my Mama Gut).
6. Gestational Diabetes does NOT lead to more stillbirths, poor management of it does
First of all, most of the studies I found were bunk because they did not differentiate between poorly-controlled and controlled diabetes. This is a crucial element that should be studied more in depth. If women are controlling their diabetes perfectly, then we are putting them and their babies at greater risk by inducing them early. This fantastic paper published in 2014 outlines all the problems with the current Obstetric line of thinking.
My favorite lines are “It is possible that delaying delivery to a later gestational age would increase late stillbirths, but there is little evidence to quantify this effect… Although earlier studies reported excess stillbirth in GDM [Gestational Diabetes Mellitus] pregnancies, this has not been shown in more recent studies, including randomized controlled trials (RCTs) comparing treatment versus routine care.” and “The available studies are underpowered to address the effect of elective delivery on the risk of fetal death, which is probably one of the main reasons for adopting an approach of routine elective induction based on gestational age alone. Other clinical factors such as the type of diabetes, degree of glycemic control, degree of growth asymmetry (e.g. AC/FL ratio) and Bishop’s score have not been incorporated in the management protocols investigated in these studies.” (emphasis added)
What does this mean?
They detailed that there was a significant difference in rates of stillbirths from women with gestational diabetes versus women who had diabetes before pregnancy (it is greater in women with preexisting diabetes). They also included information about how the readiness of the mother’s cervix and management of diabetes should be greater contributing factors when deciding whether to induce early or not. Simply stated: a mother should not undertake an early induction if she has properly controlled blood glucose numbers and the cervix is unfavorable for induction. This is especially critical considering the fact that Pitocin is less effective in women with gestational diabetes.
7. If your BG # have been well controlled, nothing seems wrong with you or Baby, and your medical provider still keeps suggesting or recommending you be induced before 42 weeks, get a new provider. Seriously.
Read this other post for suggested questions to ask your provider to get a clearer picture of whether or not they are actually VBAC supportive. There is a difference between VBAC friendly and VBAC supportive. VBAC friendly providers will let you labor if you come into the hospital 4-5cm in labor. However, they prefer to schedule an induction or repeat C-Section at 38-41 weeks. VBAC supportive providers will gently induce you at 40-42 weeks if your cervix is 1-2cm dilated. My midwife and OB group will even induce VBA2C moms who have reached 1cm in labor. They also accept mothers who want to VBA3C. This is what I call ultimate VBAC support.
If you don’t believe you can find a practitioner in your area who is truly VBAC supportive, don’t give up. Keep trying. Check local natural birth Facebook groups, Hypnobirthing groups, even VBAC support groups. Broaden your search, and be willing to drive a little further for care. I found my group of midwives through a Facebook group. They had different recommendations than my doula or chiropractor because doulas and chiropractors can’t know everyone. They will forget or never have experience with certain groups. A huge group of local ladies online, though, can offer valuable insights.
Is it worth the effort?
It sounded like too much work, hassle, & effort to jump from practice to practice and to meet provider after provider for every prenatal appointment. I didn’t think I wanted to pursue finding a VBAC supportive practitioner. It didn’t seem worth it. But, after being told time after time I didn’t have a very high likelihood of delivering via VBA2C, and that they would only let me labor if I was 5cm (which I hadn’t even reached after 12hours on Pitocin), and they kept suggesting I could schedule my C-Section at 40 weeks- which conflicted with all the research I was reading- I knew I had to find someone better.
Learn 10 more things about gestational diabetes HERE
So, after much conflict with my husband (he thought I was cherry-picking, and just trying to find a risky person who claimed to be a medical provider, and putting my life and my baby’s life at risk), I finally found someone I clicked with. Someone so amazing, caring, and genuine- who actually listened to my concerns & fears, even my skeptical husband was impressed. If you live in or near Utah County, Utah, USA shoot me an email or PM/DM on Facebook or Instagram and I would love to recommend my midwife/OB group to you.
That’s okay if it’s all a little overwhelming. It’s why I laid it out in a blog post you can easily bookmark for later. Take your time to digest the fact that women with gestational diabetes have weaker & shorter contractions caused by less muscle tone in the uterus, in addition to not responding as effectively to Pitocin. Discuss with your medical provider whether they are concerned about “big babies” if your blood sugars are well-managed, & blood pressure is normal, and if they truly believe more stillbirths happen after 40-41 weeks. Evaluate whether or not you should meet with other midwives and practitioners in your area. Do some more research (make sure it is recent & up-to-date), and see what sits well with your instincts.
What is right for me may not be right for you. What is right for your current pregnancy may change with the next.
Remember: God is good, you are going to be a wonderful mother, and you don’t have to do it alone! There are many excellent support groups available on social media! Find your tribe, and have confidence that you will be divinely guided along your birthing journey!
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