So you’ve received the annoying news that you’ve got “the ‘betus” (as my husband calls it). You went through that awful screening where you had to wait, bored out of your mind, at the clinic after drinking a horrible orange drink all to get poked, probably twice… and now you’ve confirmed with your care provider that you have gestational diabetes. Now what?! Well as an Edmonton doula I can tell you that no birth person ever takes this news well, and as an Edmonton mom who’s been there, I can confirm that this limitation sucks. However, this doula in Edmonton is writing today to give you some tips on how to make this nuisance of a situation easier and more pleasant then what you may have heard of it in the past. I got you girl!
First off, don’t panic!!!!! (especially at my use of exclamation marks)
For those of you that have been following my Edmonton doula blog for a while, you’ll probably notice by some of my posts that I feel that our birth culture in many ways is set up to scare us more than it is to empower us. Gestational Diabetes diagnosis does it’s part to add to this culture and to be honest, it drives me nuts! Between the additional appointments with a diabetes-specific clinic, to the talk of “big baby”, shoulder dystocia, cesarean birth, etc. it’s no wonder why most of my clients as an Edmonton doula call me in a mad panic. So here’s the deal – yes, there have been babies that have gotten quite big from a GD mom… but there are just as many that have been a normal size, especially from those moms who did the work to keep their blood sugars under control. Yes there have been cesareans performed on GD moms… but in many cases this has nothing to do with the baby being “too big” and everything to do with other factors completely unrelated to GD. Yes a baby is at a higher risk of shoulder dystocia with a GD mom… but according to this study done by the National Centre for Biotechnology Information (my favourite evidence-based site), you can expect a 7% chance of shoulder dystocia with a gestational diabetes diagnosis (regardless of if your baby is big or not) and a 0.5% chance of an injury to the baby caused by getting stuck. So guys… don’t panic! Gestational Diabetes doesn’t mean your birth with all go to hell in a hand basket.
It’s all about the diet
I’ve said this before in my Preparing For Labour post, and I’ll say it again – the GD diet is the best diet out there (whether you’re pregnant or not!). Now I’m not about to go off on a tangent about how “carbs are the devil” and push a fad diet on you… I believe in healthy carbs! The problem with a GD patient is that eating too many carbs will send your blood sugars into a frenzy. So to start off, think BALANCE. If you want to eat a bowl of oatmeal for breakfast, great! Throw some greek yogurt in there and maybe some hemp seeds and that is a beautifully balanced breakfast right there. Love sandwiches? Cool! Consider adding lots of good meat, load up on veggies and add some avocado and grass-fed butter and you’re sandwich is perfecto (and who doesn’t love avocado?). You’re going to want to eat just as much protein and “good fats” as you are carbs. Label-reading is going to become second nature to you, because you’ll want to find out whether what you’re about to eat is a serving of carbs, protein or fat. It would also be a really good idea to start tracking your macronutrient percentages (carbs, protein and fats are macronutrients), so consider looking into an app to do so – MyFitPal is an excellent one that is free! The final thing I want to say about diet is that just because something is labelled “low fat” or “diet” doesn’t mean it’s good for you. Often times low fat labels will actually show more carbohydrates, and diet drinks like diet soda or juice often times contain aspartame which is a big no-no both during pregnancy and everyday life. Don’t be afraid of good fats – the omegas and MCT oils (coconut or palm kernel) will be your best friends with a GD diet as they will fill you and avoid that sugar crash you’d get if you ate a pack of Timbits instead.
Fear not the GD labour
My GD clients as an Edmonton doula often express the fear of what this will do to their labours – can I still have a natural birth? A home birth? Is it going to be way harder to push this baby out? Will my baby have to go to NICU after birth? The answer to all of these is very much dependant on the individual patient, but I will say that in a well-managed gestational diabetes patient the labour and birth will likely be straight-forward and average! (when it comes to all things GD, anyway). If you are a midwifery client and you end up needing insulin to manage GD, you’ll need to be transferred to an OBGYN and home birth will unfortunately not be in the cards for you. However, you still have the option of having an empowered birth as your midwife will remain involved for support (AND you can hire an Edmonton doula to help navigate the hospital birth process). Induction is commonly recommended when a GD patient reaches 41 weeks (and sometimes even before), and as always it is SUPER important to weight the risks of an induction with the risks of birthing a GD baby at 41+ weeks. Whatever you do, DO NOT rely on the weight measurements from a late ultrasound – they are about 45% effective which is not reliable, plus the whole size of the baby is not particularly what causes issues in the birth, more so WHERE GD babies gain their weight. If your labour and birth are straight forward, the only other issue you may face is a baby that has a blood sugar crash following the birth. This can be a tough issue since your baby may not want to feed and feeding is important for them specifically. Something you can do to prepare for this is what my lovely Edmonton doula partner Vanessa refers to as “the feeding insurance policy”. One you reach term (37 weeks) and it is safe for you to go into labour, start hand expressing colostrum from both breasts until you get enough to fill a small syringe (like the ones you get with a bottle of infant Tylenol). You can express into a spoon or small cup, and it may take a while to get the whole thing full but be patient or persistent. Suck the contents of the spoon or cup up with the syringe and then put the syringe in the freezer. Before you leave your house to go to the hospital (if you are birthing in the hospital), bring those syringes along. If baby is struggling to latch initially, simply assume skin-to-skin and feed them the syringe of colostrum so that their blood sugars stabilize and they are more motivated to give breastfeeding a good shot. I WISH I knew this when I had my first baby, who was GD and had a bad blood sugar crash… luckily my L&D nurse mother had my back!
To sum up, I really want all you GD moms to try your best to shift your thoughts from “this sucks” to “this is an opportunity for me to change what I put into my body to best suit my growing baby”. You’re going to be ok! And you’re going to now have tools to improve your eating habits for years after baby arrives. If you are reading this and haven’t yet done the gestational diabetes screening, I highly encourage you to read this wonderful Evidence Based Birth article before you do! Please contact me to discuss any of this info in more detail, I’ve got the unique experience of GD from both a mom and Edmonton doula perspective.