OMG, you’ve got GDM
Following my diagnosis of GDM (gestational diabetes mellitus) back in 2016 with my second baby, I was mortified, horrified and damn right stressed out of my brain. Even though I am educated on birth related topics, I had a complete feeling of failure for becoming ‘diabetic’. Rationally I knew that it wasn’t my fault, but heck, we are all emotional in pregnancy at the best of times, let alone when you feel like you might harm yourself & your unborn baby. Not to mention how I was going to survive without my nightly ritual (chocolate!). So, I set about to research the hell out of GDM, and to see if there were other ways to help me manage my BSL’s (Blood sugar levels) to try & help avoid the condition becoming an issue or out of control.
I was so much calmer when I was diagnosed with my third baby. I knew what to do, and as Calmbirth’s motto goes, with knowledge comes confidence. So, here I’ve given you the ins and outs of gestational diabetes, in the hope that it gives you the same confidence.
You will get through this.
You and your baby will be ok.
Be kind to yourself.
So you’ve been diagnosed- now what?
Don’t panic. I know easy for me to say sitting here typing away, but honestly, the research believes stress is one of the major contributing factors to increased BSL’s.
Your doctor or health practitioner will probably advise you to see a dietitian/diabetes educator first up. These guys will help you get started on the right track with your diet & also how to use the ‘finger pricking machine’. Depending on your practitioner, but most people will have to monitor their BSL’s 4 times a day. That’s when you wake, & two hours after each main meal. That’s right, you will need to prick your finger 4 times every day until your baby is born… Why so many times? You & your doctor will be wanting to monitor your sugar levels closely to make sure they stay within normal limits, therefore decreasing the risks of the condition.
So what are the risks?
If you are well controlled (keep BSL’s under normal range) without medication then the risks are minimal. If those sugar levels are creeping up, then the risk is that your baby is getting free access to a whole heap more sugar than ‘normal’, and therefore could become a large to very large baby. A large baby normally is fine (we make babies as big as we can handle 😊), however if its due to diabetes, then chances are your babe might have been given a free few hundred grams that your pelvis and vagina might not be so happy about!
Some women are advised (about 10-20%) to commence on some medication to help keep the BSL’s within that normal range. Sometimes a tablet is given & other times an injection (you give yourself) of insulin is required. If this ends up being you, know that your hormones are creating this issue- you are not failing, and it would be important to discuss with your health care provider any concerns you might have.
The other main concern with a diabetic mother, is that any disease in pregnancy can cause some concerns for the health of the placenta. Health practitioners can start to become concerned about the placental function of GDM’s especially later in pregnancy (post 39 weeks). This is by no means a fait accompli, rather another factor for your health care providers to be watching.
What can you do to help stabilize your BSL’s?
Have I mentioned, reduce your stress?! Use meditation & yoga to help decrease the stress in your life.
Obviously, diet changes are one of the biggest things you can do to help. I am not a dietitian/nutritionist, so I can only give some advice from what I found out when I was a GDM & also what worked for me. It goes without saying- no more (or only a little sneaky) refined sugar treats… bye bye after dinner chocolate! Sorry. Also, sometimes we get caught out thinking eating fruit (lots) is healthy for us. While I would never say its not healthy, fruit does contain a lot of sugar. So if you find your sugars are high but your eating lots of fruit, maybe cut back to a piece a day (berries are lower in sugar so a good option) & see how you go. Carbohydrates are complicated. I’m still yet to actually work this food group out. I did find reducing starchy foods such as potato, sweet potato and bread beneficial, but this food group is definitely one to be guided on by your levels and educator. I found that decreasing my cow’s milk intake was a win. I couldn’t work out why my porridge in the morning was giving me higher BSL’s than two pieces of toast- until I didn’t use as much milk to make it. Bingo. I also found that adding heaps of good fats like avocado, eggs, meat & proteins were all great. A banana or another whole fruit for a snack & lots of salads with tuna etc.! Spices such as cinnamon & turmeric are also great for helping stabilize blood sugar levels.
Exercise is also so important. When we exercise, our body processes insulin more effectively, therefore decreasing our blood sugar levels. It’s also so good for the mind and preparing you body for labour. Depending what you have been doing prior to diagnosis, starting with simple short walks or swimming is a great start. You can always try and start a pregnancy specific gym class (Pilates or yoga are fantastic). Just try and move as much as possible each day, until you are moving intentionally for 45 minutes/day.
Acupuncture, acupressure & massage are all becoming more main stream especially in the space of birth. All of these can help lower your blood sugar levels. Book an appointment with someone who specializes in pregnancy and see how you like it!
Sleep is also a big contributing factor to sugar levels. Please make time to enjoy your bed. Make your pre bed routine a blissful one. Think bath, herbal tea, reading of a book, meditation, essential oils…and get into a comfortable position (use pillows, kick your partner out of the bed- whatever it takes 😊!).
Your getting closer to the end of pregnancy….
Sometimes induction of labour from around the 39th week of pregnancy is discussed. Remember to ask your health practitioner for all the reasons why induction would be their preferred choice, and feel free to discuss and weigh up the risk factors for both induction & staying pregnant with GDM.
There is no evidence to suggest that a caesarean section would be required due to GDM.
You may be advised to have growth scans to determine the size of your baby in utero. These late stage scans can sometimes be misleading (depending on the visual the scanner can get) so always discuss them with your care provider, especially if your intuition (your most powerful tool!) is suggesting something different to the scan results.
Also, CTG (cardiotocography), is an external monitor used to check the babies heart rate in utero. Often health practitioners want this done towards the end of a pregnancy with GDM to check the health of the baby. Most hospitals will also want to have a CTG monitor on you throughout your labour.
Discuss with your health care provider what the hospital/providers policies around GDM and labour/birth are. Remember to always ask the ‘why?’ until you fully under stand the intentions and procedures. You have the right to discuss, refuse or chose an alternative. Being informed helps us feel empowered about the way our baby is born, and doesn’t leave us wondering the ‘what if’s’. This is the basis for providing a positive perception of your birth regardless of the way that it unfolds.
You’ve had the baby!
Congratulations! You made it, & on reflection GDM wasn’t that bad.
Breastfeeding is 100% recommended (if that’s your choice of feeding) with GDM. Some hospitals will have the policy that your babies BSL will need to be tested after birth (at least 3 times), to make sure they are having no adverse side effects to the in utero GDM. Its’s often recommended that GDM mum’s express some milk before the baby arrives, after the 36th week of pregnancy, so it is available as a top up if the bay requires it due to low blood sugar levels. Get your midwife to help show you how to do this- its a bit of an art!
Most women’s diabetes status will disappear within 3 months of birth. You will probably be advised that you should have a repeat GTT (glucose testing) around 6-12 weeks postpartum.
As you are also now at increased risk of becoming a type 2 diabetic later in life, you will be offered regular screening (approx. every 3 years).
In the end
GDM is not as scary as we may think when we first get diagnosed. Remember to keep discussing your own personal experience with your health care provider & always use your BRAIN (what’s the: Benefits, Risks, Alternatives, Intuition, do Nothing) acronym for making any decision that is going to affect YOUR self or baby.
For more information, check out these resources:
http://www.diabetesaustralia.com.au
http://www.ranzcog.edu.au/news/Diagnosis-GDM-Australia
http://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetes-gestational
http://www.racgp.org.au/afp/2013/august/gestational-diabetes-mellitus/