How To Have A Natural Birth With Gestational Diabetes?

How To Have A Natural Birth With Gestational Diabetes
You should be able to. Having gestational diabetes (GD) doesn’t necessarily mean that you can’t have your baby vaginally, You’ve got a better chance of having a birth without any interventions, such as induction or caesarean section, if you can keep your blood sugar levels stable during pregnancy.

  1. However, your obstetrician will recommend that you don’t go past your due date, even if you’ve been able to control gestational diabetes well.
  2. She’ll recommend that your labour is induced if it hasn’t started by 40 weeks.
  3. If you’ve had complications in your pregnancy, or if you’ve needed medication to control your GD, you’ll have a check-up with your doctor at 38 weeks.

Depending on how things are going, your doctor may recommend that you have an induction, or a planned caesarean, between 38 weeks and 39 weeks. The reason for your doctor’s caution is that with poorly controlled GD, you’re more likely to:

develop pre-eclampsia have a big baby (macrosomia), with a birth weight of 4.5kg (9lb 15oz) or more

Expecting a big baby doesn’t rule out vaginal birth. Almost two thirds of big babies are born vaginally. Getting into the right labour positions can help your baby to be born without needing an episiotomy, or assisted birth, It’s sensible to have a discussion with your doctor and midwife, though, because there are risks involved in giving birth vaginally to a big baby.

  • The biggest worry is shoulder dystocia,
  • Shoulder dystocia happens when your baby’s shoulders get stuck behind the bones in your pelvis as she’s being born.
  • This is a particular risk for mums with poorly controlled GD, because the extra blood sugar makes babies grow big around their shoulders and chest.

If your baby is over 4.5kg (9lb 15oz), there is a one in 13 chance of shoulder dystocia happening during birth. This increases to a one in seven chance if your baby is over 5kg (11lb). Giving birth to a big baby can also leave you with problems. It raises your risk of:

having a bigger tear in the area around your vagina (perineum) losing a lot of blood having damage to your tailbone (coccyx)

An advantage of having your labour induced a little before your due date is that it will stop your baby putting on too much weight in the final weeks of your pregnancy. Not all women with GD have big babies, especially when blood sugar is well-controlled. There is plenty you can do now to make sure your blood sugar stays stable:

eat a healthy diet for GD exercise regularly keep pregnancy weight gain under control

Talk to other mums who have gestational diabetes in our friendly community, Jenny Leach is an editor and writer specialising in evidence-based health content.

Can you birth naturally with gestational diabetes?

Will gestational diabetes affect my labor and delivery? – Most women with gestational diabetes can make it to their due dates safely and begin labor naturally. In some cases, though, gestational diabetes could change the way you feel or how your baby is delivered.

Blood Sugar and Insulin Balance —keeping your blood sugar level under control during labor and delivery is vital to your own health and to your baby’s health. If you do not take insulin during your pregnancy, you probably will not need it during labor or delivery. If you do take insulin during your pregnancy, you may receive an insulin shot when labor begins, or you may get insulin through a thin, plastic tube in your arm that goes into your bloodstream during labor. Early Delivery —Gestational diabetes puts women at higher risk than women without the condition for developing preeclampsia (pronounced pree-ee-KLAMP-see-uh), late in their pregnancies. Preeclampsia is a condition related to a sudden blood pressure increase; it can be a serious. The only way to cure preeclampsia is to deliver the baby; but delivery may not be the best option for your health or for the health of the baby. Your health care provider will keep you under close watch, possibly at the hospital, and will run multiple tests to determine whether early delivery is safe and needed. Your health care provider will give you more information about early delivery, should it be necessary. Cesarean Delivery —This is a type of surgery used to deliver the baby, instead of natural delivery through the vagina. Cesarean delivery is also called a cesarean section, or “C” section. Simply having gestational diabetes is not a reason to have a C section, but your health care provider may have other reasons for choosing a cesarean delivery, such as changes in your health or your baby’s health during labor.

When will I give birth if I have gestational diabetes?

Giving birth – The ideal time to give birth if you have gestational diabetes is usually around weeks 38 to 40. If your blood sugar is within normal levels and there are no concerns about your or your baby’s health, you may be able to wait for labour to start naturally.

  • However, you’ll usually be offered induction of labour or a caesarean section if you have not given birth by 40 weeks and 6 days.
  • Earlier delivery may be recommended if there are concerns about your or your baby’s health, or if your blood sugar levels have not been well controlled.
  • You should give birth at a hospital where specially trained health care professionals are available to provide appropriate care for your baby.

When you go into hospital to give birth, take your blood sugar testing kit with you, plus any medicines you’re taking. Usually you should keep testing your blood sugar and taking your medicines until you’re in established labour or you’re told to stop eating before a caesarean section.

How do you manage gestational diabetes during labor?

I NSULIN AND G LUCOSE T HERAPY D URING I NTRAPARTUM P ERIOD – The hepatic glucose supply is sufficient during the latent phase of labor, but during the active phase of labor the hepatic glucose supply is depleted so calorie supplementation is required.

During the active phase of labor, the supplementation is mostly in the form of intravenous glucose as the oral supplementation is restricted. The guidelines for insulin therapy during pregnancy mostly suggest infusion of insulin and glucose. The protocols for use of insulin during pregnancy are mostly based on studies in type 1 diabetes mellitus patients.

An audit of 40 pregnancies over a 4 year period was conducted to find out the blood sugar control during labor using the insulin glucose infusion and it demonstrated the practical use of a simple regimen for control of blood sugar during pregnancy. Mean blood glucose of 94 ± 40 mg/dl (5.2 ± 2.2 mmol) before delivery and 85 ± 33 mg/dl (4.7 ± 1.8 mmol) just before labor prevented neonatal hypoglycemia.

In women with type 1 diabetes mellitus, a glucose infusion with insulin is mostly required during the latent period of spontaneous labor, but when the patients go into active labor the requirement of insulin drops to almost zero and the glucose requirement is equivalent to that required during rigorous exercise There is an eight-fold increase in the glucose substrate requirement during this time.

In women with type 1 diabetes mellitus, a protocol with a normal saline infusion can also be used and when the blood sugar falls below 70 mg/dl then an intravenous glucose drip can be started while some protocols favor the use of glucose infusion at the rate of 125 mg/h with a simultaneous use of insulin infusion at the rate of 0.5-1 unit/h.

Both protocols are associated with low rates of complications. One less studied approach is rotating fluid, where patients can be on insulin drip or rotating fluids with continuous glucose and non-glucose drip, it has been observed that there is no difference in mean intrapartum maternal capillary blood glucose (CBG) levels between the two groups.

In a study on 15 patients comparing intrapartum insulin drip or rotating fluids protocol, both regimes were found to have the same effect on the control of maternal blood glucose. In women with type 1, type 2 DM or gestational diabetes during labor either a dextrose 5% solution can be used with a fixed dose of insulin to be added to the drip or a simultaneous infusion is started with glucose infusion and the dose is titrated as per the patients’ blood sugar levels and the blood sugar is mostly maintained between 72 and 144 mg/dl (4-8 mmol/l).

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The insulin requirement during the peripartum period also depends on the diabetes control during the pregnancy period. Women having uncontrolled sugars during pregnancy may require a higher dose of insulin during labor depending on whether it is active or latent labor. The women who have good glycemic control during pregnancy do not require very high dose of insulin during labor.

The rapidly acting insulin analogues are comparable option in pregnant women as they help in avoiding the postprandial excursions and cause less incidence of hypoglycemia wherever it is a concern. In clinical practice, 6-8 units of conventional regular insulin or analogue like lispro or aspart in the same dose can be added to 500 ml of 5% dextrose normal saline (DNS) according to the requirement of the patient or if the patient’s requirements are high it is advisable to start an insulin infusion with monitoring of the blood glucose every 1-2 h and to titrate the insulin infusion rate accordingly and to start simultaneous glucose infusion when the blood sugars.

Should I be induced if I have gestational diabetes?

What do the World Health Organization and NICE say? – In 2018, the World Health Organization (WHO) updated their guidelines on Induction of labour at or beyond term, The WHO recommend that induction of labour should not be offered for gestational diabetes unless there is evidence of other abnormalities occurring, such as abnormal blood glucose levels.

Even then, as above, there is no evidence that induction is beneficial. In the UK, the relevant NICE guidelines state that induction (or elective caesarean) should generally not be considered before 40 +6 weeks for women with gestational diabetes. The exception to this is if either the mother or baby is experiencing complications.

So, as above, if there is an actual problem. But also as above, this should be an actual complication or medical problem and not just a risk factor.

How big will my baby be if I have gestational diabetes?

Related Health Problems – Having gestational diabetes can increase your risk of high blood pressure during pregnancy, It can also increase your risk of having a large baby that needs to be delivered by cesarean section (C-section). If you have gestational diabetes, your baby is at higher risk of:

Being very large (9 pounds or more), which can make delivery more difficult Being born early, which can cause breathing and other problems Having low blood sugar Developing type 2 diabetes later in life

Your blood sugar levels will usually return to normal after your baby is born. However, about 50% of women with gestational diabetes go on to develop type 2 diabetes. You can lower your risk by reaching a healthy body weight after delivery. Visit your doctor to have your blood sugar tested 6 to 12 weeks after your baby is born and then every 1 to 3 years to make sure your levels are on target.

What happens during labor if you have gestational diabetes?

During labor –

Your blood glucose levels will be monitored. Sometime during labor, or perhaps shortly after your baby’s birth, your level will probably return to normal. You and your health care provider may decide that a Cesarean birth is safest for you and your baby. Talk this possibility over in advance with your health care provider and with your partner. Include any preferences in your birth plan,

Does your blood sugar go up in labour?

Most women have normal blood sugar levels during labor and do not need any insulin. Insulin is given if your blood sugar level becomes high. High blood sugar levels during labor can cause problems in the baby, both before and after delivery.

Does gestational diabetes get worse towards the end of pregnancy?

Between 32 – 36 weeks are what we know to be the toughest time for gestational diabetes. It’s at around this point that we typically see insulin resistance worsen. You think you have your gestational diabetes diet sussed out and you can literally wake and eat the same breakfast you’ve been tolerating well for weeks on end and get crazy blood sugar levels?! How To Have A Natural Birth With Gestational Diabetes What the heck is going on and what did you do wrong??? Firstly, you’ve done NOTHING wrong! This is to be expected and is completely normal and typical with gestational diabetes. To understand what’s going on, we need to understand a bit about gestational diabetes and how it works

Can you carry a baby full term with gestational diabetes?

What is gestational diabetes? Gestational diabetes is a condition in which there’s too much sugar in the blood. When you eat, your body breaks down sugar and starches from food into glucose to use for energy. Your pancreas makes a hormone called insulin that helps your body keep the right amount of glucose in your blood.

  1. When you have diabetes, your body doesn’t make enough insulin or it can’t use insulin properly, so you end up with too much sugar in your blood.
  2. This can cause serious health problems, such as heart disease, kidney failure and blindness.
  3. Pregnant people are usually tested for gestational diabetes between 24 and 28 weeks of pregnancy.

Most of the time it can be controlled and treated during pregnancy. If it’s not treated, gestational diabetes can cause problems for you and your baby. It usually goes away after your baby’s born. Once you’ve had gestational diabetes, you have a higher risk of being diagnosed with diabetes later in life.

  • Are older than 25.
  • Are overweight or obese and not physically active,
  • Have had gestational diabetes or a baby with macrosomia in a past pregnancy.
  • Have high blood pressure or you’ve had heart disease.
  • Have polycystic ovarian syndrome (also called polycystic ovary syndrome or PCOS). This is a hormone problem that can affect reproductive and overall health.
  • Have prediabetes. This means your blood glucose levels are higher than normal but not high enough to be diagnosed with diabetes.
  • Have a parent, brother or sister who has diabetes.
  • Are a member of a racial or ethnic group that has a higher prevalence of diabetes that isn’t entirely explained by race or ethnicity, such as Black, American Indian or Alaska Native, Asian, Hispanic/Latino or Pacific Islander
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Racism and risk of gestational diabetes Being a person of color is not a cause for having gestational diabetes. Researchers aren’t exactly sure why people in these groups are more likely to have gestational diabetes, but they have noticed some patterns in studies about gestational diabetes.

For example, many people of color experience chronic stress and lack access to fresh and healthy food. These factors are known as social determinants of health. They are the conditions in which you are born, grow, work, and live. In many cases, the social determinants of health are related to racism. Racism and unequal living conditions affect health and well-being and increases the risk of pregnancy complications, including gestational diabetes.

Racism refers to the false belief that certain groups of people are born with qualities that make them better than other groups of people. Racism isn’t limited to personal attacks such as ethnic slurs, bullying, or physical assault. In a racist culture, one group of people has more power than other groups.

  • Have better education and job opportunities
  • Live in safer environmental conditions
  • Be shown in a positive light by media, such as television shows, movies, and news programs.
  • Be treated with respect by law enforcement
  • Have better access to health care

In contrast, people from racial or ethnic minority groups who live in a racist culture are more likely to:

  • Experience chronic stress
  • Live in an unsafe neighborhood
  • Live in areas that have higher amounts of environmental toxins, such as air, water, and soil pollution
  • Go to a low-performing school
  • Have limited access to healthy foods
  • Have little or no access to health insurance and quality medical care
  • Have less access to well-paying jobs

March of Dimes recognizes that racism and its effects are factors in the health disparities in pregnancy outcomes and babies’ health. We must work together to bring fair, just and full access to health care for all moms and babies. Can gestational diabetes increase your risk for problems during pregnancy? Yes.

  • Macrosomia, This means your baby weighs more than 8 pounds, 13 ounces (4,000 grams) at birth. Babies who weigh this much are more likely to be hurt during labor and birth, and can cause damage to his or her mother during delivery.
  • Shoulder dystocia or other birth injuries (also called birth trauma). Complications for birthing parents caused by shoulder dystocia include postpartum hemorrhage (heavy bleeding). For babies, the most common injuries are fractures to the collarbone and arm and damage to the brachial plexus nerves. These nerves go from the spinal cord in the neck down the arm. They provide feeling and movement in the shoulder, arm and hand.
  • High blood pressure and preeclampsia, High blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy. Preeclampsia is when a pregnant person has high blood pressure and signs that some of their organs, such as the kidneys and liver, may not be working properly.
  • Perinatal depression, This is depression that happens during pregnancy or in the first year after having a baby (also called postpartum depression ). Depression is a medical condition that causes feelings of sadness and a loss of interest in things you like to do. It can affect how you think, feel, and act and can interfere with your daily life.
  • Preterm birth, This is birth before 37 weeks of pregnancy. Most women who have gestational diabetes have a full-term pregnancy that lasts between 39 and 40 weeks. However, if there are complications, your health care provider may need to induce labor before your due date. This means your provider will give you medicine or break your water (amniotic sac) to make your labor begin.
  • Stillbirth, This is the death of a baby after 20 weeks of pregnancy.
  • Cesarean birth (also called c-section). This is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus. You may need to have a c-section if you have complications during pregnancy, or if your baby is very large (also known as macrosomia). Most people who have gestational diabetes can have a vaginal birth. But they’re more likely to have a c-section than people who don’t have gestational diabetes.

Gestational diabetes also can cause health complications for your baby after birth, including:

  • Breathing problems, including respiratory distress syndrome. This can happen when babies don’t have enough surfactant in their lungs. Surfactant is a protein that keeps the small air sacs in the lungs from collapsing.
  • Jaundice. This is a medical condition in which the baby’s liver isn’t fully developed or isn’t working well. A jaundiced baby’s eyes and skin look yellow.
  • Low blood sugar (also called hypoglycemia)
  • Obesity later in life
  • Diabetes later in life

How do you know if you have gestational diabetes? Your health care provider tests you for gestational diabetes with a prenatal test called a glucose tolerance test. If your provider thinks you’re at risk, you may get the test earlier. If the glucose screening test comes back positive, you’ll have another test called a glucose tolerance test.

After this test, your doctor will be able to tell whether you have gestational diabetes. How is gestational diabetes treated? If you have gestational diabetes, your prenatal care provider will want to see you more often at prenatal care checkups so they can monitor you and your baby closely to help prevent problems.

You’ll probably have tests to make sure you and your baby are doing well. These include a nonstress test and a biophysical profile. The nonstress test checks your baby’s heart rate. The biophysical profile is a nonstress test with an ultrasound, Your provider also may ask you to do kick counts (also called fetal movement counts).

  1. Every day, time how long it takes for your baby to move 10 times. If it takes longer than 2 hours, tell your provider.
  2. See how many movements you feel in 1 hour. Do this 3 times each week. If the number changes, tell your provider.

If you have gestational diabetes, your provider tells you how often to check your blood sugar, what your levels should be and how to manage them during pregnancy. Blood sugar is affected by pregnancy, what you eat and drink, and how much physical activity you get.

You may need to eat differently and be more active. You also may need to take insulin shots or other medicines. Treatment for gestational diabetes can help reduce your risk for pregnancy complications. Your provider begins treatment with monitoring your blood sugar levels, healthy eating, and physical activity.

If this doesn’t do enough to control your blood sugar, you may need medicine. Insulin is the most common medicine for gestational diabetes. It’s safe to take during pregnancy. Here’s what you can do to help manage gestational diabetes:

  • Go to all your prenatal care checkups, even if you’re feeling fine.
  • Follow your provider’s directions about how often to check your blood sugar. Your provider shows you how to check your blood sugar on your own. They tell you how often to check it and what to do if it’s too high. Keep a log that includes your blood sugar level every time you check it. Share it with your provider at each checkup. Most parents can check their blood sugar four times each day: once after fasting (first thing in the morning before you’ve eaten) and again after each meal.
  • Eat healthy foods. Talk to your provider about the right kinds of foods to eat to help control your blood sugar.
  • Do something active every day. Try to get 30 minutes of moderate-intensity activity at least 5 days each week. Talk to your provider about activities that are safe during pregnancy, like walking.
  • If you take medicine for diabetes, take it exactly as your provider tells you to. If you take insulin, your provider teaches you how to give yourself insulin shots. Tell your provider about any medicine you take, even if it’s medicine for other health conditions. Some medicines can be harmful during pregnancy, so your provider may need to change them to ones that are safer for you and your baby. Don’t start or stop taking any medicine during pregnancy without talking to your provider first.
  • Check your weight gain during pregnancy. Gaining too much weight or gaining weight too fast can make it harder to manage your blood sugar. Talk to your provider about the right amount of weight to gain during pregnancy,
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If you have gestational diabetes, how can you help prevent getting diabetes later in life? For most people, gestational diabetes goes away after giving birth. But having it makes you more likely to develop type 2 diabetes later in life. Type 2 diabetes is the most common kind of diabetes. Here’s what you can do to help reduce your risk of developing type 2 diabetes after pregnancy:

  • Get tested for diabetes 4 to 12 weeks after your baby is born. If the test is normal, get tested again every 1 to 3 years.
  • Get to and stay at a healthy weight.
  • Talk to your provider about medicine that may help prevent type 2 diabetes.

Last reviewed: March 2022

Why do diabetics get induced early?

The goal of induction of labour in gestational diabetes (GDM) and pre-gestational diabetes (PGDM) pregnancies has traditionally been to prevent stillbirth or prevent excessive fetal growth and its associated complications.

What are the chances of still birth with gestational diabetes?

Authors list – Dr Jenny Myers, Dr Susan Greenwood, Professor John Aplin, Giovanna Bernativičius, Matina Hakim

Diabetes affects 1-2% of pregnancies and is a major risk factor for many pregnancy complications. Women with diabetes are around five times more likely to have stillbirths, and three times more likely to have babies that don’t survive beyond their first few months.

  • Diabetes can also stop babies from growing normally – they are born either too small (fetal growth restriction (FGR)) or too large (macrosomia), both of which dramatically increase the risk of stillbirths.
  • Babies who do not grow properly in the womb – whether too large or too small – are also at risk of serious health conditions later in life, such as obesity or diabetes.

High blood glucose levels are associated with abnormalities in fetal growth, but the relationship between blood glucose levels at different stages of pregnancy and how this relates to the development and function of the placenta is poorly understood.

What is the risk of still birth with gestational diabetes?

Stillbirths more likely if diabetes in pregnancy not diagnosed

Women who develop diabetes in pregnancy but are not diagnosed are much more likely to experience stillbirth than women without the condition, according to new research.The study, led by the University of Leeds and the University of Manchester, found that the risk of stillbirth was over four-times higher in women who developed signs of gestational diabetes but were not diagnosed.However, with appropriate screening and diagnosis that increased risk of stillbirth disappeared.Funded by the charities Action Medical Research, Cure Kids, Sands and Tommy’s, the study compared the symptoms and care of 291 women who experienced a stillbirth to 733 similar women who did not experience a stillbirth across 41 maternity units in England.Researchers found that across all women with high blood sugar, measured after a period of fasting, they had on average twice the risk of stillbirth than women without the condition.The increased risk was likely to be caused by the missed diagnoses and lack of subsequent care experienced by many of the women, although the results show an association only, and cannot provide certainty about cause and effect.The new research was published in BJOG: An International Journal of Obstetrics and Gynaecology.

Dr Tomasina Stacey, who led the study at the University of Leeds and now works at the University of Huddersfield, said: “There’s good news and there’s bad news. The good news is that women with gestational diabetes have no increase in stillbirth risk if national guidelines are followed for screening, diagnosis and management.

The bad news is that the guidelines are not always followed and some women therefore experience avoidably higher risk.” According to recent figures, approximately 5% of women in the UK experience gestational diabetes during pregnancy. The National Institute for Care Excellence (NICE) recommends that all women at a higher risk of gestational diabetes should receive blood screening for the condition: this includes women with a raised body mass index (a BMI of over 30), or from South Asian or Black Caribbean ethnic groups.

Only 74.3% of the participating women with a raised BMI and 74.7% of the participating women from South Asian or Black Caribbean ethnic groups received screening. On average, women at higher risk of gestational diabetes who were not screened according to the NICE guidelines also experienced higher risks of stillbirth.

  • Co-author Professor Alexander Heazell, from the University of Manchester and Clinical Director of Tommy’s Stillbirth Research Centre, said: “It’s not clear why some women missed out on being screened or diagnosed for gestational diabetes, but this needs to be improved.
  • Gestational diabetes can cause serious complications in pregnancy.

It’s important that we detect every woman with symptoms so she can receive the appropriate care and support.” In 2015, the NICE raised the threshold for diagnosing gestational diabetes to a fasting plasma glucose concentration – where blood sugar is measured after fasting – of greater than 5.6mmol/L.

  1. In the United States the threshold is 5.1mmol/L, and there is considerable debate worldwide about the appropriate level for diagnosis.
  2. The present study found little evidence to support one threshold over another, instead finding that the risk of stillbirth increased steadily with increasing glucose concentration.

: Stillbirths more likely if diabetes in pregnancy not diagnosed