Diabetic Pregnant Mothers:
Advice from a childbirth research expert and an experienced mother,
Elayne Glantzberg, who had her first cesarean for a triplet birth, her
second cesarean for medical reasons and then an unassisted birth center
vaginal, natural birth after two cesareans.
A c-section is not necessary at all just for diabetes. Indications for a
c-section include preeclampsia, placenta previa, placental abruption, cord
prolapse, uterine rupture, true cephalopelvic disproportion (only in cases
where the pelvis has been fractured or the mother suffers from rickets),
transverse lie, uterine infection, active herpes, and fetal distress.
Conditions that do not require a c-section are diabetes, postdates
pregnancy, ultrasound diagnosis of big baby, low amniotic fluid at term,
slow labor (usually labeled "failure to progress" or "CPD"), water being
broken for more than 24 hours, breech baby, and history of prior
c-section.
The most important thing you can do is to keep very, very strict control
of your sugars. Check yourself 12 times a day if you need to; I know it's
not fun, I've done it myself, but if that's what it takes, you do it. All of
the problems and complications that cause doctors to think of diabetes as
needing a c-section stem from uncontrolled blood sugar. High blood
sugars in the mother lead to macrosomia (very big babies), placenta
deterioration, and severe hypoglycemia in the newborn, and can lead to
diabetes later in life for your baby. But if you can keep your blood
sugars under tight control, and you can prove this to your doctor
with a record of tests, there is absolutely no reason for you to be
treated any differently than any non-diabetic mother.
Check out the Brewer diet at www.blueribbonbaby.org. This diet can
prevent preeclampsia, which is its biggest claim to fame, but it is also an
excellent diabetic diet. Modify it if you need to, but make sure you get in
2 eggs and a minimum of 80g of protein every day; this is the most
important part for preventing preeclampsia.
You should know that controlling your blood sugar will be more difficult
during pregnancy. The growing fetus will affect your body's utilization of
glucose and insulin. During the first trimester, you will have a tendency to
require less insulin. During the third trimester, you will need more. This
is why it is so important to do many fingersticks, every day. Maintaining
tight control during pregnancy will require constant readjustment of your
diet and your insulin doses. Keep in close contact with your
endocrinologist.
Natural childbirth is definitely possible. You may have difficulty finding
a midwife, since diabetes generally places you in the "high risk" category,
but if you're interested, check around. You might find one willing to take
you on as long as your sugars are under control. If not, and you're in the
hospital, remember that the doctors work for you, not you for them.
They are providing you a service, and you always have the right to decline
interventions. Make sure you eat during labor, to keep up your energy
and stabilize your blood sugars. Don't allow an automatic IV, and be leary
of accepting any pitocin or even an epidural. Any intervention that you
get has the potential to interfere with your blood sugar, and when you're
running a marathon (that is what labor and birth are to your body), this
can affect your ability to finish. Do your research ahead of time so you
will be prepared, and make sure that anything your doctor does besides
stand aside and watch is absolutely medically necessary, not just protocol
or impatience.
---------------------------------------------------------------------------
Brewer Pregnancy Diet:
This is the pregnancy diet The Bradley Method teaches all of its couples in
Class 2. Once you learn about Dr. Brewer's diet, apply it to your daily life
and make any necessary adjustments to control your blood sugar levels.
---------------------------------------------------------------------------
Midwives/Supportive Attendants of Diabetic Mothers
Wishing to Birth Naturally and as Normally as Possible:
The choices are scarce, unfortunately. You cannot birth in a birth center.
You cannot birth at some hospitals with a midwife, some you can. You
can do a homebirth with a midwife that agrees to take you on.
Hospital Choices:
All hospital attendants in our area will almost assuredly begin to
recommend induction at 40 weeks or before for insulin-dependent diabetic
mothers even if the mother is in good health, the baby is in good health,
the NSTs and BPPs done by the perinatologist are normal and show a
100% healthy mother and baby and even if the mother has had and
continues to have good control over her blood sugar levels.
You can birth at any hospital you choose when you are in labor, they
must take you in and treat you if you request treatment. It's best for
you to know your rights.
Advice from a childbirth research expert and an experienced mother,
Elayne Glantzberg, who had her first cesarean for a triplet birth, her
second cesarean for medical reasons and then an unassisted birth center
vaginal, natural birth after two cesareans.
A c-section is not necessary at all just for diabetes. Indications for a
c-section include preeclampsia, placenta previa, placental abruption, cord
prolapse, uterine rupture, true cephalopelvic disproportion (only in cases
where the pelvis has been fractured or the mother suffers from rickets),
transverse lie, uterine infection, active herpes, and fetal distress.
Conditions that do not require a c-section are diabetes, postdates
pregnancy, ultrasound diagnosis of big baby, low amniotic fluid at term,
slow labor (usually labeled "failure to progress" or "CPD"), water being
broken for more than 24 hours, breech baby, and history of prior
c-section.
The most important thing you can do is to keep very, very strict control
of your sugars. Check yourself 12 times a day if you need to; I know it's
not fun, I've done it myself, but if that's what it takes, you do it. All of
the problems and complications that cause doctors to think of diabetes as
needing a c-section stem from uncontrolled blood sugar. High blood
sugars in the mother lead to macrosomia (very big babies), placenta
deterioration, and severe hypoglycemia in the newborn, and can lead to
diabetes later in life for your baby. But if you can keep your blood
sugars under tight control, and you can prove this to your doctor
with a record of tests, there is absolutely no reason for you to be
treated any differently than any non-diabetic mother.
Check out the Brewer diet at www.blueribbonbaby.org. This diet can
prevent preeclampsia, which is its biggest claim to fame, but it is also an
excellent diabetic diet. Modify it if you need to, but make sure you get in
2 eggs and a minimum of 80g of protein every day; this is the most
important part for preventing preeclampsia.
You should know that controlling your blood sugar will be more difficult
during pregnancy. The growing fetus will affect your body's utilization of
glucose and insulin. During the first trimester, you will have a tendency to
require less insulin. During the third trimester, you will need more. This
is why it is so important to do many fingersticks, every day. Maintaining
tight control during pregnancy will require constant readjustment of your
diet and your insulin doses. Keep in close contact with your
endocrinologist.
Natural childbirth is definitely possible. You may have difficulty finding
a midwife, since diabetes generally places you in the "high risk" category,
but if you're interested, check around. You might find one willing to take
you on as long as your sugars are under control. If not, and you're in the
hospital, remember that the doctors work for you, not you for them.
They are providing you a service, and you always have the right to decline
interventions. Make sure you eat during labor, to keep up your energy
and stabilize your blood sugars. Don't allow an automatic IV, and be leary
of accepting any pitocin or even an epidural. Any intervention that you
get has the potential to interfere with your blood sugar, and when you're
running a marathon (that is what labor and birth are to your body), this
can affect your ability to finish. Do your research ahead of time so you
will be prepared, and make sure that anything your doctor does besides
stand aside and watch is absolutely medically necessary, not just protocol
or impatience.
---------------------------------------------------------------------------
Brewer Pregnancy Diet:
This is the pregnancy diet The Bradley Method teaches all of its couples in
Class 2. Once you learn about Dr. Brewer's diet, apply it to your daily life
and make any necessary adjustments to control your blood sugar levels.
---------------------------------------------------------------------------
Midwives/Supportive Attendants of Diabetic Mothers
Wishing to Birth Naturally and as Normally as Possible:
The choices are scarce, unfortunately. You cannot birth in a birth center.
You cannot birth at some hospitals with a midwife, some you can. You
can do a homebirth with a midwife that agrees to take you on.
Hospital Choices:
All hospital attendants in our area will almost assuredly begin to
recommend induction at 40 weeks or before for insulin-dependent diabetic
mothers even if the mother is in good health, the baby is in good health,
the NSTs and BPPs done by the perinatologist are normal and show a
100% healthy mother and baby and even if the mother has had and
continues to have good control over her blood sugar levels.
You can birth at any hospital you choose when you are in labor, they
must take you in and treat you if you request treatment. It's best for
you to know your rights.
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Trusting Our Bodies
For more information on The Bradley Method®, for an international listing of instructors or to contact the American Academy of
Husband-Coached Childbirth® directly, please contact: The Bradley Method®, Box 5224 Sherman Oaks, CA 91413-5224, 1-800-4-A-BIRTH
or 1-818-788-6662, www.bradleybirth.com
Husband-Coached Childbirth® directly, please contact: The Bradley Method®, Box 5224 Sherman Oaks, CA 91413-5224, 1-800-4-A-BIRTH
or 1-818-788-6662, www.bradleybirth.com
Excerpt from "What Doctors Don't Tell You" - Diabetes: A
Dietary Approach (Volume 3, Issue 7)
Diabetic pregnancies - whatever the mother's state of health - are still
deemed by standard medical thinking to be high risk. Dr Michel Odent a
leading pioneer of natural childbirth rejects such a blanket approach.
"Generally speaking, any label of high risk brings with it its own risk," he
says, and should, therefore, be avoided. This high risk tag means that the
whole paraphernalia of science's attempts to improve on nature will be
wheeled out when a diabetic woman is to give birth.
Inductions and caesareans are still routinely inflicted on diabetic mothers
in many hospitals. Such drastic intervention in the natural birth process
might have been necessary in the past, when it was much harder for
diabetics to keep their blood sugar levels well controlled; the excess
insulin, which encourages growth, resulted in oversized babies. However,
with the advent of more accurate blood sugar testing and improved
dietary advice, routine inductions and caesareans are anachronistic.
Many hospitals still persist in inducing diabetic mothers at 38 weeks. Anna
Knopfler, who set up the self help group Diabetic Pregnancy Network,
suggests asking your doctor what percentage of diabetic births at your
hospital are induced. If it is high, you should shop around for a hospital
with a more enlightened attitude, and make sure your doctor knows that
you want to go to term unless there are real rather than just feared
complications.
Dr Odent says there is no reason why a healthy, well controlled diabetic
shouldn't have a natural birth. By that, he means privacy, comfort,
familiar surroundings and freedom to move around. Even if home birth
isn't yet an option for many diabetics, you should try to mimic those ideal
conditions as far as possible.
A speedy birth is particularly important for diabetics, yet medicine
contrives to create conditions where that is unlikely to happen naturally.
Dr Odent says all mammals instinctively seek privacy when giving birth for
good reason. Undisturbed labour allows the "primitive structures" of the
brain which should be active during birth to come to the fore. "When you
take a woman and observe her and subject her to strong light, you make
it impossible for her to make this change in her conscious level," he says.
The hospital setting itself, therefore, slows up the birth process and
makes it more hazardous. To counter a problem of its own design,
medicine has designed a daisychain of interventions.
In the British Diabetic Association's pregnancy pack,it describes a mother
strapped up to four drips during labour; hormones to precipitate
contractions; glucose; insulin; and a drip to raise her blood pressure
which was expected to fall as a consequence of the epidural she had been
given. The process of intervention is self perpetuating. The pain and
distress accompanying an induced birth will in themselves help make the
diabetic's blood sugar levels unstable, which increases the likelihood of
needing glucose and insulin drips. Before selecting your hospital, check
whether you can elect to manage your own insulin doses during labour.
According to research published in The Lancet (13 June 1992), birth
without infused insulin and glucose remains rare. Some 87 per cent of
respondents (representing 128 of the UK's 218 health districts) routinely
use insulin and glucose drips, citing "standard practice" or supposed
"difficulty in managing without a drip". The report's authors are in no
doubt that drips are used simply for the convenience of hospital staff;
drips make for "ease of administration and simplicity of approach, and can
be used by staff who may not be experts in diabetes management." Just
2.3 per cent of respondents had ever elected to manage labour in eight
insulin dependent women without drips. (Instead, they used a regime of
4-6 hourly insulin injections and sips of glucose taken as necessary which
leaves the diabetic and her partner far more in control.) In all eight: "The
outcome of the pregnancy was a live delivery without major neonatal
problems."
In some hospitals it is still standard practice for the baby to be taken
away for 24 hours after birth for observation and to be tested for
hypoglycaemia. Dr Odent deplores this practice. "The best way for the
baby to avoid hypoglycaemia is for it to get plenty of colostrum as soon
as possible," he says. Again, you should check with your hospital whether
you will be able to keep your baby with you after the birth.
Unsaturated fats aid the action of prostaglandins as important cell
regulators during the birth process. They are essential in initiating the
process and in maintaining strong contractions which will expedite the
birth. Low insulin levels and saturated man made fats both have the effect
of inhibiting the working of prostaglandins. Diabetic mothers should eat
plenty of foods containing unsaturated fats corn oil, primrose oil, milk,
liver and kidney and avoid those containing man made fats, including
margarines. (Unsaturated fat also helps the baby's brain to grow.) Odent
also advises supplementing the diet with zinc, vitamin C, vitamin B and
magnesium.
Biography: Michel Odent, MD, has been influencing the history of
childbirth and health research for several decades. As a practitioner he
developed the maternity unit at Pithiviers Hospital in France in the 1960s
and 1970s. With six midwives, he was in charge of about one thousand
births a year and achieved excellent statistics with low rates of
intervention. Odent is familiarly known as the obstetrician who
introduced the concept of birthing pools and home-like birthing rooms.
His approach has been featured in eminent medical journals such as The
Lancet and in TV documentaries such as the BBC film Birth Reborn. After
his hospital career he practiced homebirths. Odent's 21st-century books
(The Scientification of Love, The Farmer and the Obstetrician and The
Caesarean) may be regarded as a trilogy. They raise urgent questions
about the future of our civilizations.
Dietary Approach (Volume 3, Issue 7)
Diabetic pregnancies - whatever the mother's state of health - are still
deemed by standard medical thinking to be high risk. Dr Michel Odent a
leading pioneer of natural childbirth rejects such a blanket approach.
"Generally speaking, any label of high risk brings with it its own risk," he
says, and should, therefore, be avoided. This high risk tag means that the
whole paraphernalia of science's attempts to improve on nature will be
wheeled out when a diabetic woman is to give birth.
Inductions and caesareans are still routinely inflicted on diabetic mothers
in many hospitals. Such drastic intervention in the natural birth process
might have been necessary in the past, when it was much harder for
diabetics to keep their blood sugar levels well controlled; the excess
insulin, which encourages growth, resulted in oversized babies. However,
with the advent of more accurate blood sugar testing and improved
dietary advice, routine inductions and caesareans are anachronistic.
Many hospitals still persist in inducing diabetic mothers at 38 weeks. Anna
Knopfler, who set up the self help group Diabetic Pregnancy Network,
suggests asking your doctor what percentage of diabetic births at your
hospital are induced. If it is high, you should shop around for a hospital
with a more enlightened attitude, and make sure your doctor knows that
you want to go to term unless there are real rather than just feared
complications.
Dr Odent says there is no reason why a healthy, well controlled diabetic
shouldn't have a natural birth. By that, he means privacy, comfort,
familiar surroundings and freedom to move around. Even if home birth
isn't yet an option for many diabetics, you should try to mimic those ideal
conditions as far as possible.
A speedy birth is particularly important for diabetics, yet medicine
contrives to create conditions where that is unlikely to happen naturally.
Dr Odent says all mammals instinctively seek privacy when giving birth for
good reason. Undisturbed labour allows the "primitive structures" of the
brain which should be active during birth to come to the fore. "When you
take a woman and observe her and subject her to strong light, you make
it impossible for her to make this change in her conscious level," he says.
The hospital setting itself, therefore, slows up the birth process and
makes it more hazardous. To counter a problem of its own design,
medicine has designed a daisychain of interventions.
In the British Diabetic Association's pregnancy pack,it describes a mother
strapped up to four drips during labour; hormones to precipitate
contractions; glucose; insulin; and a drip to raise her blood pressure
which was expected to fall as a consequence of the epidural she had been
given. The process of intervention is self perpetuating. The pain and
distress accompanying an induced birth will in themselves help make the
diabetic's blood sugar levels unstable, which increases the likelihood of
needing glucose and insulin drips. Before selecting your hospital, check
whether you can elect to manage your own insulin doses during labour.
According to research published in The Lancet (13 June 1992), birth
without infused insulin and glucose remains rare. Some 87 per cent of
respondents (representing 128 of the UK's 218 health districts) routinely
use insulin and glucose drips, citing "standard practice" or supposed
"difficulty in managing without a drip". The report's authors are in no
doubt that drips are used simply for the convenience of hospital staff;
drips make for "ease of administration and simplicity of approach, and can
be used by staff who may not be experts in diabetes management." Just
2.3 per cent of respondents had ever elected to manage labour in eight
insulin dependent women without drips. (Instead, they used a regime of
4-6 hourly insulin injections and sips of glucose taken as necessary which
leaves the diabetic and her partner far more in control.) In all eight: "The
outcome of the pregnancy was a live delivery without major neonatal
problems."
In some hospitals it is still standard practice for the baby to be taken
away for 24 hours after birth for observation and to be tested for
hypoglycaemia. Dr Odent deplores this practice. "The best way for the
baby to avoid hypoglycaemia is for it to get plenty of colostrum as soon
as possible," he says. Again, you should check with your hospital whether
you will be able to keep your baby with you after the birth.
Unsaturated fats aid the action of prostaglandins as important cell
regulators during the birth process. They are essential in initiating the
process and in maintaining strong contractions which will expedite the
birth. Low insulin levels and saturated man made fats both have the effect
of inhibiting the working of prostaglandins. Diabetic mothers should eat
plenty of foods containing unsaturated fats corn oil, primrose oil, milk,
liver and kidney and avoid those containing man made fats, including
margarines. (Unsaturated fat also helps the baby's brain to grow.) Odent
also advises supplementing the diet with zinc, vitamin C, vitamin B and
magnesium.
Biography: Michel Odent, MD, has been influencing the history of
childbirth and health research for several decades. As a practitioner he
developed the maternity unit at Pithiviers Hospital in France in the 1960s
and 1970s. With six midwives, he was in charge of about one thousand
births a year and achieved excellent statistics with low rates of
intervention. Odent is familiarly known as the obstetrician who
introduced the concept of birthing pools and home-like birthing rooms.
His approach has been featured in eminent medical journals such as The
Lancet and in TV documentaries such as the BBC film Birth Reborn. After
his hospital career he practiced homebirths. Odent's 21st-century books
(The Scientification of Love, The Farmer and the Obstetrician and The
Caesarean) may be regarded as a trilogy. They raise urgent questions
about the future of our civilizations.