Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

jindc wrote:..and GD is a big deal. I was really worried about it (had a first tri test for it because I am heavier) and wish people took it seriously. It can have lasting issues for mom and baby, and a doctor should be your provider to ensure everything is going well with the GD.

They don't risk out every GD patient from what I've heard, though. They do three "strikes" - so GD plus history of depression plus expecting twins, for example (twins is probably a bad example - does Wisdom do twin births?), will get you risked out.

Wow. Am I the only one who thinks this sounds somewhat punitive and offensive?

The practice or what I wrote? Midwives tend not to take high risk patients. I was risked out by Birthcare at 30 weeks (for very specious reasons). The reasoning still pisses me off, but if you're a better candidate for birth with an OB, they're better off transferring your care.

Oh no, not what you wrote. I guess the "three strikes" concept and the fact that one could get a strike for things like controlled GD or a history of depression were what got to me. On some level I feel like when you journey through a pregnancy with a provider, midwife or otherwise, they should stick with you and support you through challenges, not boot you off elsewhere. I totally understand there are some truly high risk things that would require a referral but these other, "soft" concerns seem like things a dedicated provider could deal with.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

jindc wrote:..and GD is a big deal. I was really worried about it (had a first tri test for it because I am heavier) and wish people took it seriously. It can have lasting issues for mom and baby, and a doctor should be your provider to ensure everything is going well with the GD.

They don't risk out every GD patient from what I've heard, though. They do three "strikes" - so GD plus history of depression plus expecting twins, for example (twins is probably a bad example - does Wisdom do twin births?), will get you risked out.

Wow. Am I the only one who thinks this sounds somewhat punitive and offensive?

The practice or what I wrote? Midwives tend not to take high risk patients. I was risked out by Birthcare at 30 weeks (for very specious reasons). The reasoning still pisses me off, but if you're a better candidate for birth with an OB, they're better off transferring your care.

I'm a wisdom patient and I'm fairly happy. I appreciate that they will NOT risk you out for things like twins, or a breech birth, de facto. On the other hand, they will risk you out for GD, or for hypertension, etc. (The latter being much more serious). For GD, I think they risk you out for a combo of three reasons:

1. You get risked out and go to OB's a CYA but without any pain for GW, since you just get risked out to other GW doctors and your money still stays there. Neat trick.
2. Whitney believes that a GD diagnosis is proof that you did not follow her diet.
3. They worry that GD and the big babies it can sometimes cause will cause more women to want epidurals and need c-sections. While this is a legitimate possibility, I think their risking you out has way less to do with whether or not it's "safe" for you to deliver with them (you're in a hospital surrounded by top notch OB's steps away) and more to do with keeping their c-section stats as low as they can.

Fair enough...or is it?

Anonymous wrote:

Anonymous wrote:

jindc wrote:..and GD is a big deal. I was really worried about it (had a first tri test for it because I am heavier) and wish people took it seriously. It can have lasting issues for mom and baby, and a doctor should be your provider to ensure everything is going well with the GD.

They don't risk out every GD patient from what I've heard, though. They do three "strikes" - so GD plus history of depression plus expecting twins, for example (twins is probably a bad example - does Wisdom do twin births?), will get you risked out.

Wow. Am I the only one who thinks this sounds somewhat punitive and offensive?

The practice or what I wrote? Midwives tend not to take high risk patients. I was risked out by Birthcare at 30 weeks (for very specious reasons). The reasoning still pisses me off, but if you're a better candidate for birth with an OB, they're better off transferring your care.

PP here - should note, i did not actually have GD, just asked the questions just in case.

OP, I'm with wisdom and if they risk me out for anything, I will not go with other GW docs, for a few reasons (not least of which that I'm stubborn and think the midwifes risk people out for GD because they know it will interfere with their C section stats, NOT because it's inherently risky for you to continue with them....that's assuming that you get the sugars under control with medication and diet). Anyway, if I risk out for any reason, I'll go to my former OB, Malcolm DeSouza. He is as close to a midwife as you get with a doctor. Unfortunately, he delivers at Sibley, but really, once you're out of the midwifery inner circle, most of the hospitals are the same. He is not high risk, but he'll manage your care with another high risk doctor if necessary.

No tubs at Sibley but he is truly supportive of natural birth, doesn't believe late sonograms are predictive of size, and when I took the GD test with him, because I'm anal, I asked him one bazillion questions, and he said that if it was well-controlled, I would be treated like any other birth. He also does not induce because of suspected macrosomia. That said, if you are showing other signs that baby is giant or just cannot, even with medication, keep your sugars under control, he'll recommend certain interventions for you. But I never once felt that he was anything but thoughtful about everything he suggested.

If you want to know why I'm with a midwife and not back with him, well, it's not that I don't really like him, because I do. It's because he's got the heart of a midwife and is not an actual midwife. I wanted someone who could actually help me give birth naturally, especially with respect to the positioning, rather than just not interfere with natural processes. But I bet he's come even further since my birth a few years ago. Also, GW is 10 mins from my house, Sibley is 50.

Good luck with you and I hope you still get the unmedicated birth you want, with best health for you and baby.

OP here, thanks everyone for the encouragement! I really appreciate it. It's a little unnerving being uncertain how I'll deliver/who will deliver the baby, but as long as my baby's health and my health are OK, that's the important thing...still, I appreciate the encouragement just the same. I'll let you know what happens (thanks also for the head's up about the possibility of having an IV...I just need to be mentally prepared about these things, hehe).

For what it's worth, I was thinking for awhile that I might have GD before I took the test...I have a family history of Type 2, AND I'm an older mom AND I belong to an ethnicity that is more prone to GD, so I think I've always been on the list of those to watch. Plus, I started having glucose in my urine at 16 weeks (although having fruit juice and a banana beforehand prolly didn't help matters).

I think Wisdom's policy is that if you have GD but it looks like you won't need medication, you can stay with them. Technically, I don't think I'm officially risked out yet, but my blood sugar level was so dang high that I'd be surprised if they kept me on.

Anonymous wrote:

jindc wrote:..and GD is a big deal. I was really worried about it (had a first tri test for it because I am heavier) and wish people took it seriously. It can have lasting issues for mom and baby, and a doctor should be your provider to ensure everything is going well with the GD.

They don't risk out every GD patient from what I've heard, though. They do three "strikes" - so GD plus history of depression plus expecting twins, for example (twins is probably a bad example - does Wisdom do twin births?), will get you risked out.

Wow. Am I the only one who thinks this sounds somewhat punitive and offensive?

jindc wrote:..and GD is a big deal. I was really worried about it (had a first tri test for it because I am heavier) and wish people took it seriously. It can have lasting issues for mom and baby, and a doctor should be your provider to ensure everything is going well with the GD.

They don't risk out every GD patient from what I've heard, though. They do three "strikes" - so GD plus history of depression plus expecting twins, for example (twins is probably a bad example - does Wisdom do twin births?), will get you risked out.

..and GD is a big deal. I was really worried about it (had a first tri test for it because I am heavier) and wish people took it seriously. It can have lasting issues for mom and baby, and a doctor should be your provider to ensure everything is going well with the GD.

Anonymous wrote:GD is really no big deal when controlled and monitored. Don't worry about the "high risk" label, which has no inherent meaning!

Home birth midwives don't risk out healthy GD moms. You should be fine!

OP said she will likely need medication for her GD. My home birth midwife would have risked me out if I couldn't keep my sugars under control without meds.

I love Dr Metz - she is very supportive of natural birth and doesn't 'over doctor' everything. I have met all three docs at M st and really like all of them, but her especially.

I am sorry you are going through this...but with the right provider, you can definitely have the birth you want. Keep us looped with what's going on?

I'm sorry that you've risked out of Wisdom. I also risked out of Wisdom when my blood pressure went up and I started taking bp medication. They will risk you out if you are taking any medication (for blood pressure or blood sugar or anything else).

Also, please don't think that you could have done something differently, by eating better or exercising, to prevent gestational diabetes. It is caused by your placenta interacting with your body, and is determined at implantation. Typically, having gestational diabetes requiring medication may require an IV during labor, but doesn't automatically mean a c-section.

I saw Dr. Larsen and Dr. Bathgate (I liked both of them), after I risked out of Wisdom. For delivery, it was the attending and resident, not Dr. Bathgate.

As for laboring in the tub, I believe anyone can use it first-come first-serve, but I don't know. I was induced, needed an IV and medication, so the tub was out for me.

Good luck!

GD is really no big deal when controlled and monitored. Don't worry about the "high risk" label, which has no inherent meaning!

Home birth midwives don't risk out healthy GD moms. You should be fine!

Wisdom is crazy. Loads of women who have gestational diabetes deliver vaginally. You sound like someone who will keep their blood sugars in check which will reduce the risk of a large baby (higher chance of c/s).

Don't know about the tub thing though.

I've been risked out if Wisdom because I have gestational diabetes--the kind where I will likely need to take medication (my blood sugar came back crazy high) even though I've been exercising and watching what I eat. I've been recommended to see Dr. Larsen or Dr. Bathgate. Are my odds still decent that I can deliver vaginally? Of course, I'll do a c-section if it's needed, although right now, my baby is at normal size at 28 weeks and my weight gain has been normal as well. I'll also have a doula.

Would I be delivering with Dr. Larsen or Bathgate since I'm a high-risk patient, or would I get the doctor on call? If it's the latter, should I try rotating through all the GW OBs with the appointments I have left? And this happens just after I finally finished rotating through all the midwives, argh.

Last, if you're not a Wisdom patient, can you still labor in one of their tubs?

I'm sure I'll get my answers next week from GW, but I just found out about my diagnosis and I want to know now, darn it! Thanks!