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    Questions? Ask Henci!


    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Jun 03
    2010

    URGENT! Gestational diabetes and homebirth

    Archived User

    Dear Henci,

    Are there any studies, about having a homebirth with gestational diabetes. My friend is due in June and she had her first at home and would like to stay home again. Unfortunately she has GD and has to inject insuline. They told her she had to birth in a hospital. Is that true? (Btw, she lives about 10 minutes from the hospital)

    Thanks!

    Henci Goer

    Not that I'm aware of. The inability to control blood sugar with diet does indicate a more serious problem, however, so it is not unreasonable that this would risk her out of a home birth.

    -- Henci

    Archived User

    Visitor,

          Unfortunately Ms. Goer may claim to be an expert in obstetric research, but she is not an obstetrician.  Gestational diabetes carries a host of risks, some of which can be life-threatening.  Babies born to mothers are often larger, and they have an increased risk of not fitting through the birth canal. 

    I cannot post links, but you can Google: National Institutes of Health gestational diabetes

     

    Henci Goer

    I am an expert in the obstetric research. If you want to read my analysis of gestational diabetes, along with its sources (I am also about transparency), you will find articles here and here. If you think obstetricians are experts in the research, you might like to know that years ago, Archie Cochrane, the founder of the prestigious Cochrane database of systematic reviews, gave the specialty of obstetrics the wooden spoon award for being so sadly lacking in evidence-based care practices. Nothing much has changed. The fact that one in three women in the U.S. has her baby via major abdominal surgery tells you that without needing to know anything else. Nor do I think much of the quality of much of the obstetric research. You can go here and here and here to find examples of why.

    ~ Henci 

    Archived User

    Uhm....didn't you mean PELVIC surgery

     

    Archived User
    Posted By on 17 Jun 2011 04:35 PM

    Visitor,

          Unfortunately Ms. Goer may claim to be an expert in obstetric research, but she is not an obstetrician.  Gestational diabetes carries a host of risks, some of which can be life-threatening.  Babies born to mothers are often larger, and they have an increased risk of not fitting through the birth canal. 

    I cannot post links, but you can Google: National Institutes of Health gestational diabetes

     

    I would venture to guess that Ms. Goer is ignorant (extremely so) about the nature of diabetes and pregnancy.  Ms. Goer, you are not an endocrinologist, obstetrician, perinatologist, certified diabetes educator, or even a woman with diabetes who has had one or more pregnancies, correct?  So it's safe to assume that your expertise on this subject is extremely limited.

    Using insulin or oral medications are another step in helping a pregnant woman with diabetes maintain a healthy pregnancy. It is not necessarily an indication of a more "serious problem." Insulin does increase some risk with placental health however and that is why women who are pregnant and have diabetes (T1, T2, or gestational) should be delivering in a hospital.

    I find that your "advice" is misguided at best and dangerous at worst. Obviously this is your website and message board so you may dispense any information you wish. However, it is not wise nor prudent for any pregnant woman with diabetes to follow the advice you have posted here.

    Henci Goer

    Student of Epidemiology, TexMama, and Anda have provided nothing other than their opinion and a personal attack, neither of which are productive or useful contributions to this Forum. Those who are interested in what I think about gestational diabetes and why I think it and why Forum readers cannot assume that clinicians are experts on the research simply by virtue of their degrees can follow the links to the articles in the post I wrote earlier in this thread.  

    ~ Henci

    Debra Woods

    Henci, there is a lively discussion occuring on the listserve email group that I am a part of regarding gestational diabetes testing. I am wondering if there is any further up to date research that points to not needing universal screening for all women? The discussion has brought up different opinions & links to research from a variety of maternal health professionals.

    What's missing is more current research to question testing for all women. I know that there are numerous references attached to your articles but these are from a decade or more ago and apparently there is current research which suggests universal testing is necessary and beneficial.

    I would like to be able to provide the most current evidence based research for my clients. In BC, Canada they have actually accepted new guidelines that would put more women into the category of having GDM. More of my clients are being told they are gestationally diabetic and many are recommended to take insulin. Insulin adds to weight gain so this is not really helpful. How many of them truly have GDM? It's tough to access full information so clients can make an informed decision.

    Thanks so much for any current research you may know of.

    Debra Woods

    Dakini Doula

    Henci Goer

    I wish I could be of more help, but, alas, I haven't been keeping up with the gestational diabetes research. Once in awhile something falls into my lap, as in this post to this Forum in which I was asked to review a study. Nothing that I've seen in this way has caused me to revise what I have written previously on the weaknesses of the research or the balance between benefits and harms of current approaches to diagnosing and treating what, with the exception of a small minority of women, should better be called "glucose or carbohydrate intolerance of pregnancy." I am not, however, aware of what's out there that would support taking a more moderate view.

    ~ Henci  


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