testing for gestational diabetes
I am currently 31 weeks, the first doctor i seen was fabulous then the hospital shut down the practice to save money, so i found another group and i had to take the 1 hour test and of course i failed it just like almost every other pregnant friend i have. I have been sick the whole entire time,tho i only seem to throw up bile only a couple of times have i thrown up actual food but i do beleive its from the horrible gerd i have had for the past 10 years, hence why i dont eat that much and i havent gained but 5 or 6 pounds so far but i was a little over weight to begin with and i have had about 5 ultrasounds and the baby seems perfect but anyway the midwife there wanted me to do the 3 hour test and i refused to do it because i beleive its a very controversial test, they tried to scare me into taking it and i still have not. Since they wouldnt except that i had made the decision to not take the test i went and seen another doctor to see what they had to say and this doctor said the same thing only he has decided that since im refusing to take the 3 hour test that he doesnt think he wants to continue care with me and now that leaves me with no care at all especially if i go back to the group that i refused first and they decide to drop me too. Im at a loss i can not understand why i have no say in my care, i guess my question is do i sit back and wait out the 7 weeks or so i have left and just show up at a hospital in labor or do i continue to try and find someone else? this is getting really silly, i want to try and just enjoy the end of this if i can because i have been misserable since day one and i dont think that its a benefical test to take especially since it would make the end much worse for me due to all the testing and such when you are put into the so called GD catagory. PLEASE ANY THOUGHTS WOULD BE GREATLY APPRECIATED.
Your story illustrates just how dysfunctional our system of obstetric management can be. (I can't bring myself to call it "care.") You have two medical groups firing you for exercising your right to refusal while at the same time failing to be attend to a real problem: your inability to keep food down. If I were a dr or midwife, I'd be far more concerned about your gaining only 5-6 lbs and interested in your and your baby's nutritional status than I would be about the possibility that your blood sugar might be a little high after you eat. It is shocking to say this, but I'm not sure you would be that much worse off simply showing up in labor if their prenatal management is any indication. I suggest you find someone else. Have you thought about a home birth or birth in a freestanding birth center? You can find out if there is a birth center in your community here. Finding a qualified home birth midwife is not so straightforward, but if there is a birth resource center or a birth network in your community, people there are likely to know. They and the doulas in your community are potential resources for for more progressive hospital-based providers as well as home birth providers. Another source is The Birth Survey. It's a sort of "Yelp" for midwives and doctors. Let me know how it goes.
As an addition to the topic, there was a large double-blinded, prospective study of ~23,000 women with sub-diabetic levels of blood glucose published in the NEJM in 2008:
I found this to be some very fascinating reading, particularly because they specifically recognized the potential for a caregiver's perception of a woman as "having GD" to influence how they treated her during pregnancy, labor, and delivery.
Thanks for this. I have to confess that I haven't done any thorough research into the GD literature for a number of years now because it hasn't been one of the topics covered in either of my books. However, it doesn't surprise me that the investigators found that clinician beliefs affected intervention rates. That was certainly demonstrable in the earlier research that I have looked at in depth, and it is true in other arenas. For ex., studies consistently find that c/sec rates are much higher when obs believe, based on ultrasound weight estimates, that the baby weighs 4000 g or more than when the baby actually is macrosomic, but the ob didn't suspect it. Meanwhile, I now have this study in my GD folder.
All Times America/New_York
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