Home or water birth with gestational diabetes

 

Is a home or water birth with gestational diabetes possible?

home or water birth with gestational diabetesThe majority of women diagnosed with gestational diabetes will be told that they will not be able to have either a home birth or hospital water birth.

This is due to women diagnosed with gestational diabetes being classed as high risk and being under consultant led care.

 

 

Whilst you may be told this initially, it does not mean that a home or water birth with gestational diabetes is off the cards

Women in the UK are within their rights to have a home birth. To discuss a home birth, speak to your Supervisor of Midwives at your hospital.

We have seen many mothers in our Facebook support group have successful water births and some have had successful home births. But be prepared that you may have to do a lot of research, have additional meetings with your health care professionals to make informed choices and may have to 'fight' or stand your ground.

What makes gestational diabetes a high risk birth?

Gestational diabetes can cause many complications. If blood sugar levels are not well managed and controlled then the baby can grow excessively, which in turn can cause many problems:

  • problems during delivery which could lead to shoulder dystocia, where the baby's shoulders get stuck
  • breathing difficulties in the newborn
  • low blood sugar levels (hypoglycaemia) in the newborn
  • in rare cases, still birth

However in cases where gestational diabetes is well controlled then the most commonly seen complications are low blood sugar levels in the newborn following birth. For more on the complications related to gestational diabetes, please read more here.

If a mother cannot control her blood sugar levels well, then a sliding scale insulin and glucose drip may be necessary to help gain control during labour. This is because high blood sugar levels in the mother will cause the baby to over produce their own insulin. Then when the baby is born they may struggle to regulate their insulin production, leading to hypoglycaemia.

Therefore, working hard to control your blood sugar levels can mean that your chances of having a home or water birth with gestational diabetes more likely.

 

 

Is one policy for all suitable for those with gestational diabetes?

medical policyEach mother is different and can have gestational diabetes, or insulin resistance to varying degrees.

A mother who has mild insulin resistance and is diet controlled with good, controlled stable blood sugar levels, with a baby who is growing on the average centile, with good amniotic fluid levels and cord flow is very different to a mother with high insulin resistance who has struggled to control blood sugar levels on high amounts of medication and insulin, with a baby growing above the 90th centile.

 

Working towards a home or water birth with gestational diabetes

 

researchDo your homework

We advise doing as much research as possible.

Request as many Trust policies as you can in advance so that you can see what exactly is policy within your hospital.  Many Trusts have information online or there will be a number for a Supervisor of Midwives that you can contact 24/7.

You may want to look at all hospitals in your area -  don't be afraid to switch hospitals if needs be, as a hospital that is few miles further down the road may have completely different policies and guidance.

To find out basic information on your birthing choices and facilities in hospitals local to you, take a look on the Which? birth choice site.  Read the NICE guidelines and understand what is recommended and when (bear in mind that this is guidance for England & Wales and that it is only guidance, hospitals do not have to follow the recommendations).

 

comment_acceptCommunication is key

It is very important to discuss your feelings with your health care professionals.  Your Community midwife, GP, diabetic midwife, diabetic specialist nurse, supervisor of midwives and consultant can all discuss any concerns you may have.

If you don't understand why certain things are being advised, then question the reasons and ask for further information.  If your consultant is advising an induction for example, asks for facts and figures and ask for the reasons behind advising the induction in your particular case. For more information on induction and gestational diabetes, please read more here.

water birth with gestational diabetesBe prepared that the majority of mothers diagnosed will be advised that home or water birth with gestational diabetes, or a midwife led unit will not be possible.  If this is the case then ask for the reasons behind this so that you can understand why it is being advised to help make an informed decision around your birth.

In situations where you feel your questions are going unanswered, or you feel rail-roaded into things you are not comfortable with, you could ask to speak with the SoM (Supervisor of Midwives).  Many previous members of our Facebook support group have been able to discuss birthing plans which were different to what is 'standard policy' or guidance with the SoM and have been able to draw up birth plans which they are more comfortable with as a result.

 

Previous traumatic hospital birth

If you have suffered a previous traumatic hospital birth, then you should look to discuss this with your hospital and they should be able to offer some counselling to help you.  If they don't know what you're thinking and the reasons behind your concerns, then nobody can help you.  Remember that these people are professionals. They are there to support you and communication is key.

Another brilliant source of support is the Birth Trauma Association who also have closed Facebook support group.

 

Stand your ground but be prepared to negotiate

However your gestational diabetes is managed, regular conversations with the senior midwives, consultants and diabetic team should allow some flexibility to allow you to make birth choices which you are comfortable with. But, be prepared to negotiate! Be realistic and remember why the policies and guidance are in place.  

Choose your battles, there is no point battling everything your consultant advises when actually you could negotiate a very comfortable birth - at the end of the day you both want the same thing, your baby delivered safely.  

 

home or water birth

Some example points and possible negotiations

For awaiting spontaneous labour instead of induction:
  • have you managed to lower and control your blood sugar levels to under your target requirements or under the NICE guideline recommendations?
  • are growth scans suggesting baby's growth is within the centiles required?
  • would NICE guidelines be used instead of hospital policy to allow to go to 40+6 before attempted induction?
  • would you be happy to attend daily for monitoring after a certain gestation?
  • will they offer member stretch and sweeps to help encourage spontaneous labour?
For water births in hospital:
  • how would you feel about a hospital birth instead of a home birth or an induction instead of awaiting spontaneous labour if they allow you to use the birthing pool? or deliver on the midwife led unit?
  • how do you feel about continuous monitoring?  Do they have mobile monitors, if not you may want to negotiate for intermittent monitoring instead?
  • would you be happy to use a birthing pool to help with pain relief but deliver out of the pool?
  • would you like to return to the pool after giving birth?
For home births:
  • at what point would you agree to transfer to hospital and under what circumstances?
  • how do you plan to monitor and regulate your blood sugar levels during labour?
  • how do you feel about monitoring your babies blood sugar levels at home and notifying the midwives of the results every 3 hours after birth instead of a midwife coming to you every 3 hours and agreeing to notify the hospital of any signs of jaundice? 
  • at what point and under what circumstances would you transfer baby to hospital following birth?

 

write listDraw up three birth plans

  1. a wish list - this is your best case scenario, the perfect birth plan!
  2. a compromise - this is your plan you would settle for
  3. a worse case scenario - this is if anything does not go to plan, but still a plan which conveys your wishes in an emergency situation

Be flexible with each of them. You should be looking for you and medical professionals to both agree that you're looking for a safe birth delivery and in the event of any complications, you will of course, submit to medical advice as long as you are kept fully informed

 

Consent

consentYou need to understand the risks involved and be able to weigh up what is the best decision to have your baby delivered safely.

In all cases where ladies in our support group have been agreed for a home birth, they have had to sign a form which states that there birth plan is 'against professional advice'

 

water birth with gestational diabetes
thank you to Suzi for sharing her beautiful pictures with us

 

Real life stories

Suzi is a member of our Gestational Diabetes UK Mums Facebook support group. Suzi had experienced a previous traumatic birth, followed by a natural water birth with her second baby and then had to make hard decisions over her next birth in the knowledge that she now had gestational diabetes where induction was being advised. Suzi planned for a water birth with the help and support of her SoM, however things progressed a bit faster than planned! You can read Suzi's birth story here

We also have Lisa's story, which is a story of a home water birth with gestational diabetes. You can read Lisa's story here.

And Lara's story. Lara wanted a water birth but was told it wouldn't be possible with gestational diabetes. She was prepared for induction, but on the day, due to experienced midwives who were happy to support her, she was able to have her hospital water birth! You can read Lara's story here.

 

Research articles

Planned home birth: benefits, risks, and opportunities

Benefits and harms of planned hospital birth compared with planned home birth for low-risk pregnant women

Planned hospital birth versus planned home birth

The effect of maternal age and planned place of birth on intrapartum outcomes in healthy women with straightforward pregnancies: secondary analysis of the Birthplace national prospective cohort study

The Birthplace in England national prospective cohort study: further analyses to enhance policy and service delivery decision-making for planned place of birth

How women with high risk pregnancies use lay information when considering place of birth: A qualitative study

The safety of home birth: Is the evidence good enough?

Water birthing: retrospective review of 2625 water births. Contamination of birth pool water and risk of microbial cross-infection

A retrospective comparison of water births and conventional vaginal deliveries

Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour

Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing

NICE recommend home births for some mothers (NHS article) 

The Home Birth Reference Site is a great resource to look further into planning a home birth and shows some birth stories from mothers that have had home birth with gestational diabetes.

 

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