Gestational diabetes – a serious condition – a true life story of gestational diabetes, uncontrolled blood glucose levels, shoulder dystocia and traumatic birth
I was diagnosed with GD at 22 weeks rather suddenly. Had a routine appointment on a Monday and my levels were normal. Had to go back for a second appointment the same week on the Wednesday and they tested my wee again and my sugar was 4++++
They booked me in for a emergency fasting GTT [glucose tolerance test] for the next morning. I went along first thing in the morning, they took bloods and proceeded to prick my finger to check levels. They came back at 14.9 [mmol/L] because of that I wasn’t allowed to complete the test.
I was given an emergency appointment with the GD clinic and was placed on Metformin and 10 units of insulin daily. The Metformin made me so sick I was hospitalised for a week until they could flush it out of my system and they raised my levels.
By the time of my daughters birth I was on 268 units of insulin daily and my levels were still uncontrolled even with the GD diet.
My baby went from being 2 weeks behind on growth at the 20 week scan, to jumping off the charts past 97th centile. She continued this way.
Her growth and the GD affected my body physically and my HG [Hyperemesis Gravidarum], SPD [symphysis pubis dysfunction] and sciatica became what I thought at that time unbearable, or so I thought.
One month ago at 30 weeks I started getting a pain so unbearable I was blue lighted to maternity with expected early labour. This wasn’t the case. Due to the GD, baby’s position and her size my uterus had started to detach/prolapse. I was placed on bed rest and had to use a wheelchair as my legs were useless due to the pressure of everything.
Skip ahead to Sat 7th Feb and once again I’m in maternity in agony, they perform a scan and tell me that at 34 weeks my baby’s weight is 7lb 7oz and that they will either induce me or give me section on the 17th depending on another scan on the 16th. They done a swab to test for early labour as I had a little bit of show/mucus plug and it was negative. They also gave me 2 enemas while I was there as the GD diet alongside with the prolapse, HG and baby made it so I couldn’t poop in 2 weeks. After this I felt more comfortable so I head home to finally eat and inject my insulin.
I continued in discomfort all night and Sunday day thinking it was because I might need to poop again and the the pressure was affecting the SPD etc. My partner decided to put a chicken in the oven so I could eat. While I chilling on the sofa I thought maybe I moved and dribbled a little so I got up and tried to slowly and painfully shuffle to the loo before I got there I sprung a leak! My waters continued gushing for 10 mins to realise it wasn’t a really big pee after being blocked for 2 weeks. I call my midwife and she said it can’t be my waters as the test yesterday showed no signs of labour, but she tells me to go in regardless.
I took a few pics and the pad I was wearing. She takes a one look and confirms my waters had gone and the move me to delivery right away. Labour was going fab as I took every drug offered and baby’s heartbeat was perfect so we decided to go for a vaginal birth as my last baby (14 years ago) was 7lb 4oz.
I got to 9 cm and wasn’t progressing any further and was stuck there for 6 hours, so we decide to do a forceps assisted delivery.
We get to theatre and I continue to push, baby’s heart is fine, just as she’s crowning she turns her head up towards the sky and the Dr. screams “shoulder dystocia” and pulls the alarm!
Next thing is that I’m upside down with people holding my legs up (only my head and shoulders were on the table) and other Dr. with their hands inside my vagina pulling it apart and another Dr. with her hands inside me under baby’s armpits to try to dislodge her.
I was cut and torn. She was stuck like this for nearly 10 mins before they managed to dislocate my hips to free her.
She was born not breathing and no heartbeat. They preformed CPR for 20 mins before they got her heart back. She was rushed to NICU without me even seeing her.
I had to be worked on as I lost a lot of blood and need surgery to repair the damage caused.
My baby girl Lilith Odette was born 8th February 2021 at 34 weeks weighing 8lb 3oz. She was transferred to a hospital where the proceeded to cool her body down and place her on life support to prevent any further brain damage. She has sepsis and will have a MRI to check for anything else over the weekend.
I’d like to thank Laura for allowing me to share her story with others to help raise awareness. My heart goes out to Laura, her partner and beautiful Lilith Odette for what they have all been through and I wish them strength and courage in recovering xx
Laura was diagnosed and tried her hardest to control her blood glucose levels by following a strict diet and taking the medication Metformin and insulin as advised by her health care professionals. Unfortunately her levels remained far too high which has led to complications for both Laura and her baby.
I do not have the full details of why Laura was unable to achieve lower and more stabilised blood glucose levels. I know that having HG alongside GD can be extremely difficult (from my own personal experience).
I must stress that it is very important to push for increased doses of insulin if blood glucose levels are remaining too high. Please do not sit at home struggling with persistent over target levels.
When taking insulin it is typical and expected to have to titrate doses as insulin resistance increases. To prevent hypos (blood glucose levels dropping below 4.0mmol/L) doses are typically increased in small amounts at a time. However if blood glucose levels are much higher than advised, then it is advisable to ask to increase doses in larger amounts. For myself in my third GD & HG pregnancy, this meant increases in 10 units at a time! This is a large jump for many and will not be needed or necessary, however for those will very high insulin resistance, this may be required.
Shoulder dystocia is when the baby’s head has been born but one of the shoulders becomes stuck behind the mother’s pubic bone, delaying the birth of the baby’s body. If this happens, extra help is usually needed to release the baby’s shoulder. In the majority of cases, the baby will be born promptly and safely1.
Shoulder dystocia occurs in about one in 150 (0.7%) vaginal births1. Some studies state that infants of diabetic mothers have a two- to four-fold increased risk of shoulder dystocia compared with infants of the same birth weight born to non-diabetic mothers2. Whereas other studies suggest diabetes in pregnancy increases the risk of shoulder dystocia by 6 times3.
Maternal diabetes has also been shown to be a risk factor for shoulder dystocia, a potentially devastating birth event that can cause fetal injury or death. Diabetes increases the risk of shoulder dystocia by a factor of six via multiple mechanisms . Infants of diabetic mothers are more likely to be macrosomic (defined as birth weight of greater than or equal to 4000 grams) with an odds ratio of 2.19 when compared to infants of nondiabetic mothers . The incidence of shoulder dystocia amongst macrosomic infants, regardless of diabetic status, is 13% compared to 1% when the birth weight is under 4000 g . It is theorized that other factors of fetal biometry affected by maternal glucose control also factor into the increased rate of shoulder dystocia in infants of diabetic mothers. For example, infants of diabetic mothers have significantly greater shoulder-to-head and chest-to-head proportions than those of nondiabetic mothers .Diabetes, Fetal Demise, and Shoulder Dystocia: The Importance of Glucose Screening to Prevent Catastrophic Obstetric Outcomes4
Shoulder dystocia cannot be prevented as it cannot be predicted.
There is a relationship between fetal size and shoulder dystocia, but it is not a good predictor: partly because fetal size is difficult to determine accurately, but also because the large majority of infants with a birth weight of ≥4500g do not develop shoulder dystocia. Equally important, 48% of births complicated by shoulder dystocia occur with infants who weigh less than 4000g.Shoulder Dystocia, Green–Top Guideline No. 42
Complications caused by shoulder dystocia
For the mother it causes a more traumatic birth which can lead to more severe vaginal tears and heavier bleeding.
For the baby, 1 in 10 babies suffer a brachial plexus injury1 (stretching of the nerves in the neck) due to the assisted delivery. Shoulder dystocia can sometimes cause the baby to have a fractured arm or shoulder. In very few cases a baby may suffer brain damage due to the lack of oxygen whilst being stuck during birth.
More information about shoulder dystocia:
- 1.Shoulder Dystocia. Royal College of Obstetricians and Gynaecologists; 2013:1-4. https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-shoulder-dystocia.pdf
- 2.Shoulder Dystocia, Green–Top Guideline No. 42. 2nd ed. Royal College of Obstetricians and Gynaecologists; 2012. Accessed December 2, 2021. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_42.pdf
- 3.DILDY GA, CLARK SL. Shoulder Dystocia: Risk Identification. Clinical Obstetrics and Gynecology. Published online June 2000:265-282. doi:10.1097/00003081-200006000-00005
- 4.Hussain S, Smith A, Cross J. Diabetes, Fetal Demise, and Shoulder Dystocia: The Importance of Glucose Screening to Prevent Catastrophic Obstetric Outcomes. Case Rep Obstet Gynecol. 2020;2020:8142109. doi:10.1155/2020/8142109