Self-Advocacy Toolkit

What is Gestational Diabetes?

Unlike “Regular Diabetes”, which itself has two types, Gestational Diabetes is only present during pregnancy, and most of the time miraculously cures itself after.

There are many different factors that increase your chance of developing Gestational Diabetes, but really it can happen to anyone. It doesn’t mean you’ve done anything wrong or that your diet is terrible!

It also doesn’t mean there’ll be any other issues in your pregnancy and birth, and there are lots of ways to manage it to minimise its potential impact.

How is it diagnosed?

As Gestational Diabetes doesn’t normally have any symptoms, the Glucose Tolerance Test is offered to women who have some factors that mean they may be more likely to develop the condition. If you’ve been offered it and you’re not sure why, be sure to ask your Midwife or care provider.

The test involves going to the diagnostic centre (usually at your local hospital) for a fasting blood test (where you’ve had nothing to eat or drink but water for 8-10 hours; your local trust will let you know what rules they want you to follow!). You’re then given a sweet drink, and a while later (usually 2 hours), another blood test is done to see how your body has handled the glucose. You’ll have to wait in the hospital through the process, so bring something to keep yourself entertained!

If you’re someone who likes to know all they can for peace of mind, or you simply feel neutrally about it, accepting the offer of a Glucose Tolerance Test if it is offered may be the right choice for you. It’s a minimally invasive test that gives a lot of women peace of mind. As with all things in pregnancy and birth: Your Body, Your Baby, Your Choice.

“I have been diagnosed with Gestational Diabetes. How do I manage it?”

If you’ve been diagnosed with gestational Diabetes, the best way to minimise the risk of it impacting your pregnancy and birth is to manage your blood-sugar levels. You’ll be given a kit to regularly check your blood-sugar levels at home, so that you can take ownership of the condition and your care.

You may be offered medication, such as metformin or insulin, to help keep your blood-sugar levels in a healthy range.

“How might Gestational Diabetes impact my pregnancy and labour?”

The risks of Gestational Diabetes are less due to the condition itself, and more due to consistently high blood-sugar levels caused by the condition remaining uncontrolled. Therefore, the best thing you can do for yourself and your baby is to take steps to keep your blood-sugar levels within the recommended range (through a combination of diet and exercise, and medication if needed) (RCOG).

It is important to understand, as with all risks, that there can be compounding factors. The Royal College of Obstetricians and Gynaecologists list the risks as:

• baby being bigger than average

• shoulder dystocia (where your baby’s shoulder gets stuck during birth)

• stillbirth or the baby dying at or around the time of birth. This is uncommon.

• needing additional care once they have been born, possibly in a neonatal unit

• being at greater risk of developing obesity and developing type 2 diabetes in later life

Controlling your levels of blood glucose during pregnancy and labour reduces the chances of these complications for you and your baby. (RCOG, 2023)

However, we also know that an increasingly medicalised birth also increases the risk of shoulder dystocia (the risk of which is increased by less mobility in labour caused by continuous fetal monitoring, epidurals, and birthing lying on your back), as well as other complications such as increased blood loss and difficulty initiating breastfeeding.

Consider protective factors such as mobility in labour, and promotion of oxytocin. Discuss with your care providers how these can be planned and included in a hospital setting, if that’s where you’re choosing to birth.

A diagnosis such as GD can create fear in healthcare professionals, and lead to you being offered additional interventions, as well as additional pressure from medical staff to accept these. You may well encounter a whole lot of fear-mongering; it’s always important to ask questions and use the BRAIN acronym to figure out what is right for you. A lot of recommendations may be fear-based rather than evidence-based. It is your right to question your care.

“Can I have a homebirth with Gestational Diabetes?”

YES! In fact, it may offer a protective factor against some of the potential risks of the condition.

It is always your right to choose where you give birth. If your care providers have concerns about you doing so, due to GD or any other risk factors, you can discuss this with them. You may come to a compromise; you may decline their suggestions based on your own research. What’s important is that you are confident and comfortable with your choices.

If your midwife or consultant aren’t keen, often the Head of Midwifery can be a good person to support you. If your care providers are causing you stress, sometimes PALS - the Patient Advice and Liaison Service and your local hospital - can help. Factors they may wish to discuss could include reducing risks at home, having a Plan B, how to keep an eye on baby’s blood sugar levels at home once they’re born, what you need to be aware of or seek additional help for, or support with feeding. Any concerns that your care providers have should be discussed with you.

If you’re struggling and want to discuss your options, you can book a Power Hour to talk things through, or an in-person chat or appointment advocacy through my Antenatal Doula Services.

Offers of Induction for Gestational Diabetes

You may be offered an induction for Gestational Diabetes, particularly if your blood-sugar levels have been difficult to control (as this increases the likelihood of potential difficulties). You are always, absolutely, within your rights to say no.

If you accept, be sure you are aware of the risks of induction itself, and that you are comfortable with those. Think about your protective factors - freedom of movement in labour, making your birth environment work for you, promotion of oxytocin and so on - and make sure that these are built into your birth plan, along with anything else you feel will support your positive birth experience. Make sure your birth partner(s) are prepared to advocate for you if needed. Plenty of people feel positively about their inductions; the key is stocking your personal birth toolkit with what is right for you!

If you don’t want an induction, and are concerned about your personal risk factors during a vaginal birth with GD, an elective abdominal birth can help some women feel in control of their birth experience in a way that induction doesn’t.

Whatever you choose: Your Body, Your Baby, Your Choice.

Below are some resources on induction for Gestational Diabetes, and Induction in general.