Gestational Diabetes

We have strong evidence that treating Gestational Diabetes Mellitus (GDM) improves birth outcomes for mothers and babies.

• Gestational diabetes begins during pregnancy, but some people enter pregnancy with pre-existing diabetes (type 2 diabetes) that was previously undiagnosed. To detect pre-existing diabetes, care providers may offer screening in early pregnancy to mothers with risk factors for type 2 diabetes.

• There is widespread agreement that screening or testing for GDM should take place between 24 and 28 weeks of pregnancy. However, researchers and organizations disagree about the best way to screen and diagnose GDM:

  • Some countries and professional organizations (such as ACOG in the U.S.) prefer a two-part method that includes a screening test (frequently the “Glucola” drink), and if that is positive, women take a diagnostic test (which involves fasting, drinking a glucose beverage, and having multiple blood tests).

  • However, most other countries and organizations prefer a one-part method where everybody (or at least everybody with risk factors for GDM) receives the one-part diagnostic test.

  • With the two-part screening and diagnostic method used in the U.S., cutoffs for GDM diagnosis vary by hospital. When you get your results, it may be helpful to obtain the actual numbers, rather than a statement that you “passed” or “failed” the glucose test. Compare your test results with the Carpenter-Coustan or National Diabetes Data Group Criteria to get a better feel for where your results fall.

A handout from Evidence Based Birth is available here on testing for GDM and here is the info on induction of labor due to GDM.

Group Beta Strep (GBS) Testing and Treatment Options

Group B Streptococcus (GBS) is a type of bacteria that can cause illness in people of all ages. In newborns, GBS is a major cause of meningitis (infection of the lining of the brain and spinal cord), pneumonia (infection of the lungs), and sepsis (infection of the blood) (CDC, 1996; CDC, 2005; CDC, 2009).

Group B strep lives in the intestines and migrates down to the rectum, vagina, and urinary tract. All around the world, anywhere from 10-30% of pregnant people are “colonized” with or carry GBS in their bodies (Johri et al., 2006). Using a swab of the rectum and vagina, people can test positive for GBS temporarily, on and off, or persistently (CDC, 2010). The gold standard test used in screening for GBS is a bacterial culture of a sample collected from a simultaneous vaginal and rectal swab done by your obstetrician or midwife. Testing between weeks 35-37 gestation is 50% more effective at predicting and preventing perinatal disease than screening earlier in pregnancy. The presence of beta-strep means you will receive prophylaxis IV antibiotics during labor unless you decline medical treatment.

Studies have found that IV antibiotics during labor or during a Cesarean probably affect the infant’s microbiome by decreasing beneficial bacteria and increasing potentially harmful bacteria. However, this effect seems to be temporary for most infants, and the negative effect is lessened when the infant is exposed to vaginal birth and/or breastfeeding. Routine IV antibiotics during labor change the microbiome and vaginal flora, which could lead to thrush and breastfeeding complications. (A Cochrane review calls into question the routine practice of giving prophylaxis antibiotics to every laboring patient testing positive for GBS.) Also, consider that when a patient is tethered to an IV they cannot move freely, which can cause discomfort.

Not every baby who is born to a person who tests positive for GBS will become ill. Learn more here about GBS prevention and your baby’s microbiome.
 

Vaginal Exams

Around your 39th week of pregnancy, your OB or midwife will offer or expect you to have a vaginal exam. You may decline. Be aware vaginal exams do not determine when labor will begin but will introduce bacteria, may cause bleeding and cramping, and puts you at risk of premature rupture of the membranes, which could force an induction if labor doesn't begin within 24 hours.

Unless you are in labor or about to be induced, knowing your dilation or effacement is not helpful. Many clients experience the early stage of labor for days (even weeks) or are a few centimeters dilated without contractions and it doesn't amount to much. The bottom line is: that it may hurt, cause issues, and isn't helpful so why endure this highly inaccurate assessment?

In this video, you will learn:

• The results from the two randomized trials on cervical checks at the end of pregnancy

• The potential benefits and potential harms of prenatal cervical checks

• How to handle a situation if your doctor traditionally does vaginal exams at the end of pregnancy, but you don’t want one for whatever reason

Membrane Stripping / Sweeping