Need sources on gestational diabetes and bf immediately after labor

[jjmoreta]

I have gestational diabetes and I'm looking for sources on the effect that
bf-ing immediately after birth has on a baby's sugar levels, especially on
babies born to GD mothers. The only citation I have is from Henci Goer, but
I'm looking for more. I'm hoping that maybe some of y'all have run across
something in all those wonderful bf-ing books I need to buy in the next week
or so.

If you can find anything that also discusses what a baby's sugar levels
during labor and immediately after birth should be normally, I would
appreciate those as well. It's my understanding that babies are slightly
hypoglycemic during labor and after anyways, but I don't have any citable
sources that I can find.

I had a discussion with my OB a couple of weeks ago at my last appt and when
I mentioned bf-ing right after birth as helping to counter any low blood
sugar problems (she wants to put me on a glucose & insulin drip during
labor), she not only knew nothing about it but scoffed at the idea
(mentioning that with my GD, the infant procedures probably wouldn't give me
time to bf for at least half an hour). I just want some sources to give
her.

And don't worry, starting tomorrow my husband and I will be actively looking
for another care provider. I didn't do a good enough job with questions
early in pregnancy (she was my gyn and family doctor before this) and I have
only now gotten the distinct impression that she is very pro-intervention
(she said I'll need the IV anyways because I probably won't be able to go
through labor without an epidural LOL). If I can't get another OB for my
birth (timing and insurance may prevent it), she'll at least never get her
hands on my baby afterwards (she was going to be my pediatrician). Thank
goodness I know that I have the right to say no to any procedure I don't
want (and if I'm stuck with her, I'm going to be saying no to a lot of
stuff)

- Joanne
#1 - 35w2d

[New York Jen]

"jjmoreta" > wrote in message
...
> I have gestational diabetes and I'm looking for sources on the effect that
> bf-ing immediately after birth has on a baby's sugar levels, especially on
> babies born to GD mothers. The only citation I have is from Henci Goer,
but
> I'm looking for more. I'm hoping that maybe some of y'all have run across
> something in all those wonderful bf-ing books I need to buy in the next
week
> or so.
>
> If you can find anything that also discusses what a baby's sugar levels
> during labor and immediately after birth should be normally, I would
> appreciate those as well. It's my understanding that babies are slightly
> hypoglycemic during labor and after anyways, but I don't have any citable
> sources that I can find.
>
> I had a discussion with my OB a couple of weeks ago at my last appt and
when
> I mentioned bf-ing right after birth as helping to counter any low blood
> sugar problems (she wants to put me on a glucose & insulin drip during
> labor), she not only knew nothing about it but scoffed at the idea
> (mentioning that with my GD, the infant procedures probably wouldn't give
me
> time to bf for at least half an hour). I just want some sources to give
> her.
>
> And don't worry, starting tomorrow my husband and I will be actively
looking
> for another care provider. I didn't do a good enough job with questions
> early in pregnancy (she was my gyn and family doctor before this) and I
have
> only now gotten the distinct impression that she is very pro-intervention
> (she said I'll need the IV anyways because I probably won't be able to go
> through labor without an epidural LOL). If I can't get another OB for my
> birth (timing and insurance may prevent it), she'll at least never get her
> hands on my baby afterwards (she was going to be my pediatrician). Thank
> goodness I know that I have the right to say no to any procedure I don't
> want (and if I'm stuck with her, I'm going to be saying no to a lot of
> stuff)
>
> - Joanne
> #1 - 35w2d


Too exhausted right now to do research, but I'm sure if you Google it, you'd
come up with tons of information.

I had gestational diabetes while pregnant with my son and his sugar was low
when he was first born. He had a glucose drip and at first I was told that
I would not be able to nurse him. I was devastated and wish I was more
well-informed at the time. He did have some formula while he was in the
hospital, mostly because he was in the NICU and it was hard for me to get to
him for those 2 days, but his sugar went right back up (as it usually does
with babies born to GD moms) and he never had formula again.

The reason the baby's sugar can be low is because your body is doing the
glucose job for him/her and your body is out of wack. Once the baby is on
the outside, his/her body has to get used to producing its own insulin in
proper levels to regulate blood sugar. How are you managing your diabetes?
Are you on insulin or diet? If your diabetes is under control, I doubt
you'll have any problem at all. Also, try talking to a lactation consultant
beforehand to be properly armed with information when you go in.

good luck,

Jen

[Mogget]

In message >, jjmoreta
> writes
>I have gestational diabetes and I'm looking for sources on the effect that
>bf-ing immediately after birth has on a baby's sugar levels, especially on
>babies born to GD mothers. The only citation I have is from Henci Goer, but
>I'm looking for more. I'm hoping that maybe some of y'all have run across
>something in all those wonderful bf-ing books I need to buy in the next week
>or so.
>
>If you can find anything that also discusses what a baby's sugar levels
>during labor and immediately after birth should be normally, I would
>appreciate those as well. It's my understanding that babies are slightly
>hypoglycemic during labor and after anyways, but I don't have any citable
>sources that I can find.
>
>I had a discussion with my OB a couple of weeks ago at my last appt and when
>I mentioned bf-ing right after birth as helping to counter any low blood
>sugar problems (she wants to put me on a glucose & insulin drip during
>labor), she not only knew nothing about it but scoffed at the idea
>(mentioning that with my GD, the infant procedures probably wouldn't give me
>time to bf for at least half an hour). I just want some sources to give
>her.
>
>And don't worry, starting tomorrow my husband and I will be actively looking
>for another care provider. I didn't do a good enough job with questions
>early in pregnancy (she was my gyn and family doctor before this) and I have
>only now gotten the distinct impression that she is very pro-intervention
>(she said I'll need the IV anyways because I probably won't be able to go
>through labor without an epidural LOL). If I can't get another OB for my
>birth (timing and insurance may prevent it), she'll at least never get her
>hands on my baby afterwards (she was going to be my pediatrician). Thank
>goodness I know that I have the right to say no to any procedure I don't
>want (and if I'm stuck with her, I'm going to be saying no to a lot of
>stuff)

She's full of s**t. I was mildly diabetic before I was pregnant, and
gestational diabetic with knobs on during the pg. I declined the
insulin/glucose drip during labour, kept stable blood sugars during the
whole procedure WITHOUT any insulin, and gave birth to a 7lb 13 oz baby.
I remain proud of myself that I managed to keep good enough control to
have a perfectly normal size baby (and she was two weeks late, too).

How big is your baby, do you know? Have you been having growth scans?

I am sorry that I don't have the citations you ask for, but I hope that
my anecdotal experience will give you some confidence in your ability to
go without unwanted intervention.

What I did was I took my meter in with me, agreed to test hourly, and
agreed further that if my BS went over a pre-agreed threshold (6.7
mmol/l, or 120 mg/dl) then I would accept the insulin drip. It didn't,
and I was able to avoid that particular intervention (though I ended up
with every other bugger).

Breastfeeding is *bound* to raise the baby's blood sugar levels - it's
protein & sugar rich, isn't it? (Actually, not sure, what is
colostrum?) My baby was taken to NICU for hourly feedings (Satan Juice,
against my instructions) and blood sugar readings. Their treatment of
low pre-meal blood sugars was more frequent feedings. So breastfeeding
has to be even better than what they were doing, assuming you've got a
baby who's feeding a lot. If s/he's sleeping a lot, then you do have to
get the food into him/her somehow, and of the top of my head that could
be a nasal tube or a glucose drip.

FWIW, my baby was completely asymptomatic but it did take her four days
for her blood sugars to become stable, rather than the one they were
expecting. IIRC, they considered normal to be around 2.8 mmol/l (45
mg/dl).

And, apropos nothing in particular, what with my baby being taken away
from me at birth into NICU for four days, and my subsequent
complications, I wasn't able to even start trying to breastfeed her till
she was eight days old. It was BLOODY difficult. I'd like to encourage
you to stick to your guns and insist on putting the baby to the breast
as soon as possible after birth.

All the best.
--
Mogget, the Churl in the Puce Greatcoat

[shaz]

Hi,

I am an IDD, and had baby 2 weeks ago. I was quite expecting her to be
taken to special baby care very soon after birth due to her blood sugars but
very luckily escaped this. At her lowest Eloises BS went to 1.6 about 6
hours after birth, however she stayed with me and was given donor milk as
well as mine for the first 24 hours by which time her sugars were
acceptable. I would strongly fight for something similar to happen if
babies sugars are not too low, might be worth finding somewhere where donor
milk is available?

Shaz

"Mogget" > wrote in message
...
> In message >, jjmoreta
> > writes
> >I have gestational diabetes and I'm looking for sources on the effect
that
> >bf-ing immediately after birth has on a baby's sugar levels, especially
on
> >babies born to GD mothers. The only citation I have is from Henci Goer,
but
> >I'm looking for more. I'm hoping that maybe some of y'all have run
across
> >something in all those wonderful bf-ing books I need to buy in the next
week
> >or so.
> >
> >If you can find anything that also discusses what a baby's sugar levels
> >during labor and immediately after birth should be normally, I would
> >appreciate those as well. It's my understanding that babies are slightly
> >hypoglycemic during labor and after anyways, but I don't have any citable
> >sources that I can find.
> >
> >I had a discussion with my OB a couple of weeks ago at my last appt and
when
> >I mentioned bf-ing right after birth as helping to counter any low blood
> >sugar problems (she wants to put me on a glucose & insulin drip during
> >labor), she not only knew nothing about it but scoffed at the idea
> >(mentioning that with my GD, the infant procedures probably wouldn't give
me
> >time to bf for at least half an hour). I just want some sources to give
> >her.
> >
> >And don't worry, starting tomorrow my husband and I will be actively
looking
> >for another care provider. I didn't do a good enough job with questions
> >early in pregnancy (she was my gyn and family doctor before this) and I
have
> >only now gotten the distinct impression that she is very pro-intervention
> >(she said I'll need the IV anyways because I probably won't be able to go
> >through labor without an epidural LOL). If I can't get another OB for my
> >birth (timing and insurance may prevent it), she'll at least never get
her
> >hands on my baby afterwards (she was going to be my pediatrician). Thank
> >goodness I know that I have the right to say no to any procedure I don't
> >want (and if I'm stuck with her, I'm going to be saying no to a lot of
> >stuff)
>
> She's full of s**t. I was mildly diabetic before I was pregnant, and
> gestational diabetic with knobs on during the pg. I declined the
> insulin/glucose drip during labour, kept stable blood sugars during the
> whole procedure WITHOUT any insulin, and gave birth to a 7lb 13 oz baby.
> I remain proud of myself that I managed to keep good enough control to
> have a perfectly normal size baby (and she was two weeks late, too).
>
> How big is your baby, do you know? Have you been having growth scans?
>
> I am sorry that I don't have the citations you ask for, but I hope that
> my anecdotal experience will give you some confidence in your ability to
> go without unwanted intervention.
>
> What I did was I took my meter in with me, agreed to test hourly, and
> agreed further that if my BS went over a pre-agreed threshold (6.7
> mmol/l, or 120 mg/dl) then I would accept the insulin drip. It didn't,
> and I was able to avoid that particular intervention (though I ended up
> with every other bugger).
>
> Breastfeeding is *bound* to raise the baby's blood sugar levels - it's
> protein & sugar rich, isn't it? (Actually, not sure, what is
> colostrum?) My baby was taken to NICU for hourly feedings (Satan Juice,
> against my instructions) and blood sugar readings. Their treatment of
> low pre-meal blood sugars was more frequent feedings. So breastfeeding
> has to be even better than what they were doing, assuming you've got a
> baby who's feeding a lot. If s/he's sleeping a lot, then you do have to
> get the food into him/her somehow, and of the top of my head that could
> be a nasal tube or a glucose drip.
>
> FWIW, my baby was completely asymptomatic but it did take her four days
> for her blood sugars to become stable, rather than the one they were
> expecting. IIRC, they considered normal to be around 2.8 mmol/l (45
> mg/dl).
>
> And, apropos nothing in particular, what with my baby being taken away
> from me at birth into NICU for four days, and my subsequent
> complications, I wasn't able to even start trying to breastfeed her till
> she was eight days old. It was BLOODY difficult. I'd like to encourage
> you to stick to your guns and insist on putting the baby to the breast
> as soon as possible after birth.
>
> All the best.
> --
> Mogget, the Churl in the Puce Greatcoat

[KarenC]

Here is a quick quote from an article I found:
http://www.lalecheleague.org/NB/NBJulAug97p107.html
for the whole article.

"Researchers and physicians have differing opinions as to what blood glucose
levels constitute hypoglycemia. The most current research-based definition
of hypoglycemia in any newborn in the United States is a serum/plasma blood
glucose concentration lower than 40 mg/dl (whole blood glucose level lower
than 35 mg/dl). The limit is allowed to go lower by some physicians in the
absence of symptoms--whole blood concentrations of 30 mg/dl for full-term
infants, and 20 mg/dl for premature or small-for-gestational age babies. In
one study, asymptomatic (except for jitteriness) newborns with blood glucose
levels below 20 mg/dl were given human milk alone. These children were
neurologically tested a number of years later and found to have no
problems."

I was/am GD with my second and third pregnancies. I explicitly wrote in my
birth plan that the baby was not to be given any formula/glucose without my
express permission. I demanded that the baby be handed to me immediately
after birth (to h*ll with all those procedures), which is when I immediately
started to nurse him. I also said in my plan that if it were an emergency
situation and glucose were needed, I would need to have that fully explained
to me, putting the impetus on the hospital staff to be sure it was really an
emergency. He was hypoglycemic, unfortunately, and continued to be tested
for 24 hours after birth. Fortunately, he was a champ at BFing and seemed
to know just what to do. I pretty much let him nurse round the clock, which
was horrible on my nipples but got the job done. Despite the dire
predictions swirling around us that he would inevitably need formula, he
never needed anything but the breast.

I have the same instructions in my birth plan for #3. Obviously, if it's an
emergency, the priority is to get the baby back on track. What you need to
do is make sure everyone understands that it won't just be a matter of
course that your baby be given formula/glucose due to your GD. It needs to
be a situation that warrants intervention. It's your baby and you need to
demand that your wishes come first, only to be subordinated in a true
emergency.

I would also recommend that you be sure you have someone to help you with
latching on and nursing in the delivery room. The combination of my own
inexperience and my first child's cluelessness about nursing would have made
exclusive nursing impossible had I been GD with him. It took us *weeks* to
learn how to nurse. Completely different with #2, who had my DH and I in
awe that he actually knew what to do.

Best wishes,
Karen

[jjmoreta]

"Mogget" > wrote in message
...
> In message >, jjmoreta
> > writes
> >I have gestational diabetes and I'm looking for sources on the effect
that
> >bf-ing immediately after birth has on a baby's sugar levels, especially
on
> >babies born to GD mothers. The only citation I have is from Henci Goer,
but
> >I'm looking for more. I'm hoping that maybe some of y'all have run
across
> >something in all those wonderful bf-ing books I need to buy in the next
week
> >or so.
> >
> >If you can find anything that also discusses what a baby's sugar levels
> >during labor and immediately after birth should be normally, I would
> >appreciate those as well. It's my understanding that babies are slightly
> >hypoglycemic during labor and after anyways, but I don't have any citable
> >sources that I can find.
> >
> >I had a discussion with my OB a couple of weeks ago at my last appt and
when
> >I mentioned bf-ing right after birth as helping to counter any low blood
> >sugar problems (she wants to put me on a glucose & insulin drip during
> >labor), she not only knew nothing about it but scoffed at the idea
> >(mentioning that with my GD, the infant procedures probably wouldn't give
me
> >time to bf for at least half an hour). I just want some sources to give
> >her.
> >
> >And don't worry, starting tomorrow my husband and I will be actively
looking
> >for another care provider. I didn't do a good enough job with questions
> >early in pregnancy (she was my gyn and family doctor before this) and I
have
> >only now gotten the distinct impression that she is very pro-intervention
> >(she said I'll need the IV anyways because I probably won't be able to go
> >through labor without an epidural LOL). If I can't get another OB for my
> >birth (timing and insurance may prevent it), she'll at least never get
her
> >hands on my baby afterwards (she was going to be my pediatrician). Thank
> >goodness I know that I have the right to say no to any procedure I don't
> >want (and if I'm stuck with her, I'm going to be saying no to a lot of
> >stuff)
>
> She's full of s**t. I was mildly diabetic before I was pregnant, and
> gestational diabetic with knobs on during the pg. I declined the
> insulin/glucose drip during labour, kept stable blood sugars during the
> whole procedure WITHOUT any insulin, and gave birth to a 7lb 13 oz baby.
> I remain proud of myself that I managed to keep good enough control to
> have a perfectly normal size baby (and she was two weeks late, too).
>
> How big is your baby, do you know? Have you been having growth scans?
>
> I am sorry that I don't have the citations you ask for, but I hope that
> my anecdotal experience will give you some confidence in your ability to
> go without unwanted intervention.
>
> What I did was I took my meter in with me, agreed to test hourly, and
> agreed further that if my BS went over a pre-agreed threshold (6.7
> mmol/l, or 120 mg/dl) then I would accept the insulin drip. It didn't,
> and I was able to avoid that particular intervention (though I ended up
> with every other bugger).
>
> Breastfeeding is *bound* to raise the baby's blood sugar levels - it's
> protein & sugar rich, isn't it? (Actually, not sure, what is
> colostrum?) My baby was taken to NICU for hourly feedings (Satan Juice,
> against my instructions) and blood sugar readings. Their treatment of
> low pre-meal blood sugars was more frequent feedings. So breastfeeding
> has to be even better than what they were doing, assuming you've got a
> baby who's feeding a lot. If s/he's sleeping a lot, then you do have to
> get the food into him/her somehow, and of the top of my head that could
> be a nasal tube or a glucose drip.
>
> FWIW, my baby was completely asymptomatic but it did take her four days
> for her blood sugars to become stable, rather than the one they were
> expecting. IIRC, they considered normal to be around 2.8 mmol/l (45
> mg/dl).
>
> And, apropos nothing in particular, what with my baby being taken away
> from me at birth into NICU for four days, and my subsequent
> complications, I wasn't able to even start trying to breastfeed her till
> she was eight days old. It was BLOODY difficult. I'd like to encourage
> you to stick to your guns and insist on putting the baby to the breast
> as soon as possible after birth.
>
> All the best.
> --
> Mogget, the Churl in the Puce Greatcoat

I get my first u/s since 8 wks in a week to check size and position. I'm so
thrilled! She didn't believe in the 20 wk Level II u/s and I admit that I'm
highly curious about gender. I'm more likely to have a large baby anyways
because I'm very overweight (over 300lbs) and my husband is over 200lbs and
6'4" tall. As for weight gain, I'm currently at 2.5 lbs less than my
prepregnancy weight and have had trouble eating enough calories.

I'm glad that I have refused insulin treatment thusfar. I toured one of the
two local hospitals last night to find out that if I was on insulin, the
glucose drip would be something they would definitely insist on. As for
now, I am going to refuse it. At least this hospital will allow me fluids,
including Sprite and fruit juices, so I won't be glucose deprived. I've
been doing well on the diet, and they only want me on insulin for my fasting
level because it likes to hover between 90 and 105mg in the mornings. My
post-meal readings have been under the thresholds. I'll make sure to bring
my blood sugar monitor with me in case I need to make a bargain with them
like that.

In what research I've found recently, I found out that unless the baby shows
visible signs of hypoglycemia (i.e. tremors), the blood sugar test can be
considered routine and I can deny it, which I will fight to do. And if they
take the baby out of my room without my permission and/or without my
accompaniment, there will be hell to pay. My husband will help support me
in that.

I wasn't sure about the amount of glucose in colostrum. I guess it didn't
seem like "true" milk to me, but I'm an inexperienced first timer. I'd be
curious to find more about its nutritional content.

This hospital I toured has the reputation of being the more "uptight"
hospital and I was still pleased with how much intervention I may be able to
bypass there. If the other one would ever call me back to schedule a tour,
I am definitely hopeful that I'll get even better results even though its
the one that my diabetic center is at.

- Joanne