The Importance of Birth Plans...

Birth Plans are a great idea for any pregnant person to have ready! We all know birth is unpredictable and having a "plan" in place is no guarantee that anything will go in any particular way. However, the great thing about putting together a Birth Plan is that it makes you think about how you'd want things to go ideally…and it helps prepare you for the alternatives.

There are so many interventions that you may wish to avoid (or elect to have) during your birth experience, and preparing your Birth Plan is a great way to discover what all these interventions are and what they mean for you and your baby. I found that for my pregnancy, the easiest thing for me to do was find a template for a birth plan (BabyCenter has a good one HERE) and then researched the options in each section to determine what best fit my preferences.

You can start putting together your preferences as early as your first trimester, although the recommendation is to have some sort of idea ready by your 5th month of pregnancy. It's important to know as early as possible what is important to you (for example, perhaps you absolutely DO NOT wish to have continuous monitoring so you can move freely during labor, or maybe you absolutely NEED to eat and drink during labor) so that you can discuss these things with your care provider. The reason it's best to do this early is because it gives you the best chance of finding a doctor or midwife you LOVE, should you decide your current care provider is not the best match for the type of birth experience you have in mind. *By the way, remember you can ALWAYS change doctors…even at the very VERY last minute!

If you and your care provider agree that your plan is feasible and safe, and you are SURE your provider is giving you the best possible care and not just considering what is most convenient for THEM, then a good idea is to have the doctor sign your birth plan. It's not in any way a binding contract or anything, but the idea is that if you go into labor and arrive at the hospital or birth center before your care provider does, you can have something to show the nurses and support staff that shows that your care provider is on board with your preferences. It's also important to have several copies on the day of the birth for the nurses, your doula, etc. Every one that comes in contact with you during your labor should see your birth plan, to avoid miscommunications or misunderstandings.

You can include things in your birth plan regarding pain management, what you wish to happen to the baby immediately after birth (like immediate skin to skin and waiting to do newborn exams for an hour so you have a chance to bond, for example), and your plans for feeding your baby (bottle or exclusively breast feeding?).

It's definitely important to be flexible and be ready to forgive yourself if things don't go exactly as you'd hoped…The most important thing is to be educated about all of your options so that if things DO need to go in a different direction, you are equipped to make the best choices for you and your baby. Remember, even if your Birth Plan doesn't come to fruition, preparing one is always beneficial because it familiarizes you with your options (and their risks and benefits), and the policies of your care center and provider.

What advice would you give a first time mother about preparing a birth plan? What is something you think every plan should include?

May 5th is International Day of the Midwife

It's not just Cinco de Mayo today! More importantly (I think), today is International Day of the Midwife. In case you don't know, a midwife is a specialist of well woman care, prenantal care, labor and delivery of babies in a less clinical (and intervention-laden, usually) way than obstetricians. Obstetricians are medical doctors that are trained as surgeons first, so midwives are a great choice for women that are having healthy pregnancies and have no risk factors that require a surgical birth.

Weird Pregnancy Behaviors...

the things no one talks about.

originally dated 2/25/11
Since I’ve been pregnant, I’ve been having thoughts and urges that scare even me.

Namely, the urge to lick things.

I’ll wait for you to laugh. I find it hilarious, myself.

I’ve asked my mom if she ever had a similar urge, and she only giggled. I’ve googled it and found nothing. Even my husband can only smirk when I get a certain look on my face because he knows I’m actively holding myself back from licking something in my vicinity.

Now before you get any ideas, I only have had urges to lick food, and stranger still, the television when there’s an image on food on it. I haven’t ACTUALLY licked the TV (yet LOL), but this anxious NEED to lick the screen comes over me whenever something tasty appears! LMAO

My theory is that I’m having too many cravings to actually fit all these foods in my tummy at once, and lately I can only eat about half what I used to, but get hungrier much more often…so I guess maybe I want to lick things just so I can taste them without actually ingesting them? IDK…it’s the only thing that makes sense to me. Also, I’ve much more aware of textures in my food lately, so maybe I get the urge to lick things because I’m not interested in chewing them…(?) Any ideas/theories would be appreciated (and probably laughed at).

I’ve heard of women eating chalk and dirt while they’re pregnant, so me wanting to lick a chicken wing or a tamal isn’t THAT strange…is it? ;)

This was something I wrote on my blog back when I was about 7 weeks pregnant with my son. Have you experienced weird or unexpected inclinations during your pregnancies? I'd love to hear from other mommas so I know I'm not the only weirdo! hahaha ;)

Guest Post - "Wrapping Your Pregnant Belly"

You can use your shortie woven wraps before baby is ever born, for comfort and relief for tired bodies. Here I'll briefly outline two techniques for helping to support your pregnant body as you grow! For both of these, I'm photographed with a size 2. A size 2 or 3 woven is recommended, or a longer rebozo, 9 feet or more.

Belly Lift:

1. Starting at your middle marker, wrap and tighten around the lower portion of your belly.

2. Reaching around behind you, cross the tails over one another and bring over your shoulder. You can gather or spread these passes.

3. In your front, pull downward on the tails, to cause a lift in the belly and relieve tired muscles and pelvis.

4. If you want to use this for an extended period of time, use a longer wrap and tie tightly between the shoulder blades.

Hip Squeeze

1. Starting at your middle marker, gather and place low and evenly across your hip bones.

2. Tie in the back very tightly, at the tailbone.

3. Leave here for knot 1 variation

4. For knot two variation, you can use the tails to twist up and around your knot, forming a large knot. Lean against a wall, sit back, or use your palm to apply pressure down and in, relieving a sore tailbone while squeezing your hips.

   Both of these techniques have a place in difficult or uncomfortable labors as well. Find a doula or other care provider who is familiar with rebozo techniques to discuss when it may be appropriate to use them in labor.

Cortney Baca is a Birth Doula and Certified Babywearing Consultant through the Center for Babywearing Studies. Mama to a sweet 3 year old boy and due with baby #2 in early Spring 2014, if she's not working, she's cooking, reading, gaming, or enjoying the outdoors through exploring and geocaching. You can follow her through her website: www.motherstrong.com, or find her as MotherStrong on facebook, twitter, or pinterest.

Breech Presentation...What? Why? How?

A baby in "breech" position is basically considered an automatic cesarean, at least in the United States. Many doctors are no longer trained in breech deliveries, and so the immediate conclusion that they come to is that mom will need major abdominal surgery due to their lack of training. It is what it is, right?

Wrong.


What is Breech?

• Frank Breech, which tends to be the most favorable. This is when baby’s bottom presents first and feet are by the head.
• Footling Breech is when baby has one or both feet presenting first.
• Complete Breech is when your baby is comfy sitting cross legged.

Why won’t my doctor do a vaginal breech birth?
This could be due to a variety of reasons:

• They may not have a lot of experience attending vaginal breech births.
• May not feel comfortable attending vaginal breech births.
  
• May have had a bad experience in the past.
  
• There may not be suitable back-up at the hospital where they practice (on call anesthetists, pediatricians, experienced midwives, 24 hour operating room staff).
  
• They may not believe in vaginal breech birth.
  
• Defensive practice in current childbirth culture means that doctors are more likely to err on the side of intervention (cesarean section) rather than non-intervention (vaginal birth).
  
• It is easier for a doctor to perform a cesarean section than a skilled vaginal breech birth.
  
• Cesarean is an accepted birth method in today’s culture.

How should I approach my child's breech position?
*Do nothing.
Depending how many weeks pregnant you are, you may decide just to wait for your baby to turn. The majority of babies turn spontaneously pre-term.

*Non-medical turning
Alternatively, there are various non-medical turning techniques you can try.  You can read more on Spinning Babies. 
 
*Look for a care-provider who will support you in whatever option you choose
Many maternity care-providers do not support vaginal breech birth and will advise a planned cesarean section at 38 or 39 weeks if your baby does not turn.  This is partly because most obstetricians and midwives do not possess skills in vaginal breech birth and so they are unable to offer this option safely. However, depending on various maternal and fetal factors, vaginal breech birth is not necessarily any riskier than cesarean section, particularly with the support of an experienced attendant. 

Before 37 weeks of pregnancy, breech presentation is much more common - about 20% of babies at 28 weeks are breech, and 15% at 32 weeks. Before term, which is defined as 37 weeks, it doesn't matter if the baby is breech, as there is always a good chance that she will turn spontaneously. Some babies do turn by themselves after this time, but it is much less likely, and some preparations should be made to decide how delivery is going to take place. About 10% to 15% of breech babies are discovered for the first time late in labor!


Very soon, I will post two guest birth stories. One of these stories is from Felicia, who had a cookie-cutter, non-complicated pregnancy but was forced into cesarean delivery solely due to a breech presentation. The second is from Kristel, whose daughter came out booty-first at home in the water. These ladies are examples of how having supportive care providers can make the difference between the birth experience you want and the experience that is forced upon you.

Further Reading:
Spinning Babies 
The Webster Technique
Breech Decision Making Sheet

UPDATE: Please click HERE for the Breech Babies tab, so you can read the birth stories mentioned above and any other resources on this site regarding breech babies.



Sources: 1, 2, 3, 4

Guest Post: "Baby After Bypass"

So I was fat. I still am fat (not that there's anything wrong with that!), but I was REALLY fat when I was little. I was born and raised in Jersey and I have a stubborn German for a father and a pile of moosh n' love for a mother. I heard a lot of crap from my dad about being heavy. "Put the food down." "You'll die big you know." "Try to lose weight so you can play with your friends..." I don't ever think he meant anything bad by it, but it really took a toll. And as for my mom: "lets go get ice cream so you won't be sad anymore.." (you can see how this snowballs, right?)

When I entered high school I had already had years of bullying. As if being big wasn't enough, I had pimples, I wore glasses, and I had super short hair. I was a target for sure. But as I went to doctors for check ups, we realized one thing: weighing 380 pounds when you were 15 years old was pretty darn unhealthy. It was literally killing me and I was scared.

Around this time gastric bypass was pretty knew, but something drastic needed done. I had all the visits and analyzing one could ever want, and I was in. I was going to get the Roux-En-Y gastric bypass procedure on December 13th, 2002. I went under the knife and came out alive. AND SUPER GASSY! In one week I lost 36 pounds. In one month I lost 90. In 6 months I lost 200 pounds. I could finally walk up the stairs and not be in pain and out of breath. My life had changed for the better.
I did have some complications but they were minor. I still have skin, 10 years later, that I'd like gone, but I'm married now and my husband loves me for what I am and he thinks I'm sexy. (I met my husband on match.com and said hello because I thought his beard was AWESOME. It was love at first beard )

My husband and I said we wanted a family and we started TTC in january of 2012. Frustrated 3 months later we were told to relax and grab some champagne. We did...and voila! Pregnant! I had some concerns having had the surgery and being pregnant. Also, trying to conceive wasnt difficult and it was fun my husband is big too so our positions are limited but our energy never is! We wanted a baby so bad so we tried all the time. The surgery had no impact on our ability to conceive.

 I asked all the doctors if I was safe and how to get my calories in. NOTHING that went in my mouth could be crap calories. Everything I ate had to be good for me and for baby. So that's what I did.
Everything I had was high in protein and I ate many small meals through the day. I drank protein too, tried to cut back on coffee (so hard!), and tried not to head to fast food too often. I did have my fair share of ice cream and pickles for sure, but I did crave healthy things too which helped a lot. I had a complication free pregnancy: no gestational diabetes, no problems whatsoever. I kept myself in check and made sure to do things right. This baby was too important to my husband and I.

In February I gave birth to a chubby 7 pound 13 ounce boy: Edward Remy. I was in labor for 2 hours before fully dilated, and pushed for 18 minutes until he came into this world. He truly is the most amazing thing. My husband and I can't wait to have another!

The gastric bypass was harder to deal with when it was initially done. I was young and didn't follow "the rules" like I should have, but I managed to keep the weight down (although I gained back a little bit). Once I got pregnant I didn't want anything to damage my tummy or my baby, so I kept in close contact with the gastric doctors and they helped me a lot. I would do BOTH of these things again if given the chance. I've never looked back!

This story was shared by Molly, momma of one from Levittown, PA. Molly is the owner of MollyCakes Bakery, find out more about her awesome cakes here.

Factors for VBAC success, Part 1/2

In this post, I will discuss why each of the following factors are important in VBAC success:

*reasons for previous c-sections
*arriving at the hospital as late into labor as possible
*not having continuous fetal monitoring
*epidural as late as possible into the labor, if at all
*no induction or acceleration
*previous vaginal birth

*Reasons for previous cesareans
If previous cesareans happened because of something unlikely to reoccur, like the baby being breech (which is a whole other topic, and I will be featuring both facts on breech babies and a couple of guest post on the topic next month), you have a pretty good chance of a successful VBAC. Something like CPD (a medical condition where one's pelvis is actually too small to allow a baby to pass) can make a VBAC more difficult, but it is still not impossible. According to The VBAC Handbook, as many as 2/3 of women with CPD that attempt VBACs are successful!

*Arriving at the hospital as late into labor as possible
The reason for this is simple. The longer you labor at home, the less opportunity the hospital/doctors/nurses have to "help" you with a cascade of interventions that could just lead to a RCS.

*Not having continuous fetal monitoring
Continuous monitoring restricts your mobility, which is a huge problem because being able to move around in labor is a necessity to help labor progress. You might also experience more pain/discomfort constantly laying on your back because you're stuck in bed, hooked up to a monitor. 15 minutes an hour is more than sufficient to give care providers an idea of how baby is doing, and then momma can focus the other 45 minutes of the hour on LABORING how she's most comfortable. Another reason to avoid monitoring if you can help it is that results are often misread, which leads to more cesareans unnecessarily.

*Epidural as late as possible into the labor, if at all
Epidurals usually require continuous fetal monitoring so that the laboring moms lowered blood pressure (a side effect of the epidural) can be checked regularly, along with it's effect on the baby. Because you don't want CFM (see above), you should wait as late as you can to get the epidural, if you get one at all. Epidurals have also been shown to stall labor.

*No induction or acceleration
Any sort of induction or acceleration of labor, including artificial rupture of membranes (AROM, or having your water broken) can raise the risk of the previous cesarean scar "unzipping". Some doctors might want to administer pitocin once a labor really gets going to speed things up, but be aware of the risks before you consent to ANY sort of augmentation!!!

*Previous vaginal birth
If you have had a vaginal birth before your cesarean, you are likelier to have a successful VBAC. You are also likelier to have a successful VBAC if you've already had a VBAC! Crazy, huh? ;) Not much help for mommas like me, that had an unnecesarean right out of the gate, but perhaps good news for other mommas out there!


The next post will finish up the list of factors and the reasons behind them. I'd love to hear your thoughts on the list so far!

Guest Post: "Swollen to full capacity"

Swollen to full capacity

Stirring, moving life inside.

Stretched, marred with creation.

Blemished beautifully, and changed.

A mothers body, the evolution,

Grasping the transformation.

The meaning of a new skin,

Showing without, what once was within.

Battle wounds, large hips, tender chest, a mother's breast. 

Accepting the new as a bold declaration.

Not wistfully wishing, 

Fondly remembering,

And proudly remembering 

this new mothering skin.

So amazingly capable of bringing forth life!

I will not detest,

I shall not disguise,

And I will PROUDLY wear...

This mother's skin.

 

 

 

 

 

This beautiful poem was written by Miranda Irvin. I read it and LOVED it, and asked her immediately for permission to repost! In the spirit of Thanksgiving, I wanted to post it this week as it is a beautiful reminder and example of being proud and grateful for the incredible thing our bodies can do: creating, sustaining and bringing forth new life! I hope you all love it as well, please check out her blog to see more from this wonderful crunchy momma!

My Birth Plan Revisited

 Originally posted in 2011 at Plus Size Preggo

 Spoke to an OB at my practice yesterday (they rotate so you get to know everyone), and I was pretty disappointed with what I was told about my birth plan, even PO’ed at one point…As I told my sister, who came to the appointment with me: “Unless something magical happens during birth that makes me want to blow everyone in that hospital, I am NOT going to do a hospital birth with the next baby!” (Blunt but true story LOL)



* I’d like the following people to be present during labor and/or birth: My husband, my sister, and my mother. “OK”

* I’d like to wear my own clothes during labor and delivery. "OK, but you probably won’t want to"

* I’d like to take pictures and/or video during labor and delivery. “Only allowed BEFORE labor, AFTER birth and NOT during newborn tests”

* I’d like the option of returning home if I’m not in active labor. "OK"
* Once I’m admitted, I’d like my partner to be allowed to stay with me at all times. "OK"

* Once I’m admitted, I’d like to eat if I wish to. "Not going to happen"

* Once I’m admitted, I’d like to try to stay hydrated by drinking clear fluids instead of having an IV. "Not going to happen, either"

* Once I’m admitted, I’d like to walk and move around as I choose. “You’ll be strapped to a monitor so you can walk as long as you’re not far from the edge of the bed” read: NO.

* As long as the baby and I are doing fine, I’d like to have intermittent rather than continuous electronic fetal monitoring. "We can do it, but it’d be a nuisance." read: "Not going to happen"

* As long as the baby and I are doing fine, I’d like to be allowed to progress free of stringent time limits and have my labor augmented only if necessary. "OK"

* If available, I’d like to try a birthing ball, birthing stool, squatting bar, and/or a birthing tub/pool. “What are these things?” I WISH I was kidding.

* I’d like to try the following pain-management techniques: bath/shower, hot/cold therapy, massage. "No bathing or showering, stay home and do that until you MUST come to the hospital"
* Please don’t offer me pain medication. I’ll request it if I need it. "Make sure you tell them that at the hospital" I thought that’s what the point of THIS was?

* If I decide I want medicinal pain relief, I’d prefer regional analgesia (an epidural and/or spinal block). "OK"

* When it’s time to push, I’d like to be coached on when to push and for how long. "OK"

* I’d like to try the following positions for pushing (and birth): semi-reclining, squatting, hands and knees, whatever feels right at the time… "We’re not equipped for that" read: "Not going to happen"

* During delivery, I’d like to give birth without an episiotomy. Again, “Make sure you tell them that”. Um, will do.

* After birth, I’d like to hold my baby right away, putting off any procedures that aren’t urgent. "OK"

* After birth, I’d like to breastfeed as soon as possible. "OK"

* After birth, I’d like not to get oxytocin (Pitocin) after I deliver the placenta unless it’s necessary. This is where I got pissed. "Well, we will do that so you don’t bleed. I mean, you’re going to bleed anyway…but we’re physicians. This is what we do." Uh-huh. So basically, fuck yourself. We’re medicating you one way or the other.

* After birth, I’d like my partner to cut the umbilical cord. "OK"

* If I have a c-section, I’d like my partner present at all times during the operation. "OK"
 
* If I have a c-section, I’d like the baby to be given to my partner as soon as he’s dried, if appropriate. "OK"

* If I have a c-section, I’d like to breastfeed my baby in the recovery room. "OK"

* I’m planning to bank cord blood privately. "OK"

* After delivery, I’d like all newborn procedures to take place in my presence. "OK"

* After delivery, I’d like my partner to stay with the baby at all times if I can’t be there. "OK"

* I’d like 24-hour rooming-in with my baby. "After the birth, ALL babies go to the nursery for a bit, but then he’s all yours" I almost clawed at her face when she said that. I’m going to fight this one.

* I plan to breastfeed EXCLUSIVELY. "OK"

* Do not offer my baby: formula, sugar water, a pacifier. "OK"

* I do NOT want my baby circumcised. "OK"

* I’d like to wait and see how I feel before deciding about the timing of hospital discharge. "OK"



So I reiterate…I knew I’d be disappointed because I was expecting too much from a hospital, but for the most part, I expected this. Next go round, once I know I can successfully have a birth without complications, it’s birthing center all the way!!!

My Birth Plan

 Originally posted in 2011 at Plus Size Preggo


* I’d like the following people to be present during labor and/or birth: My husband, my sister, and my mother.

* I’d like to wear my own clothes during labor and delivery.

* I’d like to take pictures and/or video during labor and delivery.

* I’d like the option of returning home if I’m not in active labor.

* Once I’m admitted, I’d like my partner to be allowed to stay with me at all times.

* Once I’m admitted, I’d like to eat if I wish to.

* Once I’m admitted, I’d like to try to stay hydrated by drinking clear fluids instead of having an IV.

* Once I’m admitted, I’d like to walk and move around as I choose.

* As long as the baby and I are doing fine, I’d like to have intermittent rather than continuous electronic fetal monitoring.

* As long as the baby and I are doing fine, I’d like to be allowed to progress free of stringent time limits and have my labor augmented only if necessary.

* If available, I’d like to try a birthing ball, birthing stool, squatting bar, and/or a birthing tub/pool.

* I’d like to try the following pain-management techniques: bath/shower, hot/cold therapy, massage.

* Please don’t offer me pain medication. I’ll request it if I need it.

* If I decide I want medicinal pain relief, I’d prefer regional analgesia (an epidural and/or spinal block).

* When it’s time to push, I’d like to be coached on when to push and for how long.

* I’d like to try the following positions for pushing (and birth): semi-reclining, squatting, hands and knees, whatever feels right at the time…

* During delivery, I’d like to give birth without an episiotomy.

* After birth, I’d like to hold my baby right away, putting off any procedures that aren’t urgent.

* After birth, I’d like to breastfeed as soon as possible.

* After birth, I’d like not to get oxytocin (Pitocin) after I deliver the placenta unless it’s necessary.

* After birth, I’d like my partner to cut the umbilical cord.

* If I have a c-section, I’d like my partner present at all times during the operation.

* If I have a c-section, I’d like the baby to be given to my partner as soon as he’s dried, if appropriate.

* If I have a c-section, I’d like to breastfeed my baby in the recovery room.

* I’m planning to bank cord blood privately.

* After delivery, I’d like all newborn procedures to take place in my presence.

* After delivery, I’d like my partner to stay with the baby at all times if I can’t be there.

* I’d like 24-hour rooming-in with my baby.

* I plan to breastfeed EXCLUSIVELY.

* Do not offer my baby: formula, sugar water, a pacifier.

* I do NOT want my baby circumcised.

* I’d like to wait and see how I feel before deciding about the timing of hospital discharge.


I’ m sure a lot of these won’t be do-able (I’m looking at YOU, eating during labor and no IV!) but I’m going to take this to my OB appointment tomorrow and talk everything over with my doctor to see what I am willing to compromise and what MUST be.


(This nifty PDF was a big help in articulating just what I wanted during my labor and delivery.)

Gestational Diabetes - Now What? (3/3)

So you've been told you have Gestational Diabetes...now what happens?

Usually, the first line of treatment is a diet/meal plan. There is an example of one here. The thing about GD meal plans is that they make a great structure for what your diet should be like in pregnancy anyway! I am not saying "diet" as in "plan to lose weight", I mean "diet" as in "the food you take in". You're building a whole new body within your own, so it can't hurt to eat plenty of fruits and vegetables, whole grains and lean proteins. These will be the building blocks of someone else's (your baby's) entire organism! Just that thought was enough for me personally to start eating more whole foods and less processed junk.

It is also recommended hat one exercise daily, even a brisk walk after ever meal. Exercising increases the muscle tissue sensitivity to insulin, which helps your body metabolize sugar. Ideally, a woman would be on an exercise program before and during pregnancy not just for overall health (at ANY size), but because this is the more surefire way to help your body metabolize. No amount of exercise will keep you from developing GD (as one cannot control their ethnicity or family history), but it can definitely help in its management.

You may also be asked to monitor your blood glucose levels several times a day, usually fasting first thing in the morning and after every meal. The reason for this is to check for patterns and look for any spikes in blood sugar. This can give care providers a window into how you metabolize sugars regularly, outside of a lab setting. High sugars after eating could signal that a change in diet is needed.

High sugars in the morning, however, may signal that the body is overall not metabolizing sugar, and a doctor may then suggest a regimen of medication. The most common form of medically treating gestational diabetes is with insulin injections, which are self administered, usually directly into the belly. Obviously, one is taught how to do this by professionals so that the baby is never in any harm due to the injections. Another alternative is pills, such as glyburide and metformin.

 I hope this series has helped answer some questions about what Gestational Diabetes is and what it really means. I will be sharing a guest post soon about a readers experience with Gestational Diabetes, and I hope if anyone has any questions or would like to share your own experience, you will please comment or email me. Thank you!

Gestational Diabetes - How is it diagnosed? (2/3)

How is the test administered? A one-hour test screens for (but does not diagnose) gestational diabetes mellitus (GDM). If your blood sugar levels seem high after a one-hour test, you'll have to come back for more gestational diabetes testing.The best method for diagnosing gestational diabetes is taking a glucose test (glucose tolerance test). The test measures how the body reacts to a large amount of glucose (sugar).

According to The US National Library of Medicine: "For this test you will drink a glass of water that contains 50 grams of dissolved sugar. You do not need to fast beforehand. One hour later, blood will be taken from a vein in your arm to determine the blood sugar level. If the value is below 7.5 millimoles per liter (mmol/L, about 135 mg/dL), the results are considered normal and no more testing is done.
If an elevated level is found in the glucose challenge test, it is still not considered a final diagnosis. It only serves to determine which women will be offered a second and final test. This second test, called the oral glucose tolerance test, is more involved. For the test, the pregnant woman must fast beforehand, which means not eating or drinking anything but water for at least eight hours. The first step in this test is taking blood. After this the woman drinks a sugar solution containing 75 grams of glucose. Blood is taken from an arm vein again after one hour and after two hours. If any of the following three blood sugar values is exceeded, gestational diabetes will be diagnosed:

• After fasting: 5.1 mmol/L (92 mg/dL)
• After one hour: 10.0 mmol/L (180 mg/dL)
• After two hours: 8.5 mmol/L (153 mg/dL)" 

Testing for Gestational Diabetes can be done as early as 8 weeks in women that have certain risk factors, and is done routinely on all women at about 28 weeks gestation. Interestingly, however, not all women NEED to be tested for diabetes during pregnancy.
 
According to pregnancy.com:

"One of the most intriguing recommendations is that a woman may not need laboratory testing to screen for GD if she meets all of the following criteria:

• less than 25 years old
• not a member of a racial or ethnic group with a high prevalence of diabetes (eg, Hispanic, African, Native American, South or East Asian, or Pacific Islands ancestry)
• a body mass index (BMI) 25
• no history of abnormal glucose tolerance
• no previous history of adverse pregnancy outcomes usually associated with GDM
• no known diabetes in first-degree relative

Women who are at a higher risk for GDM usually have one of the following risk factors:

• age
• ethnicity
• obesity
• family history of diabetes
• past obstetric history"

 Before testing, you should eat normally for the few days prior. Women used to be told to eat less carbs or sugar in the days before their test, but that could just make your body react more aggressively to the glucose in the drink, giving a false higher result. If you are opposed to drinking loads of sugar water and various other chemicals, you can arrange to eat a specific breakfast and have your blood drawn at an interval following your meal instead. Many doctors frown upon such a request, but it is your right to request it.  
 
My own experience and advice for others that are deemed "borderline" like I was: I demanded a retest and that one came back ok but they were "concerned", so I compromised and told them I'd do my best to follow a GD diet and I'd monitor my sugars for a couple of weeks to "put their minds at ease". I figured I could use healthy eating guidelines anyway (though I did still have my daily vanilla ice cream cone) and when monitoring was all good, they left me alone. They insisted I get urine/ketosis sticks and keep a food log which I was meant to fax to them, but I did neither because EFF THAT, THEY'RE NOT MY MOMMA.

I had a bit of a rebellious streak during my pregnancy as you can tell ;) But honestly, I think it's a fair compromise and it'll give you AND the doctors a chance to see how your sugars are doing in the real world over time, rather than just once during a lab test. And then I think no matter what happens, everyone will have peace of mind that they're making the right decision on how to proceed; whether your sugars really ARE high or not. This was something I did in order to appease my doctors because I had one slightly elevated level on my test but otherwise showed no symptoms, but you can also request to have this several-times-a-day self-monitoring in place of the glucose challenge. Again, your doctor might fight you on this request, but as I mentioned previously, this is the best way to get a REAL WORLD view of your glucose metabolism, which is much more accurate than a one-time lab setting.

In the next last post on GD, I will discuss the various ways that Gestational Diabetes can be treated if you are, in fact, diagnosed with GD after your tests.