Last week we got serious about Gestational Diabetes Mellitus (GDM), where we talked about the why, the who, the what, the how, the risks. If you missed it, check it out here.
This week you’re meeting Betsy. Betsy and I went to the same high school back in Western New York. High school for me was a time of feeling mostly lost and out of place. After graduation I lost touch with most of my high school pals, however, as many can attest Facebook changed all that. And may I add, for the good.
Betsy was kind enough to reach out and congratulate me at the inception of KimLeneghan.com. She also shared she had gestational diabetes with her pregnancy and after some fun email conversations back and forth we decided it was time to share her GDM experience on the KimLeneghan stage.
Let’s dive in.
Kim: GDM is typically diagnosed in the 2nd trimester ~22-24wks. Is this when your test was done?
Betsy: Yes, the first test was done at 22 weeks, and I failed that. But lots of people do. Then I had to take the timed test where you drink the glucose solution and have blood draws at one hour intervals. It was not my favorite thing. Any test I have to take fasting makes me feel terrible because I take thyroid medicine in the morning, and generally really need to eat within an hour afterwards.
Kim: I’m the poster person for “Hangry”. That sounds awful. How had your baby been measuring prior to that? Were they concerned about him being too big?
Betsy: I honestly don’t remember, but there was no concern over his being too large or too small.
Kim: Do you remember being told what GDM was and how it could affect YOU and your baby?
Betsy: I received word that my results had come back showing I had GDM, and I instantly felt panicked and sad. I had to make an appointment at the Gestational Diabetes clinic at St. Lukes-Roosevelt Hospital (now Mount Sinai West) in NYC, where I was planning to deliver the baby. I remember it seeming surreal and very upsetting. However, the nurse there who explained everything to me was incredible.She drew a schematic for me, showing me how hormones, the placenta, glucose, and insulin work with my body and the baby’s. She made sure that I understood that this condition was not a condemnation of the way I had acted during my pregnancy, that it was not my fault, but I would have to change a lot of things to ensure a safe delivery. She did tell me that because I had been diagnosed with pre-diabetes at another time in my life, and because of the GDM, I am more susceptible to developing Type 2 Diabetes later in life.
She also drew the shape of babies affected by GDM to demonstrate that the broader shoulders a baby can develop when they are exposed to more glucose than they can process, to demonstrate why it is important to not let a baby get too large – they may not be able to pass through the birth canal (I had made it clear I was intending on a natural birth). Additionally, they may be predisposed to obesity later in life. IN terms of the delivery, there are added risks of premature birth and preeclampsia when GDM goes uncontrolled.
Kim: Was Sebastian a large baby?
Betsy: No! He was 5 lbs, 11 oz, and 19.5 inches. (And to stand corrected, that is a pug and NOT a great dane! He was so tiny!)
Kim: You mentioned working with a doula, midwives and went to a GDM clinic. Who helped create a plan of care for you?
Betsy: So, I had switched OB practices between the first and second GDM tests. GDM did not have to do with that decision. I wanted a practice with midwives and a natural birth at a birthing center. My previous OB’s practice was affiliated with a hospital that does not have a birthing center, and a couple of the OB’s there were not receptive to my working with a doula. Ultimately it was a combination of the GDM clinic, my OB, midwife and me. Having been sick with autoimmune conditions in the past, and largely recovered from that, I knew that it was up to ME to control this. I had to do the work. I had to stay on top of it. I had to be proactive. The ones who might suffer if I didn’t were my baby, my husband, and me, not the GDM clinic. This was important and I had to be the one to manage it.
Kim: I’m assuming you had to change your diet? Did you have to check your blood sugars too?
Betsy: At that first meeting at the GDM clinic, I was given a glucose screening kit – I had to test my blood 7x/day. I was told that I may be able to control the GDM with diet and exercise, and so I should give that a try for 2 weeks. They gave me some sample meal plans that work for someone with GDM, including how much of what kind of food per sitting and per day, how to count carbohydrates and sugars, to focus on protein at my first meal of the day, etc. I followed that daily, meticulously. During this trial period, I flew to Buffalo for my baby shower. A party for me, where I basically drank water, and was careful with what I ate, tested my blood sugar when I was supposed to, and honestly, it really hadn’t mattered. I was increasingly upset, starving all the time, irritable, and those numbers wouldn’t budge.
Kim: How discouraging! What happened then? Insulin?
When I got back to NYC, I called the nurse at the GDM clinic and told her I wasn’t going to be able to control it through diet and exercise. I knew after 10 days. There was no point in torturing myself further. I went back to the GDM clinic earlier than planned; I was going to have to start taking insulin daily.
Kim: Did this change your birthing plan?
Betsy: When I went to my (new) OB’s office after that second visit to the GDM clinic, and had an appointment with one of the midwives, I was informed that I would not be able to deliver at the birthing center, and the OB would have to do the delivery, not the midwives in her practice. I was disappointed, though I already knew that this was going to be the case.
The GDM clinic and my OB had informed me at one point or another that generally speaking, women with GDM are not allowed to go full term and are induced at 38 weeks if they do not go into labor on their own. I remember telling them “well, we’ll see. Let’s worry about that when the time comes.” I had NO intention of being induced, and certainly not before 40 weeks.
Kim: Were you allowed to exercise?
Betsy: It was required! For the duration of the pregnancy, I ate how I was supposed to, continued my regular yoga practice with modifications as needed, generally walked 3.5-5 miles/day (it’s NYC, and I walked to ALL my appointments even in December and January), and gave myself an insulin injection every night. When I would see my blood sugar levels creeping up, even when I hadn’t changed anything, I would adjust my insulin and call or email the nurse at the GDM clinic and tell them. They’d record that change, and we would pick up from there the next time I was in.
Kim: Did you make it to 40 weeks?
Betsy: At my 37 week visit, the doctor at the GDM clinic said that I had done such an impeccable job at keeping my blood sugar stable that not only were they going to not recommend I be induced the following week, but they were going to recommend to my OB that I go 40 weeks. He said they really never do that, and even when I went to my OB’s office later that day for a follow-up, they called over to the GDM clinic to make sure they had heard the information correctly. I went into labor naturally at 39 weeks.
Kim: How did you FEEL having GDM from a physical AND emotional level?
Betsy: Terrible but I know enough about health and science that I really did understand it was not my fault. It was hormonal. So I did my part. But, it’s really hard for people to understand and it’s exhausting trying to explain it to people. (As you can see) There is really not an easy “elevator talk” way to describe it. Couple that with the fact that I had it between mid-November and early January, and worked in an office. Can you say junk food and holiday parties?! I didn’t go to most of the parties – I had all those appointments every week (4 of 5 days a week I left for at least a couple hours) and so I used that time to catch up on what work I hadn’t gotten done. Plus it was torture. And then there’s the whole “but you’re eating for two” deal. Even if you don’t have GDM, you’re NOT really eating for two. Because of my restricted diet and the exercise I was doing, I only put on 14 lbs the entire pregnancy. So of course that raises mostly well-meaning questions from people about why you aren’t indulging. It was pretty exhausting, on top of being normal pregnant-exhausted!
Kim: Did GDM affect your desire to have (or carry) more children?
Betsy: To some extent, yes. There’s no guarantee I’d have it again, but there’s no reason for me to think I wouldn’t. It really was kind of miserable, but in some ways, it has changed the way we eat all the time as well. It became instructive to have to think about what we were putting in our bodies and the effects of that on the body as a system. I say WE because I wouldn’t have been able to do it without my husband, Alex. He ate how I ate. We only had things in the house I could have. He’s a great cook and would prepare most dinners and my lunches for me.
Kim: How would you characterize your health pre-pregnancy?
Betsy: Pretty good. I was really sick for about 8 years with a variety of autoimmune things, migraines, food sensitivities, depression, anxiety, etc. I had gotten that under control a little over a year before I got pregnant. But, I had reverted back to letting more things into my diet than I should have, in terms of carbs and sugar.
Kim: And Now?
Betsy: I really can’t remember when I felt better. Between the lessons I learned and steps I took that helped me recover from a time when I was really ill, to the sharp reminders I got while having GDM that there’s little leeway for me when it comes to diet, nutrition and exercise have made it to the core of my daily life.
Kim: What advice would you give a mom to be who was diagnosed with GDM (and to the dad, family members, etc.)
Betsy: It really is not your fault. People that you wouldn’t think by looking at them have this. But YOU have to be the one to act. Educate yourself about GDM, nutrition, obesity, diabetes, giving birth when you have GDM, and understand all sides of these issues. It’s empowering and you can make a lot of choices that determine your experience. Dads, do all of this too. You have to know what is going on and why. And get involved in the nutrition and exercise.
If you don’t feel like going out because there’s food you can’t have and you’re tired of talking about it, don’t. And don’t worry about. Sometimes you just have to let go of potentially stressful situations. Go to yoga instead. Or take a nap 😉 If you do want to go, check out the menu ahead of time so you know if there will be some good options for you. And order as soon as you get there, even if others aren’t, so you don’t get low blood sugar waiting or have a healthy snack before you leave.
Kim: What do you wish your doctors/providers would have done differently?
Betsy: I wish that I knew about this as soon as I knew I was pregnant. Why do providers wait to tell you about it until the test? If it really had been able to be controlled by diet and exercise, I would have wanted to start that right away, especially since I knew I had had pre-diabetes in the past.
I wish providers focused more on nutrition for moms-to-be right at the outset. Nothing about nutrition was ever mentioned to me until the midwife talked to me about it (after I had switched practices), more than halfway through my pregnancy.
Kim: Can I post a picture of Sebastian?
Does Betsy’s story resonate with you? or someone you know? Have similar frustrations or experiences? Please comment below or drop me an email.
Betsy can also be found in Facebook land here. She’s a former Anthropologist (how cool is that !?!?) and current Beachbody Coach. I’m not affiliated nor promote Beachbody, but I do applaud people that want to spread the word of good health. We all just have different ways of getting there!!
Hugs to Betsy for sharing her story and to you for taking the time to read it!