Gestational Diabetes

Proper nutrition, regular exercise and reducing your sugar intake might be a better option than testing for Gestational Diabetes, which is controversial. Unless you decline, the glucose tolerance test is given at 28 weeks gestational age. If you don't have a risk factor for diabetes, ask your care provider what happens if you test positive - perhaps his or her answer is the advice you should be following now. Besides, are you aware of the ingredients (and risk factors) of the Glucola that they want you to ingest for the test?  

 

Group Beta Strep (GBS) Testing and Treatment Options

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.

Routine IV antibiotics during labor changes the microbiome and vaginal flora, which impacts the immune system for both mother and baby and may lead to thrush and breastfeeding complications. (A Cochrane review calls into question the routine practice of giving prophylaxis antibiotics for every mother testing positive for GBS.) Also, consider that when a mother is tethered to an IV she cannot move freely, which can cause discomfort for the mother.

Not every baby who is born to a mother who tests positive for GBS will become ill. An excerpt from this handout written by Aviva Romm, MD:

"While any baby can develop GBS infection if the mother is colonized, the following factors increase a baby’s risk: birth prior to 37 weeks, African-American descent, high temperature in the mom during labor, rupture of membranes before entering labor, a prolonged time between membrane rupture and birth, chorioamnionitis (infection of the membranous sac surrounding the baby), intrauterine monitoring during labor.

You do have the right to decline antibiotic prophylaxis in labor. If you decline, while there is an overall very low likelihood (2-3% chance) that your baby will develop early onset GBS infection; the risk is about double than if you did accept the antibiotic. It’s important to be fully aware of the risks of GBS before choosing to pass on the antibiotic prophylaxis. All newborns exhibiting signs of GBS infection must receive immediate and aggressive antibiotic therapy. Keep in mind that if you decline in labor, and are GBS positive, you may be pressured to give your baby antibiotics after birth."

 

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. Bottom line is: 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