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Place of birth for women with GDM

Up to Antenatal Corticosteroids to Reduce Neonatal Morbidity (RCOG Green-top 7) - Sonia Clark
September 27. 2012
Julie Murphy

I am looking into women who have GDM, diet controlled and have a normally grown baby to potentially deliver on the birth centre to improve normality. I am wondering what's happening across the UK?

Are these women having continuous EFM or intermittent FH monitoring in labour in other units? The evidence base appears to be limited.

 

October 02. 2012
Juliet Burgess

Hi Julie,

we have been in negotiation with our birthing unit to allow our diet controlled GDM mothers to birth in the unit. We are going to give it a go and see what happens unfortunately none have forfilled the criterior yet. ~The criterior is that they go into spontaneous labour between 38 and 40 weeks and that they continue to self monitor their BM's 2hourly in labour, any BM > 10mmol/l should be reviewed in 1hour and if remains > 10mmol/l for transfer to delivery suite for active management of diabetes and fetal monitoring.

 

October 16. 2012
heather chandler

Our ladies who are diet controlled could also use our birthing unit, but again not happened as they would need to come in, in labour, however, they could also go in the birthing unit if they come back in labour following induction with Propess. We allow these women to go home for 24 hours, reality is that generally they need further prostaglandins!

November 21. 2012
chrissie bond

What would happen in the birthing units with regards to monitoring the babies BM's.

We do not monitor any women diet controlled or on metformin  in labour unless any other indications. Dont do any BM's either. 

 

 

 

 

 

 

November 21. 2012
chrissie bond

Sorry should clarify we dont use FCTG routinely in labour

 

November 23. 2012
suzannah kelly

I think you have to have very specific criteria for this to work properly. there still is a theory amoungst midwives that diet treated is the lesser  and low risk group compared to those treated with metformin or insulin, when in fact they could be the high risk group due to not being treated. some women are diet treated because:

1. they have refused treatment

2. their blood glucose levels are not perfect but not high enough to or consistently high enough to warrent starting treatment

3. some diet treated women are starving themselves to avoid treatment

4. some are non complient to avoid treatment, i.e not recording their abnormal levels

I would consider women on insulin to have better control therefore less risk of neonatal hypoglycaemia.

we treat all our gestationals as high risk regardless of which treatment they have , but do not do continuous fetal monitoring in labour just because of diabetes. they would only have continous monitoring for the same reasons women do without diabetes. 

October 02. 2013
Sarah knight

As its been a while since this was discussed on forum, I wondered if any units are succesfully delivering diet controlled GDMS with normally grown babies and who fulfill the criteria in their birth centres yet.

We have recently had a multidisciplinary meeting and it was discussed with some differing views mainly between obstetricians, are other units are doing it succesfully? I am keen to implement for my GDMs on diet.

 

 

October 09. 2013
Edwina Lee

We also treat our women with GDM as high risk and so at present these women are not offered the opportunity to use the birthing unit.

Please update us with your progress on implementing this in your unit as I would be very interested in the outcome and what resistance if any you encountered.

April 30. 2018
Leisa Foad

Hi All, I was wondering if there were any updates to your 'place of birth for women with GDM'  My Trust is currently looking to develop a SOP for our women with GDM and I'm looking for criteria for admission and/or outcomes.  Or anything really...still so little out there in this field.  

May 09. 2018
Jane O'Brien

We use our birth centre for GDM women who go into spontaneous labour with a baby between 10-90th centile controlled on diet. We don't have a SOP we do individualised care planning and write the discussion in green handheld notes.

Our intrapartum mangement of GDM on diet is no BG monitoring or any extra fetal monitoring they are managed like low risk labourers.

We have been doing this for a couple of years and we occasionally get a lady there who is not induced! It took a bit of training support and reassurance for the midwives working on the birth centre ( two floors above Deliver suite).

 

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