Does anyone else think the traditional oral glucose tolerance test to screen for gestational diabetes, is enough to put anyone in to a diabetic coma? For regular healthy women who are conscious about what they eat, this test is highly inappropriate.
Let me explain why…
Firstly, let’s go over some basic physiology to understand how a healthy body deals with the breakdown of sugar (glucose). As glucose is ingested, blood glucose levels rise almost immediately. The pancreas responds by secreting insulin. Insulin helps the liver store excess glucose as glycogen until it is needed. As blood glucose levels begin to fall a few hours later, the stored glycogen is converted back to glucose to provide energy until more food can be eaten.
What many people don’t realize is that during pregnancy the placenta produces the hormones Lactogen, Estrogen and Progesterone, all of which counteract the function of insulin. The placenta also makes potent enzymes that destroy Insulin. Why would that be, I hear you ask. The body suppresses insulin purposely to allow more glucose to remain available in the mother’s bloodstream for longer periods of time. This is known as ‘glucose sparing’. Glucose sparing increases as pregnancy advances, peaking during the third trimester when the fetus gains most weight and needs more nourishment to grow. In other words, at 28 weeks (the time gestational diabetes screening is performed) the body actively creates higher levels of blood glucose (the very thing the test screens for) so that it is available for the baby to use to support its growth in the last trimester. In the medical field this is seen as a malfunction, a glucose ‘intolerance’, however this is normal pregnancy physiology.
For those of you who are not familiar, I will briefly explain the procedure of the oral glucose tolerance test (OGTT).
- A woman fasts for (at least) 8 hours before the test
- Her fasting glucose level is taken via a blood sample to gain a baseline result
- She is given a sugary drink containing 100g of glucose (often with artificial colors and additives too) within 5 minutes
- Blood is taken at 1, 2 and 3 hour intervals after the drink is consumed
The problem with this test in women who don’t ordinarily ingest such high levels of glucose, is that their body is not used to handling the overload. The pancreas cannot produce sufficient quantities of insulin fast enough to meet the demand. Therefore levels become temporarily elevated until the pancreas has chance to catch up. This decreased carbohydrate tolerance is known as starvation diabetes. When the pancreas catches up with the glucose overload, insulin surges, and glucose levels plummet. This is called the rebound effect. This shock reaction is not true diabetes. A woman with a diet with a low intake of refined carbohydrates is at high risk of starvation diabetes.
Giving a woman a concentrated refined sugar load before testing is not recommended. She can have a physiological reaction to the glucose overload which can mimic diabetes. When the pancreas is presented with such high levels of glucose, not enough insulin can be produced fast enough to compensate. A temporary peudo-diabetes results, making results abnormally high. When the pancreas catches up insulin surges and blood glucose levels crash. This rebound effect actually mimics hypoglycemia. The period of time for this to occur varies, but often the 1-3 hour OGTT is not long enough to allow levels to come down to a normal baseline.
This test is bad enough to put the mother through, but think what effects this has on her unborn baby. Think carefully before willingly undergoing this seeming ‘harmless’ procedure.
Ask your health care provider for alternative screening methods.
You’re a midwife?? That’s cool, I wanted to do that when I was a kid. What do you make?” “WHAT DO I MAKE?” I make holding your hand seem like the most important thing in the world when you’re scared, i can make your baby breathe when they stop. I can help you to survive a postpartum haemorrhage, I make myself get out of bed at 5am, so I can care for you and your partner on one of the most important days of your life, and am privileged to do so. I make my family wait for dinner, until I know your family is taken care of. I make myself skip lunch so that I can ensure everything I did for you today is documented. I make myself work weekends, nights, and holidays, because people don’t just birth babies 9-5 Monday – Friday. Today, I might save you, or your baby. I make a difference, what do you make?” REPOST if you are a very proud midwife. I am!
This week I was lucky enough to be able to go to the premiere of the new Business of Being Born documentary, More Business of Being Born, at the Laemmle’s Royal Theater in Los Angeles. As a Midwife, I believe that the first ‘Business of Being Born’ documentary has done a lot to open the eyes of the masses, and educate people about modern childbirth and the maternity system, not just in the States, but around the world. It discusses the huge and somewhat controversial (to some people) topic of homebirth, natural birth, cesarean birth, obstetric care, aswell as Midwives and Doulas-which to the average American, are professions most people had never heard of. I think it has played a huge part in educating people in a topic that they wouldn’t have ordinarily thought about. Most women of childbearing age today, only consider birth once they become pregnant. It is no longer something which is talked about amongst family and friends, or witnessed before becoming pregnant. Since birth left the home around 50 years ago, birth has become shamed, hushed and secret. Something that takes place in a hospital bed, behind closed doors, in private, so that no-one can hear you. As a society we are overwhelmed with images and stories in the media of dramatic, medicalized, traumatic births with emergencies around every corner, where women are passive participants in their care, following the doctor’s every order. These are the only images of birth we ever see. The ones which make the news, or bring in the ratings. This is our only perspective. These births are fictional! We need some reality, and not ‘Reality TV’, but REAL birth stories from REAL families.
I have certainly noticed in the 3 years since the first documentary came out, the awareness of these issues has greatly increased. Many of our clients come to us having watched it, saying that this was the catalyst which launched them in to looking at different alternatives to mainstream obstetric care, or that it made them realize they did have options, or it was recommended to them from a friend or colleague. The birth world in America, and in California especially is changing, and Ricki Lake and her team, have helped to put those wheels in motion.
The new Business of Being Born documentary is a series of 4 mini documentaries, covering various topics which felt needed further explanation. Although the first documentary was extremely informative, it still left people with questions such as, ‘What’s the difference between a Midwife and a Doula?’. Producers Ricki Lake and Abby Epstein hope that this follow-up series will help to fill in a few more gaps. They cover conversations with Ina May Gaskin (America’s leading Midwife), celebrity mothers talking about their birth experiences, Doulas, birth centres, Cesarean and VBACs (vaginal birth after cesarean).
At the premiere we watched only the second in the series, ‘Special Deliveries’, which includes an hour’s worth of testimonials from Christy Turlington Burns, Cindy Crawford, Alyson Hannigan, Melissa Joan Hart, Gisele Bundchen, and Alanis Morissette, all of whom describe a wide range of birth experiences, including some tellingly unhappy ones. Their voices fuse into a compelling chorus of maternal will and desire. None of them paint a picture of labor and birth as an easy ride, but they are honest and open about their emotions and their journey.
Even as a Midwife, I found it hugely inspiring to watch. It ignited my passion behind creating an alternative for women and their families. There is a greater issue behind all of this. It is not just all about homebirth, or natural birth, or the hospital. It’s about choice. Something we all have the right to.
‘So if you’re thinking of having a baby, do what more and more people are doing. See The Business of Being Born (and More Business of Being Born). And decide what to do for yourself’.
I’m really excited as a Midwife and a Doula, and someone who loves all things birth, about the launch of this new project. I’m equally excited that the 2 front runners of this project are Brits!! 2 wonderfully passionate film makers Toni Harman and her partner Alex Wakeford, inspired by their own childbirth journey, decided to launch a new global film project about birth-a video website aimed at birth professionals (and anyone else interested in birth) to empower women to believe that they CAN give birth fully informed of their choices.
What’s great about these videos is that they offer credible evidence-based information and opinions from leading birth experts around the world. Toni and Alex have not just filmed anyone, they have filmed many of the BIGGEST, most influential names in the business, including…Ina May Gaskin, Sheila Kitzinger, Michel Odent, Elizabeth Davis, Debra Pascali-Bonaro, Cathy Warwick (RCM), Mary Newburn (NCT), Marilyn Curl (Lamaze International), Dr Sarah Buckley, Professor Soo Downe, Professor Lesley Page, Professor Cecily Begley, Professor Kerstin Uvnas-Moberg, Professor Ngai Fen Cheung, Associate Professor Denis Walsh and lots more leading midwives, academics, obstetricians, authors, doulas, birth educators and birth warriors around the world.
The One World Birth website launched today, is a fantastic video resource aimed at birth professionals, campaigners and parents who want to place their finger right on the pulse of what is happening in birth today. It’s an on-going, online TV channel about birth. The idea is that people like you and me use the site as a ‘grab bag’, taking clips that interest us and spreading the word via as many different social media mediums as possible. They want us to post their clips on Facebook, Twitter, Google +, blogs…wherever, to get as much exposure to this information as possible. They want us to power the revolution in birth! Stand up and shout, wave our hands and make our voices heard! The only way the wheels of this revolution will really get moving, is by uniting all of the voices around the world. We need to build a strong, powerful community of passionate followers in order to create a global movement to make change.
They’ve done their bit, let’s do ours!
Save Birth, Change the World.
Join them today at www.oneworldbirth.net
As a follow on from my earlier post (Pregnancy Myth Buster) you should be aware by now that not all fats are equal. It will not do your body any good to avoid all sources of fat. Certain types of fat are extremely valuable, and essential to our bodies, despite common myth! Not getting enough fat in our diets can result in any number of the following conditions: Dry scaly skin, hair loss, poor immune function-leading to lower resistance to infection, low body weight, cold intolerance, bruising, poor growth, poor wound healing and loss of menstruation.
Sources of Heathy Fats
Meat and Dairy From Grass-Fed Animals
Organic Milk Fats
(Salmon, Sardines, Herring, Trout, Tuna)
Great article from Ricki Lake, ‘Mothers Deserve Options’, discussing why she felt it necessary to bring out ‘More Business of Being Born’.
Join Ricki Lake in her fight for the right of all mothers to have access to safe, intervention-free options. Click here to support her Kickstarter campaign.
(This project will only be funded if at least $100,000 is pledged by Thursday Jul 14, 1:03pm EDT.)
So what are you waiting for?-Get Involved!
How and where you decide to bring your child into this world is a choice that belongs to you.
An article published in the Los Angeles Times, last month, really left me feeling deflated. It brought me back down to earth with a bang as I remembered just how big a job it is to create awareness and change surrounding a topic as huge as childbirth. On the other hand, it did make me even more eager to be part of a new birth movement.
The article is based on a new study led by Dr. Michael Klein of the Child & Family Research Institute and University of British Columbia. Researchers surveyed 1,318 healthy pregnant women, all pregnant with their first baby. The study found an amazing lack of knowledge from the women about various childbirth options. Less than 30% of first time moms attended prenatal childbirth education classes, with many reporting that they informed themselves via books or the internet instead. However, many still couldn’t answer basic questions about the pros, cons and safety issues of many common interventions in labor, including the use of epidurals, episiotomies, cesarean deliveries and other childbirth issues. It seems women are happy to go along accepting the notion that ‘doctor knows best’, when quite clearly (some of the time) they don’t!
Why are women not paying attention to what is happening to them? Why are we not asking more questions? Why are we not doing their own research? Everyday we are surrounded by technology. Technology has become everything. We are at ease with it and find it reassuring. The latest and most up-to-date technological equipment is much prized and sought after in all areas of our lives. We become so distracted by the many gadgets laid out before us-ipads, laptops, GPS, Bluetooth, Tweets, ipods, iphones, apps for everything you could possible imagine, that sometimes, we no longer have to think for ourselves! It is easy to see how this would automatically transfer on to the birth scene. But in the birth world, technology really isn’t everything! Don’t get me wrong, it does have its place, and in some circumstances it can be life-saving, but for the majority of the time, it is unnecessary. Just because a hospital has every gadget and machine to hook you up to under the sun, doesn’t make it the safest place to give birth. Long before maternity units opened their doors to the masses, the only items traditional Midwives carried were their hearts, their hands and their intuition, and despite popular belief, actually had extremely good outcomes considering the times.
If only we spent the same amount of time researching the things happening to our bodies and our babies, as we do the material things in our lives, maybe the birth world wouldn’t look quite such a scary place!
Come on ladies, take control, know your options and inform yourselves!!!
- Natural Birth by Aleksandra Evanguelidi (smiffybaby.com)
- Childbirth: #1 Reason for Hospital Admission for U.S Women (smiffybaby.com)
- Join the Revolution (smiffybaby.com)
- Avoid heavily processed foods-often contain huge amounts of fat, salt and sugar
- Eat organic, locally produced foods-these contain the highest amounts of nutrients and least pesticides
- Enjoy foods in their natural state-for example, eat fresh fruit, rather than frozen or canned
- Eat a rainbow of foods-a variety of colors, types, and textures, to get a full spectrum of vitamins and minerals
- Eat little and often-this helps to balance your blood sugar, and may prevent nausea
- Drink at least 2-3Ls of water a day-your body needs water to function, plus dehydration can lead to premature labor
- Try to exercise a little every day-brisk walking is an excellent form of exercise, yoga, swimming & cycling are also great
- Do not diet or detox during your pregnancy
- Find healthy alternatives to your cravings*-this is usually your body’s way of telling you something is missing from your diet.
*Eg, If you do find yourself drawn to the giant golden arches of McDonald’s desperate for a big juicy burger, your body is probably in need of some iron, why not try cooking a steak at home-a healthier alternative to a big greasy burger with plastic cheese.
Be aware though, if you are craving sugar, try not to give in. Craving sugar is usually a sign you are in need of protein (strange as this may sound). This is usually your body telling you to eat more frequently and that your blood sugar is low. Protein helps to sustain and stabilize blood sugar levels to prevent this from happening. Don’t go more that 2-3 hours without eating something. Try carrying bite size snacks in your purse so that you never are without!
Eating Habits Programmed During Infancy-Healthy Child Healthy World
During pregnancy it is not uncommon to find yourself as a human magnet. You will find that without realizing it, you have entered in to a new ‘members only’ club. Women of all ages will smile at you in the street, random people will stare at your belly in awe, doors will be held open for you, and total strangers will feel the need to put their hands on your bump. People love to tell you all sorts of things when you are pregnant. They will relish in telling you the joys, the horrors, the hells, the triumphs of their pregnancy and birth experiences. People will tell you ‘you should never do this’, and ‘definitely do that’, whether you ask for their opinion or not! You will hear things from your mother, your mother in law, your aunty, your cousin, your best friend, your boss’s wife, the elderly lady down the street, people on the bus, mom’s in the park, and it is likely that they are all saying completely different things. All this advice can become overwhelming and confusing, and is often not based on anything more than old wives tales. So I wanted to set a couple of common pregnancy myths straight.
The common pregnancy myth about ‘eating for two’, is just that-a myth. Although you want to nourish yourself during your pregnancy, you do not want to over eat. In reality, we only require an additional 100 calories in the first trimester, and 300 extra calories during the second and third, which when you think about it really isn’t a lot. During pregnancy your body becomes more efficient at absorbing nutrients from the foods you eat. Eating twice as much does not double your chances of having a healthy baby. Have you ever wondered why pregnant women are so prone to constipation? Unfortunately, constipation affects approximately half of all women at some point during their pregnancy. Although it may be annoying, it does have its purpose. The passage of food through the gut is slowed down due to the effects of pregnancy hormones progesterone and relaxin. The hormones relax the muscles of the intestines, which takes the body longer to move food along. The longer the food sits within the intestines, the more time the body has to absorb its nutrients needed to grow a healthy baby. Unfortunately, this can lead to constipation. The best ways to avoid constipation is by increasing your fiber intake, drinking plenty of water (around 2-3Ls a day) and by doing regular exercise.
Make healthy choices during your pregnancy. Your baby’s health is directly related to what you eat before, during and after pregnancy. Nutrition is key to a healthy pregnancy and birth and is the biggest and most valuable tool you have for avoiding discomforts and complications, such as nausea and vomiting, heartburn, leg cramps, high blood pressure and swelling. Overall, healthy moms have healthy babies.
Think quality over quantity. Nutrition is one of the only things you have complete control over. So make every bite count. Eat nutrient rich, organic whole foods whenever possible. Avoid processed and refined foods, artificial sweeteners and preservatives. This is important throughout, but especially during the first trimester, as many women will experience ‘morning sickness’, (which by the way is another myth, morning sickness can occur at ANY time of the day!) where it may be difficult stomach a lot of food. If you are throwing up, you want to be sure that the food you are getting is the best it can be, and full of all the vitamins and minerals you need for your baby.
It is normal to gain between 25-35lbs during pregnancy, but remember that weight gain is individual. If you start off with a BMI (body mass index) slightly lower than average, you may find your put on a little extra weight-don’t be alarmed! We put on weight for a reason, and it is normal. Do not try to diet or loose weight whilst pregnant. It is dangerous and can lead to a number of complications. Also, don’t expect the weight to just fall off once you’ve given birth. Although breastfeeding does help to loose some of the weight put on during pregnancy, our body does still need additional calories and weight whilst nursing. Be kind to yourself. Remember that the pregnancy weight took 9 months to put on, and it is perfectly acceptable for it to take 9 months, if not longer, for you to return to your normal weight again. Unfortunately, our bodies don’t just ping back in to shape the moment we give birth. Don’t be put off by stories of celebrities or even friends, returning to their pre-pregnancy skinny jeans 3 days after stepping foot outside of the hospital doors! This is not a reality, and we should not adopt these unrealistic expectations. It is not healthy for anyone!
Myth number 2 ‘fats will make you fat’ is another common misconception, not just in pregnancy but in general too. Avoiding fats will not stop you from gaining weight. Gaining weight is inevitable during pregnancy. In fact eating the right kinds of fats will actually help you burn fat, control your moods, and fight fatigue.
For years nutritionists and doctors have preached from the low-fat bible, claiming that cutting fats will aid weight loss, prevent heart disease and manage cholesterol. But eliminating fats entirely from our diets is not the answer. In our culture we are obsessed with fat-free, dairy-free and low-fat alternatives, we forget that certain amounts of fat are essential for our bodies to function effectively. Fats are crucial for the nervous system and the development of the baby’s brain. It is not about the total amount of fat in our diet, it is about the type of fat that we eat. We have to remember that not all fats are equal.
A walk through the aisles of Albertsons or Ralphs provides us with many supposedly ‘guilt free’ alternatives: Fat free ice cream, low fat candies, cookie and cakes. When you come to browse the shelves for milk, for example, it is pretty hard to come across a carton of whole, or full fat milk. The array of low-fat and fat-free alternatives are all around us, but they do not take the importance of essential milk fatty acids and fat-soluble vitamins (A & D) in to consideration. Today most people think they are doing a good thing by drinking low-fat milk, but most of these commercial milk products are completely deficient of these vital nutrients. These products are marketed to our nation’s insecurities surrounding body image and weight gain. The low-fat label is a marketing tool, and a good one at that. One that’s had us fooled for many decades. If you think about it another way, 2% milk still has a very low fat content-2%-that’s 98% fat free!
The truth is, pregnancy is not the time to be doing fat-free anything. Don’t get me wrong, I’m not advocating bingeing on nothing but cheesey fries with lashings of ranch dressing, Twinkies and chocolate sundaes, but the key is seeking out the ‘good’ fats. Ones which really are healthy for us. It is about cutting out the bad fats and replacing them with healthier choices to promote optimum health.
Remember what your mother always told you, ‘You are what you eat’.
‘Pre-pregnancy diet affects health of future offspring’-Science Daily, July 4th 2011
Eating Habits Programmed During Infancy-Healthy Child Healthy World