Trish: [00:00:00] My name is Trish Ware and I am obsessed with all things pregnancy and birth and helping you to navigate with the practical and the magical seasons of this journey called motherhood. I'm an all day coffee sipping mama of seven. I've had the amazing privilege of delivering many babies in my 15 plus year career as a labor and delivery nurse and as a mama of seven.

I'm here to help you take the guesswork out of childbirth so you can make the choices that are right for you and your baby. Quick note, this podcast is for educational purposes only and does not replace your medical advice. Check out our full disclaimer at the bottom of the show notes.

Hello everyone and welcome to the birth experience. Today we are joined by an incredible [00:01:00] guest, Sarah, who is the gestational diabetes nurse, by the way, and she's here to break down everything you need to know about managing your gestational diabetes during pregnancy. We're We're going to talk about understanding the diagnosis, and she's going to give you guys some practical tips for blood sugar control, mindset, and birth.

And Sarah has so much expertise, so I'm excited. Welcome, Sarah. Tell us who you are and why you're the gestational diabetes nurse.

Sara: Hi, Trish. Thank you for having me. I'm so excited. So I am a labor and delivery nurse. I've been a nurse for over six years and my entire career has been in labor and delivery, and women's health.

So I definitely like this is my jam. And basically as labor and delivery nurse, my first job, I noticed right off the bat that lack of prenatal education really impacted my [00:02:00] patient's birth experience and just really caused birth trauma and. ultimately affected their health and well being for them and their baby postpartum.

And then when I switched to my second job, which the, basically the clientele of my patients were more educated. I was like, Oh, like, let me see like the difference. And I, I felt like, yes, they were more educated, but they still lack that prenatal support and education as far as labor and their diagnosis.

And like, All the different things that go into every single person's unique motherhood and pregnancy journey and ultimately, again, their postpartum experience, can be negatively impacted by, you know, their lack of education and support prenatally. So I got this awesome opportunity to start working as a, high risk OB nurse.

I'm actually a contract nurse. So I like. Got to see like a [00:03:00] little bit of everything, which is awesome. And I got to piece both worlds together and see like, okay, as an OB high risk OB nurse, I'm talking to these mamas and developing a relationship with them every single week. They come at least once a week or twice a week, depending on their diagnosis.

And again, I see like, yes, we have resources OB. Where I work, which is MFM maternal fetal medicine. We do have diabetic educators that meet with these, mamas, depending on their control of their diabetes, either, once a week, if it's really not controlled or every two weeks or three weeks, they do like do telehealth visits with them, but they're still lacking the support because how much can you.

or educate a mama in 30 minutes, really. So as I was taking care of these mamas, which my role is doing NSDs and BPPs, so I spent a lot of time with mamas and basically I actually got [00:04:00] certified in BPPs also, which is awesome. So as I'm putting them on the monitor and as I'm doing the ultrasounds and spending over an hour with them, I asked them, like, how are your sugars?

What difficulties are you facing with, you know, your postperennial sugars? What difficulties are you facing with your fasting sugars? And how is, how are you feeling? Feeling with this pregnancy and the like. It was so astonishing to me how the lack of support really like was a common theme and they all had the same questions.

What's gonna happen to my baby after I deliver? Can I breastfeed? And I was so like astonished by that. And I said, you know, like, I love helping these mamas. And I really, truly, like, it's a passion of mine to educate these mamas, but, I decided to take that to the online space and just really help even more mamas.

So, yeah, that's what I'm doing now. Really just trying. I know I can't. fix the system. We can't, we, all of us, [00:05:00] our hands are tied, but helping one mama at a time is just, amazing. And I really do want to help as many mamas as I can with their diagnosis, with their pregnancy, to have a healthy baby, to have an amazing delivery, their dream birth, and then postpartum to just recover postpartum and bounce back as they say.

But yeah.

Trish: So let's start with this. Like, What exactly is gestational diabetes or GDM as a lot of people and how is it diagnosed?

Sara: So I love that question. Gestational diabetes is diagnosed after you take your one hour glucose test If you actually sorry, let me just rephrase that you when you take your first hour glucose test it might be if it's elevated, they'll have you take the three hour glucose test so after you first take your fail the three hour glucose test, they diagnose you with gestational diabetes and that's typically around 24 to 28 [00:06:00] weeks.

Sometimes they do it earlier if you have any risk factors for that. And really what it means is it's so common Trish, but really what it means is that your body, it's just not producing either enough insulin or the hormones of the placenta are impacting insulin resistance. and causing insulin resistance, really.

So it's just, everyone is different regarding gestational diabetes, but, it's something that can be controlled, and it's something that you can still have a healthy pregnancy with this diagnosis. So it sounds a little scary, but it's so common now.

Trish: Yeah, and I think that is really important to note and I'm glad you said that because I tell my mama members and my students They all are so afraid of getting diagnosed.

I'm like, you know knowledge is power You already have it if you have it like it's happening. You need to know about it so you can handle it So if you're listening out [00:07:00] there and you've just gotten diagnosed I just want to say the same as what Sarah's saying you didn't do anything wrong. You're not at fault I've known people who are super fit who end up.

Yeah. And people who are not fit at all that end up with it. People that eat really healthy that end up in people that don't. So I, I love that you, you said that. So now they're diagnosed. What are some first steps that you would recommend?

Sara: So once you're diagnosed, we kind of try diet first, which is great.

We don't go straight to medication. And honestly, we see such a big difference when you start implementing healthy lifestyle choices. And the second thing I want to say is that exercise has been proven to really help manage your blood sugars. I always have mamas tell me like, yeah, you know, I noticed after I ate, I went on a walk and my blood sugar got much better.

Which is something so practical to implement. So those are like really, like key things to start with, [00:08:00] with as far as diet, so I live in New York and it's really hard, to tell like a melting plot of people, like stop eating rice when it's part of their culture, right? So what we do is, we recommend that you, okay, you, if you want to eat a carb, you pair it.

First of all, with a protein, whether it's an animal protein, whether it's a plant protein, and then you add like some avocado, which is a healthy fat to balance it out. And then you walk after you eat, and then increase your, fluid intake, your water, and that really helps manage your blood sugars as well.

Trish: I love

Sara: that.

So they don't have to. Like you, what Sarah's saying is like there's options and I love that and you guys can find Sarah on Instagram. Your handle is

Gestational diabetes nurse.

Trish: There you go. Very straightforward and easy and she can give you more tips on what to eat and the other so like are there [00:09:00] specific foods that are like No, ma'am out of the question or is it all moderation?

Sara: It's really moderation it's hard to tell a pregnant woman like I mean, you don't, you don't want to like, you don't want to overdo it. Like eat like donuts and an ice cream like all day and, and cheat days are kind of like also a little tricky. If you do, if you are craving a carb, I recommend you pair it with a protein, you eat it with a healthy fat, you drink a lot of water and go for a walk and go for a walk exactly.

And also try not to make it most of your plate. So get a smaller plate and do like a third of the plate whatever you're craving whether it's french fries Whether it's a burger and then pair and put pile on some salad pile on some avocado make it simple But you know, you can have a little bit of what you're craving, but you also want to make sure it's not like overboard Yeah, so yeah [00:10:00] So,

Trish: all right, so let's say mama is keeping her blood sugars You Manage diet controlled.

How is her birth affected that we're talking right now for diet controlled first?

Sara: Okay, for diet control. I love that question. Actually, there are patients that doctors let them go past 40 weeks. If your diet control and your baby's growth is normal. Right? So we look at the baby's growth. We make sure the baby's belly is not too big.

We call it the abdominal circumference. And then we make sure that you don't have poly, which is polyhydramnions, which you know, Trish, is a lot of water, a lot of amniotic fluid. So, a lot of doctors have been letting patients, you know, you know, late, like not inducing them before 40 weeks if you're diet control, which is awesome.

And then for Medicaid, yeah, go ahead.

Trish: I was just gonna say, my moms that are listening are like, Oh, because [00:11:00] I don't like the term, let them, because ultimately, it's up to you as the mom and inside my My world we say we don't refuse things just because we can But for most of you guys listening if you are diet controlled Even if your doctor is like and i'm saying this in quote not letting you go past 40 weeks.

You can go past 40 weeks Yeah, but I do recommend you go see someone like sarah you get your nsts. You get your bpp. Yeah, keep an eye out but Just remember you guys have choices, even if you have like the worst doctor in the world who is like completely induction happy for everyone. You don't, like I always tell my students, like the induction police don't come out to get you.

Sara: A hundred percent. You

Trish: can do what you want, just be smart. Yeah.

Sara: I, we see it all the time and I was gonna add also as long as your NSDs are reactive and your BPPs are eight out of eight, which is 10 within, NST, then we are [00:12:00] reassured when you continue your pregnancy. So that's a really key component. So, and a lot of doctors, I feel like a lot of doctors have been okay with, not inducing as you say, and if your doctor isn't okay with it, you can always switch.

Trish: Yeah. And you, and you, and you. Don't have to so a lot of times what will happen is these doctor's offices will schedule the induction without you really playing a part in that And you don't have to do that as long as you and baby are healthy.

Okay, so The difference here. I want to really emphasize is if you have a mom Who is on medication and even if you're, if you're on some medications and you're controlled, you don't necessarily have to be induced. But what about a mom who her blood sugars are not staying in control? She's having to take insulin.

She can't get it. She's just not maintaining. What's your thoughts for them?

Sara: So I would, I would reach out for help. [00:13:00] I would love to help you with that because we need to maintain normal blood sugars, not just for the baby, but for you. There can be complications for you as well. Preeclampsia is very common.

If your blood sugars are uncontrolled, you can have high blood sugar levels and go into DKA, which is an emergency also. So I would definitely reach out. We're all willing to help you. And we want to make sure your blood sugars are in control for your baby as well, because if the, if your blood sugars are not in control, when the baby's born, the baby's used to so much blood sugar, so it produces a lot of insulin.

And then when you take that blood sugar away, after you cut the umbilical cord, the baby's blood sugar will drop. And that's the issues that I faced as a labor and delivery nurse. When my Patients babies blood sugars were so low and I had to keep running back and forth to the NICU, and then they would ultimately recommend formula, and then ultimately baby would go to the NICU because it just wasn't stabilizing because of uncontrolled diabetes.

So that's [00:14:00] really important.

Trish: So for those of you guys listening, one of the things that I recommend, and I'm sure Sarah would agree, is to collect some cholesterol before, like, I, not all of you have to do that, but if you do have GDM or there's something else, maybe you know your baby's going to have a cleft palate or something like that, coming in with cholesterol already collected, my favorite are the HACA ones, and you can have that collected, so if that situation happens, like Sarah just said, said they can give your baby cholesterol instead of formula.

So that's just a little side tip. Okay. So, Oh, go ahead.

Sara: Sorry. Or we can give, glucose gel. So my first job that I worked at, we didn't have it, but my second one we did, and it really, really helped because we would give the baby some glucose gel and then we would latch the baby on with, for the mom and the baby's blood sugars were able to rise and, you know, level out.

So that's a great option. Also, you should definitely ask. That when you're in labor and delivery, hopefully you don't [00:15:00] have that situation, but that's a great option.

Trish: Yeah, instead of formula. I love that. Okay, and so One of the things that I see inside my community is that there's a couple things emotionally they feel a lot of guilt

Sara: Yeah,

Trish: and they feel overwhelmed So I love that you've created, you know, tell them a little bit about what you've created with the gestational diabetes nurse

Sara: So, I do offer one one consultations because I know some people just really benefit from that.

But I do have a membership, which I'm so excited about, because it's a great community. Because like you said, mamas feel like guilty and, and, Honestly, you're not alone. So many women face the same issues and they all feel some some similar Emotions as you do so and you can you know bounce back off each other and get that support from each other and then grow together and it's just such an amazing community.

And then we do offer [00:16:00] support, you know, for postpartum as well. And I forgot to mention, I do do childbirth classes as well, which is awesome. So we'll help you prepare for your delivery for your dream birth. But I do focus a lot also on postpartum because I've seen like such a big lack for that in my current role where I am working in MFM.

You know, the patients are so like, Oh, wow. Like I have somebody checking in on with, with me every two weeks or whatever it is on the diabetes team. But then once you deliver, it's kind of like you're on your own, which is really sad because gestational diabetes, yes, it can go away and it does go away most of the time, but you don't.

still need to make sure that the mother has support and education and a lot of them don't know they need to retake the glucose test four to six weeks postpartum. And then implement continuing to implement healthy lifestyle choices to decrease your risk for diabetes later on in life. So we do [00:17:00] really, support women with, you know, postpartum because it's such an important time where a lot of people just forget about you and we don't forget about you.

We're here for you every step of the way.

Trish: I love that. So one of the other things that I hear a lot, a lot of women are like, okay, I had GDM with this pregnancy. Will I have it with all of my pregnancies?

Sara: So a very common question. So it depends on your lifestyle choices postpartum. Like I said, and I've seen how it's so funny because I've been working at this center for a while now. So I've seen women that get pregnant, like, you know, postpartum right away, and they can go from GDM one, which is diet control.

And then their second pregnancy, their need medication, or they're diagnosed early. So Yes and no. It depends on how you educate yourself. You get the support and you make the lifestyle changes and they don't have to be crazy ones. But it's just continuing [00:18:00] whatever you learned in your pregnancy. You continue postpartum and really that will give you the key to help you have healthy pregnancies for the rest of your life.

And just a healthy, you know, lifestyle without just postpartum. You'll be healthy, which is really important.

Trish: I love that because I think that is a huge, a huge concern. Okay, so what are some like, okay, I find, you find yourself saying this a lot to your members or to your, your patients in person. What are some like little bonus tips you can give these moms that you want them to know?

Sara: You are not alone. You can have the most amazing delivery experience. You can have the most amazing postpartum, and really implementing these small, like I said, just take walking after you eat, even when you're postpartum, just taking your baby in the stroller and just walking after you eat, it's just really going [00:19:00] to benefit you.

pregnancy and postpartum. And I've seen women do extraordinary things. I've seen a woman have uncontrolled diabetes, taking medication and then going from that to diet control. I've seen women postpartum lose all the weight and just be completely healthy and next pregnancy past their GDM test.

So, you really can do it and just this small life, small tips really are beneficial. And yeah, it's really, yeah.

Trish: I, another question I have that I, I meant to ask before, but I definitely, before we get off, I want to say like, what. What can they expect during labor? What is, what are, what are the particulars for them during labor?

Sara: I love that question. During labor, you're going to have the same labor process as every other woman. Labor is labor. The only difference, in labor when you have gestational diabetes is that we check your glucose, your finger stick every, [00:20:00] it depends on the organization, but every, you know, 2 to 3 hours, sometimes some hospitals check it, more frequent when you're in active labor.

Another thing is that we may, Like change your IV line. So if your sugar is on the lower end, we'll give you like a started like we'll give you LR with D5 If it's on the higher end, we'll give you normal saline some organizations do that If your sugar is high we can we might start you on an insulin drip Again, that might affect, you know, baby's sugar when, postpartum, but we do have to, do that to regulate your blood sugar during labor, but otherwise it's the same labor process.

It's really not different. It's just checking your blood sugars, making sure your blood sugar is normal so that baby's blood sugar is normal as well.

Trish: Is it common for women who are, let's say, diet controlled, to have problems with their blood sugar during labor?

Sara: Not at all. Usually they're, usually they're, because they always tell me my fasting is perfect.

So, like, in [00:21:00] pregnancy, they always tell me my fastings are perfect. And then when they're in labor, it's usually like totally normal values. It's really the women who have uncontrolled diabetes and my type 1. Usually the type ones have, they need to be on insulin drip just because they're on the insulin pump during pregnancy.

But, the women who have uncontrolled diabetes, they're usually the ones who are on insulin drips during labor, but otherwise it's a totally the same. Labor process, nothing different.

Trish: So, you guys, I'm asking, I obviously know the answers to these questions, but I want you guys to hear, so a mom who has diabetes, controlled or uncontrolled, can they go unmedicated without an epidural?

Okay, because that's one of their fears. I hear all the time, like, no, I can't have the birth of my dreams. Yes, you can.

Sara: Yes, you can.

Trish: You, you can. Okay, what about for baby? For a mom who's GDM during pregnancy, what does it look like for baby after birth?

Sara: So, after your baby is born, we're not going to be checking your blood sugars [00:22:00] anymore, but we are going to be checking the baby's blood sugars.

So usually we put the baby's skin to skin, which helps maintain normal blood sugars. And we usually keep the baby on you for at least an hour. If the baby, as long as baby's pink and crying and everything is great with the baby, we'll keep the baby on you. Then we'll check the blood sugar and the weight one hour after.

If the blood sugar is normal, we'll check it. Three times, like every hour for three times. And then once again, in 12 hours, and then once again, in 24 hours, and then the baby's done.

If the baby's blood sugar is low, then, we will give the baby glucose gel.

We'll help the baby latch, and help you breastfeed, and we'll check it again. Every organization is different. This is just where I work. And then we'll recheck it, 30 minutes after you've finished feeding. And then if it's still low, we'll do the same process. Obviously, we'll call the provider and just let them know.

Usually it's Nick, you, or whoever. Okay? And we'll do the same process. If it's three consecutive low [00:23:00] sugars, which means the baby cannot maintain normal blood sugars, with the glucose gel and feeding, or if it's just a critically low value, the baby will, will, ultimately end up in NICU. But that's not so common only because it really happens if the mother's sugars are uncontrolled or if the baby is super, super small or super big, sometimes that can happen too, but usually it's not the case day by day.

Yeah.

Trish: I have a terrible story. So when I had Laney, my baby number five, I, so long story short, the place that I delivered her, I also worked at and we used to check every baby's blood sugar.

Sara: No, no. Somewhat.

Trish: And, and what was funny is I didn't know that wasn't normal. I did my first tribal assignment and I'm like, You guys aren't checking the baby's blood sugar?

And they're like, not unless she's GDM. And I was like, Oh, so when I got back to my facility, I looked up the policy and someone somewhere misread the [00:24:00] policy. So we have been doing this and it wasn't policy, but that's a side show, but I have Laney. The nurse checks Laney's blood sugar, and it was critically low, so they rushed her to the NICU.

She gets to the NICU, they check it again, and it was totally fine. So it was the machine that was wrong.

Sara: Oh no. Yeah, it was like,

Trish: wait, what? Cause I, I was like, what? So that was my horrible story. Okay, so let's just, for these moms, what would you say would be like, so, I, I'm gonna just say this for you. Your number one tip is how to combine the foods.

Take a walk and drink more water.

Sara: Yeah.

Trish: And that's gonna really be a front line. Yeah. Your defense.

Sara: And portion control.

Trish: Okay. Yeah. Yeah. I love that because I feel like that is simple advice.

Sara: And meal prep. I didn't mention meal prep. I forgot to. But meal prep is so important because if you're waiting to the last minute and you're starving and when you're pregnant and starving, it's not a good [00:25:00] combination.

No. Yeah. No. No. Yes, so then you'll just eat whatever is in sight. If you meal prep and you, which is a great tip when you are postpartum and you have a newborn and you have toddlers, you need to meal prep for that. Like this is preparing you for that. Side note. Yeah. When you meal, when you meal prep, you take the, the stress.

And just the guessing game out of everything. And you just know, like, okay, this is my breakfast. This is my lunch. This is my dinner. And you have these small snacks throughout the day to space them out so that you're never really hungry and you feel full. The goal is for you to get all your, the calories that you need.

Because you are growing a baby, you can't take away carbs from a pregnant woman that's growing a baby, right? So, that's really the goal, also for meal prep. I would just recommend in the beginning of the week or however your schedule is, obviously you want to make it realistic. Do shopping in advance and then plan out what you're going to eat and [00:26:00] have, like, if you're going to eat, for example, I recommend apples and peanut butter, right?

So, okay, so prepare, like, the snacks before, like, the night before, so that way when you're at work or whatever, you're running around with your toddler, like, you have these things on hand so you're not going to be eating foods that are potentially going to spike your blood sugar.

Trish: I love that so much. Okay.

So before we get off of here, I want you to tell everyone again where they can find you and just any, any other. So let me just say, I didn't say Sarah is a mama. She also has children. So she's been there, done that. So tell everyone where they can find you.

Sara: Yes. I'm at Instagram mostly. Gestational diabetes nurse.

That's where you can find me. I have so many tips for you guys. So many meal ideas for you guys, labor, tips, postpartum tips. So it's just a really great place to hang out and you could definitely message me. If you have any questions and join the membership [00:27:00] and. Find a community of mamas just like you.

Trish: Oh, I love that so much. Thank you so much for coming on today, Sarah.

Sara: Thank you so much, this is so amazing.

Trish: Wow. What an insightful conversation with Sarah, the gestational diabetes nurse. Managing gestational diabetes might feel overwhelming. I get it. I see you, but with the right information and skills. support. You can take control of your health and your baby's wellbeing. You can have a beautiful labor and delivery.

If you love this episode, hit subscribe, leave a review and share it with a mama to be who needs this support. And don't forget to follow Sarah for more tips and expert advice. Her insights are invaluable until next time. Stay informed, stay empowered, and remember. If you write a review, we'll put you in a drawing for a special little gift, [00:28:00] and we know you are so much stronger than you think.

I'll see you again next Friday. Bye for now.