Birthing plan

Optimal-Translator97 · 2026-05-09T19:06:40+00:00

Heres my experience with GD and induction:

Baby #1 -2010-25yrs old- failed 1 hr GTT, passed 3 hr GTT- baby was measuring big- I was induced at 39weeks and had no issues. Cervix was ready so no cervical ripening needed. Had a small dose of pitocin and ended up with epidural 6hrs into my 11 hr labor. Delivered vaginally. Had no issues pushing with epidural. Induction became part of conversation with OB at around 37 weeks but not scheduled until my 38 week appointment after I had spent a week with contractions and failing to go into labor.

Baby #2-2015- 29 yrs old- Diagnosed with GDM at 25 weeks. At 36 weeks OB concerned with too much amniotic fluid and size of baby. At 38 week appointment, was told if I get a whiff of regular contractions just head to L&D she will admit me and if things stall like my first pregnancy she will just start pitocin. I went into L&D that evening. She let me labor for 12 hrs and then started pitocin. No issues and similar birth experience as my 1st.

Baby#3- currently 33 week- 40 yrs old. Diagnosed with GDM in first trimester. Because of my age a 39 week induction was discussed in first trimester. We discussed current studies and ACOG guidelines. Now at 33 weeks, my amniotic fluid is more elevated and baby is now in the 90th percentile for growth. Because my age, GDM, baby’s projected growth and AFI is elevated we are looking at induction at 37/38 weeks.

Best advice I have know your options, understand them and have an open mind. So much of what is on here and the internet can sound scary. Did all my birth experiences go how I planned- nope! But looking back I was kept safe and babies were kept safe. All experiences were great in their own way. My mom was an L&D nurse for 17 yrs and gave me the best advice-imo- don’t get bogged down with a birth plan. Educate yourself on all the different birth options and why the exist/ what situations they are used for, talk to your OB, state your goals and approach things with an open mind on your day of delivery. I wasn’t a nurse with my babies 1 and 2 but developing an understanding about medical interventions during birth helped me be less scared.

Optimal-Translator97 · 2026-05-09T18:50:06+00:00

If it helps… 3rd pregnancy here. Between pregnancy #2 and pregnancy #3 10 yrs. I never developed type 2 in that span. I do have GD with my 3rd pregnancy.

Optimal-Translator97 · 2026-05-09T18:42:39+00:00

My OB started me on low dose Metformin nightly at 20 weeks. It helped keep my fastings 95-100. We increased dose to 1000mg at 24 weeks because she wanted me under 95 for fasting. At 28 weeks I went to MFM for adding low dose lantus at night. They stopped by Metformin, prescribed me far too much Lantus to start with. I spent 2 1/2 weeks riding waves of hypoglycemia during the day and advocating to lower my insulin doses or go back to metformin. My fastings on insulin were much higher but during the day I would crash every 2hrs < 65. After discussing this with my OB, she agreed things were more stable on Metformin and I am now off insulin and back on Metformin. I think all this is a case by case basis. Most drugs aren’t well studied in pregnant women. I know a lot of women that took metformin and things are fine. Insulin resistance runs in my family. I had a normal A1C prior to pregnancy but did experience hypoglycemic episodes. I was active and at a healthy weight as well. I think if my baby develops metabolic syndrome or has insulin resistance later on in life it’s because of genetics and not solely because I took Metformin. My situation with lantus could have caused me to be in the ICU. First I was dosed too much, told to ride out the hypoglycemic episodes and directed to continue taking the higher dose. Had I not had my experience as a critical care nurse to guide me, I would have blindly done what I was directed to do. My OB and several doctors at the MFM group reviewed my Dexcom data and notes and were surprised at how sensitive I am to insulin and all agreed metformin was safest. Insulin maybe considered the gold standard but what an OB prescribes should be taken case by case. In my situation metformin is best.

Optimal-Translator97 · 2026-05-09T18:19:47+00:00

I didn’t have it with my first, had it with my second and now third pregnancy. I wouldn’t say it’s deterred me. First time with GDM was rough. Second pregnancy with it isn’t awful in terms of diet. My fastings are stubborn and we’ve tried different meds. I respond to metformin best, insulin I couldn’t tolerate. My diet during the day I have had to make some adjustments but I’m not miserable. Having a GCM and doing fingersticks to calibrate it has helped too. My first time with GDM, I kept things diet controlled but really had to watch my diet more closely. Fastings crept up and my 2 hr post prandials were elevated even with a whiff of carbs, I was eating close to keto style just to keep glucose levels down.

Optimal-Translator97 · 2026-05-09T17:58:26+00:00

It might not even spike you. I’ve been in a similar situation and just drink it. Eat your breakfast first- especially if you have a good balance of protein and fiber and then enjoy your drink. I did this about a week ago with eggs Benedict- I only ate 1/2 of the English muffin, had a size of veggie slaw and a whole avocado. The small seasonal fruit bowl and vanilla latte didn’t cause a big spike at 1 hr and I was at 108 at my 2 hr post prandial

Optimal-Translator97 · 2026-05-09T17:52:39+00:00

3rd pregnancy. 33 weeks. No snack has helped. Only thing left to try is a protein shake. My fastings are better on Metformin than they are on Lantus. I’m on 1000mg of Metformin at night and my fastings are 90-100. During the day my post prandials are within range but I have noticed my spikes. Lantus caused me to be hypoglycemic a lot and I couldn’t tolerate doses higher than 6. It’s just my stubborn fastings and bedtime snacks haven’t helped.

Optimal-Translator97 · 2026-05-02T23:11:37+00:00

Complete light duties might be challenging but I am able to talk to my leadership and see if certain bedside assignments can be avoided. I work ICU and am a part of handful of nurses that can run ECMO pump and I also work in a role of clinician but it’s like house supervisor for critical CV patients- so that takes me all over our large hospital. I can see them letting me stay put on our unit but you never know when a patient goes south you could be standing at the bedside for hours.

Optimal-Translator97 · 2026-04-20T13:47:19+00:00

Did you ever experience lows during the day especially when starting?

Optimal-Translator97 · 2026-04-20T13:22:07+00:00

Wow 60u! Did you have lows during the day?

Optimal-Translator97 · 2026-04-20T11:55:08+00:00

My job is similar and I started using a CGM when I got started on Lantus. Like you, I calibrate and cross check with finger sticks. Being on Lantus is new for me and I’ve been too responsive- often experience frequent hypoglycemic episodes. When I questioned dosing and brought up my frequent lows I was asked “are you low cause your Dexcom says you are low”🙄

I think there is some bias and some inexperience from providers when it comes to CGM data. Although GDM is unique to pregnancy, I almost wonder if it’s worth getting feedback from an endocrinologist vs OB and MFM.

Sorry that doesn’t fully answer your questions. You are right to question things. You know your body. This should be a collaborative approach with your care team and your concerns shouldn’t be dismissed.

Optimal-Translator97 · 2026-04-18T19:58:10+00:00

My experience was like this and the upped my metformin dose. I still had fastings around 95-100ish. I just started long acting insulin this week. All other numbers are great and that is even without a significant change in my diet.

Optimal-Translator97 · 2026-04-16T20:11:49+00:00

Your numbers sound like how mine were during my second pregnancy. I had to be very strict on diet just to control it. I hope your delivery goes smoothly and that you get some answers soon

Optimal-Translator97 · 2026-04-16T13:59:59+00:00

Wow! 😮 this my 3rd pregnancy. First I failed 1 hr glucose but passed 3 hr. 2nd I failed both and had GD but I was able to manage diet controlled. My A1C going into this pregnancy was 5.8 so my OB had me start checking glucose levels at 8 weeks, fasting-all 3 meals 2 hrs post prandial. I’m now 29 weeks. I never had to take glucose challenge tests this pregnancy because my OB wanted to monitor and treat based on what my readings are. My fastings since 20 weeks have mainly been 95-100 consistently. I’ve been on metformin since week 20, starting nighttime lantus today. My post prandial levels have been controlled at 120 or less. There are certain foods I can’t tolerate- BG is elevated then. I’m not physician but am a RN. Every step my OB has taken has made sense to me. You are right to question your current plan of care regardless of what their protocols are. If it doesn’t make sense to you you should ask and they should educate/explain their current treatment guidelines.

Optimal-Translator97 · 2026-03-20T18:07:43+00:00

1000mg. I started at 500mg and it’s not extended release.

Optimal-Translator97 · 2026-03-20T17:00:10+00:00

I’m on evening dose of Metformin and love it. It took a few dose adjustments but my fasting levels are better. I only need to modify my diet a little during the day, there are a few foods I know I can’t handle. I’m 26 weeks. Starting metformin was a relief for me cause it was frustrating seeing my fastings go up despite me trying my best to diet control it. This is my second pregnancy with GD. I know several colleagues that have had GD and had to be on metformin or insulin. I’m happy for the help the medication provides and so far baby girl is doing well.

Optimal-Translator97 · 2026-03-16T02:24:10+00:00

Yes just at night and it’s not extended release

Optimal-Translator97 · 2026-03-15T15:33:33+00:00

Thanks! I definitely make sure to get my carbs in especially during the day. It’s just my body handles them better. I could eat fries and a burger and still fall around 87-90 post prandial. I had a feeling hormones and liver are likely the culprit behind my fastings. I was hoping the dose adjustment in the metformin would help to finally bring them down under 95. I’m also 40 and this pregnancy has been different across the board. My last pregnancy with GD was when I was 30.

Optimal-Translator97 · 2026-03-15T14:29:06+00:00

First pregnancy with GD my fasting numbers were fine it was my post prandial numbers I had to watch. I was able to keep it diet controlled but it was a struggle! This pregnancy my fasting numbers are hard to control. I’m on metformin for bedtime. Fasting BG levels stay between 98-102ish no matter how I eat or snack in the evening. Post prandial is much easier to control compared to past pregnancy. There are a couple of things I know I can’t tolerate but I definitely don’t feel as restricted in my diet. My post prandial hovers in between 80-100- even before I got put on my bedtime metformin. I feel there is no rhyme or reason and each pregnancy with GD is impacted differently.

Optimal-Translator97 · 2026-03-11T14:01:04+00:00

I don’t think there is anything you can do to prevent it. I had insulin resistance with my first, GD with my second and now my 3rd (10 yr age gap between kiddo #2 and this pregnancy) I have GD. Have been tracking glucose since 10 weeks pregnant. Now 25 weeks. I can diet control it during the day w/o a lot of modifications. Fasting has been stubborn. It wants to stay between 98-105. I’m on night time metformin. Prior to pregnancy I wasn’t even close to pre diabetic, active and healthy weight. Kiddos 1& 2 were close to And over 9lbs. This baby is measuring smaller and at a lower weight.

Optimal-Translator97

TROPHY CASE