A recent article disclosing the results of a large study relating to Gestational Diabetes has caused quite the furor. Gestational Diabetes: Blood Sugar Levels Once Considered Normal Are Not Safe for Baby, Mother is one of the overviews written about the studies that came out in the March issue of Diabetes Care. (I went to read the article, but it costs $45, so I’m going on the several overviews I’ve read. I tried to pick the most comprehensive article with which to begin this discussion.) (Subsequently, several people sent me the study. You all are the best!) The study looked at 23,000 women in nine countries over an almost ten-year period and was sponsored by the National Institute of Health.
Looking from far away or merely taking the majority of the headlines into consideration, it sounds like the study only says, “New gestational diabetes guidelines could find more women at risk.” This sends Natural Birth Advocates (NBAs) into a frenzy because they see obstetric care pulling in droves of women with a wider net, stamping them with the screaming diagnosis, “GESTATIONAL DIABETIC” with the sub-text, the true meaning of the diagnosis, “I get to call more of you Gestational Diabetics, will order more testing, will schedule more inductions and will cut more of your bellies.”
There is another way to look at this.
The information given to us via this study is vitally important. It can be used to save more mothers and babies if care providers are able to impart proper instructions regarding how to confront and manage Gestational Diabetes Mellitus (GDM). Granted, the track record isn’t so great, but someone has to start somewhere. There are so many NBAs involved in the different organizations; ICAN, Birthing From Within, Bradley classes, state midwifery organizations as well as all the midwifery schools, childbirth educators and even doulas can all play a part in curbing the GDM crisis.
I can understand the concerns about increasing the intervention rates, but what I have a problem with is the number of women who discount the information at all. It doesn’t take but one look on a city street to see the enormous amount of obese people coming and going. Add to the obviously fat folks the sort of chunky women and you have an idea of what the study is reporting. Not acknowledging how fat we are, how poorly we eat or how little we exercise is sticking our heads in the sand.
We in the NBA group totally get the quality food thing; eat close to the earth, eliminate artificial foods and drinks, more veggies than carbs and meat and dairy as condiments rather than main dishes. Yet, how many of us adhere to this all the time? How many of us really eat the way the soldiers did on the Lewis and Clark Trail… foraging, hunting and carrying any food eaten. I use the L&C expedition because that is, in our country, one of the last examples of a number of Anglos eating the way these bodies were meant to eat. They also are somewhat representative of the amount of exercise our bodies are equipped to accomplish every single day. The expedition averaged 8 miles a day. That is if they walked every single day of the 2.5 year journey, which they did not. They camped several times, they were stopped by the elements, sometimes for several weeks and many days, they stopped simply to hunt for and prepare food. (I’m kind of a L&C weirdo, having read books and books about their travels and, of course, watching the PBS Ken Burns special several times.) When the Corp was moving on foot, they averaged 15-20 miles a day. Carrying everything they owned and ate. With a woman who was carrying a newborn, then toddler (who certainly nursed)… and Sacagawea never held the Corp back, to the surprise of the men.
Around the world, we can find similar examples… or we could have before Western influence changed many cultures. Migrating used to be the norm all over the earth, farming being a relatively recent discovery. And, before technology, farming was back-breaking, continuous work. Do any of us do remotely this sort of movement in our lives? Do any of us only eat food we can grow or forage or hunt? Do any of us only drink water we travel to and carry back to our houses? Imagine the calories expended looking for or gathering food. Imagine how eating occurred… some days extremely small amounts while others, after a hunt, great amounts (L&C ate an average of 9 pounds of meat per person after a hunt.)
Was there Type 2 Diabetes Mellitus (DM) in these days? Unlikely. The pancreas doesn’t struggle to keep up with the food intake until there has been too much for, sometimes, several years. But, before DM come more subtle insulin issues, what we know as Insulin Resistance, Metabolic Syndrome, Syndrome X or Pre-Diabetes. DM doesn’t just appear out of nowhere; it isn’t there one day and wasn’t there the day before. Diabetes slowly and gradually builds, the pancreas, at first, able to tackle the extra loads, but getting tired always pumping out insulin until there is just no keeping up with what’s needed.
DM used to be a disease of old people, but the age of diagnosis has gotten earlier and earlier, now, sometimes as early as six years old. Six years old. As diagnosing the disease has gotten younger and younger, have people had fits that the pharmaceutical companies are making up the disease so they can make more money? Is there anyone thinking doctors are full of crap that someone under ten could possibly have an old person’s disease? If they are, they are rare –and delusional. Look at our kids. Look at their pot bellies, their fat arms and legs, watch how they walk slower and slower, sitting more and more –and eating less and less fresh and home-prepared meals.
If we see these people, know these people, become these people, how can the NBA discount the new information that the numbers needed to create unhealthy pregnancies, unhealthy babies and babies that are far larger than our bodies are meant to make?
For years, NBAs bragged about having babies over ten pounds; I was one of those women. We stuck our noses up to those stupid doctors who told us our babies were too big and wouldn’t fit through our pelvises. We said, “See… nothing was wrong with us. You tried to scare us with your doomsday predictions, yet we showed you, didn’t we.” Today, we have information that really, really, women do not naturally make babies that big without having some insulin issues. I’ve heard for years, “Big babies run in my family.” Well, so does diabetes. That you had a big baby and your mother had big babies is a wild red flag that, unless you keep your weight in the normal range, the range that doesn’t tax the pancreas, you are courting diabetes and, most assuredly, dancing with insulin issues already.
How long do we want to taunt the odds that “We’re just fine and dandy, thank you,”? If we can see and know the serious number of diabetics in our lives, look around and see how fat we’ve all become, why is it so far-fetched to think that there could be damage far earlier than previously thought? Information isn’t finite. We continue learning from experiences and this study that was just released offers that new information.
Midwives wholeheartedly embrace (cling to) any new study that says great things about midwifery, home births, that says less technology or interventions are called for, yet when something new comes out that asks for more technology or new standards, it isn’t just railed about, but outright ignored. How do NBAs justify these contradictions?
Instead of freaking out that doctors are, once again, trying to wrangle women into the operating room, perhaps we can hear the message of this study as, “Let’s do our best to keep women from having cesareans.” In fact, this information is stated specifically in the articles. Instead of blah blah blah-ing that doctors are meanies and they try and find anything they can to institute more rules on us, maybe we can see this as an opportunity to try and get a handle on the diabetes issue.
Just like we talk about speaking to young girls about their choices in childbirth, we need to add to that discussion how vital good/proper/healthy eating is for our growing babies’ health and, in many circumstances, even life.
It’s time we stop seeing fat talk as something rude or that hurts someone’s feelings. It’s time we stand toe to toe with the fat issue and do something about it. Obviously, being polite and ignoring it hasn’t gotten us anywhere. As women get fatter and fatter, we will all begin to see the devastation insulin issues can have on our pregnancies and babies. When will we begin paying attention? Let it be now.
(My dad, 1939, born weighing almost 13 pounds. My entire paternal side has died from complications of diabetes. You can see my grandmother's poochy belly 20 years before her diabetes diagnosis.)