Gestational Diabetes Test Letter

Christa is a very well informed expecting mom on the Hypnobabies Yahoo Group.   She felt the request for her to do a Gestational Diabetes Test was not warranted.  Here is the letter she wrote to her group. 
Come back next week as I share the response to her letter!

I thought that this might be of interest to some.  I hope you enjoy reading it as much as I enjoyed writing it.  It was very liberating!! 🙂
PS.  4.5 kg is 10 pounds and 56cm is 22 inches.
PPS. the full test is a lot more intrusive than the glucose screen.  It involves following a certain diet for 3 days then fasting then having 3-4 needles over a period of 3 hours.  This woud not only inconvenience me (I have 2 children aged 1 and 2) but would be very uncomfortable and stressful.  It is also questionable whether it is healthy to consume such a large amount of sugar in the glucose drink.

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To Whom It May Concern,

I am currently booked in at the C*** Maternity Clinic on Caseload with Midwife Jo.  I have been informed that as my last baby was 4.5kg, the Hospital recommends I have a full test for Gestational Diabetes (even though I am only 14 weeks at present).  This is done as a precaution in case the reason for having a large baby was that I had an undiagnosed case of GDM.  I have considered my options and have decided to decline this test.  I discussed my decision with Jo who informed me that it was policy that I consult with a doctor at the Clinic regarding my decision to decline.

As I am not going to change my mind, and I do not like confrontation I felt that it would be constructive for me to express my views in a letter which can be perused by the doctor and kept on my record.

I presume that the reason for the policy to consult with a doctor is so that they can attempt to persuade me that doing the test is in the best interests of my baby.  Firstly, I would like to state categorically that “hospital policy” does not necessarily prescribe what is best for my baby.  I believe that I am the best person to decide what is best for my baby because it is I (not the hospital) that has the great responsibility of nurturing this baby and preparing my own body for birth.  I am responsible for the outcomes that my decisions lead to and I take this responsibility very seriously.

I have decided to decline the test for several reasons:

1. I do not believe the test is necessary or that I had/have GDM.
2. I did not eat particularly healthy food during my last pregnancy and this is likely to have contributed to my baby’s birth weight.
3. My baby was also very long (56cm!).  One might assume that this contributed to his birth weight.
4. I do not have a repeated history of all my babies being large.  My first baby was a normal 3.5kg.
5. I was not overweight during my last pregnancy, my pregnancy before that or this pregnancy!  Furthermore, my pregnancies have been void of any health complications.
6. I have always been a healthy weight and have never been overweight even before pregnancy.
7. I am young and have no health problems.  I have only just turned 26.
8. I am not part of a high risk ethnic group.
9. I have successfully birthed 2 babies vaginally with excellent healthy babies.  I see no reason why I should be worried that I would have problems with my next birth.
10. There is no family history of GDM or diabetes.
11. I am completing a birth preparation course (called Hypnobabies www.hypnobabies.com) which includes a complete nutrition, health and fitness component.  This will ensure that I will have a healthier diet during this pregnancy.
12. As I understand it, if I were to be found positive with Gestational Diabetes, the prescription would be to monitor my diet and glucose levels closely.  I am basically doing this anyway by improving my diet and general health.
13. I believe that the “nocebo effect” (see extract from Gentle Birth, Gentle Mothering by Sarah J Buckley MD, provided on my file, for explanation of this term) is very real and that a mother’s emotional well-being is an essential component to a healthy pregnancy, birth and baby.  Prenatal care which is constantly focussing on potential problems creates an unintended risk to the mother and baby due to an increase in levels of stress hormones.
14. I am considering doing the glucose challenge test at 26 weeks anyway so I don’t see the necessity to do the full test now.

I have been primarily informed by the book titled Gentle Birth, Gentle Mothering by Sarah J Buckley, MD.  This book explains how to make an informed decision based on the BRAN model of decision-making, weighing up the benefits (B), risks (R), alternatives (A) and the option of doing nothing (N).  It cites research both for and against with respect to a number of prenatal issues and equips the reader with enough knowledge to make an informed decision.

Furthermore, I would rather not “consult” with the doctor at the hospital for the following reasons:

1. I do not know the doctor and would not feel comfortable with them.  I am familiar with Jo and I am familiar with my family GP and would rather not see anyone else.
2. I suspect that the consultation will leave me feeling upset due to a personal aversion to confrontation (there will certainly be confrontation considering I disagree with the recommendation to do the test).
3. I resent having to justify my reasons personally with the doctor considering I have already explained my decision to Jo and provided an extract from my primary source of information for my file.  This letter further indicates my resolve in my decision and that I am fully informed of the benefits and risks of the test.
4. I am undertaking a course of hypnosis for childbirth for preparation of a natural and positive birth.  This involves “programming” beliefs into the inner mind.  (Whilst I’m sure this sounds very “new-agey”, hypnosis is medically based and has numerous health benefits).  I believe that the consultation with the doctor would be a negative experience, challenging (undermining) the programming that I have been working on.

I am happy to accept that due to the birth weight of my last baby, I should ensure that I maintain a healthy diet during this pregnancy to reduce the risk of having an unnecessarily large baby.  I am also happy for Jo to monitor the growth of the baby in the usual manner (measuring fundal height).  I will not consent to an ultrasound nearing the time of birth to estimate birth weight as I am opposed to unnecessary ultrasounds (for many of the reasons previously cited).  I believe this is sufficient measures to ensure a healthy pregnancy and healthy baby.

I ask that you respect my wishes and understand that I am fully informed of the risks and benefits of doing the test.  If you insist on the consultation I will comply begrudgingly and assure you that it will result only in irritating a sensitive pregnant woman (which I believe is not helpful in my mental and emotional preparations for birth!).  If this is the case, I would respectfully ask that prior to the appointment, the doctor read this letter and the material I provided to Jo (the extract from Gentle Birth, Gentle Mothering – Note: I do not wish to debate particulars from the book, I only wish the doctor to be informed of my view so that I do not have to repeat myself).  I suppose it would also be appropriate for me, in that case, to mention that I intend to decline the Group B Strep screen and may as well “discuss” this with the doctor so that I do not have to be inconvenienced twice!

Yours sincerely,

Christa