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.

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.

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.

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.

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.

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?

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.

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.

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.

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.

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.

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.

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?

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.

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.

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.

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.

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 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?

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?

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.

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?

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.

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?

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.

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.

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.

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.

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