Two Illawarra women frustrated by the conventional care given to women with gestational diabetes are pushing back against "outdated" advice given to those diagnosed with the common pregnancy condition.
Dietitian Renee Jennings and postpartum doula Naomi Chrisoulakis will this week run an online masterclass to share their experiences and some of the latest research into how to manage gestational diabetes mellitus (GDM).
Diagnosed when higher than normal blood glucose levels first appear during pregnancy, the condition affects between five and ten per cent of pregnant women.
All women are tested, usually at around 28 weeks pregnant with a glucose tolerance test, as without management the condition can increase the risk of complications during pregnancy.
Under the conventional guidelines, women are encouraged to count carbohydrates - eating 175 grams of carbs each day - and measure out food portions and are told to eat low fat foods, with the standard dietary advice pushing a number of processed low-GI convenience foods.
The masterclass was the brainchild of Ms Chrisoulakis, who was diagnosed with GDM in both her pregnancies but had two very different experiences.
Pregnant with her daughter seven years ago, she remembers feeling "s--t" about weekly weigh-ins and overwhelmed by confusing dietary advice, and says her GDM diagnosis was eventually used to push her into having an induced birth.
"I went through the standard care in hospital with her and I followed the guidelines and I was really scared, I felt s--t about it," she said.
"I just felt like I was very confused about the whole thing - they were telling me to eat this pretty high carb diet and I couldn't see how that worked.
"I ended up going on a low dose of insulin and I was pushed into an induction per the hospital protocol.
"I came out with birth trauma, which is not necessarily related to the induction, but certainly the whole process. I was told you need to do this because you're at risk of stillbirth, and I didn't feel like I had a choice in the matter."
Four years later, she was keen to not repeat this experience during her second pregnancy.
"The second time round, I self-monitored at home because I wanted to get on to it early, so I self-monitored for about 14 weeks with a blood glucose monitor and I could see where it was heading," she said.
"I was planning for a home birth and I engaged a private endocrinologist to manage my care on that front.
"I went on insulin and I ended up having my son at home at 42 weeks, which would be unheard of in the hospital system basically."
Now a postpartum doula, who helps to cook and care for women in the weeks after birth, Ms Chrisoulakis said she hoped the masterclass would help other women to speak up for themselves during pregnancy.
"I would love to see women not being pushed into induction until they are past 40 weeks because I think it puts a lot of unnecessary stress on people in the last days of their pregnancy and it's not based on evidence and what the international guidelines say," she said.
"We also want to encourage women not to get bogged down in the label and feel overwhelmed and disheartened, and actually to take it as an opportunity to get empowered to understand their options - whether it's about food, birthing options - and feel like they're up to date with the latest evidence versus being stuck with something that's 15 years old."
"Being diagnosed with gestational diabetes isn't actually the problem - if you get a diagnosis and you take charge and get empowered and educated, you can then manage your blood sugar levels, keep them in a normal range.
"Then you also have a lot more leverage argue a case to say if your blood sugar levels are normal, you don't need to be induced."
Women avoid getting tested due to 'anxiety' over GDM
Enter dietitian Renee Jennings, who sees women experiencing anxiety due to a GDM diagnosis.
She said some women were being scared off by the "restrictive" conventional approach and avoiding a diagnosis.
"I see the amount of anxiety and fear and guilt that a lot of women seem to carry with the diagnosis," she said.
"I'm seeing some women who are just not doing the [GDM] testing at all, especially if it means that they can't have a home birth or something, and that is definitely much more dangerous because we know that gestational diabetes can be managed so well if we know about it.
"If we don't know about it, then that's when you get the biggest risk for mum and bubba."
Ms Jennings said she wanted to destigmatise the condition, adding that many of her clients ended up seeing their diagnosis as a blessing in disguise as it gave them lifelong skills in understanding how food affects their body.
"Women I see in my clinic, they come in extremely stressed and they leave feeling really empowered," she said.
"So I wanted to help spread the word a little bit more in a more affordable way because I understand it's quite expensive to see a private dietitian."
She relies on a whole food diet and uses recent research that shows that protein and fats help to slow down the absorption of glucose into the bloodstream.
"We want to show women that, you know, the diet doesn't need to be restrictive, it doesn't need to be focused only on carbs," she said.
She said balancing meals with the right ratios of protein, fats and carbs could help women avoid higher blood sugars, and wants to share other strategies that help make eating during pregnancy feel less rigid.
"The main thing for me is letting women know that just with that label of gestational diabetes doesn't actually mean that they're at a higher risk of any of those complications," she said.
If you control your blood sugars, then it doesn't really put you at any higher risk of any of those risk factors than it would for someone who's not got the diagnosis.
"There's so much we can do from a dietary perspective, and sometimes women will need to do a bit of both - a bit of diet and a bit of insulin - but if people are aware of what their blood glucose levels are doing, it's not the label of gestational diabetes that matters.
"It's actually something that you can feel empowered by, to make some dietary changes that will benefit you for the rest of your life."