Hi ladies!
I'm preparing to have my baby at my local hospital/birthing center with a CNM in Aug.  I had homebirths for my last two and wanted a little clarification on some of the tests I can expect to be different.  For instance, is it just me, or is the Glucose Tolerance Test a bit redundant? With my homebirth midwife, she tested my urine often and could tell if I was having blood sugar issues.  Any reason the urine test shouldn't be sufficient?  I would be fine to do the GTT if any issues were detected, but if they aren't there, why do it?  Or am I missing something? I'd just like to have some info to bring with me, the CNM's there have had to become a little more medically oriented since the BC attached to the hospital.  :-(

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I considered this with my last pregnancy (my first planned home birth and first experience with a midwife instead of an OB). I decided not to do the GTT because I was having no symptoms and all of my urinalysis were normal. The nurse practitioner at my OB's office still gave me a hard time about my choice and tried to talk me into it, but I didn't feel it was needed. My home birth midwife supported my decision and said that we would have caught something in the prenatal visits if there were something wrong.
"The ADA definition of low risk is: age < 25 years; normal body weight; no family history of diabetes; and ethnicity other than African American, Hispanic American, or Native American."

Hey that's me! Thanks!
Is it possible that it is a liability issue for them? It seems to me you SHOULD be able to sign a waiver and decline the test, but it might go against policy where you are delivering.

Purely out of curiosity, why are you choosing a birth center birth for you third?
Straight up money! :-). I was on Medicaid for my first two children, and they covered all but $1,000 which we could pay over the course of the pregnancy. That wasn't too much of a financial strain. But recently, we've come to some new convictions regarding state and government funded medical care, and we couldn't in good conscience remain on it. So now I'm on Cigna which basically doesn't acknowledge that homebirth exists.
I feel fairly comfortable with this birthing center. I've seen my mom give birth there twice, my SIL 3 times, a friend twice, and supported another friend through a horrific emergency C-sec, not to mention, I transferred there with my first birth. Their C-section rate is 20.1%, which is under the state average (they are attached to the hospital, right down the hall from the one OR :-).
A lot of the reasons I didn't want to give birth there to begin with, was because I wanted to try a home birth, not because I didn't like and respect the staff and the midwives. So, I'm a little older, I've done this twice, I think I can hold my own without being a jerk a little better. And it seems this is the way we need to go this time, so I'll rest in what God's doing.
Emily, congrats on taking charge of your birth :) I'm curious how you got Medicaid to pay for part of your home birth. My understanding is that they won't cover it at all.
In VT, where I live, they pay for prenatal care with any kind of midwife, LM, CNM, or CPM. So, what they didn't cover was the actual home birth, which I paid out of pocket for, the $1,000. But they covered the rest of the midwifery care, all told $3,100 for my particular midwife. Honestly, I had no dealings with them at all, I just told the midwife I was interviewing what insurance I had and she told me what would be covered. Maybe she knew a way around the red tape?

The cigna plan I have on the other hand only covers CNM's affiliated with a hospital for prenatal and birth, and I can find no CNM's in Vermont who do home births
That's good to know :) Thanks for the info.
Emily--

What Cigna plan are you on? What state are you in? I have Cigna, and although I am fighting with them now on the network status of my MW on the new plan that took effect in 2010, in my state on my plan they cover midwives and birthing centers. It might be worth looking into...
I live in VT. When I called Cigna about my husbands plan, they told me they only covered CNM's who were practicing within a hospital setting. I honestly wish I could have seen the guys face when I asked him about homebirth. It was incomprehensible to him.
I am in TX and my Cigna plan covers CNM (not CPM's though) and also covers Birthing Centers--by state law they cannot exclude only HB/BC CNM, ins companies don't have to cover CNM but if they do they cannot disqualify only HB/BC CNM--its all or nothing. There is a CNM in my city that works out of a BC and does HB. Although neither are in my network. I had to force Cigna to cover them since they didn't have any in network CNM or BC within 75 miles of my house. They did agree to cover them as in network (called GAP coverage) since it is required by my state's laws. They then proceeded to decline every claim since "the provider is not in network." I have had to have each claim reprocessed, but eventually they have paid every one.

When I called to get the exception and told the guy I needed a CNM that does Out of Hospital Births and they offered none on my network close to my house he kept giving me the name of CNMs on my plan--but they all worked w/Ob's & delivered only at hospitals. It took me several attempts to get him to understand that you don't HAVE to have a baby in a hospital. I would have loved to have seen his face too when it finally clicked that I was having my baby at my house. I told him over and over "I want a home birth" Finally he said "you mean like at your house? can you do that?" I just laughed.
My homebirth midwife did a glucose tolerance test after having me eat a special breakfast. I think I had to eat toast, eggs, juice and milk and then she tested my blood. We actually found out that I was hypoglycemic which helped me eat at the right times so my blood sugar wouldn't get too low. But anyway, can they do a natural one instead of the sugar water? Maybe you can suggest it or it sounds like it may not be necessary. I would just decline the test, you should have the right to do that.
I don't think the research we have supports routine testing with the GTT, but I think most doctors do it just to be safe. I don't think it hurts you to have it, but if your low risk, it may not be needed. Like many things in the research, it's still up in the air. I opted not to do it with my last birth with a family practice doc, and she was very supportive of me(I think she didn't have it done with her pregnancies either),

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