Is it OK for a midwife to offer an alternative glucose test?

Dear Honest Midwife,

I am using a midwife and she told me that for the gestational diabetes test I don’t have to drink that special soda, but I can instead eat a meal. She gave me a couple options of meals to eat. What are your thoughts on this?

Thanks!
Lindsay 

Dear Lindsay,

Pregnant woman drinks orange juice

Before I became a midwife myself, I used one for my second baby. I was so relieved that I didn’t have to drink “that drink”! I was instructed to eat a sandwich and drink some juice for my glucose tolerance test. I later adopted this practice as a midwife, telling my clients to bring a special meal (sandwich, piece of fruit, juice) for their test. Some midwives use other test meals, including a fast food pancake breakfast!
 
So, what your midwife is recommending is common among home birth or birth center midwives. Is it scientifically valid as a screening test? Well, no. The meal alternative hasn’t been standardized and studied the way the official screening with the glucose drink has been. Midwives are simply guessing/hoping that the test will give them “good enough” information that they will be able to reassure you that you are low-risk enough to remain in their care.
 
Gestational Diabetes (GD) is a real and serious health issue that can cause complications for both mother and baby during pregnancy, birth, and after the birth. Unfortunately, many midwives don’t even believe that GD exists! They are often happy to let their clients skip the testing altogether. Ask your midwife about GD: is it real? Does she think that testing is important? Does she think that women with GD are still low-risk as long as they eat a good diet? Beware of any midwife who doesn’t have a healthy respect for the risks of GD. She must understand that simply eating a healthy diet does not make a GD client low-risk.
 
Most women tolerate the glucose screening (with the special glucose drink) very well. If you are very concerned about taking the test for some personal reason (for example, some women really cannot tolerate sugary drinks and are convinced they will vomit), there are legitimate alternative ways to screen for GD that you can discuss with a Certified Nurse Midwife or obstetrician. It may be more of a hassle and involve numerous finger sticks, but it will not include an untested and non-standardized meal or drink. 
 
Screening for and diagnosing GD is one of the main ways that prenatal care helps keep modern moms and babies safe. “Cheating” the test by using an unproven method is really only cheating mothers and babies out of safe care.