C-section - Update Dec 20th

[myarnton1]

Hello,
I am probably going to be having a c-section some time next week. I have been told that I cannot keep my pump while having a section because I will be starved for a period of time. Is this true? Has anyone kept their pump on during a section? How did you find recovery time and did you experience an infection? I am quite anxious about this.
TIA

 

[azure]

Tagging @tigger because I think she had a section. There are other ladies here who did too.

I haven't ever had one, but remember they'll have done lots and lots of these, and if it's all planned out then there shouldn't be any problems. Ask them exactly what will happen - what anaesthetic you'll have, how long it'll take to do, ask to see baby, ask when you'll be back with baby, ask how long it'll be before you can be up and about, ask about support with feeding - basically ask lots of questions because knowing helps relax you and you can go through it in your head before the event. Well, that's how I like to do things anyway

When I was in hospital, there were a number of ladies who'd had sections and they were ok

Good luck and all the best for a speedy recovery. XX

 

[myarnton1]

Tagging @tigger because I think she had a section. There are other ladies here who did too.

I haven't ever had one, but remember they'll have done lots and lots of these, and if it's all planned out then there shouldn't be any problems. Ask them exactly what will happen - what anaesthetic you'll have, how long it'll take to do, ask to see baby, ask when you'll be back with baby, ask how long it'll be before you can be up and about, ask about support with feeding - basically ask lots of questions because knowing helps relax you and you can go through it in your head before the event. Well, that's how I like to do things anyway

When I was in hospital, there were a number of ladies who'd had sections and they were ok

Good luck and all the best for a speedy recovery. XX

Thank you @azure i have an appointment with the head diabetes consultant at the hospital where I'll deliver so will be asking lots of questions, although many of my questions were answered today as I knew c-section was being considered.
My main concern is the sliding scale as I had a negative experience in hospital last week while receiving steroids. I was put on a sliding scale because this is the policy in the hospital during steroids as the nurses know how to deal with the sliding scale but they didn't and I was left without insulin for nearly an hour and a half so sugars shot up.
Thanks again for the reply!

 

[azure]

That sounds very stressful. I'd definitely ask who'll be in charge of your sliding scale this time and how long you'll have to have it. My last induction took ages and the anaesthetist kept coming in to check on me in case I ended up needing a section, but nobody mentioned removing my pump.

I found this thread for you:

http://forums.thebump.com/discussion/5362664/insulin-pump-during-labor

But I imagine it will come down to the individual hospital policy unless you push to keep it on.

 

[catapillar]

I have been told that I cannot keep my pump while having a section because I will be starved for a period of time.

If the basal rate on your pump is set correctly, fasting for a while shouldn't make any difference. Hope you have a useful chat with the consultant.

 

[myarnton1]

If the basal rate on your pump is set correctly, fasting for a while shouldn't make any difference. Hope you have a useful chat with the consultant.

@catapillar thats exactly what I thought. I did ask and they said it's because they worry about blood sugars going low. I believe it's just the policy, this is why I have been given a sort of appointment with the consultant to see if he can override this, allowing me to keep my pump. I would only have to fast from approx 12midnight to 11am, for the majority of the time I would be sleeping anyway. Thanks for the reply

 

[myarnton1]

That sounds very stressful. I'd definitely ask who'll be in charge of your sliding scale this time and how long you'll have to have it. My last induction took ages and the anaesthetist kept coming in to check on me in case I ended up needing a section, but nobody mentioned removing my pump.

I found this thread for you:

http://forums.thebump.com/discussion/5362664/insulin-pump-during-labor

But I imagine it will come down to the individual hospital policy unless you push to keep it on.

Thanks @azure that thread is useful! I am pushing to keep my pump on as long as it is feasible which is why I have asked you lovely ladies just in case I was thinking it is and it isn't. I think the reason they are saying I cannot keep my pump on during the section is if something went terribly wrong and I had to be put to sleep which I have gathered doesn't happen often with elective sections

 

[tigger]

@1Sarah1 I think you had cs with a pump on? Mine was an emergency one after my induction failed and I was on injections then so sliding scale was in. Yes it's very scary giving control to someone else even without any bad experiences. If you're having an elective then providing your pump is well out of the way I don’t see why you can't do it. It is effectively the insulin part of the sliding scale. Or if you inject just factor it around the timing. I've had a minor operation under general anaesthetic on injections without a sliding scale.

 

[tigger]

Also push for the earliest slot. Whether you're on a sliding scale or not your sugars are likely to be unpredictable with stress.

 

[azure]

Thanks @azure that thread is useful! I am pushing to keep my pump on as long as it is feasible which is why I have asked you lovely ladies just in case I was thinking it is and it isn't. I think the reason they are saying I cannot keep my pump on during the section is if something went terribly wrong and I had to be put to sleep which I have gathered doesn't happen often with elective sections

Something going terribly wrong is very unlikely If you want to keep your pump on, I can't see why you won't be allowed to. Do check where you should put your site though so you're all prepared.

I had it written I to my birth plan that I wanted to control my diabetes and wanted to keep my pump on unless there was an emergency and that wasn't possible.

You could also maybe have a chat to,your DSN before your appointment as often they're easier to talk to than consultants and may know other ladies who've kept their pump on.

 

[myarnton1]

Thanks @tigger for the reply and useful information! Yes as diabetics we have to have tight control and giving it to someone else is like losing your left arm lol. Did you have to push much to manage your own diabetes during the operation with local anaesthetic?

 

[tigger]

It was general and no. It was all a bit of a **** up really. I think i was meant to be on a sliding scale and done in the morning but they booked me in the afternoon and after i started asking questions got the doctors who pushed me to 1st operation and i injected after to lower a very high bs. It was an erpc to deal with a miscarriage so i wasn't concerned about hypers only hypos.

 

[kitty55]

@myarnton1 I had my baby via emergency section under GA in August and kept my pump on during the procedure. I have had a very bad experience in the past on a sliding scale and had told my consultant that I will not go on a sliding scale under any circumstances unless for some reason my hubby and I weren't able to control my sugars during labour/delivery. She fully supported it.
It is your pregnancy and birth so I'd say you can do whatever you like (I learned that during my pregnancy that in the end it is your decision and whatever doctors suggested I enquired why and if I didn't agree I explained why and was working nicely with everyone together. There was luckily no one dictating to me how to do things). I had written a birth plan and put in that I will stay in complete control of my diabetes (as I am the expert in it after 37 years) together with hubby unless I fall unconscious or we can't control it for some reason and all my team supported me in this decision. The libre made it relatively easy to keep everything in check as well. And funny enough - during my 48hr labour and following section my sugars were nicely in range all the time. Good luck to you! xx

 

[myarnton1]

@myarnton1 I had my baby via emergency section under GA in August and kept my pump on during the procedure. I have had a very bad experience in the past on a sliding scale and had told my consultant that I will not go on a sliding scale under any circumstances unless for some reason my hubby and I weren't able to control my sugars during labour/delivery. She fully supported it.
It is your pregnancy and birth so I'd say you can do whatever you like (I learned that during my pregnancy that in the end it is your decision and whatever doctors suggested I enquired why and if I didn't agree I explained why and was working nicely with everyone together. There was luckily no one dictating to me how to do things). I had written a birth plan and put in that I will stay in complete control of my diabetes (as I am the expert in it after 37 years) together with hubby unless I fall unconscious or we can't control it for some reason and all my team supported me in this decision. The libre made it relatively easy to keep everything in check as well. And funny enough - during my 48hr labour and following section my sugars were nicely in range all the time. Good luck to you! xx

Thank you @kitty55. I have spoken to the head diabetes consultant and unfortunately it is policy that I go on a sliding scale during the actual surgery. But he's agreed that I won't need it when being starved and it can come off as soon as I have my first meal after surgery so I am quite pleased as I will not be on it for long.
It is true that we are the experts in our own diabetes management and much better than a machine that midwives (some that are clueless) are trying to work out

 

[kitty55]

Thank you @kitty55. I have spoken to the head diabetes consultant and unfortunately it is policy that I go on a sliding scale during the actual surgery. But he's agreed that I won't need it when being starved and it can come off as soon as I have my first meal after surgery so I am quite pleased as I will not be on it for long.
It is true that we are the experts in our own diabetes management and much better than a machine that midwives (some that are clueless) are trying to work out

This was the issue I had when I had been admitted with DKA cos my pump (unbeknown to me) stopped working during pregnancy. In hospital they had a piece of paper that told them which dose of insulin to give for which BS. And it went from 1u to 2u to 3u per hour and nowhere near the small dose increments we can do with our pumps. And I explained and they didn't get it and told me they had to follow the protocol ..that was when I decided no sliding scale for me.
At least you won't be on it for long as the section as such obviously won't take long. Good luck again and let us know how you get on

 

[myarnton1]

Just a question to all, I didn't want to make another thread.. Are unexplained low BS a sign of placenta failure or is it that low BS cause placenta failure? I always thought it was a sign that your placenta is failing but a midwife has now said that it causes it to start failing

 

[azure]

Just a question to all, I didn't want to make another thread.. Are unexplained low BS a sign of placenta failure or is it that low BS cause placenta failure? I always thought it was a sign that your placenta is failing but a midwife has now said that it causes it to start failing

I'm not a medical person but my consultant told me that hypos were a sign of a failing placenta not a cause of it.

As I understand it, if the placenta starts to fail, the placental hormones then reduce and that causes the normal insulin resistance of pregnancy to,suddenly decrease, thus causing hypos.

 

[myarnton1]

I'm not a medical person but my consultant told me that hypos were a sign of a failing placenta not a cause of it.

As I understand it, if the placenta starts to fail, the placental hormones then reduce and that causes the normal insulin resistance of pregnancy to,suddenly decrease, thus causing hypos.

Thanks @azure that was exactly my understanding too! I'm in hospital now as BS have been low the last few days and hypos seem to be harder to treat (needing more lucozade for hypos). But of course no one here has a clue what I'm talking about. Hopefully the consultants in the morning will understand and find out if the hypos are due to placenta failure or not

 

[azure]

Tell them what you and I know. Explain the process like I did above, so they understand. Ask if there's a DSN available that they could speak to,perhaps?

Keep calm - that will do both you and baby good. You're in the right place

Test your blood sugar lots and make sure you have plenty of glucose and snacks near you {{hugs}} XX

Edited to add that not every woman with hypos has placental issues. There was a lady here who had lows but this was just put down to one of those things unique to her, so don't panic. Hypos are a sign that a check up is a good idea, but they don't definitely mean placental,deterioration.

 

[sekv]

I had significant lows towards the end from around week 34 and went into hospital to get checked out. I really struggled with getting the midwives to understand that I was worried as to why I was having hypos not the actual hypos themselves. I eventually managed to see a consultant the next day and she understood and carried out a scan to check blood flow from the placenta.
My insulin needs did drop to prepregnancy rates and I, like you, was incredibly worried. My diabetic consultant reassured me that this does happen with some people. He said it's not common but it's not unheard of either. I went on for traces on the baby and scans on the placenta every other day and the decision was to bring forward the induction from 38 to 37 weeks just to be safe. On delivery, my placenta was perfectly healthy as was my beautiful baby boy.
I hope that helps. I know how terrifying it is when all literature says your insulin needs go up and if not there are placenta issues. Keep insisting for an ultrasound to check placenta blood flow. The way my husband explained our worries to the midwives was that imagine someone comes in with a bleeding arm (drop in insulin needs).. they know how to stop the bleeding (jelly babies etc) but want to know why the bleeding happened in the first place (placenta issues?).
Hope everything is okay xx