Labour Advice!

[StephS]

Hi everyone,

I am new to the forum but was just after a bit of practical experience from other diabetic mum's... I am currently 27 weeks pregnant with my first baby and have type 1 diabetes. I know (well hope) that these kind of things will be discussed with me at some point with the professionals, but I am starting to feel a little overwhelmed and slightly anxious at the thought of what my labor is going to be like as a diabetic.

I am also starting to wonder what 'birthing plan' options are going to be available to me? I have other friends and family who have had babies and are all giving advice such as 'water births are the best option' etc. but I don't even know if a water birth would be an option for me?

I know everyone is different so it may be hard to say what are the best options for me personally but I would love to hear different stories of what the experience has been like for others and what is involved in it, who took the drugs, who didn't, how much did the babies weigh etc...

Also, my due date is 15th August, but I know there's a chance I could be induced from 38 weeks (which will be 2nd August), but I am supposed to be a bridesmaid for one of my oldest friends on 5th September. She doesn't really have anyone else and really want to do all I can for her on the day. Again, I've had varying advice from different people on this from "you'll be fine - I had a C-Section and went to a wedding 2 weeks later" to "just tell her now you can't be a bridesmaid, and if you have to have a C-Section then you won't be there" so if there's anyone who could give me a realistic view on this aspect too that would be fab and if there will be anything else I need to consider here from a diabetes point of view...

Any help or pointers or advice anyone can give would be greatly appreciated and I apologise for my massive long post!

Thanks!

Steph x

 

[JessP]

Hi Steph,
firstly huge congratulations on your pregnancy. How's it been going?
I am a type 1 on a pump and had my first baby in February. My pregnancy was relatively straight forwards (as much as they can be with diabetes), with an HbA1c of about 5.0 throughout, until 37 weeks when I had reduced movements so they induced me. I was given the hormone pessary on the Wednesday evening and began contracting about 2 hours later. Unfortunately I contracted for 20 hours with the pessary in but it didn't make me dilate beyond 1cm. Thankfully my waters broke on the Thursday evening (by themselves) at about 9pm and then my contractions really picked up in strength. I was taken around to the delivery suite an hour later and just after midnight my gorgeous daughter was born by natural delivery. She weighed 6lb12oz and thankfully didn't have any problems with hypos. During my labour I managed my blood sugars myself until after my waters broke when I then went into a hypo I couldn't get out of (awful nausea with the contractions was stopping me eating enough sugar) so they put me on a sliding scale for the rest of my labour. We were both discharged home the following day.

With regards to the wedding, is it a long way away from where you live? I was out and about from the day after we got home from hospital but was absolutely shattered and not sure how a wedding would have been. Having said that I can understand it must be really tough if it's so important to your friend. Can you say to her that you plan to come but things will need to be flexible depending on when you deliver, how you deliver and how you and the baby are doing?

Hope that's helpful. Good luck with the rest of your pregnancy.
Jess
x

 

[StephS]

Hi Jess,

Thanks for your reply! So far the pregnancy has been going ok. Been lucky enough not to have any sickness or anything and my sugars have been relatively stable considering... Just had the odd spate of being a bit high every so often with the odd hypo but told that's normal and have just increased my insulin doses. I know this is possibly a really thick question, but I've noticed a few people in the forum mention about this sliding scale, what is it? It's not something I've heard of before... Do they have a target sugar level for you to stick at during labor? Or does it not matter too much so long as you're not hypoing?

The wedding is taking place at a venue which is about 45 mins - an hour away from where I live. I was supposed to be staying over the night before with her but have said that I can't now. She is really understanding but I just feel sooooo bad as she was an amazing bridesmaid to me last year and know how much it will mean to her to have me there as one. She also has zero experience of being around new borns so I'm not too sure she quite realises how much work they are. I have told her I will be doing everything I can to be there for as long as I can but it really is hard for me to guarantee anything until I know what happens.

Your baby girl is super cute by the way! That picture is gorgeous!

Thanks again for the advice.

Steph x

 

[JessP]

HI Steph,
a sliding scale is where you are on in intravenous infusion with insulin and dextrose going in at different concentrations depending on what your blood sugar is so they can control your sugars. When you're in labour they want you to keep your sugars between 4-7 as a BM of higher than 7 increases the risk of the baby having hypos after they are born and obviously a hypo isn't ideal for you.
Good luck over the next few months and deciding what to do with the wedding!
x

 

[Robinredbreast]

Congratulations, I hope your pregnancy continues to go well. I had my teen 14 years ago and the time has gone far too quickly.

Good luck and all the best for a safe and a healthy delivery.

RRB x

 

[StephS]

Ah right! I have heard of the IV's, thanks for explaining Jess! x

 

[ealingr]

In terms of your delivery date, I understand that most hospitals have a policy of inducing type 1 diabetics at either 38 or 39 weeks so I'd suggest asking your consultant at your next appointment what the policy is for your hospital. That will at least give you a date to plan towards, although the induction could take a few days.

From a birth plan perspective, I didn't make a formal birth plan as such, but did decide in advance (after talking through the options with the medical team) that if I had to have the hormone drip I would also have an epidural. I also agreed with my diabetic consultant that I would use my insulin pump until I went into active labour, then move onto the sliding scale until delivery, and go back on the insulin pump (at pre-pregnancy rates less 10%, which I'd pre-programmed into my pump) as soon as possible after delivering. This was all documented in my notes so the team looking after me on the day knew what was happening.

My experience of birth was planned induction, but when I was put on the hormone drip it started to affect my baby's heart rate so I ended up having an emergency c-section. There was a lot of monitoring throughout, so I'm not sure a water birth would have been a possibility, but I couldn't speak more highly of the team looking after me - the care was fantastic - and they did a great job of making me feel like a real person, despite the medicalised environment. One thing I would say is that they ask you for your total daily insulin when they're setting up the sliding scale - I was careful to only give them my basal rate for their calculations (rather than my total daily rate, as I wasn't eating during labour) so you might just want to be mindful of that. The sliding scale worked really well for me - very stable levels throughout.

It's really lovely that you want to support your friend at her wedding. I don't think there'll be a problem with you attending, but in your position I would probably want to make sure that I had a room I could retire to during the day if I needed to rest. It may also be worth just having a frank discussion with your friend about the fact that you won't know until closer to the time how you feel - if you end up having an infection or a particularly challenging baby then you might not be able to support her as much as you'd like. Perhaps you can agree a backup plan with her so that there is someone who can step in if you aren't able to do as much as you'd like, and then maybe a week before the wedding decide what will happen? That way, she knows you really want to be there for her, but also has a contingency so she doesn't need to stress/you don't need to feel guilty if you can't do everything?

My final tip would be to be open to plans changing last minute. My little girl was measuring around average throughout my pregnancy and up to 36 weeks, so I had an induction scheduled for 39 weeks. She then had a sudden dramatic growth spurt which showed up in a 38 week scan, which meant my induction was brought forward. She arrived healthy and well (weighing 9lb 5oz) at just over 38.5 weeks.

Good luck with it all!