Having now gone through this for the 3rd time (including being readmitted currently yet again for jaundice) i thought this might be helpful for those who haven't yet had this experience. Although these are depressing the key thing to bear in mind is the importance of having partner/family there to support you so you can concentrate on recovery and not hypo.
Post delivery my sugars go all over the place. They don't instantly return to pre pregnancy and breastfeeding is like constant exercising so has huge hypo potential. Also my hypo symptoms are very similar to a lot of things you get in the newborn stage -intense tiredness, shakiness, muddled thinking and because of the feeding i find that hypos can come on very suddenly particularly in my sleep.
If you are on a post natal or neonatal ward they will have little knowledge of type 1.
These are some of the things I've encountered. Most are from my 1st child-we got considerably better at making a fuss and standing ground after that.
1. Your diabetes will have gone away. You can't have hypos
I have type 1 not GD. I'm sure the doctors would love it if the cure was this simple.
2. I know all about diabetics. She isn't having a hypo she's just being difficult.
Said while meter was reading 3 and i ws eating glucose sweets and because i wouldn't feed my baby for fear of dropping him. Dh after trying to explain i had type 1 and just receiving a repeat of 1st phrase told her not to return.
3. So if you have a hypo we give you insulin.
Yes seriously. From a nurse, not even a midwife. After explaining about sudden hypos developing into comas. My response "that would give me brain damage"
4. Would you like to stay in hospital to improve your control?
An odd belief of obs and endos that staying in a place where you have no control over your food or when it comes and suffer all sorts of stress improves your numbers. Usually if you explain the first bit to them they revise their opinions and discharge you.
5. On neonatal /paeds- you can't leave the ward and we don't feed the parent. Your hypo is not our concern.
The only solution I've found to this one is friends/family bringing food. It's a catch 22 and really not great particularly with a sick toddler who gets very upset when you leave to go to the toilet.
Hi Tigger
It's definitely unbelievable.
I had a bad time with my dd now just 2 and diagnosed type1 a few weeks ago.
Anyway I was post emergency section and she was in special care. I had pre eclampsia and was quite ill. I didn't know much about dramatic sugar drops and couldn't move after section. I said to the midwife that I may need to buzz as I couldn't move to get my lucozade and got told not to buzz as they were busy!!! I actually complained about this along with a couple of other things. I'm type1 and have been for 35yrs -not something that I don't control on a daily basis!! The complaint was taken quite seriously and I was told it would be addressed....
Second time around with my twins I was a lot more prepared-test kit, lucozade etc right where I could get to them and one really good night midwife who woke me up to test and good job she did as the tiredness and post op just knocks me out.
I'm paranoid about being in hospital they may have a general awareness of diabetes but they don't understand it. Like you say it's not like gestational that disappears. And they are obsessed with the sliding scale too. I kept my pump on through both my sections as I'm a control freak -I just got the doctor to write up a glucose prescription in case of hypo as I was nil by mouth before section.
My twins are 3m and my sugars/insulin still not back to pre pregnancy as the bf/expressing defo does impact. And obviously all the hormones.
With my daughter who I was in hospital for a week with early this month I pushed to come home as she wasn't eating and managing my diabetes is a nightmare. There is no way you can get control in hospital. In my experience.
There is no follow up from a mum perspective post natal I personally think this should be factored in. I might check the nice guidance whenever I get a second as think this is a gap and hopefully can mean a better experience for type1s!!
Hi @1Sarah1 it's awful and definitely a gap that needs to be addressed. I was meant to be on a sliding scale in labour but the midwife kept on saying i was at 3 cm and 4cm was active labour. Trust me it was active enough so i had already set my pump to 50% of basal and managed it that way. When they finally decided i was in active labour we had an argument about the insulin they wanted to use as i have a bad reaction to synthetic. So in between contractions i argued this point suggested alternatives that were possible (but not on early morning xmas day it appeared ) and eventually they let me use the pump.
Yes they completely don't understand it. Trying to explain to someone that if you hypo the effects can be more rapid than an hour and that if you could communicate you could probably treat it is deeply frustrating.
Also the advice on handling type 1 post natally isn't there in the diabetes team either in my experience. I received the reassuring advice with my 1st not to worry about my numbers and just check for ketones from the consultant but when i wanted to avoid the night hypos and get better control the dsn's advice was test every 2 hrs starting from midnight. I explained i was breastfeeding a baby on a 2 hr schedule (that means 2 hrs from the start of each feed to the beginning of the next) and was testing before and after each feed. This it seemed was not sufficient. She also didn't say what to do with these results as i don't use an mdi regime. That was the last time i tried asking a dsn for advice.
I'm fully in support of doing something to change the status quo but i'm not entirely sure what would help most.
I hsven't been through this, but what i'd like (if it does get addressed) is first of all a leaflet explaining ideal treatment after birth and so what I should be trying to get in place and agreed beforehand. Then I'd like tips on what to do if the care team isn't playing ball (like the simple thing of you having your Lucozade within reach).
Once there is a best practice leaflet then diabetes and people know what we are trying to get, then diabetes organisations could start campaigning for it to become standard practice and for diabtes teams to have more awareness.
@letsy My OB wrote notes about management of my diabetes in my notes - basically, that I'd be doing it myself. I think it helps if your OB can do something similar.
I didn't have any problem at all about keeping Lucozade and food nearby post-delivery or during labour. It would have been nice if there was a routine for just asking if I was ok in the hours after delivery. My DSN popped in afterwards and during labour, which was fantastic, but the first 24 hours after birth are a bit exhausting and sometimes wards are busy. I think anyone with an 'extra' medical condition should be checked regularly but not in a fussing way.
When I was first admitted to delivery, one midwife got quite panicky when I had a blood sugar of 3.5 (long walk from the car park!) and tried to say I needed Glucagon even though I was happily eating some glucose and chatting normally!
In general, I think all hospital staff should have refresher courses on diabetes. The level of knowledge seems to vary enormously - as shown above.
Hi, tbh I had so much care when I had my daughter( but it was far from straight forward) I will never forget Margaret the senior midwife, who was very caring and understanding. I couldn't fault the hospital and my scar healed perfectly and it's barely visible, that was 15 years ago.
My experience of 3 births in just under 9 years has been:
1. The more straightforward the birth the less care you and the baby will receive. You are assessed on an obstetric standard only. Therefore my last birth which was thankfully a standard vaginal delivery i had to keep on sending my husband and then my mother to try and get them to do theblood sugar test on the baby as they weren't at all concerned.
2. The level of resources in the nhs has gone down massively in this time and post natal was stretched to begin with.
3. It's always best if you can take over your own control as you will manage best but depending on how the birth goes and what state you are in when you get sent to post natal you may have trouble moving.
St Marys but point 2 has been said to me about the royal free and uch by non-diabetic mothers. I've been readmitted twice now to the royal free and 3 holds for there as well. I don't imagine that anywhere is much better. The only advantage of having type 1 (at st marys and i assume elsewhere ) is they keep you in a minimum of 24 hrs with a normal delivery to monitor the baby as opposed to discharging you after 6 hrs. I've no idea how anyone manages to walk 6 hrs after birth.
xx
