Labour on Self Injections vs Sliding Scale

[Emmah89]

Hi all,

Just turned 27 weeks pregnant and researching all I can about labour with T1 (had it for nearly 16 yrs and is generally well controlled) this is my first pregnancy and I’m not too thrilled about the prospect of induction so I’m leaning towards declining that offer and see what the growth scans are saying nearer the time.

My other concern is labour and delivery and the “insulin/glucose drip” they want to put me on. I cannot stand cannulas and I think it will stress me more having that in my hand/arm than trying to control it myself, but I don’t use a pump just cartridge pens for both basal and bolus. I’ve seen that people have had successful deliveries with pumps on but nothing much about injections…

Does anyone have any experience of labour and delivery self injecting and not on a drip or a pump? I know I’ll be busy doing other things so my mind won’t be fully on my levels but I really don’t want the cannula!!

Any advice?

Thanks

 

[becca59]

I delivered 40 years ago pre my diabetes so do not have an insight into the management. The birth was straight forward, I managed on gas and air and after a terrible pregnancy quite enjoyed the birth. However, I know for a fact that my brain would not have coped with managing insulin in the later stages. The actual producing of this wonderful human being takes all your concentration. I would take all the help they want to give you. If a cannula is in already it can be used in all eventualities and may need to be in for other reasons.
Enjoy the rest of your pregnancy and hope all goes well.

 

[Charliem035]

Hi Emmah,

Please let me know how you get on - I'm really wanting the same thing. Currently 24 weeks with baby number two (type one diabetic for 30+ years, well controlled, also just on injections). Birth with baby one a year ago went really well, super healthy and an appropriate 5lb 15, but the sliding scale was presented to me as obligatory and I was in labour for 14+ hours, even after my waters were broken and the oxytocin drip (on day 3 of my induction!). There were times I'd have killed for a cup of tea during the labour! I'm planning to say no this time round and would love to hear how you get on.

From all the reading I've done, you can 100% decline to have the sliding scale. They may talk to you like you don't have options (and frustratingly sometimes as if you are stupid), but you absolutely do, and those choices are really important.

Obviously, completely your choice but I'd also say that if it's all going well, leave the induction as late as seems sensible to you. I started mine at 37 weeks and he definitely took his time! Not sure if related, but I'll also be pushing back to at least 38 weeks this time around.

Good luck - please let me know how it all goes for you.

 

[Samee1985]

Hi all,

Just turned 27 weeks pregnant and researching all I can about labour with T1 (had it for nearly 16 yrs and is generally well controlled) this is my first pregnancy and I’m not too thrilled about the prospect of induction so I’m leaning towards declining that offer and see what the growth scans are saying nearer the time.

My other concern is labour and delivery and the “insulin/glucose drip” they want to put me on. I cannot stand cannulas and I think it will stress me more having that in my hand/arm than trying to control it myself, but I don’t use a pump just cartridge pens for both basal and bolus. I’ve seen that people have had successful deliveries with pumps on but nothing much about injections…

Does anyone have any experience of labour and delivery self injecting and not on a drip or a pump? I know I’ll be busy doing other things so my mind won’t be fully on my levels but I really don’t want the cannula!!

Any advice?

Thanks

Hey! Congratulations on your happy news for starters! What a blessing.

Yes I had 3 babies in 2012, 2014 and 2015. I had gestational diabetes with all of them. I was also induced with all of them. The reason inductions are more necessary is because the placenta starts to break down earlier when you are on insulin injections. My last baby was born at 37 weeks exactly because of this. So although it is super scary.... please follow medical advice when it comes to inductions. With regards to the sliding scale. I would say it depends entirely on the hospital you are with and the medical team. It was forced on me with the first 2 labours. They just took over and did the sliding scale and as I was already on induction drugs through the canula, it was already inserted. I can promise you though... I barely noticed it. I actually noticed it more after the birth. During the birth I was solely focused on the contractions. But if you are set against having a cannula I would put this clearly in your birth plan and discuss at length with your OBGYN and midwife. Also stick up for what you want... it is YOUR birth... not theirs. On the last one they tried to put the cannula in as I was pushing the baby out... it was ridiculous. There was no need for the cannula at all. All of my babies were born healthy, but they all had low BSL for the first few days. I want to also warn you because they successfully forced me onto formula feeding with my first. Do not let them pressure you into it, unless it is something you want to do. I found that there were lots of people giving me advice, but not a lot of people actually listening. SO MAKE SURE THEY HEAR WHAT YOU WANT! Its super important for you and your baby. I found the book, Expecting a baby? By the One Born Every Minute show... super helpful (you can buy copies on amazon!). It took me through all of my options. But you do need to make it clear to your OBGYN what you want and you need to write a plan, but it does need to be safe for you and for baby. So with regards to the induction, listen to what they say. They tried to force me to take aspirin and I refused because it can cause complications in pre-term labours, it was my choice and was the right choice for me. They took away all my options for the birth because I did not have anyone standing up for me and what I want. So if you do get induced, ask for pessaries only, ask for advice on natural ways to induce birth, but say that you do not want the induction drugs via cannula unless there is an issue (ie slow labour causing decelerated heartbeats), also insist that you handle yoru sliding scale, independently with the help of your "labour coach" whoever that may be.... but make sure your partner, birth coach, mother, whoever it is (and have back ups!!) knows exactly what you want and can verbalise that for you!

I can tell you now... the NHS procedures make them push the sliding scale rubbish on you, but as long as you have a birthing coach that can inject you and test you and keep an eye on your levels and keep a record.... it is no different to what they do and you don't need the cannula in for that! But you do have to seek consent from your hospital and your OBGYN for this. Its a pain in the bottom. The only labour I felt comfortable was my last and that's because they didnt believe I was in labour until I was 8cms... and then I was pushing her out when I got to the labour ward pmsl!

I am not telling this to scare you and I really hope it hasn't done that, but I wanted to be honest. For some reason, being diabetic in England, means having all your rights terminated at the door. It is messed up and I personally do not understand why they do it! But get knowledgeable and get strong and maybe you will have the birth you desire!

Good Luck hun!

 

[Sarahc1984]

Hi all,

Just turned 27 weeks pregnant and researching all I can about labour with T1 (had it for nearly 16 yrs and is generally well controlled) this is my first pregnancy and I’m not too thrilled about the prospect of induction so I’m leaning towards declining that offer and see what the growth scans are saying nearer the time.

My other concern is labour and delivery and the “insulin/glucose drip” they want to put me on. I cannot stand cannulas and I think it will stress me more having that in my hand/arm than trying to control it myself, but I don’t use a pump just cartridge pens for both basal and bolus. I’ve seen that people have had successful deliveries with pumps on but nothing much about injections…

Does anyone have any experience of labour and delivery self injecting and not on a drip or a pump? I know I’ll be busy doing other things so my mind won’t be fully on my levels but I really don’t want the cannula!!

Any advice?

Thanks

Hi there, just wondering what happened in the end with your labour. Did you go on the sliding scale/ induction route? Im 36 weeks pregnant now and desperate to hear other type 1's experiences! Thanks

 

[Emmah89]

Update:

I refused induction until the last week of my pregnancy (I wasn’t pressured but in my mind I was happy to be induced within the last week or so) I was planned for induction on 39+3 and the best option was presented as the cervical ripening balloon (non hormonal so I was pleased with that as I had said I didn’t want hormones!) if the balloon hadn’t worked within 24 hours the pessary would be the next step. Luckily it worked! It was uncomfortable to say the least but I’m glad I went with that option. My waters were broken the next day and my contractions started strong straight away. Luckily no need for a hormone drip either!

The consultant came to see me right before they broke my waters and I said I didn’t want the cannula, hormones or sliding scale and he agreed that we could hold off and see how we got on. As I didn’t need the hormone drip to start labour they held off on the cannula, also managed to get in the water bath so couldn’t have an epidural at that time which also meant no need for a cannula. (I actually managed the whole delivery with no pain relief as I vomited after the gas and air! I had one codeine pill about 6 hours before I delivered because I wasn’t even thinking about getting out of the bath to have anything else) I delivered out of the water about 1 hour after I got out. My blood sugar was stable the whole labour and only at the last minute (literally about 15 mins before she arrived) I had a blood sugar of 10 and I took a shot of insulin myself, feet in the stirrups and everything!

I had a really good experience of labour and delivery, even the induction. I would 100% do it the same way again and stand by my decisions. I have to say I felt in no way pressured to have anything done on anything other than my terms. The midwives were happy to let me manage my blood sugars myself because I’m the expert. I cannot praise them enough for everything, after baby was born they gave us lots of time and support showing us how to change her, dress her, feed her etc. and they were all so patient. (I had wanted to breast feed but she had low blood sugar at birth and struggled to keep any food down so ended up on formula, I want to stress that no way do I blame the nurses or drs for that path as baby was not feeding and that was the right decision for her to make sure her sugars came up and she was able to feed properly, and keep it down)

When I went into labour and the decision was I could manage my own blood sugar the nurse said that she would have to prick my finger every 2 hours for her records (I did have a Dexcom sensor on but they said they needed their own test) I was happy to oblige if that meant no sliding scale! Word of warning, remember I said I’d taken a shot of insulin right before delivery? I think that contributed to baby’s blood sugar levels so if you can hold off on taking any insulin I would recommend it but it totally depends on the individual circumstances.

I hadn’t eaten in about 10 hours by the time I delivered and usually I am eating all the time but I didn’t even notice until after birth how hungry I was! I sipped Lucozade and water throughout labour.

I would absolutely do the whole thing again the same way! Hopefully this helps any of you in some way, any questions for me personally I am happy to respond, I know others have different experiences but mine was as close to perfect as I could have asked for

Good luck everyone!

 

[Sarahc1984]

Ah wow, thank you so much for your detailed and speedy response- much appreciated! Really glad it all worked out so well and was very positive, go you! Nice to hear that you didn't feel forced to do anything and that you managed to stay off sliding scale and get in the water too. I want to give birth in water at the birth centre but they've turned me down as they are adamant that i need the continuos fetal monitoring/ sliding scale/ induction otherwise something awful will happen, and the birth centre is only for 'low risk' pregnancies. I know they have my best interest at heart but they also seem to forget that it's my body/ my choice and don't seem to like to listen. They even threatenend to go legal on me
Anyway, I look forward to updating you on what happens in a few weeks time! x

 

[Emmah89]

That’s so disappointing that they say you can’t get in the water, i was on continuous monitoring whilst in the water with the fetal monitors strapped to me but they were waterproof and wireless.

Induction shouldn’t be a reason for you not to be in the water and I’d absolutely fight your case to get in the water! I loved it and it was really good for when the contractions were getting stronger and helped with the pain.

Luckily for me the birth centre is in the hospital and most rooms had baths so I was in the right place. But if you decide on induction then you can choose where you’d like to give birth even if it’s not the nearest hospital so might be worth checking some other local hospitals for their facilities?

Good luck, wherever and whenever I hope it’s a great experience for you!