The Big Day: Delivering a Baby When You Have Type 1 Diabetes
It’s almost time to give birth—within hours, you may be seeing and holding your baby! Even if you have discussed your birth plan with your OB/GYN and endocrinologist, there is a possibility that things may not exactly happen as per your plan. There is a chance that you may require induced labor or delivery by cesarean section (C-section). Some high-risk obstetricians prefer to deliver the babies of women with type 1 diabetes (T1D) prior to their due date as concerns about macrosomia (when a baby is of larger-than-average size), fetal health or maternal health are not uncommon.
Interestingly, scheduling the birth of your baby can be an unexpected source of stress relief because you will no longer wonder when the baby will arrive. Furthermore, as a pregnant woman with type 1 diabetes, you’ll likely have the advantage of not going past your due date (and feeling uncomfortably huge), unlike many without the disease.
However, being a pregnant woman with type 1 diabetes does not mean that you have no say in the matter, or that you will be forced to have a C-section. The arrival of your child depends on you, your baby’s health and your medical team. Be sure to talk to your doctor about your preferences and desires and discuss available options for the birth of your child.
What to Expect During a Natural (Vaginal) Birth
If labor is induced, you will arrive at the hospital at a predetermined time (most likely a weekday morning). You are probably anxious, nervous and excited all at once. You will be placed in a birthing room and set up on an IV of contraction-inducing medication (such as Pitocin), a suppository medication or a Foley catheter. Depending on what medication you are on, you may start to feel some pain as the contractions begin.
The amount of pain you feel after the contraction medication is dependent on several factors, such as how quickly and how far your cervix dilates and how high your pain threshold is. Some women choose to get an epidural (an anesthetic that numbs below the waist) early on, while others wait longer. This is purely a personal preference. If you choose to hold off, be sure to ask your physician how long you can wait. Medically, there is a definite cutoff time in the birthing process, after which you can no longer receive an epidural.
Hospitals often have limits on the number of people who can be in the birthing room, so consider checking with the hospital about its policies in advance and plan ahead. Also consider having your entertainment options easily available that can keep you engaged and distracted while you wait for your baby. The labor could last for as long as a couple of days, or it could be over in as quickly as one hour. Since you can’t predict how fast your labor will progress, come prepared with your favorite books, magazines, television shows, music and games.
How Giving Birth Differs When You Have type 1 diabetes
Your birth experience will be similar to that of other expectant mothers who do not have type 1 diabetes in a lot of ways. However, one main difference is that your blood-sugar level will be monitored very closely throughout the entire process. If you are not using a continuous glucose monitor (CGM), this means you may need to endure a lot of finger pricks (but, rest assured, it is all for a very good reason).
This kind of close monitoring is required to ensure that your blood sugars remain within the target range as the physical and emotional stress of labor can potentially increase your blood sugar levels. If you do experience a high or a low during the birthing process, your medical team will give you the necessary amount of insulin or glucose needed to return your blood sugar to the target range.
If, in a worst case scenario, you were to experience a complication during your vaginal birth that would require a C-section, your consumption of food or drink may further complicate the delivery of your baby. Which is why it is important that blood sugar levels are closely monitored during labor.
As your baby’s arrival grows closer and your cervix dilates, you will be asked to push more and more frequently. If and when someone on the healthcare team announces that the baby’s head has crowned, you are about to see your baby! Although it differs slightly from woman to woman, your insulin requirements will drop dramatically either just before or immediately after you give birth. In fact, many women are able to return to their pre-pregnancy insulin requirements at this time. This varies from women to women and is dependent on several factors, so your experience may differ from other women with T1D.
What to Expect During a C-section
For any pregnant woman preparing to give birth, there are times when the baby is breech (meaning the baby is positioned head-up in the woman’s uterus, so the feet are pointed toward the birth canal) or the mother experiences unexpected health issues. In these cases, an emergency C-section may take place to keep the mother and baby as safe as possible.
While the C-section can potentially be a last minute surprise addition to the birth plan, a woman with type 1 diabetes may need to plan and be prepared for a C-section in advance. There are a number of reasons that you may include a C-section in your birth plan, such as the size of your baby, retinopathy or kidney issues. An early delivery may also be scheduled if you have had a previous C-section, or due to maternal or fetal health issues.
If your C-section is scheduled, you will have the opportunity to discuss the plan well before the actual birth. Some medical teams are comfortable letting the patient and their caregiver manage type 1 diabetes during the birth, while others prefer to assign a doctor to this task throughout the surgery. If you wear an insulin pump, continuous glucose monitor (CGM), or other type 1 diabetes device, you may need to remove it prior to the surgery, but again, this is at the discretion of you and your medical team.
A spinal block (also known as an epidural) is used to numb the lower half of your body to prepare for the incision. Usually two IVs will be in place for the surgery: one for fluids, and one for the insulin drip (if your pump is removed). The insulin drip is often combined with the glucose drip, and the contents can be adjusted based on blood-sugar levels. If your blood-sugar starts to drop, your medical team can increase the amount of glucose in the drip, and vice versa.
The C-section surgery itself takes about an hour, though everyone’s surgical experiences vary.
Recovery from a C-section
Recovery from a C-section is very different than recovery from a vaginal birth. You may have a urinary catheter in place, and/or staples or stitches. As mentioned earlier, it’s important to carefully monitor your blood-sugar levels before, during and immediately following your C-section, as hormone fluctuations and stress may have a huge impact on your insulin needs and blood-sugar levels. You’ll also heal better with blood-sugar levels as close to normal as possible. Some women experience “the shakes” or vomiting during and after their C-section, so talk with your medical team beforehand to put a low blood-sugar plan in place, should your blood-sugar drop unexpectedly.
Once you are home and continuing your recovery process, be sure to follow the precautions put in place by your doctor. Discuss pain management plan and required medication regimen with your doctor before you head back home with your baby. Don’t lift anything over 10 pounds (unless it is your baby). Don’t be afraid to ask for help, especially right now! Visually monitor your incision for signs of infection, and call your doctor if you experience excessive vaginal bleeding.
Remember: a C-section is a major abdominal surgery, so go easy on yourself. Your body has been through a tremendous physical and emotional experience. And now it is time to recuperate and enjoy time with your new baby and loved ones!
